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The Global Online Sexuality Survey: the USA in 2011, marriage, coital frequency, and contraception among English-speaking men

Shaeer, Osama; Shaeer, Kamal

doi: 10.1097/01.XHA.0000432478.15222.20
Original articles
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Purpose The Global Online Sexuality Survey is a worldwide epidemiologic study of sexuality and sexual disorders, investigating cultural characteristics and uniqueness, and comparing sexuality across cultures and races, launched in the Middle East in 2010 and USA in 2011. The current report investigates trends in marriage, coital frequency, and contraception in USA as of 2011.

Materials and methods The Global Online Sexuality Survey was deployed randomly to English-speaking male web surfers in USA through paid advertising on Facebook, comprising 146 questions.

Results 63.4% of participants were married, mostly among the 50–59 age group (40.5%), with no effect on the rate of erectile dysfunction or premature ejaculation (PE). Longer duration of coital relationship was associated with higher prevalence of PE. Utility of phosphodiesterase inhibitors despite normal erectile function (recreational use) was most common among the married (69.5%). Monthly coital frequency decreased with age from a median of 10 in the 18–39 years group to 4 in the above 60 age group. 28.8% reported the use of one or more contraceptive measures for birth control. The most frequently used was condom, although least preferred. Vasectomy and female contraceptive measures were the most favored.

Conclusion Patterns in marriage, coital frequency, and contraception are described. Couples with a longer duration of coital relationship should be educated about PE and its management options. The data presented here may be informative for female partners as to the preferences of men in normal coital frequency and contraceptive measures.

Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt

Correspondence to Osama K.Z. Shaeer, MD, PhD, 21 Gaber Ibn Hayan St., 12311 ARE, PO Box 47 Bab El-Louk, Cairo 11513, Egypt Tel: +20 2 333 59047, +20 2 333 74360; fax: +20 2 376 05181; e-mail: dr.osama@alrijal.com

Received June 13, 2013

Accepted June 21, 2013

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Introduction

The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders, investigating cultural characteristics and uniqueness, and comparing sexuality across cultures and races, as well as across time where the survey is intended to be relaunched every 5 years. In addition to evaluating the age-adjusted prevalence of erectile dysfunction (ED), premature ejaculation (PE), their risk factors, penile size, penile deviation, and curvature, and trends in medical treatment for sexual dysfunction, further data on sexual practices, coital frequency, sexual positions, masturbation, and number of partners were collected, among others, a total of 146 questions. The current report investigates trends in marriage, multiplicity of partners, polygamy, coital frequency, and contraception.

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Materials and methods

GOSS was deployed to English-speaking male web surfers in the USA in 2011 through paid advertising on Facebook, on pay-per click basis, totally funded by the authors. Inclusion criteria were merely being older than 18 years of age and English being the mother tongue. Web browsing and Facebook group preferences were disregarded to minimize bias. Total anonymity was assured. The survey included several sections: an introduction (explaining the nature of GOSS, its scope and contents, and ensuring total anonymity, followed by a consent question), demographics, erectile function [including the abbreviated international index of erectile function (IIEF-5) 1 among other questions], risk factors for ED, PE as per the Premature Ejaculation Diagnostic Tool (PEDT) 2, therapeutic trends, genital anatomy, sexual preferences of heterosexual men (including trends in marriage, polygamy, coital frequency, sexual positions, and contraception), and homosexuality/bisexuality. Approval of the ‘Ethical Committee of the Department of Andrology, Cairo University (Egypt)’ was obtained. The work was carried out in accordance with the ethical standards of the responsible institutional committee on human experimentation or with the Helsinki Declaration of 1975, as revised in 1983.

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Results

Out of 2022 men participating in the survey from the USA, data analysis was restricted to those who lived most of their lives in USA (n=1133). The mean age was 52.38±14.5 years, median 54, with 17.5% in the 18–39 years age group, 15.1% in the 40–49 group, 37% in the 50–59 group, and 30.4% in the more than or equal to 60 years age group. Risk factors and general ailments included diabetes (9.4%), hypertension (17.9%), smoking (21.6%), obesity as per BMI 3 (37%), and coronary heart disease (4.9%), among others. As evaluated by the IIEF-5 1, 37.7% showed various degrees of ED: mild ED: 19.4%, mild to moderate ED: 7.3%, moderate ED: 4.4%, and severe ED: 6.6%. Adjusted to the World Standard Population by the WHO 4, the collective prevalence was 33.7%. This is in contrast to a 4.9% prevalence rate of ED in response to the simple question: ‘do you suffer erectile dysfunction/impotence’. 49.6% reported PE as per PEDT.

