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Satisfaction in the Sex Life of a General Population Sample

Kate M. Dunn; Peter R. Croft; Geoffrey I. Hackett

To cite this Article Dunn, Kate M. , Croft, Peter R. and Hackett, Geoffrey I.(2000) 'Satisfaction in the Sex Life of a General
Population Sample', Journal of Sex & Marital Therapy, 26: 2, 141 — 151
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 Journal of Sex & Marital Therapy, 26:141–151, 2000
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Satisfaction in th e Sex Life

of a Gen eral Population Sam ple
KATE M. DUNN and PETER R. CROFT
Primary Care Sciences Research Centre, University of Keele, Staffordshire, England
GEOFFREY I. HACKETT
Good Hope Hospital, Sutton Coldfield, England
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A questionnaire asking about satisfaction and problems in the sex

lives of respondents and their partners was sent to 4,000 adults
registered with general practices in England. A quarter of respon-
dents said that they were dissatisfied with their sex lives, men more
so than women, particularly with the frequency of intercourse. Re-
spondents were more likely to be dissatisfied with their sex life if
they perceived their partner to have a sexual problem. Respondents
who were dissatisfied were more likely to report that their partner
was dissatisfied with their sex life. The benefits of treating sexual
problems have wide implications for both partners in a relation-
ship.

Much clinical research in the field of sexual behavior, problems, and satisfac-
tion has focused on selected samples, such as people attending sexual dys-
function clinics. Some studies have been carried out on broader based samples,
and the estimations of satisfaction from these studies vary widely. Pepe,
Panella, Pepe, and D’Agosta (1989) reported that 38% of women attending a
gynecology clinic in Italy were not satisfied with their sexual relationship.
Rosen, Taylor, Leiblum, and Bachmann (1993) reported a 25% prevalence of
dissatisfaction among women registered with a gynecology clinic in the United
States. A 21% level of sexual dissatisfaction was reported in a sample of
British men selected through their workplace (Spector & Boyle, 1986).
The differences in levels of satisfaction between men and women have
been investigated in a number of studies, and the results are inconclusive.
One study in Israel, of family practice attenders, reported that male respon-

Address correspondence to Peter R. Croft, ICHRC, Keele University School of Postgraduate

Medicine, Thornburrow Drive, Hartshill, Stoke-on-Trent, Staffordshire ST4 7QB, England.
E-mail: [email protected]

141
 142 K. M. Dunn et al.

dents were more likely than female respondents to report dissatisfaction

(Shahar, Lederer, & Herz, 1991); however, Ard (1977) found that a higher
proportion of husbands (70%) than wives (57%) got great enjoyment out of
their sexual relationships. Two other studies have found very high levels of
satisfaction (over 85% satisfied) in both men and women with no particular
differences between the sexes (Frank, Anderson, & Rubinstein, 1978;
Golombok, Rust, & Pickard, 1984).
Studies have already been conducted that investigate satisfaction with
frequency of intercourse. One study of a random sample of the Danish popu-
lation found that men wanted intercourse more frequently than their part-
ners, and almost all respondents wanted to have intercourse more frequently
than they were currently having (Solstad & Hertoft, 1993). Half of the women
in another study said that their overall frequency of sexual activity was less
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than desired (Rosen et al., 1993), whereas in a study of older men in the
United States (Panser et al., 1995), only 16% said that they were dissatisfied
with their level of sexual activity.
The relationship between satisfaction and sexual dysfunction is a com-
plicated issue, which has only been investigated in a small number of stud-
ies. One study reported that dissatisfaction with sex life was highest in men
with erectile problems (Panser et al., 1995), and another stated that a stron-
ger association was with premature ejaculation (Moore & Goldstein, 1980).
One study of married couples (Frank et al., 1978) found that sexual dysfunc-
tion was related to dissatisfaction, but the relation was stronger in women,
particularly in women with arousal problems. Two further studies (Catania,
Pollack, McDermott, Qualls, & Cole, 1990; Spector & Boyle, 1986) of partici-
pants selected from social and work situations have reported a general asso-
ciation between sexual problems and dissatisfaction. However, other work
on a random sample of married Swedish men and in Israeli family practice
attenders found that sexual satisfaction was not related to sexual dysfunction
(Nettelbladt & Uddenberg, 1979; Shahar et al., 1991). The most recent and
authoritative survey has been the analysis of the U.S. National Health and
Social Life Survey (Laumann, Palk, & Rosen, 1999). The authors reported
strong associations of sexual dysfunction with emotional and physical satis-
faction and with feelings of general happiness. Low desire in both genders,
arousal disorder in women, and erectile dysfunction in men were the cat-
egories most strongly associated with dissatisfaction.
Although most research has focused on people in heterosexual relation-
ships, one study that recruited homosexual men and women through adver-
tising and organizations (Bell & Weinberg, 1978) found levels of sexual prob-
lems similar to those found in studies of heterosexuals.
Contrasting results have emerged from work on the effect of sexual
problems on the satisfaction of the partner. Two studies (Frank et al., 1978;
Rust, Golombok, & Collier, 1988) have reported that sexual dysfunction in
the wife had no bearing on male sexual satisfaction, whereas another study
reported that 64% of female dissatisfaction was due to premature ejaculation
 Sexual Satisfaction in the General Population 143

