There is evidence that emotional intimacy can buffer the distress associated with sexual difficulties. Considering that older adults are at an increased risk of chronic illness, many of which (including their medical treatment) can impact their sexual well-being, the link between intimacy and sexual distress may be particularly relevant for older couples. To start bridging the gap in our understanding of the links between older couples’ emotional intimacy, distress about sexual function, and seeking professional help for sexuality-related issues, the current study used a 4-country sample with 218 Norwegian, 207 Danish, 135 Belgian, and 117 Portuguese couples aged 60–75 years. Two hypotheses were explored with a hybrid dyadic analysis: (1) a couple’s emotional intimacy is negatively related to partner’s distress about sexual function, but (2) positively associated with their help-seeking for sexual health issues. Less than 10% of participants in the current study reported seeking professional help, with the majority reporting their primary care physician as the contacted person. Couples’ emotional intimacy was consistently (and negatively) associated with female partners’ sexual distress across countries, but was unrelated to help-seeking for sexual problems. The findings illustrate the role of shared emotional intimacy in older women’s distress about sexual function, but also indicate that older couples characterized by high intimacy should not be assumed to seek professional help for sexually related issues more readily than other couples.
Your institute does not have access to this article
Subscribe to Journal
Get full journal access for 1 year
only $14.88 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
The term effect is not used to indicate a causal link, but to distinguish between partner’s contributions.
The questionnaire was developed in English and translated into the four languages by members of an international research team.
Ten categories (social worker, nurse, primary care physician, secondary care physician, physiotherapist, psychologist, psychotherapist, sex therapist…) were listed, including “other”.
Considering the likely association between sexual distress and age, as well as the observation that sexual distress is directly related to seeking help (see ), the behavior is probably substantially less common among older compared with younger individuals.
Orr J, Layte R, O’Leary N. Sexual activity and relationship quality in middle and older age: findings from the Irish Longitudinal Study on Ageing (TILDA). J Gerontol Ser B Psychological Sci Soc Sci. 2019;74:287–97. https://doi.org/10.1093/geronb/gbx038.
DeLamater J, Koepsel E. Relationships and sexual expression in later life: a biopsychosocial perspective. Sex Relatsh Ther. 2015;30:37–59. https://doi.org/10.1080/14681994.2014.939506.
Fileborn B, Lyons A, Heywood W, Hinchliff S, Malta S, Dow B, et al. Talking to healthcare providers about sex in later life: Findings from a qualitative study with older Australian men and women. Australas J Ageing. 2017;36:50–6. https://doi.org/10.1111/ajag.12450.
Hinchliff S, Gott M. Intimacy, commitment, and adaptation: sexual relationships within long-term marriages. J Soc Personal Relatsh. 2004;21:595–609. https://doi.org/10.1177/0265407504045889.
Berdychevsky L, Nimrod G. Sex as leisure in later life: a netnographic approach. Leis Sci. 2017;39:224–43.
Barrett C, Hinchliff S. Addressing the sexual rights of older people. New York: Routledge; 2018.
Træen B, Hald GM, Graham CA, Enzlin P, Janssen E, Kvalem IL, et al. Sexuality in older adults (65+)—an overview of the literature, part 1: sexual function and its difficulties. Int J Sex Health. 2017;29:1–10. https://doi.org/10.1080/19317611.2016.1224286.
Laumann EO, Glasser DB, Neves RCS, Moreira ED. A population-based survey of sexual activity, sexual problems and associated help-seeking behavior patterns in mature adults in the United States of America. Int J Impot Res. 2009;21:171–8. https://doi.org/10.1038/ijir.2009.7.
Muise A, Maxwell JA, Impett EA. What theories and methods from relationship research can contribute to sex research. J Sex Res. 2018;55:540–62. https://doi.org/10.1080/00224499.2017.1421608.
Barbieri, D. et al. Gender Equality Index 2017: Measuring gender equality in the European Union 2005–15. Vilnius: European Institute for Gender Equality; 2017.
World Economic Forum. The Global Gender Gap Report 2017 Insight Report. Geneva: World Economic Forum; 2017.
Štulhofer A, Carvalheira AA, Træen B. Is responsive sexual desire for partnered sex problematic among men? Insights from a two-country study. Sex Relatsh Ther. 2013;28:246–58. https://doi.org/10.1080/14681994.2012.756137.
Træen B, Štulhofer A, Landripet I. Young and sexual in Norway and Croatia: revisiting the Scandinavian versus Mediterranean gendered pattern of sexual initiation. Int J Sex Health. 2011;23:196–209. https://doi.org/10.1080/19317611.2011.574786.
Schnarch D. Constructing the Sexual Crucible: An Integration of Sexual and Marital Therapy. New York: W. W. Norton; 1991.
