Abstract
Introduction Sexual activity is an essential human need and an important predictor of other aspects of human life. A literature review was conducted to investigate whether sexual abstinence in young and middle-aged men is generally considered a deliberate, healthy behavior and whether it has other causes and consequences.
Aim To review the prevalence and factors associated with sexual abstinence in young (10–24 years) and middle-aged (25–59 years) men.
Methods Studies were retrieved from Science Direct, PubMed, and EBSCOhost published from 2008 to 2019. The selection criteria were original population- or community-based articles, published in the English language, on sexual abstinence, and in young and middle-aged men.
Main Outcome Measure This article reviewed the literature on the proportions of and factors associated with sexual abstinence in young and middle-aged men.
Results A total of 13,154 studies were retrieved, from which data were extracted for 37 population- or community-based studies. The prevalence of sexual abstinence varied from 0% to 83.6% in men younger than 60 years. The prevalence of primary sexual abstinence was 3.4%–83.3% for young men and 12.5%–15.5% for middle-aged men. The prevalence of secondary abstinence for young men ranged from 1.3% to 83.6%, while for middle-aged men, it was from 1.2% to 67.7%. The prevalence of sexual abstinence decreased with increasing age in young men but increased with increasing age in middle-aged men. The significant factors reported were age, single status, poor relationships, low socioeconomic status, sex education, religious practices, caring and monitoring parents, and not using alcohol, cigarettes, or drugs. Although the variations in findings from different studies can be explained by different regions and cultures, the information cannot be generalized worldwide because of a lack of studies in Asian and Australian populations.
Clinical Implications The studies on sexual abstinence in the future should use a consistent and standard definition, cover all sexual behaviors, and investigate all related factors.
Strength & Limitations The restricted timeframe (2008–2019), English language, availability of full text, and variability in definition and time duration may be the sources of bias.
Conclusion Young men had higher proportions of sexual abstinence than middle-aged men, and age, unavailability of a partner, lower educational levels, low socioeconomic status, conservative and religious conditions, and no or less knowledge about sexually transmitted infections were common predictors of sexual abstinence in most of the men. Although determinants of sexual abstinence were identified, further investigation of biological factors in men younger than 60 years is needed.
Key Words: Sexual InactivitySexual AbstinencePrimary Sexual AbstinenceSecondary Sexual AbstinenceSex Education
Discussion
The present systematic review aimed to investigate the proportions of sexual abstinence in young and middle-aged men younger than 60 years. We identified a previous, nonsystematic, descriptive review of the lack of sexuality in young men, with no information on the included studies,45 but proper systematic reviews were more focused on the effectiveness of various sexual abstinence programs.46,47
Sexual abstinence has previously been stressed in youth, but it is currently considered that protected (using condom) sexual activity is important for a healthy psychosocial life of men.24 In the literature review, the unavailability of a partner, lower educational levels, low socioeconomic status, conservative and religious conditions, and no or less knowledge about STIs were common predictors of sexual abstinence in most of the young and middle-aged men.
Most of the studies published on sexual abstinence in young and middle-aged men were focused on North American and African populations, but Asia (the most populated continent) and Australia had limited publications, and South America had none. Primary sexual abstinence was mostly studied in young men, and no study was found in the 45- to 59-year age group. However, primary sexual inactivity could persist until later ages if caused by no or low sexual desire, asexuality, or homosexuality, which should be investigated in the future.
Most of the studies were focused on the absence or cessation of penile-vaginal sexual intercourse, which underestimates sexual activity in young men. Adolescents and young adults who may have difficulties in finding a partner, be threatened by negative outcomes (pregnancy and STIs) or face social taboos may be involved in other sexual activities, such as solitary or mutual masturbation, caressing, or oral-genital sexual activities.
The present review shows that the reported prevalence of sexual abstinence varies considerably based on various factors. Most of the studies defined sexual abstinence differently and used different tools of assessment (questionnaires, interviews) and different methods of administration of those tools. Similarly, variations were also attributed to the different durations (a few days to 5 years) of sexual abstinence.
The proportions reported in the included studies for the same or similar age groups were wide, and there were inconsistencies in the associated factors, possibly due to differences in methodologies, research designs, participant characteristics, sample sizes, variables investigated, and presentation of results.
The studies used a self-administered questionnaire reported relatively increased proportions of primary and secondary sexual abstinence as compared with the interview or interviewer-assisted questionnaire. The reason behind this may be the men found it difficult to describe their sexual inactivity to the interviewer. The prevalence of sexual abstinence decreased with the increasing age in young men because they can consent and have greater chances to have sexual partners through a casual encounter, commitment, or marriage.48 The other factors of decreased sexual abstinence in young men include physical and mental growth and increased sexual desire with age.2,14,19 However, in middle-aged men, the onset of self and partners' health issues, divorce, and low sexual functions due to the process of aging may increase the prevalence of sexual abstinence.49
The present review established evidence that as in elderly men, young and middle-aged men also have physical and mental health–related issues that lead to sexual abstinence. Similarly, young and middle-aged men also have sexual abstinence due to the difficulties to have a sexual partner or have an estranged relationship with the partner. The other factors may be related to socioeconomics, lifestyle, behavioral, relationship status, and involvement in religion. Therefore, it is suspected that the assessment of success in any sexual abstinence program may not be correct without considering the role of these factors.
The studies for adolescents and young men were more focused on the prevention of STIs and unwanted pregnancies in specific populations and circumstances,16,17,29,30,32 and the results were more dependent on the characteristics of the participants in each study. Therefore, the factors identified are not generalizable to the wider population of young men. The variations due to different populations and different methods could not be separated, and a direct comparison of rates of prevalence reported in the different studies could not be performed.
Recommendations for Future Research
First, the definition and time period for which sexual abstinence is defined in future research should be consistent and standard. Second, the studies should include the proportions of sexual activities other than penile-vaginal sexual intercourse and investigate the role of biological factors in men younger than 60 years. Third, there is a need to review studies conducted before 2008 also and compare decade-wise to get information on the trends of sexual abstinence. Fourth, while assessment of the success of a sexual abstinent program, the other factors should also be considered. Finally, primary sexual inactivity should also be investigated in middle-aged men older than 45 years in the future.
Limitations
The review was limited to the published studies that may create bias because of the increased probability of the publication of studies with significant results. The other sources of bias were that studies published in language other than English and full text not available were not included in the review. There were also a few studies that had a nonrandom sampling design. Furthermore, we picked age groups less than 60 years from among studies that focused on men of all age groups, which may have affected the accuracy of the findings and compromised generalizability. Only 12.5% (n = 4) of the studies were from Asia and 6.3% (n = 2) from Australia, affecting the generalizability of the findings to Asian, Australian, and South American men. Most of the studies on young men defined sexual inactivity as no sexual intercourse with a partner but did not consider other sexual activities (masturbation, noncoital, and so on), yet the studies on middle-aged men defined sexual inactivity as including some of coital and noncoital behavior.
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