in the partner (Moore & Goldstein, 1980). The most recent U.S. report
(Laumann et al., 1999) did not specifically examine the effect of sexual prob-
lems and dissatisfaction on quality of life in the partner.
In summary, there has been limited investigation on satisfaction in the
sexual relationship and its relation to other areas of sex life; the results from
a wide variety of study types are disparate and conflicting. This study pre-
sents an epidemiological investigation into sexual satisfaction and its related
components within a large general population sample of adults.

MATERIALS AND METHODS

Four general practices in England, which were diverse in terms of geographical

location and urbanization, took part in the study which was conducted dur-
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ing 1996. The study population consisted of a stratified random sample of

1,000 adults aged 18 to 75 years selected from the age-sex register in each
general practice. In the United Kingdom more than 95% of the population is
registered with a general practitioner. The registers of individual practices
can thus be used as sampling frames representative of local populations, and
most important, the registers will not be influenced by whether individuals
actually consult their doctor or not.
The main objective was to study the prevalence of sexual problems in
the general population, and the survey methods have been described in
detail elsewhere (Dunn, Croft, & Hackett, 1998). In summary, a question-
naire was developed which used previous clinic-based instruments concern-
ing sexual satisfaction and sexual problems. Questions were included re-
garding frequency of intercourse, specific sexual problems, satisfaction with
the frequency of intercourse, and sex life in general. The key questions for
the current analysis were: “Do you regard yourself as having a problem with
sex at present?”; “Has this problem with sex affected your quality of life?”;
“Has this problem with sex affected your relationship with your partner?”;
“Do you think that your partner has a problem with sex at the moment?”; and
“How satisfied do you think your partner is with your current sexual rela-
tionship?”. All of these questions were accompanied by a 4-point Likert scale,
except for the first, which was a simple “yes/no” dichotomy.
Questions regarding sexual activity and dysfunction were derived using
previous clinic-based questionnaires, such as the International Index of Erectile
Function questionnaire (Rosen et al., 1997); and questions on psychological
status and social problems (Corney, 1988; Zigmond & Snaith, 1983) were
based on published validated schedules. The whole instrument was devel-
oped with attenders in a sexual problems clinic and tested in a community
pilot sample of 100 adults. Demographic information was also elicited through
the questionnaire.
This self-completion questionnaire was sent to the study sample in each
general practice, together with a letter from each participant’s general prac-
 144 K. M. Dunn et al.