Sinclair VG, Dowdy SW. Development and validation of the Emotional Intimacy Scale. J Nurs Meas. 2005;13:193–206.
Hinchliff S, Gott M. Perceptions of well-being in sexual ill health: What role does age play? J Health Psychol. 2004;9:649–60. https://doi.org/10.1177/1359105304045361.
Štulhofer A, Jurin T, Graham C, Janssen E, Træen B. Emotional intimacy and sexual well-being in aging European couples: a cross-cultural mediation analysis. Eur J Ageing. 2019;1–12. https://doi.org/10.1007/s10433-019-00509-x.
Bouman WP. Sexuality in later life. In: Dening T, Thomas A, editors. The Oxford Textbook of Old Age Psychiatry (2nd Editio, pp. 703–23). Oxford: Oxford University Press; 2013.
Erens B, Mitchell KR, Gibson L, Datta J, Lewis R, Field N, et al. Health status, sexual activity and satisfaction among older people in Britain: a mixed methods study. PLOS ONE. 2019;14:e0213835. https://doi.org/10.1371/journal.pone.0213835.
Sánchez-Fuentes M, del M, Santos-Iglesias P, Sierra JC. A systematic review of sexual satisfaction. Int J Clin Health Psychol. 2014;14:67–75. https://doi.org/10.1016/S1697-2600(14)70038-9.
Hinchliff S, Tetley J, Lee D, Nazroo J. Older adults’ experiences of sexual difficulties: qualitative findings from the English Longitudinal Study on Ageing (ELSA). J Sex Res. 2018;55:152–63. https://doi.org/10.1080/00224499.2016.1269308.
Lodge AC, Umberson D. All Shook Up: Sexuality of mid- to later life married couples. J Marriage Fam. 2012;74:428–43. https://doi.org/10.1111/j.1741-3737.2012.00969.x.
DeLamater J. Sexual expression in later life: a review and synthesis. J Sex Res. 2012;49:125–41. https://doi.org/10.1080/00224499.2011.603168.
Kleinstäuber M. Factors associated with sexual health and well being in older adulthood. Curr Opin Psychiatry. 2017. https://doi.org/10.1097/YCO.0000000000000354.
Gabb J. The relationship work of sexual intimacy in long-term heterosexual and LGBTQ partnerships. Curr Sociol. 2019.001139211982661. https://doi.org/10.1177/0011392119826619.
Kingsberg SA. Attitudinal survey of women living with low sexual desire. J Women’s Health. 2014;23:817–23. https://doi.org/10.1089/jwh.2014.4743.
Neese LE, Schover LR, Klein EA, Zippe C, Kupelian PA. Finding help for sexual problems after prostate cancer treatment: A phone survey of men’s and women’s perspectives. Psychoncol. 2003;12:463–73. https://doi.org/10.1002/pon.657.
Schover LR, Fouladi RT, Warneke CL, Neese L, Klein EA, Zippe C, et al. Seeking help for erectile dysfunction after treatment for prostate cancer. Arch Sex Behav. 2004;33:443–54. https://doi.org/10.1023/B:ASEB.0000037425.31828.06.
Frederick DA, Lever J, Gillespie BJ, Garcia JR. What keeps passion alive? Sexual satisfaction is associated with sexual communication, mood setting, sexual variety, oral sex, orgasm, and sex frequency in a national U.S. study. J Sex Res. 2017;54:186–201. https://doi.org/10.1080/00224499.2015.1137854.
Gillespie BJ. Sexual synchronicity and communication among partnered older adults. J Sex Marital Ther. 2017;43:441–55. https://doi.org/10.1080/0092623X.2016.1182826.
Moreira ED, Brock G, Glasser DB, Nicolosi A, Laumann EO, Paik A, et al. Help-seeking behaviour for sexual problems: The Global Study of Sexual Attitudes and Behaviors. Int J Clin Pract. 2005;59:6–16. https://doi.org/10.1111/j.1742-1241.2005.00382.x.
Reed RG, Butler EA, Kenny DA. Dyadic models for the study of health. Soc Personal Psychol Compass. 2013;7:228–45. https://doi.org/10.1111/spc3.12022.
Mustanski B, Starks T, Newcomb ME, Edu B. Methods for the design and analysis of relationship and partner effects on sexual health. Arch Sex Behav. 2014;43:21–33. https://doi.org/10.1007/s10508-013-0215-9.
Ledermann T, Kenny DA. Assessing mediation in dyadic data using the Actor-Partner Interdependence Model. Struct Equ Modeling. 2011;18:595–612. https://doi.org/10.1080/10705511.2011.607099.
Kenny DA, Kashy DA, Cook WL. Dyadic Data Analysis. New York: Guilford Press; 2006.
