Sexual Behaviors of Middle-Age and Older People in Southern Taiwan

Original Article Taiwanese Journal of Psychiatry Vol. 23 No. 4 2009 • 307 •

Sexual Behaviors of Middle-age and Older People in Southern Taiwan

Jian-Kang Chao, M.D.1,2, Yen-Chin Lin, Ph.D.2, Mi-Chia Ma, Ph.D.3, Lyh-Jyh Hao, M.D.4, Ming-Der Shi, M.S.5

Objective: This study was to investigate the relationship of demographic variables to the sexual behavior, sexual desire and sexual satisfaction of the elderly population in Southern Taiwan. Methods: A total of 283 individuals over the age of 45 years was recruited from communities in Southern Taiwan. Participants were asked to complete a questionnaire form. Results: In the past year, except for masturbation (20.1%), the percentage of people participating in general sexual behavior at least once per month was found to be nearly 40% for most elderly adults, including touching/hand holding (42.8%), embracing (42.8%), kissing (38.2%), mutual stroking (41.7%) and sexual intercourse (40.3%). The most common sexually related problem was found to have a hypoactive sexual desire in both male and female participants. This study clearly showed that age, partner, education level and health status inﬂ uences sexual behavior, these items also have relevance to sexual satisfaction and sexual desire. If sexual satisfaction was rated using a binary outcome and then analyzed using multiple logistic regression analyses forward model selection the factors inﬂ uencing sexual satisfaction were found to be partner, alcohol and sexual desire. Conclusion: The sexual life of the elderly should be observed from a broad point of view, rather than just focusing on sexual intercourse, because simple hand holding, intimate closeness, hugs, or mutual stroking can also give elderly partners sexual satisfaction.

Key words: sexual behavior, older adults, sexual satisfaction, sexual desire (Taiwanese Journal of Psychiatry 2009;23:307-19)

has reached 10.43% of the total population in Introduction Taiwan [1]. This increasing population of the elderly has led to an increase in physical and mental According to the Department of Statistics of problems for both older adults and family the Ministry of the Interior of Taiwan in December members. 2008, the elderly population (65 years or older)

1 Department of Psychiatry, Yuli Veterans Hospital, Hualian County, Taiwan 2 Graduate School of Human Sexuality, Shu-Te University, Kaohsiung County, Taiwan 3 Department of Statistics, National Cheng Kung University, Tainan, Taiwan 4 Department of Internal Section, Endocrinology and Metabolism, Yong Kang Veterans Hospital, Young Kang, Taiwan 5 Department of pathology and Laboratory Medicine, Yong kang Veterans Hospital, Young Kang, Taiwan Received: July 7, 2009; revised: August 18, 2009; accepted: September 10, 2009 Address correspondence to: Dr. Jian-Kang Chao, No.91, Xinxing Street,Yuli Town, Hualian County 98142, Taiwan • 308 • Sexual Behavior of Middle-age and Older People