titioner emphasizing the importance of the work and the anonymity of the
questionnaire. A reply-paid envelope for the return of the questionnaire was
included. A reminder letter was sent to the entire sample approximately a
week after the mailing of the initial questionnaire: This second mailing could
not be restricted to nonresponders because of the need to preserve the
anonymity.
The data were entered into the Epi-info package (Dean et al., 1994).
Analysis was carried out using the STATA statistical package (StrataCorp,
1995). Categorical data were analyzed using chi-square tests for trend, on 1
degree of freedom. Odds ratios and 95% confidence intervals were calcu-
lated for the association between sexual dissatisfaction in respondents and
specific sexual problems.
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RESULTS

1,768 adults (44% of the study population) replied to the survey. The median
age of the respondents was 50 years (range 18 to 75 years). Two hundred
and thirty-five men (34%) and 290 women (41%) reported having a current
sexual problem, the most common problems being erectile dysfunction and
premature ejaculation in men and vaginal dryness and orgasmic problems in
women.

Frequency of Sexual Intercourse

Overall, 24% of respondents reported that they had not had sexual inter-
course at all during the previous three months; 53% reported a frequency of
up to once a week, and 23% reported having sex more than once a week.
There were no differences in the reported frequency of sexual intercourse
between men and women.
Respondents were also asked whether they wished to have sex more or
less than the present frequency (Table 1). Women reported being more sat-
isfied with the current frequency of intercourse than men and were less
likely to desire a higher frequency. There was little variation of desired fre-
quency with age in either gender. The proportion of people having sex more
frequently than they desired was small in both genders.
There was a clear correlation between the proportion who reported the
frequency of sex to be “as much as desired” and the actual frequency of sex
in the previous 3 months (see Table 1); at all reported frequencies, women
were more likely to be satisfied with the frequency than men. However, the
overall picture is similar in men and women; most responders to the survey
reported being satisfied if the frequency of sex was once per week or more,
whereas most were not satisfied if there had been no sex in the past 3
months.
 Sexual Satisfaction in the General Population 145

TABLE 1. Desired Frequency of Sexual Intercourse

Men Women
Less than As much More than Less than As much More than
desired as desired desired desired as desired desired
no. (%) no. (%) no. (%) no. (%) no. (%) no. (%)
328 (50.2) 314 (48.0) 12 (1.8) 198 (26.8) 508 (68.8) 32 (4.3)
By age a
<45 134 (53.8) 109 (43.8) 6 (2.4) 110 (27.9) 264 (67.0) 20 (5.1)
45–64 127 (47.4) 136 (50.7) 5 (1.9) 67 (25.2) 193 (72.6) 6 (2.3)
>65 64 (48.9) 65 (49.6) 2 (1.5) 18 (25.4) 47 (66.2) 6 (8.5)
By marital status b

Married 257 (48.6) 262 (49.5) 10 (1.9) 123 (20.8) 443 (74.8) 26 (4.4)
Living with 13 (38.2) 19 (55.9) 2 (5.9) 20 (31.7) 39 (61.9) 4 (6.3)
partner
Single 37 (64.9) 20 (35.1) — 23 (65.7) 11 (31.4) 1 (2.9)
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Divorced 17 (73.9) 5 (21.7) 1 (4.3) 23 (71.9) 8 (25.0) 1 (3.1)

Widowed 6 (60.0) 4 (40.0) — 7 (63.6) 4 (36.4) —
By frequencyb
Never 123 (83.1) 24 (16.2) 1 (0.7) 77 (59.2) 48 (36.9) 5 (3.8)
< 1 per week 124 (57.7) 87 (40.5) 4 (1.9) 68 (27.8) 166 (67.8) 11 (4.5)
1 per week 49 (36.6) 84 (62.7) 1 (0.7) 41 (22.3) 140 (76.1) 3 (1.6)
2–3 per week 30 (25.4) 84 (71.2) 4 (3.4) 9 (6.8) 114 (85.7) 10 (7.5)
> 3 per week 8 (18.6) 32 (74.4) 3 (7.0) 4 (8.9) 38 (84.4) 3 (6.7)
By self-perceived problemb
None 223 (42.6) 289 (55.3) 11 (2.1) 146 (23.7) 451 (73.2) 19 (3.1)
1 or more 105 (80.2) 25 (19.1) 1 (0.8) 52 (42.6) 57 (46.7) 13 (10.7)
Note. Numbers in columns do not always add to the same totals because of missing or spoiled answers
to some questions; p values are calculated as chi-square tests for linear trend, on 1 degree of freedom.
a
p = 0.4 (ns) for men, p = 0.5 (ns) for women
b
p < 0.05

