We determined the number of sexual concerns per respondent by recoding the Likert scales into dichotomous (yes/no) responses and summing the positive responses. Responses recoded as “yes” included all positive responses on the Likert scale, from “occasionally” to “always.” We also recoded positive responses into “high” and “low” categories to illustrate the distribution by frequency of sexual concerns. Missing data were excluded from analysis. We used descriptive statistics to define the study population.
Results
We received 964 completed questionnaires from 1480 eligible subjects, for a response rate of 65.1%. Demographic data are shown in Table 1. Respondents were 18 to 87 years old (mean=45.4 years, median=44.0 years, standard deviation=16.79). Almost half were exclusively homemakers, and a smaller percentage was employed outside the home. Eighty-five percent of the women in the sample were married.
Sexual Concerns
Almost all respondents, 98.8% (n=952), reported one or more sexual concerns, with a mean of 12.5 concerns per woman. Frequencies of sexual concerns are listed in descending order in Table 2. Single women had more sexual concerns than married women (80.5% vs 71.5% having 10 or more sexual concerns), and widowed women had even fewer (50.8% having 10 or more sexual concerns, (X = 21.97, P=.001). The total number of sexual concerns increased with level of education ( X = 30.42, P <.001) and decreased with increasing age (X=41.90, P=.000). Women who reported concerns about thinking of or having had an affair were more likely to report concerns about having different sexual desires than their partners (X=56.89, P <.000), not having their sexual needs met (X=66.69, P <.000), and their partner having sexual difficulties (X = 42.05, P <.000).
For the sample as a whole, 57.1% (n=550) reported concerns about having exposure in one or more of the areas of sexual, emotional, or physical abuse during their lifetime. Nearly half, 42.0% (n=398), reported concerns about sexual coercion at some point in their lives, and 43.6% (n=412), reported concerns about having been physically or emotionally abused.
Discussion
Our study confirms that sexual concerns are virtually universal among women, and since many of these sexual concerns have health implications, it reinforces the public health importance of this domain.8 In our study, 98.8% reported one or more sexual concerns, a higher percentage than in previous studies that have indicated a prevalence of one or more sexual concerns ranging from 53% (n=228)9 to 75% (n=212).10 The greater prevalence of sexual concerns in our study may be in part because of the broader range of sexual concerns queried by our instrument. Thus, our study substantiates the ubiquity of sexual concerns and underscores the potential importance of addressing sexual issues in the clinical encounter. A much lower percentage of women in the general population8,11 are reported as having specific sexual concerns: dyspareunia (14.4%), preorgasmic (24.1%), lack of interest (33.4%), and difficulty lubricating (18.8%). Our results may indicate a higher prevalence for women who are seeking health care, supporting the case for physicians’ active inquiries about sexual concerns. Many sexual concerns are potentially treatable by physicians.
Nearly half of our respondents reported a concern about sexual coercion at some point in their lives, a percentage very similar (47.6% to 57%) to that of a recent report of lifetime prevalence of sexual victimization of women.12 Survey data for the general population11 revealed that 22% of women aged 18 to 59 years reported being forced to have sex by a man, and 17% of women reported having been sexually touched when they were children. The higher percentage in our study may be because these women are more likely to seek health care or because of the much broader age range of our respondents.
Limitations
A weakness of our study is that the results may not be generalizable to other patient populations. Although this study sample of military beneficiaries is undoubtedly different from a random sample of women from the general population, there is no reason to believe that these differences are so great as to alter our main findings and conclusions. For example, compared with the 1990 census data from the state of Washington, the study sample had a similar age distribution and only a small difference in racial composition. Most notable, our sample had substantially fewer (2.4%) single, never married women in comparison with the state (20.8%), a difference that would probably result in our underestimation of the prevalence of sexual concerns. Our study does provide a better sample across all income groups than previous studies, which tended to include more upper-class and middle-class subjects.