Although people have gradually paid more In fact so-called broadly defi ned sexual be- attention to related topics in recent years, such as havior includes touching, caressing, fantasy, mas- the health of the aged, medical treatment and so- turbation, physical closeness and intimacy. The cial welfare etc., the sexual behavior of old people effect of the aging process on sexuality and sexual is less likely to have been described. There is lim- function depends on the mental and physical ited information on the sexuality of middle aged health of an individual [12]. To study the topic of and elderly people. Furthermore, people do not sexuality is rare in men over the age of 45 years, think that the elderly need to participate in sexual because of the infl uence of the inherent culture in behavior as they are living under the infl uence of Taiwan. In general, old men avoid discussing sex, Taiwan’s conservative cultural background. From therefore any investigation into this aspect of their 1960, there have been great changes in the view of lives is rare. While later-life sexual health issues the role of sex with a more free expression of sex- have typically been given a low priority in policy, uality, but there are still some stereotypical im- practice and research, a socio-cultural shift in atti- pressions that exist concerning the elderly. For ex- tudes to sexuality and aging is challenged by the ample, that their bodies have relatively little sexual traditional stereotype of “asexual old ages.” Now, appeal and that there is relatively little interest in sexuality has become a major quality-of-life issue, having a continuing sexual relationship. We can even into advanced age. Although relatively few fi nd many descriptions and discussions about the studies have addressed sexuality, most studies sexual behavior of teenagers and adults but we have emphasized the decline of both sexual per- seldom see any articles discussing the sexual be- formance and satisfaction with aging [13]. havior of the elderly. Have old people really no Therefore, this study was designed to assess sexu- demand? Sexuality encompasses partnership, ac- al, behavior in the elderly (people over the age of tivity, behavior, attitudes, and function [2]. 45 years) and to fi nd any relevant factors related Sexuality in life is a major issue and naturally to the degrees of satisfaction achieved. The pur- one that people are interested in. Maslow regards pose of this study had two aims: it as one of mankind's basic physiological needs (A) to fi nd any relationship between the de- [3]. Even after entering old age, sex is still an im- mographic data of the elderly and their sexual be- portant factor in the quality of life. As people age, havior, level of sexual desire, and sexual satisfac- sexual satisfaction and the sex function decline tion; and [4,5]. Some studies showed that along with aging, (B) to fi nd the infl uencing factors on the level the frequency of intimacy and sexual intercourse of sexual satisfaction in the elderly. with companions reduced but sexual satisfaction is not infl uenced [6]. Normal physiological chang- Methods es such as decreased vaginal secretions and fl at- tening of the vaginal epithelium in women, and Study subjects delayed or decreased erections in men also affect The participants in this study were residents the sexuality of the older patient [7-9]. Limited of the Tainan and Kaohsiung communities: the data have indicated that some women and men veteran’s home, a nursing home and volunteers maintain intimate sexual relationships and desire and outpatients in a southern Taiwan’s veterans throughout their lives [10, 11]. hospital. The subjects recruited were all adults Chao JK, Lin YC, Ma MC, et al. • 309 •

over 45 years old. Participants were eligible if Assessment instrument they could understand and complete the question- A cover letter described the purpose of the naire and had no known disability. Excluded were study and emphasized that the data collected from those who could not complete the survey or who participants were anonymous. were unwilling to complete the forms. Of 387 eli- A. Demographic questionnaire gible persons, 283 (83 women and 200 men) were successfully interviewed. A total of 283 partici- The demographic questionnaire included 14 pants were then evaluated between September 30, items, predominantly multiple-choice questions. 2008 and May 31, 2009. East participant signed a The descriptive items included the participants’ consent form for this study. gender, age, educational level, smoking and drinking habits, awareness of his/her health conditions, The procedure their relationship with a partner, and so on. This study was reviewed and approved by B. Scales to assess Sexual function the institutional review board (IRB) of the Department of Nursing, Chung Hwa College of The Sexual Behavior Scale (SBS) question- Medical and Technology. The participating staff naire addressed 13 items which questioned both members were usually the key researchers of this social and physical sexual activity and frequency. study. The participants and staff members were The frequency of sexual activity was listed as interviewed separately in a quiet room. Informed never, less than monthly, monthly, weekly, and consent was obtained from the subject before their daily during the last 12 months (including the fre- visit to the hospital for an interview with the re- quency of hugging, holding hands, embracing, search team. All assessment measures were ad- kissing, caressing, masturbation and sexual inter- ministered in accordance with written protocols course) [14]. constructed from original materials, where they This study used the Sexual Desire Inventory were available. (SDI) introduced by Spector et al. in 1996 [15], Data were collected from self-report ques- and the Chinese version of the SDI (SDI-C) pro- tionnaires and interviews. Participants were asked posed by Lee in Taiwan [16]. to complete the questionnaire form, which the The Sexual Satisfaction Scale (SSS) [17,18], doctor distributed. The doctor informed subjects and the Chinese version of the Sexual Satisfaction that completion of the questionnaire was volun- Scale (SSS-C) were developed by a Taiwanese, tary and that their responses were anonymous. A Wang, was also used as a standard tool [19]. research assistant and doctor were available to an- The SDI-C and the SSS-C were used to con- swer any questions. After they completed the struct the survey questionnaires. All 14 SDI-C questionnaire, the participants were asked to place items were categorized into three factors accord- it into the provided envelope and sealed it. Most ing to the factor analysis results of Lee et al. [16]. interviews took place either in the home of the These factors were solitary, dyadic, and mixed, participant or at the veterans hospital. the latter comprised of overlapping items which were extracted to form this third factor. Their ﬁ t results are p=0.68 and GFI=0.93 for the three-factor model. The predicted Cronbach's α value of • 310 • Sexual Behavior of Middle-age and Older People

