ISSM – Abstract – March 2014
Lack of Sexual Privacy Affects Psychological and Marital Domains of Male Sexual Dysfunction
Valentina Boddi, MD; Alessandra Daphne Fisher, MD; Elisa Maseroli, MD; Giulia Rastrelli, MD; Giovanni Corona, MD; Emmanuele Jannini, MD; Valdo Ricca, MD; Edoardo Mannucci, MD; and Mario Maggi, MD
ONLINE: November 21, 2013 – The Journal of Sexual Medicine
Insufficient privacy during sex is one of the most common issues that can interfere with a couple’s intimacy and sexual function. For example, lack of privacy may be an issue for young people who live with their parents or with roommates. It can also affect parents who have children at home.
Assessments of sexual function do not usually include items on sexual privacy.
This study examined the issue in a large sample of men who were consulting for sexual dysfunction.
The participants in this study were 3,736 men who were seeking first-time help for sexual problems. Their mean age was 52 ± 12.9 years and almost 94% of them were in a stable relationship.
To learn more about sexual privacy in this group, the researchers asked one standard question: “During the last three months, have you had enough privacy during your sexual activity?” In their response, men could choose 0 (yes), 1 (sometimes), 2 (rarely), and 3 (never).
All participants underwent a standard diagnostic protocol for new patients. Before any treatment, each man was assessed using the Structured Interview on Erectile Dysfunction (SIEDY). This 13-item instrument includes three scales:
• Organic disorders (medical history, morning and nocturnal erections, and ejaculate volume)
• Relationship disturbances (presence of disease in the primary partner, the partner’s climax and desire, and menopausal symptoms)
• Psychological factors (presence of life stressors, conflict in the primary relationship and with family, extramarital affairs, and patient’s hypoactive sexual desire)
For this study, premature ejaculation (PE) was defined as “ejaculation that always or nearly always occurs prior to or within about 1 minute (as reported by the patient) of vaginal penetration.”
The participants also completed the modified Middlesex Hospital Questionnaire (MHQ). This tool is a self-reported questionnaire used to screen symptoms of mental disorders in nonpsychiatric settings. It assesses free-floating anxiety, phobic anxiety, obsessive-compulsive traits and symptoms, somatization, depressive symptoms, and histrionic/hysterical symptoms.
Main Outcome Measures
Each participant had a complete physical examination that included measurements of the following:
• Blood pressure
• Waist circumference
• Blood glucose
• Total cholesterol
• High-density lipoprotein cholesterol
• Total testosterone
• Luteinizing hormone (LH)
• Thyroid stimulating hormone
Of the 3,736 men:
• 83.9% reported no problems with privacy during sexual intercourse.
• 8.6% sometimes had enough privacy.
• 5.7% rarely had enough privacy.
• 1.7% never had enough privacy.
Men who reported any lack of privacy tended to be younger and have a younger partner. They were also more likely to smoke. The following data have been adjusted for patient’s and partner’s age and smoking status.
Using a confounder-adjusted, ordinal logistic model, SIEDY scales 2 (relationship domain) and 3 (intrapsychic domain) were related to an increased severity of lack of sexual privacy. SIEDY scale 1 (organic domain) was not related, however.
For SIEDY scale 2, a partner’s reduced sexual desire was significantly associated with lack of privacy. Lack of privacy was also significantly associated with total MHQ scores, and with scores on the following MHQ subdomains: free-floating and phobic anxiety, obsessive-compulsive traits and symptoms, and histrionic traits.
Participants lacking privacy were at higher risk for relationship conflict and stressful employment.
Longer relationship duration and a higher number of children were also associated with lack of sexual privacy, although cohabitation did not appear to be related.
When relationship duration and the number of children were introduced in an ordinate logistic model, along with previously mentioned confounders and scores on SIEDY scales 2 and 3, the researchers found that the severity of lack of privacy was affected by the number of children for all age bands except the highest quartile.
Childless participants who did not cohabitate were almost twice as likely to lack sexual privacy, especially if they were younger.
Lack of sexual privacy was associated with problems keeping an erection during intercourse. It was also associated with mild problems in achieving an erection, but not with moderate or severe problems.
Those with ejaculatory problems were more likely to experience lack of privacy.
Except for LH and glycemic levels, no major differences were found in hormonal and biochemical parameters.
Men who reported a lack of sexual privacy tended to have higher rates of marital and intrapsychic problems that affected their erectile and ejaculatory function, even though they were generally healthier than the rest of the sample.
The authors wrote, “Our study demonstrates that lack of privacy during sexual intercourse is an often unexplored, but still important, contextual factor, participating in the determinism of male sexual dysfunction, in particular in young individuals.”
They recommended that healthcare providers address this issue with patients.
They added, “We can postulate that individuals suffering from avoiding and anxious traits are more likely to choose quick and hurried occasions for making sex (supposing to be at lower risk to fail), and this can exacerbate their psychopathological traits.”
In addition, the researchers found an association between obsessive-compulsive traits and symptoms. They suggested that such individuals may be “excessively meticulous, perfectionist, inflexible, and, therefore, more sensitive to a lack of privacy.”
Participants who lacked sexual privacy were more likely to have relationship problems, including reduced libido in the partner. It’s possible that women with low sexual desire may create situations with less privacy, such as having children co-sleep with parents.
Aside from sexual issues, men with reduced sexual privacy tended to be healthier than the rest of the sample, with lower glycemia and LH levels. However, they had greater psychological and marital problems that interfered with sexual function when compared to the sexually dysfunctional men with no privacy issues.
The researchers found that men with children had almost twice the risk of reduced sexual privacy. Length of relationship was also associated with reduced privacy, although this association disappeared when fatherhood was included as a cofactor in the analysis. Children appeared to decrease a couple’s opportunities for intimacy.
Older men, however, may not have this problem, as their children are often adults and understand the importance of sexual privacy.
For younger couples without children, cohabitation was a risk factor for reduced sexual privacy, as such couples might need to find less secure places to have sex.
Sexual problems associated with lack of privacy were related to performance anxiety and mood disturbances, such as erectile problems and delayed ejaculation. Lack of privacy could now be considered an “additional life stressor that can impair the orgasmic reaction,” the authors said.
They noted that, to their knowledge, no instruments designed to assess sexual function and experiences address sexual privacy. However, considering sexual privacy may help clinicians better understand sexual dysfunctions and help them develop interventions, particularly therapies that don’t involve medication.