Difficulties with sexual functioning in a sample of male and female late adolescent and young adult university students.(Report)

Abstract: Despite the considerable research attention given to sexual health outcomes such as sexually transmitted infections and unwanted pregnancies among youth, little is known about either the positive or problematic aspects of sexual functioning in late adolescence and early young adulthood. The current study sought to document the experience of difficulties with sexual functioning (e.g., interest, arousal, orgasm, pleasure, pain) in a sample of 43 male and 128 female participants (mean age 19.5 years; range 17 to 21). Questionnaire responses indicated high levels of positive desire, pleasure and satisfaction, but also lifetime experiences of a range of sexual difficulties or problems. A comparison of these responses with those from an older sample of 28 male and 65 female students aged 22 to 28 years, recruited for this purpose, showed very few differences suggesting that the foundations for sexual functioning may be established early in the sexual lives of young people. In-depth interview findings from a sub-sample of 30 of the 171 younger students indicated that the sexual difficulties they experienced appeared to significantly disrupt sexual and relationship functioning. The implications of the findings for promoting healthy sexual functioning among young people are discussed.

Introduction

The study of sexual health among young populations has largely focused on avoidance of negative outcomes, such as sexually transmitted infections (STI), unwanted pregnancy, and sexual coercion (Ahern & Kiehl, 2006; Brindis, 2006; Rosario & Schrimshaw, 2006). In contrast, research on adults has given a great deal of attention to sexual functioning and particularly to the related sexual difficulties or dysfunctions that may occur (DeFronzo, Leiblum, Rosen, Menza, & Marin, 2006; McCabe, 2008; Seal & Meston, 2007). As sexual functioning is such an important component of sexual health, it is surprising that so little is known about the sexual functioning of young people or about the difficulties they may encounter. The current study seeks to address that limitation and its implications. The literature review that follows documents the current status of our knowledge in this area.

Late adolescents have occasionally been included in population studies of sexual functioning. However, these samples tend to be small in number and combined with samples of older respondents in which difficulties with sexual functioning tend to be relatively high; the findings for the younger population are typically obscured. For example, a national probability sample of men and women in the U.S. (18-59 years of age) found that 32% of women reported a lack of sexual interest in the preceding year, 26% reported anorgasmia, 21% experienced pain during intercourse, 27% reported experiencing no sexual pleasure, 16% reported performance anxiety, and 19% reported trouble lubricating (Laumann, Paik & Rosen, 1999). Among men, 14% reported a lack of sexual interest, 7% reported anorgasmia, 30% reported premature ejaculation, 10% reported no sexual pleasure, 19% reported performance anxiety, and 7% reported difficulty achieving or maintaining an erection. Overall, sexual difficulties were more prevalent among women (43%) than among men (31%). Laumann et al. use the general term "sexual dysfunction" in their title to categorize these symptoms. However, as Bancroft, Loftus and Long (2003) point out, such manifestations may represent symptoms of a problematic state, but do not necessarily imply malfunctioning of the sexual response system. For example, low sexual interest may prove distressing for an individual, but may also represent an adaptive response to overwhelming stress in one's life. Other studies use the term sexual "problem" but do not ask whether the "symptom" is a problem for the individual. Thus, the term sexual "difficulties" is used here except in cases where the source or context dictates otherwise.

In a British national sample of men and women (16-44 years) that also included some respondents at the younger ages, 35% of men and 54% of women reported one or more sexual problems lasting a month or longer during the preceding year (Mercer et al., 2003). The most common of these among men were low sexual interest (17%), premature ejaculation (12%), and performance anxiety (9%), whereas among women the most common were low sexual interest (41%), anorgasmia (14%) and pain during intercourse (12%). Of note, 33% of the men and 62% of the women who reported a sexual problem indicated that they subsequently avoided sex because of it. Neither this Mercer et al. study nor the Laumann et al. (1999) study presented data from late adolescents separately from the adults in their samples. Although these studies confirm the high rates of sexual difficulties in Western populations, they ultimately tell us very little about the extent to which young people experience these difficulties.

One exception to the dearth of data on sexual functioning of late adolescents and early young adults is the 1998 Canadian Contraception Study (CCS). Using findings for the 18-24 year-old-group of younger women from this national sample, Fisher and Boroditsky (2000) found that 33% reported that their sexual desire was often much lower than they wanted it to be, 22% often experienced pain during intercourse, and 31% usually did not have an orgasm when they had intercourse. Although the primary focus of this investigation was on contraception and reproduction health in women, these relatively few questions about sexual difficulties and concerns represent the first data on the sexual functioning of young populations. The prevalence of sexual difficulties among young women in this age group appears comparable to that in the previously described studies of the older adult women.

We know that young people face a host of factors that may contribute to sexual difficulties, including inadequate sexual education (Byers et al., 2003; Santelli et al., 2006), a shorter sexual history from which to draw experiences compared to adults, less advanced sexual communication skills (Abel & Fitzgerald, 2006; Halpern-Felsher, Kropp, Boyer, Tschann, & Ellen 2004), and overall higher rates of compromising health factors, such as STIs (CDC, 2006; Lehtinen, Paavonen, & Apter, 2006). Late adolescents and young adults, then, might be expected to report fewer positive components of sexual functioning and higher rates of sexual problems or difficulties compared to older adults. On the other hand, the difficulties that young people experience may be different in kind compared to older adults. Older adults may be more likely to experience organic breakdown, and have lifestyles characterized by greater demands on time and attention (Breslin, Karnakar, & Smith, 2007; Scott & Willits, 1998). Findings from the 2002 CCS (Fisher, Boroditsky & Morris, 2004), based on a large national sample of women aged 15-44, showed that unmarried women were more likely than married women to report having experienced none of five sexual concerns (desire lower than wished, infrequent coital orgasm, pain with intercourse, partner's difficulty with rapid ejaculation, partner's difficulty maintaining erection). To the extent that unmarried women are younger, age may be a factor although confounded here by marital status. A subsequent analysis of factors associated with such concerns, found that older women and married women were both more likely than younger and unmarried to report low sexual desire (Gruszecki, Forchuk & Fisher, 2005). In contrast, neither age nor marital status was associated with reports of coital pain or infrequent orgasm in intercourse.

Although the rates of sexual problems in the general adult population are high (Laumann et al., 1999; Mercer et al., 2003), little is known about how these problems evolve from experiences stemming from youth. Intimate experiences, including sexual experiences in adolescence and young adulthood, are frequently considered the foundation upon which adult sexual lives are based (Bickham et al., 2007; Else-Quest, Hyde, & DeLamater, 2005), yet few researchers have examined the extent to which young …