the SSS-C including 25 items is 0.96, and the of the major independent variables (e.g., age, mar- Cronbach's α value of formal examination is ital status) and binary sexual satisfaction was esti- 0.94. mated by odds ratios with 95% confi dence inter- vals (CI). Data analyses were performed with C. Quality of life scale Statistical Package for Social Science version 14 The WHOQOL is a measurement tool, for for Windows (SPSS, Chicago Illinois, USA). the evaluation of the quality of life in Taiwan de- The differences of the groups were consid- veloped by Yao in 2001 [20]. It is a self-adminis- ered signifi cant if p-values were smaller than 0.05. tered questionnaire. The WHOQOL-T is a valid and reliable instrument to evaluate HQOL of com- Results munity elders. The scale includes 28 items asking physical, psychological, social-relational, and en- Table 1 lists sexual experience of the subjects vironmental aspects of the quality of life. in the past year. Table 2 presents sexual problems Respondents were asked to make a subjective of female and male for middle-age and older peo- evaluation of their own lives on a fi ve-point Likert ple. Table 3 lists the proportion if sexual behavior scale. at least once per month under gender, age, partner status, health condition, and education level. Table Statistical Analyses 4 lists the relationship of demographic factors and Univariate descriptive statistics included the sexual satisfaction, life of quality and sexual frequency of distributions for categorical demo- desire. graphic variables and/or outcome variables (e.g. Tables 5 and 6 list the simple and multiple type of sexual activity in a typical one month peri- logistic regression analysis, respectively, of sexual od), means and standard deviations for measure- satisfaction for middle-age (45-64 years) and old- ment of sexual behavior, sexual desire and sexual er (≧65 years). satisfaction. In particular, participants’ responses Figures 1 and 2 depict predicted probability about their sexual experience, sexual problems, of sexual satisfaction score larger than 75 versus various types of sexual behavior, their sexual de- drinking status and sexual desire, respectively, sire and sexual satisfaction were summarized. The with and without a partner. association of sexual behavior and categorical demographic variables (e.g., gender, marital status) Discussion were examined using the Chi-square test. The means comparison of sexual desire (or sexual sat- Although much literature exists about ado- isfaction) under each categorical demographic lescent and adult sexuality, relatively few papers variables (e.g., gender, marital status) were not a have been published to highlight the nature of normal distribution. Hence, in this study, We used sexuality in older age groups. Sexuality may in- the Mann-Whitney U test or Kruskal-Wallis H test clude touching, caressing, fantasy, masturbation, for evaluation. physical closeness and the warmth generated by If sexual satisfaction is separated into larger emotionality [12]. While the term “sex” refers to than 75 or lesser than or equal to 75 as satisfi ed physical aspects, particularly the act of sexual in- and nonsatisfi ed groups, the association for each tercourse, “sexuality” has a broader meaning, in- Chao JK, Lin YC, Ma MC, et al. • 311 •

Table 1. Sexual experience in the past year

subjects living subjects living all without spouse/ with spouse/ partner (n=104) partner (n=179) n % n % n % Touching Not at all 63 60.6 34 19 97 34.3 /holding hands