Wickham RE, Macia KS. Examining cross-level effects in dyadic analysis: a structural equation modeling perspective. Behav Res Methods. 2018. https://doi.org/10.3758/s13428-018-1117-5.
Galovan AM, Holmes EK, Proulx CM. Theoretical and methodological issues in relationship research. J Soc Personal Relatsh. 2017;34:44–68. https://doi.org/10.1177/0265407515621179.
Pazmany E, Bergeron S, Verhaeghe J, Van Oudenhove L, Enzlin P. Dyadic sexual communication in pre-menopausal women with self-reported dyspareunia and their partners: associations with sexual function, sexual distress and dyadic adjustment. J Sex Med. 2015;12:516–28. https://doi.org/10.1111/JSM.12787.
Bois K, Bergeron S, Rosen N, Mayrand M-H, Brassard A, Sadikaj G. Intimacy, sexual satisfaction, and sexual distress in vulvodynia couples: an observational study. Health Psychol. 2016;35:531–40.
Merwin KE, O’Sullivan LF, Rosen NO. We need to talk: Disclosure of sexual problems is associated with depression, sexual functioning, and relationship satisfaction in women. J Sex Marital Ther. 2017;43:786–800. https://doi.org/10.1080/0092623X.2017.1283378.
Træen, B., Štulhofer, A., Janssen, E., Carvalheira, A. A., Hald, G. M., Lange, T., & Graham, C. Sexual activity and sexual satisfaction among older adults in four European countries. Arch Sex Behav. 2019;48:815–29.
Ledermann T, Kenny DA. The common fate model for dyadic data: Variations of a theoretically important but underutilized model. J Fam Psychol. 2012;26:140–8. https://doi.org/10.1037/a0026624.
Jones KG, Mitchell KR, Ploubidis GB, Wellings K, Datta J, Johnson AM, et al. The Natsal-SF measure of sexual function: comparison of three scoring methods. J Sex Res. 2015;52:640–6. https://doi.org/10.1080/00224499.2014.985813.
Byrne BM. Structural equation modeling with AMOS: Basic concepts, applications, and programming. Routledge (Vol. 22); 2010. https://doi.org/10.4324/9781410600219.
Arbuckle, JL. (2016) IBM AMOS 22 User’s Guide. Amos Development Corporation; 2013.
Graham JW. Missing data: analysis and design. New York: Springer; 2012. https://doi.org/10.1007/978-1-4614-4018-5.
Hobbs LJ, Mitchell KR, Graham CA, Trifonova V, Bailey J, Murray E, et al. (2019). Help-seeking for sexual difficulties and the potential role of interactive digital interventions: findings from the third British National Survey of Sexual Attitudes and Lifestyles. J Sex Res. 1–10. https://doi.org/10.1080/00224499.2019.1586820.
Baumeister RF. Gender differences in erotic plasticity: the female sex drive as socially flexible and responsive. Psychological Bull. 2000;126:347–74.
Štulhofer A, Hinchliff S, Jurin T, Carvalheira A, Træen B. Successful aging, change in sexual interest and sexual satisfaction in couples from four European Countries. Eur J Ageing. 2018;16:155–65. https://doi.org/10.1007/s10433-018-0492-1.
Moreira ED, Glasser DB, Nicolosi A, Duarte FG, Gingell C, GSSAB Investigators’ Group. Sexual problems and help-seeking behaviour in adults in the United Kingdom and continental Europe. BJU Int. 2008;101:1005–11. https://doi.org/10.1111/j.1464-410X.2008.07453.x.
Hart G, Wellings K. Sexual behaviour and its medicalisation: in sickness and in health. BMJ. 2002;324:896–900. https://doi.org/10.1136/bmj.324.7342.896.
Štulhofer A. Medicalization of Sexuality. In: The International Encyclopedia of Human Sexuality. Wiley; 2015. https://doi.org/10.1002/9781118896877.wbiehs297.
Wood JM, Koch PB, Mansfield PK. Women’s sexual desire: a feminist critique. J Sex Res. 2006;43:236–44. https://doi.org/10.1080/00224490609552322.
Bancroft J. Human Sexuality and Its Problems (3rd edition). Edinburgh: Churchill Livingstone; 2009.
The Research Council of Norway fully funded the study (grant 250637 awarded to the last author).
Conflict of interest
The authors declare that they have no conflict of interest.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Štulhofer, A., Hinchliff, S. & Træen, B. Relationship intimacy, sexual distress, and help-seeking for sexual problems among older European couples: a hybrid dyadic approach. Int J Impot Res 32, 525–534 (2020). https://doi.org/10.1038/s41443-019-0214-z
The Relationship Between Romantic Attachment, Intimacy, and Dyadic Adjustment for Female Sexual Function
Sexuality Research and Social Policy (2022)