[ Editorials | Departments and Series | Index ]

Sexual Health & Intimacy

Is My Sex Life Normal?

Heather Hoffmann, PhD

This is one patient query that can often be difficult for the physician to answer. A lack of honest conversation about sex among people in general, as well as a dearth of representative research data, leave a fuzzy picture of what constitutes a normal sex life. Another complicating factor is the definition of "normal." Some define normal as behavior in which (many) others engage, so common is normal. Psychologists often include the concepts of personal distress and maladaptive functioning in defining what is normal, so if the patient is happy with her sex life and it is not causing her other problems, then she is probably normal.

The information in this article discusses how a patient's behavior compares with that of others. The data come from two studies. One is the National Health and Social Life Survey (NHSLS) from the early 1990s.¹ Although it is more than 10 years old, it provides the most comprehensive information to date on sexual behavior in the United States. The method used by the NHSLS scientists to select subjects yielded the largest, most representative sample yet for a sex survey. In addition, the data cover a wide range of sexual behaviors. Participants were 3,432 women and men aged 18 to 59 years, and the information was obtained mainly from face-to-face interviews. The second study is a more recent, smaller telephone interview study conducted by researchers at The Kinsey Institute.² It was performed between 1999 and 2000, and included 987 women aged 20 to 65 years.

FREQUENCY

There seems to be a general impression that people, particularly single men, have sex frequently. The NHSLS study suggests otherwise.¹ Overall, frequency numbers were similar for men and women, with approximately 33% of the sample reporting sexual activity at least twice per week and another 33% reporting activity a few times per month. The final third engaged in sexual activity a few times per year or not at all. Perhaps surprising to some, those with a regular partner (ie, those who were married or cohabiting) had sex more frequently than those who were single. There were also differences in frequency based on age. People in their 20s and 30s had the most frequent sexual activity. This dropped off after age 40 years, but more than 33% of people in their 50s were still engaging in sex a few times per month. The Kinsey Institute study revealed a somewhat similar picture in terms of overall frequency.² Of the women interviewed, 37% had sex once or twice per week in the past month, with only 25% reporting having sex more often, and 40% saying they had sex less frequently.

ACTIVITY

Although penile-vaginal intercourse is the most popular form of sexual activity, people engage in a wide range of sexual behaviors. Of the other variations, oral sex is the most common, with approximately 75% of the NHSLS sample having experienced it and at least 25% engaging in oral sex during their last sexual interaction.¹ The numbers were slightly higher for men. Anal sex was less common, but still practiced by approximately 20% of men and women. Forty-one percent of men and 16% of women reported having purchased sexual materials (eg, erotic magazines or films, sex toys) and 60% of men and 40% of women reported masturbating in the last year. Masturbation occurred in all age ranges, and those who masturbated tended to be more educated, have regular partners, and engage in a wider range of other sexual behaviors than those who did not masturbate. Nonetheless, 50% of men who masturbated reported feeling guilty about it. For women who masturbate, the rates of experiencing guilt may be somewhat higher. The Kinsey Institute study revealed that 57% of women had not masturbated in the last month.² Of those who had masturbated in the past month, 27% of women reported a rate of less than once a week and about 16% cited a greater frequency.

PREOCCUPATION

Of men in the NHSLS sample, 54% reported thinking about sex at least once a day, compared with 19% of women.¹ More women reported thinking about sex a few times per week or month (67%), compared with 43% of men. Fourteen percent of women and 4% of men reported less frequent erotic thought. The Kinsey Institute study found that 16% of women thought about sex daily in the past month, 76% thought about it sometimes, and 8% said they hadn't thought about sex at all in the past month.²

ORGASM

There was a notable gender difference in the numbers of people reporting that they always reached orgasm during sexual activity, with 75% of men but only 29% of women consistently experiencing orgasm. Interestingly, 44% of men said their partners always had an orgasm.¹ On the other hand, women's estimates of the frequency of their partner's orgasms more accurately reflected male reports. The Kinsey Institute study showed similar rates of orgasm for women, with only 36% reporting orgasm more than 75% of the time and more than half having an orgasm 50% of the time or less.² However, the frequency of orgasm does not necessarily translate into degree of satisfaction with sexual activity. In the NHSLS study, 40% of both men and women reported being extremely physically pleased with their sex lives, and 40% reported being extremely emotionally satisfied with their sex lives.¹

PROBLEMS

The NHSLS study found that 40% of women reported sexual problems.¹ The Kinsey Institute study found a similar rate,² but the distribution of specific problems varied between the studies. The Kinsey Institute participants cited more physical problems (eg, impaired lubrication),² whereas the NHSLS women most often reported low sexual interest/desire.¹ In both studies, the rates of sexual problems for men were lower than that for women, with the leading male complaint being premature ejaculation.
Clinicians have yet to agree on what constitutes a sexual problem (particularly in women), and whether the problem arises from dysfunction in the sexual response system or another, more general, difficulty. The Kinsey Institute study concluded that a woman's overall physical and mental health, level of education, and relationship with her partner were the most important predictors of sexual distress.²

CONCLUSION

Americans' sex lives seem to be tamer than the media images would indicate, but still more active than some might admit. In addition to comparing a patient's sexual behavior with that of others, the physician should also consider how he/she feels about his or her sexuality, both as it contributes positively to other aspects of personal well-being, and as it could affect views of patients' sexuality. Also, it is important to bear in mind that a normal sex life (ie, one that reflects national norms) does not necessarily equate with a healthy sex life (ie, one that is satisfying to the individual). So while the studies discussed here can be used to reassure patients that their sexual activity isn't infrequent or unusual and their problems aren't uncommon, the physician must remember that physical and emotional satisfaction is the ultimate determinant of health.

Heather Hoffmann, PhD, is associate professor of psychology, Knox College, Galesburg, Ill.

References

1. Michael RT, Gagnon JH, Laumann EO, Kolata GB. Sex in America. Boston, Mass: Little, Brown & Company; 1994.
2. Bancroft J, Loftus JL, Long JS. Distress about sex: a national survey of women in heterosexual relationships. Arch Sex Behav. 2003;32(3):193-208.

back to top