Table 2. Sexual problems of female and male for middle-age and older people

Female (%) Male (%) middle-age older people Total middle-age older people Total n (%) n (%) n (%) n (%) n (%) n (%) normal 16 (26.2) 8 (38.1) 24 (8.5) 27 (32.1) 18 (15.7) 45 (16.0) Hypoactive Sexual Desire 28 (45.9) 8 (38.1) 36 (12.8) 51 (60.7) 79 (68.7) 130 (46.3) Vaginismus 0(0) 0(0) 0 (0) - - - Dyspareunia 8 (13.1) 3 (14.3) 11 (3.9) - - - Anorgasmia 9 (14.6) 2 (9.5) 11 (3.9) - - - Premature ejaculation - - - 4 (4.8) 3 (2.6) 7 (2.5) Erectile Dysfunction - - - 2 (2.4) 9 (7.8) 11 (3.9) Inhibited or retarded ejaculation - - - 0(0%) 6 (5.2) 6 (2.1) Total 61 (100) 21 (100) 82 (29.2) 84 (100) 115 (100) 199 (70.8) them had intercourse at least once a week. This 2,828 urban respondents aged 20–59 years. In that data indicate that some women and men maintain subpopulation, 13% of women and 35% of men sexual and intimate relationships and desire reported that they have had masturbation during throughout their lives. These results are similar to the preceding year. In our study the high propor- those in Addis et al.’s report [2]. Obviously, the tion who had not masturbated may be due to the proportion of people being sexually active for infl uence of the conservative culture, age and reli- those who have a partner/companion is higher gion in Taiwan, hence the participants did not than those who do not have one. Similar fi nding masturbate. is also report by Diokno et al. [23], who reported The participants in this study were less likely that nearly 74% of married men older than 60 to have been touched or embraced (Table 1) than years remain sexually active. This result is also the respondents in Ginsberg et al.’s sample [14]. found in Lindau et al.’s report [24]. He found that But the fi nding of our study showed that mastur- 73% of his respondents are 57 to 64 years old, bation and intercourse were more likely than the 53% of them are 65 to 74 years old, and 26% of respondents in Ginsberg et al.’s sample. This study them are 75 to 85 years old to remain sexually also showed there was a marked difference in lev- active. els of sexual activity between the elderly with a In this study, we also studied attitudes of staff partner and those without (Table 1). towards elderly people in their care, especially About 46.3% of the elderly people in this those in nursing homes and veteran’s homes. study had sexual problems with hypoactive sexual Masturbation, particularly if it occurred openly, desire (Table 2). Men who have erectile dysfunc- provoked the strongest negative responses. These tion, would express hypoactive sexual desire rath- fi ndings are similar to those reported by McCartney er than erectile dysfunction which leads to smaller and colleagues [25]. The fi nding of this study proportion (7.8%) for erectile dysfunction (Table 2). showed that 56.9% participants had never mastur- As shown in Table 3, the infl uence factors of bated in the past year (Table 1), being similar to sexual activity in this study were found to be sig- Das et al.’s report in 2009 [26]. They focused on nifi cantly to be related to age, partner, and health Chao JK, Lin YC, Ma MC, et al. • 313 •

Table 3. The proportion of sexual behavior at least once per month under gender, age, partner status, health condition, and education level

