Center for Demography and Ecology University of Wisconsin-Madison Sexual Satisfaction in the Seventh Decade of Life

The purpose of this research was to present and interpret data on the sexual behavior and satisfaction of men and women in their mid-sixties. These results fill an important gap in our understanding of human sexual activity across the life course. The data are from the Wisconsin Longitudinal Study 2003 mail survey, including 2,409 men and 2,717 women. The original sample consisted of graduates of Wisconsin high schools in 1957. Regression analyses were used to identify variables independently associated with sexual behavior and satisfaction. Included in the analyses were measures of physical health, sexual functioning, psychological distress, and satisfaction with the relationship. Frequency of sexual activity was significantly predicted by one measure of sexual functioning. Satisfaction with the sexual relationship was predicted by satisfaction with the relationship and frequency of sexual activity. The results support the conclusion that sexual expression remains a significant aspect of intimate relationships in the seventh decade of life. Sexual Satisfaction 3 Sexual Satisfaction in the Seventh Decade of Life Empirical studies of the sexual behavior and satisfaction of representative samples of people in the United States are few in number. The most frequently cited study is the National Health and Social Life Survey (NHSLS), based on interviews with a probability sample of 3,432 men and women, conducted in 1992 (Laumann, Gagnon, Michael & Michaels, 1994). Unfortunately, for budgetary reasons, the researchers limited the sample to persons between the ages of 18 and 59 (Laumann, et al., 1994, p. 52). The most recent study of a probability sample is the 2002 National Survey of Family Growth (NSFG; Mosher, Chandra, & Jones, 2005) based on interviews with 12,571 males and females. Because this survey is focused on reproduction, the sample was limited to men and women ages 15-44. Empirical studies of the sexuality of persons over 60 are even fewer in number. Brecher and the editors of Consumer Reports Books (1984) reported the results of the largest survey of older persons to date, based on 4,246 questionnaires from persons over 50 years of age. These data were from a volunteer sample explicitly recruited to participate in a study of sexuality. Recently, two papers have been published reporting data from the American Association of Retired Persons Modern Maturity Sexuality Survey (DeLamater & Sill, 2005; DeLamater & Moorman, 2007). This survey involved 1,384 persons ages 45 and older. Participants were volunteers and told in advance that the survey included questions about sex. The paucity of data on a representative sample of persons over 60 has both applied and substantive consequences. In the applied realm, without such data, mental, physical, and sexual health care professionals do not have a baseline on which to evaluate Sexual Satisfaction 4 the sexual health and sexual functioning of older persons. In the United States and elsewhere, men and women are living longer, and remaining sexually active longer (Laumann, Paik, Glasser, et al., 2006). The development of drugs and devices to treat sexual dysfunctions, many of which are thought to increase with age, highlights the need for better information about sexual functioning beyond age 60. The absence of data also hinders efforts to develop our conceptions of and theories about sexuality and intimacy in later life. Social scientists are increasingly calling for a comprehensive life-course perspective on sexuality, in order to better comprehend the interconnectedness of sexual expression at various ages and life-stages (DeLamater, 2002; Lindau, Laumann, Levinson & Waite, 2003). Plans to resurvey the participants in the Wisconsin Longitudinal Study provided an opportunity to collect limited data on the sexuality of this cohort. The study began with a brief survey of more than 10,000 randomly selected members of the high school graduating class of 1957 across the state of Wisconsin. Follow-up data have been collected at several points in time, and a major follow up, involving both interviews and mailed questionnaires, was conducted in 2003. In the original recruitment and followups, there was no mention of questions about sex; thus, there is no self-selection bias based on knowing the research was about sex. All of the participants were ages 62 to 67, allowing analyses of data from a large sample of this age cohort. Conceptual Framework Sexual Satisfaction Sexual satisfaction figures prominently in a number of analyses of intimate and marital relationships (Blumstein & Schwartz, 1983; Edwards & Booth, 1994; Lawrance & Byers, 1995). Lawrance and Byers defined it as “an affective response arising from Sexual Satisfaction 5 one’s subjective evaluation of the positive and negative dimensions associated with one’s sexual relationship.” (p. 268; emphasis in original) In a recent review of the literature, Sprecher and Cate (2004) define it as “the degree to which an individual is satisfied or happy with the sexual aspect of his or her relationship.” (p. 236) In their cross-national study, Laumann and colleagues (2006) focus on subjective sexual well-being, defined “as the cognitive and emotional evaluation of an individual’s sexuality.” (p. 146) These definitions share an emphasis on affect/evaluation of the sexual relationship. Edwards and Booth (1994) point out that sexual satisfaction has rarely been studied in persons over 60, an observation that remains true in 2007. This paper is intended to fill this gap in the literature. There are several reasons to study the nature of and influences on sexual satisfaction. Several studies report that sexual satisfaction is linked to marital quality and marital stability (e.g., Edwards & Booth, 1994) but the data are from cross-sectional surveys so the directionality of the relationship is not clear. Yeh and colleagues (2006), using cross-lagged models to analyze longitudinal data from a midlife sample, conclude that sexual satisfaction influences marital quality both directly, and indirectly via an influence on marital instability. Given the importance of the marital relationship as a source of companionship and social support, particularly to older adults, the study of sexual satisfaction is valuable. Published research on married couples that includes measures of sexual satisfaction or related constructs such as subjective sexual well-being find that most participants report very high or high satisfaction (Sprecher & Cate, 2004). Given the link between satisfaction and marital stability, this is not surprising; persons experiencing