Sexual Dysfunction among Heterosexual Adults: Description, Epidemiology, Assessment, and Treatment
Michael P. Carey and Christopher M. Gordon
At least two factors conspire to limit our knowledge about sexual function and dysfunction among heterosexual adults. First, most men and women, young and old alike, are reluctant to seek help for sexual difficulties. In an interesting nonclinical field study conducted with middle-class couples, Frank Anderson, and Rubinstein ( 1978) found that 40 percent of the men had experienced an erectile or ejaculatory difficulty, and a similar proportion of women had experienced a desire or orgasmic difficulty; however, only 12 percent had participated in any kind of therapy. Further, 83 percent of both husbands and wives rated their marriage as "happy" or "very happy," and the vast majority of couples did not cite sexual dissatisfaction as a complaint about their marriage. Even when clients do seek help, they are embarrassed about their difficulties. Whether due to conservative sexual attitudes, religious values, or simply a desire to keep their intimate lives private, many people prefer not to share information about their sexuality. They come to therapists as a last resort, when all self-help strategies have failed.
Second, social and cultural influences limit the sexual expression of many older adults, who believe that sex belongs to the young; many older men and women expect their sexual lives to end as they reach their 50s or 60s. Comfort ( 1980) speaks eloquently to this issue: "In our culture . . . many features of aging as observed are examples not of natural change, but of role-playing, based on a combination of folklore and prejudice" (p. 885). Several studies confirm these attitudes in older adults, despite our knowledge that satisfying sexual re-