Touching Embracing Kissing Stroking Masturbation Intercourse n (%) n (%) n (%) n (%) n (%) n (%) At least once a month (n =283) 121 (42.8) 121 (42.8) 108 (38.2) 118 (41.7) 57 (20.1) 114 (40.3) Gender Female (n =83) 40 (48.2) 42 (50.6) 36 (43.4) 41 (49.4) 16 (19.3) 36 (43.4) Male (n =200) 81 (40.5) 79 (39.5) 72 (36.0) 77 (38.5) 41 (20.5) 78 (39.0) p-valuea 0.23 0.09 0.25 0.09 0.82 0.50 Age 45~64 (n =147) 85 (57.8) 86 (58.5) 74 (50.3) 84 (57.1) 39 (26.5) 83 (57.1) 65-74 (n =33) 22 (66.7) 20 (60.6) 20 (60.6) 22 (66.7) 8 (24.2) 17 (51.5) ≧75 (n =103) 14 (13.6) 15 (14.6) 14 (13.6) 12 (11.7) 10 (9.7) 13 (12.6) p-value <0.01* <0.01* <0.01* <0.01* <0.01* <0.01* Partner No partner (n =104) 28 (26.9) 23 (22.1) 20 (19.2) 23 (22.1) 14 (13.5) 27 (26.0) With partner (n =179) 93 (52.0) 98 (54.7) 88 (49.2) 95 (53.1) 43 (24.0) 87 (48.6) p-value <0.01* <0.01* <0.01* <0.01* 0.03* <0.01* Health Poor (n =71) 17 (23.9) 21 (29.6) 12 (16.9) 17 (23.9) 6 (8.5) 19 (26.8) Common (n =139) 58 (41.7) 59 (42.4) 55 (39.6) 64 (46.0) 34 (24.5) 53 (38.1) Very good (n =71) 44 (62.0) 39 (54.9) 39 (54.9) 35 (49.3) 16 (22.5) 40 (56.3) p-value <0.01* 0.01* <0.01* <0.01* 0.02* <0.01* Education Below 9 (n =131) 35 (26.7) 41 (31.3) 38 (29.0) 43 (32.8) 27 (20.6) 40 (30.5) Over 9 (n =152) 86 (56.6) 80 (52.6) 70 (46.1) 75 (49.3) 30 (19.7) 73 (48.7) p-value <0.01* <0.01* <0.01* 0.01* 0.86 <0.01* Smoking No (n =188) 80 (42.6) 85 (45.2) 78 (41.5) 82 (43.6) 42 (22.3) 70 (37.2) Yes (n =93) 40 (43.0) 35 (37.6) 29 (31.2) 35 (37.6) 15 (16.1) 43 (46.2) p-value 0.94 0.23 0.09 0.34 0.22 0.15 Drinking No (n =214) 91 (42.5) 90 (42.1) 83 (38.8) 92 (43.0) 44 (20.6) 83 (38.8) Yes (n=67) 29 (43.3) 30 (44.8) 24 (35.8) 25 (37.3) 13 (19.4) 30 (44.8) p-value 0.91 0.69 0.66 0.41 0.84 0.38 a Using Chi-squared test * Signiﬁ cantly different (p-value < 0.05) status and education level (p<0.05). In this study, with a partner (p<0.05). Furthermore, the sexual people in good physical health who were more activity in the study participants was found to be likely to have a spousal or other intimate relation- relatively low for the people whose age is over 75 ships were also more likely to be sexually active years old (p<0.05), without partner (p<0.05), in a • 314 • Sexual Behavior of Middle-age and Older People

Table 4. Relationship of demographic factors and sexual satisfaction, life of quality and sexual desire

Sexual Life of Sexual Dyadic Mixed Solitary satisfaction quality desire Gender Female (n =83) 93.3±19.2 82.1±17.9 15.9±18.0 9.8±11.1 3.6±4.2 2.7±4.6 Male (n =200) 90.8±23.3 87.6±13.5 24.7±22.6 13.5±12.7 6.2±5.3 5.3±7.2 p-valuea 0.34 0.01* <0.01* 0.01* <0.01* <0.01* Age 45~64 (n =147) 96.7±22.0 85.1±17.5 23.7±21.8 15.2±12.9 6.1±5.0 3.5±6.2 65-74 (n =33) 93.3±13.0 86.9±13.1 34.4±23.6 17.6±12.2 8.2±5.2 8.3±8.0 ≧75 (n =103) 83.5±22.7 87.0±11.7 15.7±18.8 7.2±9.6 3.8±4.7 4.7±6.3 p-valueb <0.01* 0.95 <0.01* <0.01* <0.01* <0.01* Partner without partner(n=104) 82.5±22.4 83.1±15.7 15.3±19.3 7.9±10.7 3.4±4.6 3.7±5.1 with partner(n =179) 96.8±20.3 87.8±14.4 26.0±22.1 15.2±12.5 6.7±5.0 5.0±7.4 p-valuea <0.01* 0.02* <0.01* <0.01* <0.01* 0.27 Health Poor (n =71) 82.4±25.3 78.3±14.0 15.9±17.5 8.7±10.5 3.9±4.2 3.1±4.3 Common(n =139) 92.7±21.0 86.9±13.2 22.7±22.1 13.1±12.4 6.0±5.3 3.9±6.5 Very good(n =71) 97.9±18.4 91.6±16.7 26.2±23.5 14.6±13.2 6.0±5.4 7.1±8.1 p-valueb <0.01* <0.01* 0.03* 0.04* 0.03* <0.01* Education ≧9(n =131) 88.4±20.6 86.8±15.3 16.2±17.5 8.0±9.6 4.2±4.5 4.4±5.8 over 9(n =152) 94.2±23.2 85.4±14.9 27.1±23.7 16.0±13.2 6.5±5.4 4.6±7.3 p-valuea <0.01* 0.70 <0.01* <0.01* <0.01* 0.80 Smoking No (n =188) 92.1±20.5 86.7±14.5 21.9±22.8 11.6±12.2 5.4±5.2 4.9±7.5 Yes (n =93) 90.8±25.1 85.0±15.9 22.4±19.2 14.1±12.5 5.6±5.0 3.7±4.1 p-valuea 0.99 0.65 0.25 0.07 0.58 0.18 Drinking No (n =214) 92.7±19.9 87.7±15.1 21.7±22.4 12.0±12.3 5.3±5.3 4.9±7.3 Yes (n =67) 88.3±27.9 81.1±13.3 23.1±19.0 13.8±12.5 5.9±4.7 3.3±3.8 p-valuea 0.12 <0.01* 0.14 0.16 0.14 0.82 a Using Mann-Whitney U test b Using Kruskal-Wallis H test * Signiﬁ cantly different (p-value < 0.05) poor health status (p<0.05), and with education vaginal intercourse, and masturbation even in the level below nine years (p<0.05). The prevalence seventh and eighth decades of life (Table 3). for sexual activity declined with age, yet a sub- Of all participants in the present study, 81.6% stantial number of men and women engaged in were found to be capable of achieving sexual sat- Chao JK, Lin YC, Ma MC, et al. • 315 •