low satisfaction are likely to divorce. This might be less true of older persons, for whom Sexual Satisfaction 6 divorce may be unappealing, due to distaste for being single again, fear of being alone, or both. Theories of Sexual Satisfaction Several theories have been offered to explain the importance of sexual satisfaction, and why most persons in intimate relationships are satisfied. The interpersonal exchange model of sexual satisfaction proposes that sexual satisfaction is a result of the rewards (e.g., physical pleasure, sense of intimacy) and costs (e.g., time, effort) that the person experiences in the sexual relationship; the balance of rewards and costs is evaluated according to what the person feels she or he deserves, and the perception of the partner’s reward/cost balance (Lawrance & Byers, 1995). Yeh and colleagues (2006) suggest that satisfying sexual interactions are a reward that contributes to marital satisfaction. Laumann and colleagues (1994) measured sexual satisfaction with two items: how physically pleasurable did you find your relationship with ..., and how emotionally satisfying did you find your relationship with ...? Response categories ranged from extremely pleasurable/satisfying to not at all pleasurable/satisfying. Eighty-seven percent of spouses reported being “extremely” or “very” physically pleased, and 84 percent reported being “extremely” or “very” emotionally satisfied. The researchers offer an “economic” perspective. The commitment and exclusivity associated with an intimate relationship gives one a greater incentive to invest in “partner-specific skills,” including skills that enhance the pleasure and satisfaction of sex with the partner. Also, it is more cost-effective to remain in a long-term relationship than to search for new partners. Sexual Satisfaction 7 Sprecher and Cate (2004) present a symbolic interactionist perspective. Relationship properties emerge as two people interact, based on the meanings about interaction that they bring to the relationship, and their shared experiences. These meanings include role definitions and expectations that influence behavior, including sexual behavior. Partners develop interpersonal scripts that govern the what, where, and when of their sexual interactions, and these scripts are an important influence on the extent to which sexual interactions are satisfying. Influences on sexual satisfaction We turn to a review of the published literature on sexual behavior and satisfaction in later life. We include influences on behavior for two reasons. First, frequency of activity and satisfaction are closely related (Sprecher & Cate, 2004; Young, Denny, Luquis, and Young, 1998). Second, there are a limited number of studies of each. We review biological, psychological, and social influences. In the biological realm, the important variables are age and physical health. With respect to age, frequency of sexual behavior in men and women declines steadily into older age, and to a lesser extent there is diminution in sexual desire (Maurice, 1999). Some researchers have attributed these declines to increasing incidence of illness and or medication use. However, in their study of sexual desire in a sample of persons age 45 and older, DeLamater and Sill (2005) found that, controlling for illness and medication use, there was still a significant negative effect of age on sexual desire in both men and women. Call and colleagues (1995) analyzed data from the 1988 National Survey of Families and Households, a representative sample of 7,463 adults (average age = 45.7). Focusing on the frequency of marital sexual activity (frequency of sexual intercourse Sexual Satisfaction 8 with the spouse in the past month), they report that, in regression analyses, age was the strongest predictor; as age increased, frequency decreased. The frequency among persons 50-54 was 5.5 times per month, declining to 2.4 times per month among persons 65-69, and .8 times a month among persons 75 or older. However, the researchers state that much of the decline was due to a decrease in the proportion of couples engaging in intercourse rather than frequency gradually decreasing; persons over 75 who were sexually active reported a frequency of 3 times per month. Physical health includes overall ratings or assessments of physical health, and as appropriate, measures of illness, medications, and limitations related to physical condition. Numerous studies of small samples link declines in frequency of sexual behavior with various chronic conditions, including cardiovascular disease, hypertension, diabetes mellitus and arthritis (Schiavi, 1999). However, most of these studies are of samples of men and women who have been diagnosed with the condition, often with no comparison group. Also, persons with chronic conditions often are taking prescription drugs that have adverse effects on sexual functioning, such as anti-hypertension medications. In their cross-national study of subjective sexual well-being, Laumann et al. (2006) report that self-rated health (on a four-point scale) was positively associated with sexual well-being; using ordered logit analysis, self-rated health attained the largest coefficients. The relationship was stronger in a group of Asian cultures, including China, Japan and Taiwan, than in the cluster of western cultures. Sexual Satisfaction 9 The psychological realm includes relevant attitudes, especially attitudes about sexual expression and sexual relationships, and mental health. Attitudes toward, knowledge about, and expectations with regard to sexual expression of one’s self have impacts on behavior. For example, if a person assumes that frequency of activity will decline with age, he or she may make no effort to preserve sexual intimacy. Ageism, and specifically negative attitudes toward sex among older men and women are common (Story, 1989; Edwards & Booth, 1994). In part, these attitudes reflect the emphasis on youth and beauty characteristic of the United States (Burgess, 2004). DeLamater and Moorman (2007), analyzing the AARP survey data, found that men and women who believed that sex was not an important part of their relationships reported less frequent sexual behavior. Mental health is an important influence on sexual functioning. Depression is associated with loss of interest in sex (Cyranowski, Bromberger, Youk, et al., 2004; Nicolosi, Moreira, Villa, & Glasser, 2004). Other psychological disorders may be related to sexual functioning. Drugs used to treat these disorders can cause sexual side effects. Antipsychotic medications, SSRI antidepressants, monoamine oxidase (MAO) inhibiters, and sedative drugs may contribute to decreasing levels of sexual desire (Schiavi, 1999;