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Marital status and duration of coital relationship

63.4% of participants were married, 15.6% were single, 12.4% were divorced, 3.8% were widowers (oldest age group), and 4.8% unspecified. Marriage was mostly among the 50–59 age group (40.5%), followed by the above 60 group (34.5%), 40–49% (15.7%), and least among 18–39% (9.3%). No statistically significant differences were found in ED (as per IIEF-5) and PE (as per PEDT) across the above-mentioned marital statuses (Table 1). The median duration of coital relationship (DCR) with the current partner was 10.3 years, range 23 days to 64.1 years, with 55.3% reporting DCR longer than 10 years, longest among the married (Fig. 1). DCR was inversely proportional to the IIEF-5 score (r=−0.12, P<0.05), although not to the extent of causing ED, where no significant difference was detected in the prevalence of ED among those with DCR less than and more than 10 years (39.1 and 36.6%, respectively, P=0.26), odds ratio 0.9, 95% confidence interval (CI) 0.7–1.2. A negative correlation with statistical significance was detected between approximate intravaginal ejaculatory latency time (IELT) and DCR (r=−0.18, P<0.005). Along the same line, those with DCR more than 10 years showed a slightly higher prevalence of PE as per PEDT (53.2 vs. 45.2%, P<0.05). The odds ratio for having PE among those with DCR more than 10 years was 1.4 (95% CI 1–1.9). There was no significant difference in age among subjects with DCR more than 10 years with PE and those not (57.4±10 and 57±11 years, respectively, P=0.66).

Table 1

Table 1

Figure 1

Figure 1

Utility of phosphodiesterase inhibitors (PDEi’s) was most among widowers (41.7%), followed by the divorced (34.7%), married (22.8%), and least among singles (9.2%). However, utility of PDEi’s despite normal erectile function (recreational use) was most common among the married (69.5%), followed by the divorced (16.9%), singles (5.1%), and widowers (3.4%).

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Coital activity

The mean monthly coital frequency was 8.7±9.3, median 6, range 1–75, with the different frequencies presented in Fig. 2. The mean monthly coital frequency expected for normal was 14±11.5, median 10, range 1–100. Monthly coital frequency decreased with age from a median of 10 in the 18–39 years group to 4 in the above 60 age group (P<0.05). The median for expected normal frequency also decreased from 15 in the 18–39 group to 10 in the above 60 group (P<0.05), although much higher than the actual frequency (Table 2). Coital frequency correlated negatively with age (r=−0.26, P<0.001) and positively with IIEF-5 (r=0.16, P<0.005) and approximate IELT (r=0.14, P<0.005).

Figure 2

Figure 2

Table 2

Table 2

13.3% of participants reported an ‘always regular’ coital relationship, 28% ‘mostly regular’, 24% ‘variable’, 13.6% ‘mostly irregular’, and 21.1% ‘always irregular’, the latter three grades grouped together into 58.7% with irregular coitus. Irregular coitus was a possible risk factor for ED (odds ratio 3.95, 95% CI 2.8–5.5) as well as for PE (odds ratio 1.86, 95% CI 1.38–2.51).

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Contraception

28.8% reported the use of one or more contraceptive measure for birth control in the form of condoms (39.2%), vasectomy (37.8%), female contraceptive pills (17.5%), coitus interruptus (9.1%), safe period (7%), intrauterine device (IUD) (4.9%), and other in 2.8% including hysterectomy and female patch. Collectively, female contraceptives were used by 25.2%.

The highest rate of satisfaction with the contraceptive measure used was detected with IUD, followed by vasectomy, female contraceptive pills, safe period, coitus interruptus, and least of all condoms.

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Discussion

The USA is a cosmopolitan country encompassing a wide diversity of ethnicities, cultures, and attitudes. However, every community – USA included – have common values and characteristics despite the diversity. This is why we restricted our analysis to those who have lived most of their lives in USA such that they are imprinted to the largest extent possible by some common values, in comparison with recent immigrants, who would better be analyzed in the context of their countries and cultures of origin. We also recognized the language barrier that distinguishes two distinct populations, English-speaking and Spanish-speaking, among others. This report focuses on the former, which constitutes the largest group.

The results at hand show that a considerable proportion of participants (63.4%) were married. However, the age of marriage seems to be relatively advanced, mostly among those above the age of 50. Marriage was not associated with a higher risk for ED or PE. However, the longer DCR was associated with a higher prevalence of PE. This was not a consequence of aging as there was no significant difference in age among individuals with DCR more than 10 years with PE and those not. This is in agreement with other reports that deny an effect for age on ejaculatory control 5. Thus, couples with a longer DCR (mostly the married) should be made aware of the treatment options for PE, possibly by family physicians and/or mass media.