Table 5. Simple logistic regression analysis of sexual satisfaction for middle-age (45-64 years) and older people (≧65 years) Variable Middle-age (n =147) Older people (n =136) All (n =283) Odds ratio 95% CI for Odds ratio 95% CI for Odds ratio 95% CI for (OR) OR (OR) OR (OR) OR Sex 1.67 (0.81, 3.44) 3.17* (1.21, 8.28) 1.66 (0.97, 2.83) Age 1.09* (1.02, 1.17) 0.93 (0.87, 1.00) 0.99 (1.97, 1.00) Partner 12.27* (5.0, 30.1) 2.10* (1.04, 1.09) 4.48* (2.64, 7.60) Health status Health status 1 8.44* (3.2, 22.3) 0.82 (0.36, 1.84) 2.20* (1.22, 3.97) Health status 2 3.56* (1.39, 9.13) 2.23 (0.72, 6.88) 2.71* (1.33, 5.50) Education 0.99 (0.91, 1.09) 1.06 (0.99, 1.14) 1.05 (0.10, 1.11) Smoking 0.64 (0.31, 1.33) 0.88 (0.39, 1.97) 0.83 (0.49, 1.41) Drinking 0.47* (0.22, 0.99) 0.45 (0.17, 1.17) 0.55* (0.31, 0.96) Sexual desire 1.08* (1.05, 1.12) 1.06* (1.04, 1.09) 1.07* (1.05, 1.09) * Signiﬁ cantly different (p-value < 0.05) Abbreviations: CI = conﬁ dence interval; OR = odds ratio.

Table 6. Multiple logistic regression analysis of sexual satisfaction for middle-age (45~64 years) and older people (≧65 years) Variable middle-age (n =147) older people (n =136) All (n =283) Odds ratio 95% CI for Odds ratio 95% CI for Odds ratio 95% CI for (OR) OR (OR) OR (OR) OR Partner 4.65* (1.4, 15.0) 3.25* (1.8, 5.9) Drinking 0.23* (0.1, 0.6) 2.21 (0.5, 10.4) 0.40* (0.2, 0.8) Sexual desire 1.09* (1.05, 1.13) 1.11* (1.05, 1.17) 1.07* (1.05, 1.09) Partner × Drinking 0.06* (0.007, 0.5) Partner ×Sexual desire 0.93* (0.88, 0.99) Constant 0.98 0.37* 0.45* * Signifi cantly different (p-value < 0.05) Abbreviations: CI = confi dence interval; OR = odds ratio. isfaction (Table 4). The results of this study indi- steadily from adolescence into old age because of cated that age was found to be signifi cantly asso- reduction in levels of sexual desire. Recently, ciated with the levels of sexual desire, sexual Chen et al. [29] suggested that age and gender dif- satisfaction and sexual activities. Those categories ferences should be taken into account when mea- were declined with an increase in age, especially suring sexual satisfaction. They also pointed out over the age of 75 years old, but age did not infl u- that the age of 40 years could be an anchor point ence the quality of life. The results in this study for sexual functioning in the female population of are consistent with previous study fi ndings [27,28]. Taiwan [29]. The fi nding of this study showed Sexual behavior in women and men declines clearly that age, partner, education level and health • 316 • Sexual Behavior of Middle-age and Older People