Marital status did have a link with desired frequency of sex; although
numbers were small, the single, separated or widowed had similar high
proportions of those reporting less-than-desired frequency of sex, and, in
these categories, the overall gender differences in desired frequency were
abolished.
Finally, a suboptimal frequency of sex was more likely to be reported if
there was an accompanying perception of a problem with sex. This was
found to a similar extent in men and women.

Satisfaction with Current Sex Life

Most of the respondents indicated that they were satisfied with their current
sex life, with three quarters reporting that they were extremely or quite
satisfied (Table 2). Women were more likely to be satisfied than men, with
79% of women indicating that they were either extremely or quite satisfied
with their sex life compared to 70% of men—a difference of 10% (95% con-
fidence interval 5% to 14%).
 146 K. M. Dunn et al.

There was little variation among ages in reported satisfaction. There

was, however, a strong correlation between satisfaction and reported fre-
quency of sex among both men and women.
Respondents were less likely to be satisfied with their sex life if they
perceived themselves to have a current sexual problem. Of those with such
a problem, 69% reported being extremely or quite dissatisfied with their
current sex life. This compared with 6% reporting dissatisfaction among those
who did not perceive themselves to have a current sexual problem.

Perceived Satisfaction in the Partner

When respondents were asked whether they thought that their partner was
satisfied with their current sex life, 80% thought that their partner was satis-
fied (see Table 2), higher than the level of satisfaction among the respon-
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dents themselves. In general, women thought that their partners were about
as satisfied as they were themselves, whereas men thought that their part-
ners were more satisfied than they were themselves.

TABLE 2. Own Satisfaction with Current Sex Life and Perception of Partner’s Satisfaction
Own Satisfaction Perception of Partner
N1 = 1,482 N2 = 1,244
Number (%) Number (%)
Satisfied Dissatisfied Satisfied Dissatisfied
All 1111 (75.0) 371 (25.0) 1000 (80.4) 244 (19.6)
By age a
<45 495 (74.9) 166 (25.1) 452 (79.4) 117 (20.6)
45–64 427 (75.0) 142 (25.0) 390 (80.4) 95 (19.6)
>65 168 (75.0) 56 (25.0) 141 (82.5) 30 (17.5)
By gender b
Male 489 (69.9) 211 (30.1) 484 (82.9) 100 (17.1)
Female 622 (79.5) 160 (20.5) 516 (78.2) 144 (21.8)
By frequency*c
Never 169 (48.0) 183 (52.0) 113 (62.4) 68 (37.6)
< 1 per week 324 (70.9) 133 (29.1) 305 (71.9) 119 (28.1)
1 per week 280 (88.3) 37 (11.7) 263 (87.7) 37 (12.3)
2–3 per week 241 (95.3) 12 (4.7) 232 (95.1) 12 (4.9)
>3 per week 86 (96.6) 3 (3.4) 81 (93.1) 6 (6.9)
By self-perceived
problem*c
None 1022 (85.1) 179 (14.9) 898 (89.5) 105 (10.5)
1 or more 83 (30.9) 186 (69.1) 95 (40.6) 139 (59.4)
Note. p values are chi-square tests for linear trend, on 1 degree of freedom, and used the original four
categories: (extremely, quite) and dissatisfied (quite, extremely)
* numbers do not always add to column totals at top because of spoiled or missing answers to some
questions.
a
p = 0.4 (ns) for own satisfaction, p = 0.2 (ns) for perception of partner
b
p = 0.05 for own satisfaction, p = 0.2 for perception of partner
c
p < 0.05
 Sexual Satisfaction in the General Population 147

