Debunking the myths: what is sex really like for ordinary people?

"Few people enjoy a perfect sexual relationship - we need to encourage those people to access the services and support they need."

As a nation we’re fascinated by sex and we all want to know whether our own sex lives are ’normal’. It’s surprisingly difficult to find out, because media stories tend to focus on the sensational and many people hesitate before sharing their personal experiences with others. We are vulnerable to the myth that we can, and should, have the perfect sex life. This myth shapes our expectations of our own sex life and can leave us feeling dissatisfied. Unbiased, reliable data is so important in getting the facts straight.

The three National Surveys of Sexual Attitudes and Lifestyles (Natsal) have been documenting trends in sexual behaviour in Britain from 1990 through 2000 to 2010. Over that time they have collected data on over 46,000 individuals and provide the most reliable information on sexual behaviour and sexual health in Britain. The results of the most recent survey - Natsal-3 - led by the London School of Hygiene & Tropical Medicine, UCL and NatCen Social Research, have just been published. In Natsal-3, we extended the age range to 74 (in Natsal-2 it was 44) and we broadened our focus to look at health and well-being in relation to sexuality. This enabled us to explore how health and relationships affect our sex lives.

The Natsal data show that on average over the past two decades there has been a decrease in how often people have sex, from a median of five times a month in 1990, to three times in 2010.This is partly because fewer people are in relationships, but even those in relationships are having sex less often. This trend is best explained by changes in lifestyle, and the increased stress and busyness of modern life seem likely culprits.

Our health can also affect our sex lives. The Natsal-3 survey shows that one in six people have a health condition that affects their sex life. Those in poorer health are less likely to have had sex recently and are less likely to be sexually satisfied, even after taking into account their age and whether or not they have a partner. Poor health does not necessarily spell the end of an active and satisfying sex life, but what is striking is that only a quarter of men and a fifth of women who say they have a health condition that has affected their sex life have sought help or advice from a professional. That suggests that there are a lot of people with unmet need.

Sexual problems are a common feature of ordinary sexual relationships. Around half of women and four out of ten men report a recent sexual problem, with lack of interest being the most common. Young people are not exempt from experiencing sexual problems either. One in ten women aged 16-24 say they lack enjoyment in sex and one in ten young men say they lack interest. Some things get easier with age - as they get older, women tend to experience less anxiety and men are less likely to climax too quickly. But some things get more difficult - older women increasingly report vaginal dryness and men increasingly experience difficulty getting and keeping an erection. Although sexual problems are common, only one in ten people report distress about their sex life, so it’s important to take account of the personal significance of problems to each individual.

Few of us enjoy a perfect sexual relationship. Around a quarter of men and women say they don’t share the same interest in sex as their partner and almost one in ten do not share the same sexual likes and dislikes. Just under one in five of us has a partner who has experienced difficulties in the last year, and this proportion increases with age, particularly for women.

Natsal-3 used a new measure to come up with a composite score of sexual function – the extent to which an individual is able to participate in and enjoy a sexual relationship. The measure takes account not only of sexual problems, but also of the relationship in which they occur and the degree of personal distress and dissatisfaction. Using this composite score, we found that individuals with depression and poor general health are more likely to have low sexual function. We also found a strong connection between low sexual function and experiencing relationship breakdown and not being happy in a relationship.

It seems that few of us have the perfect sex life and that it would be healthier to aim for a good-enough one instead. On the other hand, there are a large number of people who are not seeking help even though they would benefit from doing so. We need to encourage those people to access the services and support they need, and when they do, we must ensure that we have the resources to provide them with good quality advice and treatment. We also need to spend more time educating young people so that they start out with realistic expectations, and so that they learn that sex is about relationships and relationships are about respect.

Dr Kirstin Mitchell is Lecturer in Sexual and Reproductive Health at the London School of Hygiene & Tropical Medicine and co-author of the Natsal study, which was conducted in partnership with UCL and NatCen Social Research.

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Donald Trump's healthcare failure could be to his advantage

The appearance of weakness is less electorally damaging than actually removing healthcare from millions of people.

Good morning. Is it all over for Donald Trump? His approval ratings have cratered to below 40%. Now his attempt to dismantle Barack Obama's healthcare reforms have hit serious resistance from within the Republican Party, adding to the failures and retreats of his early days in office.

The problem for the GOP is that their opposition to Obamacare had more to do with the word "Obama" than the word "care". The previous President opted for a right-wing solution to the problem of the uninsured in a doomed attempt to secure bipartisan support for his healthcare reform. The politician with the biggest impact on the structures of the Affordable Care Act is Mitt Romney.

But now that the Republicans control all three branches of government they are left in a situation where they have no alternative to Obamacare that wouldn't either a) shred conservative orthodoxies on healthcare or b) create numerous and angry losers in their constituencies. The difficulties for Trump's proposal is that it does a bit of both.

Now the man who ran on his ability to cut a deal has been forced to make a take it or leave plea to Republicans in the House of Representatives: vote for this plan or say goodbye to any chance of repealing Obamacare.

But that's probably good news for Trump. The appearance of weakness and failure is less electorally damaging than actually succeeding in removing healthcare from millions of people, including people who voted for Trump.

Trump won his first term because his own negatives as a candidate weren't quite enough to drag him down on a night when he underperformed Republican candidates across the country. The historical trends all make it hard for a first-term incumbent to lose. So far, Trump's administration is largely being frustrated by the Republican establishment though he is succeeding in leveraging the Presidency for the benefit of his business empire.

But it may be that in the failure to get anything done he succeeds in once again riding Republican coattails to victory in 2020.

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.