Asexuality Development among Middle Aged and Older Men

Citation: Huang Y-P, Chen B, Ping P, Wang H-X, Hu K, et al. ( Asexuality Development among Middle Aged and Older Men Yan-Ping Huang 0 Bin Chen 0 Ping Ping 0 Hong-Xiang Wang 0 Kai Hu 0 Hao Yang 0 Tao Zhang 0 Tan Feng 0 Yan Jin 0 Yin-Fa Han 0 Yi-Xin Wang 0 Yi-Ran Huang 0 Alice Y. W. Chang, Kaohsiung Chang Gung Memorial Hospital, Taiwan 0 Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Andrology , Shanghai , China Objectives: To assess erectile function in middle-aged and older men with asexuality status and further analyze their specific reasons for this condition. Subjects and Methods: Men who had regular sexual intercourse attempts (sex frequency$1 time per month) were classified into mild erectile dysfunction (ED), moderate to severe ED and non-ED according to International Index of Erectile Function-5, and men having no sexual intercourse attempts for at least 6 months were defined as having an asexuality status. The risk factors associated with ED were collected in a sample of 1,531 Chinese men aged 40 to 80 years, and the selfreport reasons for asexuality were recorded in asexual cohort individually. Comparative analyses and multivariate regression models were conducted among these groups. Results: The prevalence rates of ED and asexuality status were 49.9% and 37.2%. The asexuality status group had higher risk factors than the moderate to severe ED group in terms of old age (age$65, adjusted odds ratio (OR) 17.69 versus (Vs.) 7.19), diabetes (crude OR: 2.40 Vs. 2.36) and hypertension (crude OR: 1.78 Vs. 1.72). The specific reasons for the asexuality status were ''erectile difficulty'' (52.9%), ''do not care about sexuality'' (53.5%)'', ''no longer necessary to have sexuality at this age'' (47.7%), ''severe stress'' (44.4%), ''severe fatigue'' (26.3%) and ''masturbation'' (26.9%). Conclusions: Men with an asexual status suffer from higher risk factors for ED than men with moderate to severe ED. The majority of this asexual status could be attributed to a full ED, although the reasons for this transient asexuality also involved sexual attitudes and interests, sexual partners and masturbation. - Funding: This study was funded by the grant from the National Natural Science Foundation of China (No. 81270741). Science and Technology Commission of Shanghai Municipality Project (No. 08411951700). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. With the development of society and the process of aging, medical attention and services relating to sexual function are increasing, and the middle-aged and older adults are the most common target population in many studies for surveying and treating sexual problems. Erectile dysfunction (ED) is the most common sexual problem discussed by a growing mass of studies all over the world, yet there is limited information for the asexuality status which may differ from ED in psychological and physical conditions. As opposed to the permanent asexuality condition afflicting around 23% of men and not defined as yet as a disorder [1,2], an asexuality status may be defined as a temporary or irreversible stage in middle aged and older men who had sexual prior sexual experience but are now in a stage of disinterest towards heterosexual intercourse. Often, health-care professionals consider that an asexuality status is related to psychogenic factors, religion, sexual partners and even homosexuality, and they fail to assess these asexual men, defined as having no heterosexual intercourse for a long time, by applying the International Index of Erectile Function (IIEF) to determine ED. As no standard recommendations for evaluating asexuality status, how to verify the true erectile function and explore the specific reasons for asexuality in this cohort are of particular importance. But to date, no comprehensive, representative and population-based data are available to help physicians understand the status of asexuality. Shanghai took a lead in ageing process and became the first area with an old population structure in China. The number of people over 65 will reach a peak of four million in the year 2025, and then occupy 29% of the total population [3]. Thus the ageing population in Shanghai could be considered to be nationally representative, and the male population could be the optimal sample for studying sexual dysfunction. The aim of this welldesigned large population-based study was to verify the erectile function in middle-aged and older men with an asexual status by comparing the asexuality status with ED and non-ED as defined clinically, and in terms of the socio-demographic, clinical and lifestyle characteristics and further analyzing the specific reasons for asexuality. Materials and Methods Study Population This study investigated sexuality and health status in middle aged and older men from 40 to 80 years of age. Twenty-two communities were stratified as urban central area, urban outer area and urban fringe area by epidemiologists. Seven communities were confirmed for investigation by a stratified random sampling method. The participants from randomly selected communities were included by posters. During the investigation phase (from 2008 to 2011), men who had self-care ability and resided in the city for more than one year were eligible for interview. The subjects who had congenital developmental disorders and/or congenital deformity, serious diseases (i.e. severe cardiac disease and/or psychiatric disorders, significant renal and/or hepatic dysfunction) and homosexual or bisexual orientation, were excluded in the screening procedure of eligibility. All the disorders were confirmed by self-report, medical record review and interview. Of 1,720 eligible respondents, 1,591 completed the baseline in-home protocol. Of the original 1,591 respondents to the baseline survey, 60 were excluded as the conflicting or incomplete data, which left 1,531 men eligible for the statistics. Figure 2. The specific reasons for asexuality in the population without sexual intercourse. doi:10.1371/journal.pone.0092794.g002 Measures Used The field protocol was developed according to the model of Massachusetts Male Aging Study [4]. Briefly, a trained field technician/phlebotomist visited each subject in Community Service Center or his home according to standard research protocols developed for large scale fieldwork [5], collected demographic data, administered a general health questionnaire and sexual status assessment instruments, and obtained fasting blood samples. This study received institutional review board approval (Renji Hospital, Shanghai. No. RJLS2008175), and written informed consent was given by all study participants. All collected data were uploaded into a database established by using the ACCESS system plus functio (...truncated)