Older adults in four European countries: Associated factors and prevalence of masturbation

Prevalence of Masturbation and Associated Factors Among Older Adults in Four European Countries. Nantje Fischer, Cynthia A. Graham, Bente Træen & Gert Martin Hald. Archives of Sexual Behavior, Nov 9 2021. https://link.springer.com/article/10.1007%2Fs10508-021-02071-z

Abstract: Solitary sexual activity is a free, safe, and accessible way to experience sexual pleasure. Despite these advantages, research on masturbation in later life is highly understudied. Using data from a cross-sectional probability-based survey of 3816 European adults (mean age 67 years; range 60–75 years), we explored several sociodemographic, health, attitudinal, and sexual behavioral factors associated with reported masturbation frequency. Across all countries, between 41% and 65% of men and 27% and 40% of women reported any masturbation in the preceding month. Satisfaction with sexual activity and attitudes related to disapproval of sex without love were significant predictors of reported masturbation in almost all countries and in both genders. Age, education, self-perceived health, and depression were for the most part predictive of men’s reported masturbation, but not women’s. Generally, those believing sex is beneficial to older people were more likely to masturbate, while less permissive attitudes decreased the likelihood of reporting masturbation. To improve healthy sexual aging, misinformation about masturbation and sexual attitudes in older people need to be addressed.

Discussion

In this European four-country study, we assessed several sociodemographic, health, attitudinal, and sexual behavioral factors associated with reported masturbation frequency among men and women aged 60–75 years. Despite marked cross-cultural and gender differences in masturbation frequency, predictors of masturbation were in most instances more similar than different across the four countries. Satisfaction with the level of sexual activity was a significant negative predictor of masturbation in Norwegian, Danish, and Belgian men and women, and Portuguese men. Another important predictor of frequent masturbation was sexual attitudes. Specifically, attitudes reflecting the idea that sex is legitimized by love were associated with masturbation in Norwegian, Danish, and Belgian men, and Norwegian and Portuguese women. While age, education, self-perceived health, and depression were significantly related to men’s reported masturbation, few sociodemographic and health factors were associated with masturbation activity among women.

Satisfaction with sexual activity was significantly related to masturbation in almost all countries. Men and women in Norway, Denmark, and Belgium, and men in Portugal were less likely to report frequent masturbation if they were satisfied with their level of sexual activity. The central role of sexual contentment in predicting solitary sexual activity may reflect older adults’ tendency to view masturbation as a second-best alternative that is only needed if one desires more sex or partnered sex is not satisfying. Although this finding supports the idea that masturbation functions as a substitute among contemporary older populations, it is possible that this will not be the case for the coming generations. Findings from Finland and Germany indicate cultural changes in the meaning of masturbation, with younger generations increasingly considering it as an independent source of experiencing sexual pleasure (Dekker & Schmidt, 2003; Kontula & Haavio-Mannila, 2003).

Similar to previous findings, the association between intercourse and masturbation frequency was not unequivocal (Regnerus et al., 2017; Rowland et al., 2020). As with Gerressu et al. (2008), we found a gender-specific pattern where, among Norwegian and Belgian women, more frequent intercourse increased the likelihood of frequent masturbation (reflecting the complementary model), while the opposite relationship was found among Danish men (in line with the compensatory model). In contrast to this pattern was the finding in Portuguese men, where more intercourse activity was related to higher levels of masturbation. Although this finding may represent a difference in sexual culture in southern Europe, it is more likely that it reflects a sample selection bias, given a less reliable sampling method, a high refusal rate, and a much lower response rate for the Portuguese sample than for the samples in Norway, Denmark, and Belgium.

Another key finding points to the important role of sexual attitudes in predicting sexual behavior in aging men and women. Sexual attitudes mirror prevailing sociocultural norms and the attached meaning of sexual behavior within a cultural context (Masters et al., 2013). We investigated several sexual attitudes as possible predictors of masturbation and found that attitudes reflecting the idea that sex is legitimized by love were negatively associated with masturbation in Norwegian, Danish, and Belgian men, and in Norwegian and Portuguese women. This finding may reflect the prevailing heterosexual sexual script, where sexual behavior is legitimized by romantic love (also termed the “love ideology”) (Francoeur & Noonan, 2004; Gagnon & Simon, 2005; Træen & Lewin, 2008). According to this script, “good” sexuality is contextualized within intimate relationships, where partnered sex symbolizes mutual love and commitment (Fileborn et al., 2017; Gagnon & Simon, 2005; Hinchliff & Gott, 2004; Træen & Lewin, 2008). Within this love script, there exists little space for sexual self-pleasuring (Hogarth & Ingham, 2009). Disapproval of sex without love among older adults seems to reflect this traditional script and the idea that partnered sex is superior to masturbation. Hence, masturbation signifies something suboptimal and unnecessary, especially if one has access to the “real deal” (Træen et al., 2019). Moreover, practicing sexual self-pleasuring in a relationship might be associated with the fear that the partner may misconstrue the behavior as a sign of personal undesirability and sexual incompetence (Onar et al., 2020). Attitudes reflecting the notion that sexuality decreases with older age and that society has become too sexualized were also negatively related to masturbation frequency, but only in men from Norway and Denmark. In contrast to these less permissive attitudes, Danish and Belgian men and women who believed that sexual activity is beneficial for older people were more likely to report frequent masturbation than those who did not endorse these attitudes. This finding is consistent with previous research showing a positive link between more liberal attitudes/values and reported masturbation (Das et al., 2009; Gerressu et al., 2008).