Utility of PDEi’s was highest among widowers, which could be explained by the fact that this group had individuals of the oldest age relative to other groups. However, recreational use in the absence of ED was highest among the married, possibly explained by the decrease in the IIEF score with the longer DCR, although not to the extent of causing frank ED. This subtle decrease in erectile power could be the motivation for PDEi utilization. Similar motivation for recreational use was reported by other investigators where PDEi’s were used to have a harder and longer lasting erection, higher coital frequency, and to prevent sexual failure 6. The above-mentioned ‘longer lasting erection’ could also be in line with the slightly higher prevalence of PE among those with a longer DCR, although PE is not a formal indication for the management of PE.

Monthly frequency of sexual intercourse in USA was less than that reported in the Middle East 7 (8.7±9.3 vs. 13.2±11.5). However, this is influenced by the older average age of participants in USA (52.38±14.5 vs. 35.2±7.6 years in the Middle East). Comparison of respective age groups showed similar coital frequency in USA (Table 2) and the Middle East (from 14.5±12.4 in the ‘18–39 years’ age group, down to 10.1±7.3 in the ‘40–49 years’ group, and 9.1±6.2 in the ‘50–59 years’ group). Overall, both regions coincide in this domain. Frequency of sexual intercourse is known to decrease with age 7. This was reproduced in the American population with a decrease from approximately three times per week in the 18–39 years age group to approximately once a week in the above 60 group. Still, the expectations for what a normal coital frequency should be were much higher than the actual frequency in both regions. These findings may set the internationally acceptable normal frequency of sexual intercourse in various age groups, important to alleviate concerns that may lead to unnecessary utilization of erection-enhancing medications. Longer IELT along with higher coital frequencies can be explained by the close spacing, which decreases sexual craving and consequently modulates the drive for ejaculation and ejaculatory control. However, the positive correlation between IIEF and coital frequency could be attributed to the effect of better erectile function on coital frequency and probably not vice versa. The same explanation may apply to the mutual effect of irregular coital activity on erectile function and ejaculatory control, where irregularity could predispose to PE, whereas ED could lead to irregularity of coital activity.

Contraception was resorted to at a much lower rate in USA than was in the Middle East 5 (28.8 and 56%, respectively), reflecting the population problem in the latter. In USA, condoms were the most frequently used, although least preferred. Dislike for condoms was also detected in the Middle East, although matching a low frequency of use 5. The second most practiced contraception was vasectomy, although, in contrast to condoms, was associated with a high satisfaction rate in USA. This is in contrast to the Middle East, where vasectomy was extremely rare 5. The high frequency and satisfaction rates with vasectomy reflect the freedom and independence conferred, without the need for on-demand contraception. Still, condoms came first in frequency of use despite dissatisfaction, possibly because of their added benefit in the domain of safe sex. This shift to condoms was reported since 1998, where the decrease in pill and diaphragm use and the increase in reliance on condoms suggested that concerns about HIV and other sexually transmitted diseases were changing patterns of method use 8.

However, men in both USA and the Middle East favored female contraceptive measures the most, although resorted to in variable proportions. Contraceptive pills were both favored and frequently utilized by couples in USA and the Middle East. However, although IUD was associated with the highest satisfaction rate in both the USA and the Middle East, it was among the least utilized in USA and the most utilized in the Middle East. It seems that men in USA and the Middle East generally prefer the female partner to take over the responsibility of contraception, in which case, satisfaction with the contraceptive measure is highest. In USA, men prefer the independence conferred by non-on-demand methods such as IUD and vasectomy.

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Conclusion

In USA, as of the year 2011, the majority of English-speaking men above the age of 50 are married, although the age of marriage seems to be toward the fourth to fifth decades. Men with a longer duration of a coital relationship (years) are relatively vulnerable to PE, which should be discussed by the family physician, general practitioner, and in the mass media if it is to be addressed appropriately. Married men were more prone to use PDEi’s for recreational purposes, despite lack of formal ED. Coital frequency is almost the same in USA and the Middle East, ranging from approximately three times per week in the 18–39 years age group to approximately once a week in the above 60 group. Regular and closely spaced coital activity was associated with better ejaculatory control. It seems that men in USA and the Middle East generally prefer the female partner to take over the responsibility of contraception, in which case, satisfaction with the contraceptive measure is highest. In USA, men prefer the independence conferred by non-on-demand methods such as IUD and vasectomy.

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Acknowledgements

Conflicts of interest

There are no conflicts of interest.

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Keywords:

condom; contraception; epidemiology; frequency; Internet; marriage; survey; USA

© 2013 Human Andrology