Respondents were more likely to report that their partner was dissatis-
fied with their sex life if they perceived themselves to have a current sexual
problem (see Table 2). Of those with a problem, 59% thought that their
partner was extremely or quite dissatisfied, compared with 10% of those
without a problem.
There was a strong association between satisfaction in the respondent
and his or her perception of satisfaction in the partner. Sixty percent of
respondents who were dissatisfied themselves reported dissatisfaction in their
partner, whereas only 9% of respondents who were themselves satisfied
considered their partners to be dissatisfied, a difference of 51% (95% confi-
dence interval 44% to 57%).

Own Sexual Problems and Levels of Satisfaction

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Table 3 shows that the specific problems which caused the most dissatisfac-
tion in respondents were inhibited enjoyment followed by erectile problems
in men and arousal problems and dyspareunia in women.

Perceived Sexual Problems in the Partner

When asked about their partner, 19% of men and 15% of women thought
that their partner had a current sexual problem, although 10% of respon-
dents said that they did not know.
People were more likely to report that their partner had a sexual prob-
lem if they had a problem themselves: 23% of respondents with sexual prob-
lems themselves reported that their partner had a sexual problem, compared
to 14% of respondents without a sexual problem.
Respondents were also more likely to report that their partner was dis-
satisfied if they thought that their partner had a current sexual problem.
Fifty-six percent of respondents who thought that their partner had a sexual
problem also thought that their partner was dissatisfied. By contrast, partner
dissatisfaction was estimated at only 10% among respondents who did not
think that their partner had a sexual problem, a difference of 46% (95%
confidence interval 39% to 53%).
Finally, as would be expected from the above observations, respon-
dents’ reporting of their own dissatisfaction was strongly linked to their per-
ception that their partner had a sexual problem. Among those who reported
that their partner had a problem with sex, a majority of both men (60%) and
women (55%) stated that they were dissatisfied with their own sex life.

DISCUSSION

This study provides new information on satisfaction with sexual relations in

a general population sample. The findings support some of the results found
 148 K. M. Dunn et al.

TABLE 3. Dissatisfaction in Respondents: Association with Specific Sexual Problems

Total No. No. with Odds Ratio for
with Dissatisfaction a Association
Problem* (%) (95% C.I.) e
Men Erectile problemsb 161 77 (47.8) 1.8 (1.5 to 2.3)
Premature ejaculation 84 36 (43.0) 1.5 (1.2 to 2.0)
Sex not pleasantc 40 18 (45.0) 2.7 (1.8 to 4.1)
Any of above 222 95 (42.8) 1.8 (1.5 to 2.2)
Women Orgasmic dysfunctiond 160 63 (39.4) 4.1 (3.0 to 5.6)
Dyspareunia 115 28 (24.3) 5.2 (3.7 to 7.4)
Vaginal dryness 183 40 (21.9) 1.3 (1.1 to 1.6)
Arousal problems 101 51 (51.0) 5.2 (3.7 to 7.4)
Sex not pleasurablec 104 49 (47.1) 4.0 (3.0 to 5.6)
Any of above 286 77 (26.9) 1.9 (1.5 to 2.3)
*Subjects may have more than one problem.
a
Either extremely or quite dissatisfied
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b
Combination of difficulties with getting or maintaining an erection
c
A problem is recorded if making love was never or rarely a pleasant experience
d
A problem is recorded if a climax is never or rarely experienced
e
The odds ratio for the association between dissatisfaction and the specific sexual problem