Overall, more sociodemographic factors were predictive of men’s masturbation than women’s. As found by others (Corona et al., 2010; Lee et al., 2016; Lindau et al., 2007; Mercer et al., 2013; Palacios-Ceña et al., 2012; Richters et al., 2014; Schick et al., 2010), older age was negatively associated with masturbation in Norwegian, Danish, and Belgian men, and Danish women. However, as with previous cross-sectional data, it was not possible to assess whether this reflected an age or cohort effect. Regarding the level of education, we found some cultural-specific patterns. While higher levels of education increased the likelihood of masturbation frequency in northern European men (Norway and Denmark), southern European men (Portugal) with higher levels of education were less likely to report frequent masturbation. Being socialized in an environment influenced by traditional and religious structures repressing sex education (Francoeur & Noona, 2004), older educated Portuguese men may have internalized more normative constraints inhibiting sexual self-pleasure. In contrast, among Norwegian and Danish men who were socialized in the sex-liberal Nordic countries, with open discourses on sexual issues and broad dissemination of sex education, pornography, and sex literature (Francoeur & Noona, 2004), higher education may have shaped masturbation habits by diminishing health-related fears and guilt about masturbation (Kontula & Haavio-Mannila, 2003).

In terms of health, we observed a negative association between self-estimated health and reported masturbation among older men in Denmark, Belgium, and Portugal. Previous evidence on the relationship between general health and masturbation has been mixed (Das, 2007; Lee et al., 2016; Lindau et al., 2007; Schick et al., 2010). One possibility for the inconsistency is that the association might be confounded by older men’s sexual difficulties and sexual desire. While for some men poor health may negatively affect their overall sexual functioning and sexual interest, hence influencing both partnered and solo sex, others with reduced sexual function but high desire may replace partnered sex by increased autoerotic behavior. Future research is needed to address this moderation hypothesis.

In addition to self-rated general health, we assessed the relationship between negative mood and solitary sexual activity. Interestingly, our findings demonstrated a significant association between depression and masturbation among Norwegian and Belgian men; the higher the level of depression, the more likely the reported masturbation. Although this finding seems counterintuitive, it is consistent with previous research (Cyranowski et al., 2004; Frohlich & Meston, 2002; Rowland et al., 2020). One assumption has been that when feeling depressed increased masturbation might reflect a self-soothing strategy, where solo sex functions as a reliable way to make oneself feel better (Frohlich & Meston, 2002). Although self-stimulation when feeling depressed may be self-soothing in the short term, it does not necessarily enhance mood as masturbation also seems to reinforce feelings of loneliness and isolation (Bancroft et al., 2003).

Finally, regarding relationship status, we found that women in Norway and Portugal were less likely to report frequent masturbation if they were in a current relationship. This finding seems to corroborate results from previous studies among varied age groups (DeLamater & Moorman, 2007; Regnerus et al., 2017; Rowland et al., 2020; Schick et al., 2010). It seems probable that since partnered adults may anticipate the opportunity of having sex with their committed partner, they wish to channel their sexual desire into their sexual relationship and/or do not feel the need for masturbation (Regnerus et al., 2017).

Strengths and Limitations

Our survey had several strengths, including the large probability-based samples and the use of similar sampling methods, identical measures, and age cohorts across four European countries. Several limitations, however, should also be acknowledged. The sample size in Portugal, as well as the response rate, was much lower than in the other countries. Due to a less reliable sampling method, an overrepresentation of urban individuals, and a high refusal rate, the selection bias was possibly most substantial among Portuguese participants (Boughner, 2010). Overall, this gives rise to questions relating to the Portuguese samples’ representativeness and its comparability with the samples from Norway, Denmark, and Belgium, which should be taken into consideration when evaluating the study findings. A second limitation pertains to the item formation. In this study, a preexisting one-item indicator was used to measure reported masturbation frequency (ELSA; Lee et al., 2016). Because the question did not specifically refer to solo masturbation, we cannot be sure about the extent to which the results reflected only solo masturbation or both partnered and solo masturbation. However, both the wording of the item (“How often did you masturbate in the past month”) and the context (following a question asking about sexual intercourse frequency) provide some reassurance that the participants interpreted it as a question about solo sexual activity. Further, satisfaction with sexual activity was measured by the question: “How satisfied are you with the current level of sexual activity in your life, in a general way?” Considering the lack of defining sexual activity when asking about participants’ levels of sexual satisfaction, it is likely that participants used divergent definitions when they evaluated their levels of sexual satisfaction (Regnerus et al., 2017). Some might limit sexual activity to solely partnered sex, while others might incorporate solo sexual activities. Yet, a study that investigated the concept of sexual satisfaction among German women found that most of the variance in satisfaction with sex life in general was explained by sexual satisfaction through intercourse and intercourse frequency (Philippsohn & Hartmann, 2009). Another important limitation was that the survey did not assess the role of pornography use. Although our samples might have been biased toward individuals with more liberal and open views about sexuality (Boughner, 2010; Dunne et al., 1997; Strassberg & Lowe, 1995), as sexual self-stimulation is a stigmatized and sensitive topic that might be embarrassing to older individuals, the prevalence of masturbation may still have been underestimated due to social desirability. How possible volunteer bias and social desirability influenced the associations is uncertain, but it may restrict the generalizability of our findings (Boughner, 2010). Finally, due to the cross-sectional design, conclusions about possible causal relationships are not warranted.