(a) middle-age people (45~64 years) (b) older people (age over 65 years)

0.90000 partner 0.80000 partner no partner no partner with partner with partner 0.80000 0.70000

0.70000

0.60000 0.60000

0.50000 0.50000

predicted probability 0.40000 predicted probability predicted

0.40000 0.30000

0.20000 0.30000

no yes no yes drinking drinking Figure 1. Predicted probability of sexual satisfaction score larger than 75 versus drinking status under with a partner and without a partner

(b) older people (over 65 years) partner 1.00000 no partner with partner

0.80000

0.60000 predicted probability

0.40000

0.20000

0.00 20.00 40.00 60.00 80.00 sexual desire score

Figure 2. Predicted probability of sexual satisfaction score larger than 75 versus sexual desire score under with a partner and without a partner status infl uences sexual activity, were found sig- gression analysis. The sexual satisfaction level of nifi cantly related to sexual satisfaction, sexual de- a person who has a partner is relatively high and sire, the dyadic and the mixed categories (Table people with poor health have lower sexual satis- 4). faction than those with good health, especially in As shown in fi gure 1, the results indicated single old men who have poor health status that having a partner, drinking, individual health (p<0.05). status and sexual desire were found to have a sig- Analysis further showed that signifi cant fac- nifi cant association (p<0.05) with the categorized tors were included in multiple logistic regression binary sexual satisfaction in simple logistic re- analyses (Figure 2). Forward model selection Chao JK, Lin YC, Ma MC, et al. • 317 •

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台灣南部中老年人性行為

趙建剛1,2 林燕卿2 馬瀰嘉3 郝立智4 奚明德5

ҬޟȈ 本研究之目的為探討 45 歲以上中性交 (40.3%)。男與女的受試者最常的性問題老年人的人口學變項與性行為模式及探討老人為，性欲減低。本研究也清楚的顯示，年齡、性行為模式的影響因素。ПݲȈ 本研究共收伴侶、教育程度及健康狀態等，皆可影響性行集醫院志工、台南縣市社區民眾、非精神科為。這些項目也與性滿意度及性需求相關。如門診病人、護理之家及榮民之家住民，45 歲在羅輯回歸分析下，則顯示性生活滿意度與有以上有效之個案 283 名，在告知被施測者作答無伴侶、飲酒及性需求相關。๖፣Ȉ老年人的方式及問卷內容後，分別施測基本問卷及性性生活應該從較廣義的角度去看，而不是狹義行為模式問卷。๖ݎȈ 很明顯的在過去一年地集中於器官的性接觸，因為很多時候親密接中，除自慰外 (20.1%)，大部份受試者還存有觸、牽手、擁抱或愛撫等已經可以為年老的伴廣義的性經驗，如觸摸／牽手 (42.8%)、接吻侶帶來性滿足。 (38.2%)、擁抱 (42.8%)、相互撫摸 (41.7%) 及

關鍵詞：性行為，中老年人，性滿意度，性需求（台灣精神醫學 2009;23:307-19）

1玉里榮民醫院精神科 2樹德科技大學性學研究所 3成功大學統計系 4永康榮民醫院新陳代謝科 5永康榮民醫院病理檢驗科受理日期：2009年7月7日；修正日期：2009年8月18日；接受日期：2009年9月10日通信作者地址：趙建剛，98142花蓮縣玉里鎮新興街91號玉里榮民醫院