in other studies, and provide clarification of areas that previously contained

conflicting evidence. The general finding of a link in this U.K. population
survey between sexual problems and dissatisfaction confirms the findings of
a recent large U.S. survey (Laumann et al., 1999).
The response rate achieved in this study is good for an anonymous
survey inquiring about sexual relationships, a subject area that achieves lower-
than-average response rates (Dunn et al., 1998). Every attempt was made to
maximize the response rate and to ensure representative responses, and the
demographic information reported in this study is similar to comparable
figures from other types of studies.
One quarter of respondents stated that they were dissatisfied with their
current sex lives, which supports the findings of Rosen et al. (1993) and
Spector and Boyle (1986). Male respondents reported more dissatisfaction
than female respondents, a finding also noted by Shahar et al. (1991).
As previously reported (Catania et al., 1990; Spector & Boyle, 1986) and
as might be expected, sexual dissatisfaction was found to be higher among
those with current sexual problems. However, previous research had sug-
gested that there was no relationship between the satisfaction of an indi-
vidual and sexual problems in the partner (Frank et al., 1978; Rust et al.,
1988), a finding which is not supported by the results of this study. The
results here indicate that people who were dissatisfied with their sex life
were more likely to think that their partner had a sexual problem. In addi-
tion, it was found that respondents were more likely to report dissatisfaction
if they thought that their partner had a current sexual problem than if they
had a problem themselves. However, sexual problems in the partner are
only reported here as perceived by the respondent, and it is unclear whether
it is the dissatisfaction in the respondent that causes them to think that their
 Sexual Satisfaction in the General Population 149

partner has a problem or whether the problem in the partner causes the
dissatisfaction in the respondent.
By contrast, dissatisfaction in the partner was most likely to be per-
ceived by the respondents if they had a sexual problem themselves, if the
respondents themselves were dissatisfied, or if they thought that their part-
ner had a sexual problem. Dissatisfaction in the respondent was the stron-
gest predictor of his or her perception of dissatisfaction in the partner. This
may reflect the nature of reporting in this study, because all information
about the partner is reported by the respondent and respondents who are
dissatisfied may report that their partners are not satisfied due to low confi-
dence or other psychological factors. Whatever the explanation, it empha-
sizes that satisfaction is intractably linked to perceptions about the relation-
ship.
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Overall levels of perceived satisfaction in partners were higher than in

the respondents themselves. There was a disparity between overall levels of
satisfaction reported between the genders, with more men than women re-
porting dissatisfaction. This was also reflected in perceived levels of satisfac-
tion in the partner, with 17% of men compared to 22% of women estimating
that their partners were dissatisfied. Although this is not paired data, which
are the strongest test of disparity, it suggests strongly that both men and
women are underestimating the levels of sexual dissatisfaction in their part-
ners, women more so than men, and this may reflect a lack of communica-
tion within sexual relationships.
This study did not explicitly distinguish between heterosexuals and
homosexuals, therefore stratification according to this could not be carried
out. However, the questions on sexual satisfaction and problems are rel-
evant regardless of sexual orientation, and the number of homosexual people
in a study such as this is likely to be relatively small.
Whatever the precise explanation, the public health implications of these
findings are important. In the debate in Britain and elsewhere about the
public funding of drug treatment of erectile dysfunction in men, for ex-
ample, the point that two people are being treated is not emphasized. The
main focus of the treatment of erectile dysfunction is not the erection itself,
but the impact of a happy and satisfying sexual relationship on the lives of
both partners, a factor which we have previously shown to have a significant
effect on other areas of people’s lives (Dunn, Croft, & Hackett, 1999). If 11%
of women are dissatisfied because they perceive a sexual problem in their
partner, treating that problem in their partner will clearly have an influence
on the women’s satisfaction as well as that of the man being treated.
This study provides new population-based data on self-reported sexual
satisfaction and perceived satisfaction in partners. It highlights the problems
that cause the most dissatisfaction in people’s sex lives and the problems
that people consider to cause dissatisfaction in their partners. A difference of
perception between couples also has been highlighted, and further investi-
gation is needed to clarify this and to unravel cause and effect in the associa-
 150 K. M. Dunn et al.

tions reported here. Our figures highlight in particular the considerable po-
tential impact that treatment of sexual problems might have on the levels of
sexual satisfaction in society.

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