Sakurada K, Konta T, Murakami N, Kosugi N, Saito T, Watanabe M, et al. (2022) Association between lack of sexual interest and all-cause mortality in a Japanese general population: The Yamagata prospective observational study. PLoS ONE 17(12): e0277967, Dec 14 2022. https://doi.org/10.1371/journal.pone.0277967
Abstract
Background: Sexual interest is essential for maintaining positive sexual relationships and sexual function, which have recently been recognized as important indicators of good health and quality of life. Here, we prospectively investigated associations between sexual interest and mortality in a community-based population.
Methods: This study enrolled 20,969 subjects (8,558 males and 12,411 females) aged ≥ 40 years who participated in annual health check-ups in Yamagata Prefecture. Sexual interest was assessed by a self-report questionnaire. Associations between sexual interest and increased all-cause mortality, cardiovascular disease mortality, and cancer mortality were investigated by Cox proportional hazards modeling.
Results: During follow-up (median: 7.1 years), 503 subjects died; 67 deaths were due to cardiovascular disease, and 162 were due to cancer. Kaplan-Meier analysis showed that all-cause mortality and cancer mortality were significantly elevated among men who lacked sexual interest (log-rank P<0.0001, P<0.05). Cox proportional hazards model analysis with adjustment for age, hypertension, diabetes, dyslipidemia, smoking, alcohol drinking status, BMI, education, marital status, frequency of laughter, and psychological distress showed that the risk of all-cause mortality was significantly higher among men who lacked sexual interest than men who had sexual interest (hazard ratio [HR] 1.69; 95% confidence interval [CI], 1.17–2.44).
Conclusion: Lack of sexual interest is suggested to be a risk factor for all-cause mortality in Japanese males over 40 years old. This finding has implications for the importance of sexual interest in increasing longevity in this population.
Discussion
Although
sexual activity and sexual satisfaction are considered of benefit to
psychological health and wellbeing in older groups, the association
between sexual interest and longevity has not been investigated. This
study is the first to prospectively examine associations between sexual
interest and all-cause mortality, and cardiovascular and cancer
mortality in a community-based population.
In
our sample of people aged 40 years or more, 8.3% of males and 16.1% of
females indicated a lack of sexual interest. Similar results were
reported by Lindau et al. in two cross-sectional population-based
surveys of aging conducted in the US [4].
Baseline characteristics indicated that a lack of sexual interest was
associated with greater age, higher prevalence of past alcohol drinking,
diabetes, low frequency of laughter, psychological distress, and lower
education levels in male subjects. In female subjects, baseline
characteristics showed that a lack of sexual interest was associated
with greater age, higher prevalence of abstinence from alcohol, low
frequency of laughter, psychological distress, divorce or widowhood, and
lower education levels. For both sexes, negative psychological
variables, including psychological distress and low frequency of
laughter, were associated with decreased sexual interest.
Interestingly,
our study suggests that lack of sexual interest is associated with
all-cause mortality in males, even after adjustment for age, diabetes,
hypertension, dyslipidemia, smoking, alcohol intake, BMI, education,
marital status, frequency of laughter, and psychological distress. Based
on our results, we suggest that lack of sexual interest itself
contributes to an increased risk of all-cause mortality, independent of
established risk factors in men over 40 years old. However, it is
possible that some important confounding factors were not identified or
adjusted.
Although to our knowledge the mechanisms underlying the main gender difference result have yet to be clarified, men with ‘ikigai’ were at lower risk of cardiovascular mortality than men without ‘ikigai,’
subsequent to age and multivariate adjustment. Uzuki et al. found that
lack of social support was associated with risk of all-cause mortality
and cardiovascular mortality, and these associations were stronger in
males than females [22].
Previous studies have shown that risk-reduction effects of positive
psychological factors on all-cause mortality and incidence of stroke
differed according to gender [11, 17, 18].
Ikeda et al. reported that in Japan men who were divorced or widowed
were at higher risk of mortality than married men, whereas no similar
trend was observed in women [23].
Based on these results, we speculate that maintaining sexual interest
may be related to positive psychological well-being and ‘ikigai’ especially among men.
Precisely
how a lack of sexual interest impacts on health and longevity remains
unknown, although several possibilities can be considered. Male lack of
interest may be related with unhealthy lifestyles. In this study, men
who reported a lack of sexual interest included more current smokers and
cases of diabetes. Furthermore, if we assume that sexual interest is
related to positive psychological factors, the absence of interest may
affect a range of inflammatory, neuroendocrine, and immune responses.
Positive affect is related with reduced neuroendocrine, inflammatory,
and cardiovascular activities [24].
Chronic psychological stress has shown an association with suppressed
immune response and increased susceptibility to malignancy and infection
[25]. Further study is required to clarify the mechanisms which underlie the preventive effects of sexual interest on mortality.
The
strengths of this study are its prospective design and substantial
sample size. In addition, adjustment was done using a number of
well-known risk factors, including age, diabetes, hypertension,
dyslipidemia, smoking status, alcohol intake, psychological distress,
and medical history of depression. However, several limitations of the
study should be noted. First, although we conducted multivariate
analyses with adjustment for various potential confounding factors, some
unidentified confounding factors may have remained. Moreover, we did
not adjust for other medically relevant elements known to affect sexual
function and longevity, such as neurological conditions, depression, and
medications, because such information was not obtained in the baseline
survey. Also, only a small number of depressed patients were included in
this study. Second, we did not consider how the social regulation of
sexuality differs among cultures. Similar research should be extended to
other countries. Third, our question about lack of sexual interest
focused on interest in the opposite sex; we did not control for sexual
orientation. Sasayama et al. reported that the prevalence of
homoromantic attraction was 1.0% for females and 1.5% for males [26].
Based on these figures, the potential number of individuals in the
present study with sexual interest in the same sex was estimated to be
approximately 200 people. We therefore consider it unlikely that this
number would have influenced our overall results. We suggest that future
research should include lesbian, gay, bisexual, transgender, and
questioning (LGBTQs) adults. Fourth, this study collected data on
subjects who were at least 40 years old. Future research might also look
more closely at the onset of decreasing interest in sex; for example,
whether these results concern only men who had recently lost interest,
or whether they extend to men who had little interest even when they
were much younger. Fifth, all subjects participated in community-based
annual health checks, and so they might have been more health-conscious
and more socially active than the general population. In other words,
some degree of selection bias might characterize our study sample.
Notwithstanding
these limitations, the findings of this study support that idea that
maintaining sexual interest has positive effects on longevity,
especially in males. The Canadian government, through public health
promotion materials, has begun to endorse sexual activity as one element
of an “aging well” agenda [27].
In Japan, there is more prejudice about sex among the elderly than in
the Western world. We hope our findings will help promote public health
through advocating sexuality in Japan.