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CR poll: Economy isn't hurting Americans' sex lives

But insomnia and poor health could be taking a toll

Published: February 2009

At least the economic crisis hasn't affected one leading indicator: Our sex lives. That's one finding from a nationally representative sample of 1,000 adults ages 18 to 75 conducted by the Consumer Reports National Research Center in January.

Seventy-nine percent of the sexually active respondents said that the financial downturn hadn't had the same effect on how often they had sex. And while they said they planned to spend less this year on Valentine's Day, nearly half thought President Obama should take time out during the holiday to show the first lady a little love.

But if the economy hasn't hurt our sex lives overall, our health could be putting a crimp in it. For example, 81 percent of the respondents said they avoided or delayed sex with their partner in the past year. The two most common reasons given were "too tired" (53 percent) and "too sick" (49 percent). For advice on how to deal with insomnia and the other health problems that can sap your mojo, see 6 top reasons for not having sex as well as our table, Drugs and diseases that can hurt your sex life.

Perhaps even harder to overcome is the apparent disconnect between men and women when it comes to sex. For example, nearly 60 percent of the men in our survey said they thought about sex at least once a day, compared with only 19 percent of the women. Men are also far more likely than women to say that sex is highly important to them (64 percent vs. 47 percent). Interestingly, though, an equal percentage of men and women—about two-thirds—said they were highly satisfied with their sex lives.

Those findings jibe with the results of recent medical research that suggests that while roughly the same percentage of men and women report "sexual dysfunction," far fewer women are bothered or distressed by the problem. Yet the pharmaceutical industry seems to see any decline in sexual interest or performance as a medical problem that requires treatment, preferably with drugs. For example, some doctors are prescribing Viagra for women and supplemental testosterone for both men and women. For advice on when medical therapies are called for and when they're not, see Healthy sex: His and hers.

6 top reasons for not having sex

Over 80 percent of the sexually active people in our nationally representative survey of 1,000 adults said they sometimes avoided sex last year. And women were more likely than men to say that. Here are six top reasons, along with some advice about what, if anything, you should do about them.

1. TOO TIRED OR NEED SLEEP: 53 percent

You may feel amorous heading to bed, but once you're there the need for sleep can overpower all other desires. And worrying about not being able to fall asleep can make sex seem unappealing. Addressing insomnia is one obvious first step, but before turning to sleeping pills, it's usually best to adopt good sleep habits. And that can include having sex, since many people report that actually improves their sleep, says Jean Koehler, Ph.D., a certified sex therapist in Louisville and past president of the American Association of Sexuality Educators, Counselors and Therapists. But she also points out that when people say they're too tired they're sometimes really saying they're just not interested. In that case, it's important to talk honestly with your partner, and possibly with a therapist.

2. NOT FEELING WELL OR HEALTH PROBLEMS: 49 percent

"Not tonight dear, I have high blood pressure." It's not just the proverbial headache that can interfere with sex. In fact, Koehler says that your first step toward better sex should be a checkup, so your doctor can rule out the many diseases and drugs that can cause sexual dysfunction. Problems with your thyroid or pituitary gland, for example, can sap your sex drive. Conditions that can interfere with blood flow, such as arteriosclerosis or hardening of the arteries, can impair sexual function, as can nerve damage from diabetes or multiple sclerosis. And 9 percent of the people in our survey said they sometimes avoided sex because they felt overweight or unattractive.

3. NOT IN THE MOOD: 40 percent

While supplemental testosterone can sometimes boost libido in men and women, that step is rarely worthwhile. For one thing, many people who experience diminished sexual desire say they aren't bothered by it, according to a study published in the November 2008 issue of Obstetrics & Gynecology. And when they are, other factors—including illness and psychological issues—are often the real cause.

4. TAKING CARE OF CHILDREN OR PETS: 30 percent

5. WORK: 29 percent

These two are in a statistical dead heat. While taking care of children was a slightly more common excuse among women (34 percent vs. 27 percent), work was the only one that was cited more often by our male respondents (30 percent vs. 28 percent). "A lot of people say they are just too busy for sex," Koehler says. "But if sex is important to you, you may have to just make it more of a priority." One solution she recommends: Put it on your schedule. That, in fact, is something that nearly half of our respondents say they already do. Seven percent have actually done so using a calendar, smart phone, or PDA.

6. WATCHING TV OR A MOVIE: 19 percent

Other forms of entertainment that people sometimes find more diverting than sex include going out to eat (10 percent), spending time on the computer (8 percent), talking on the phone (8 percent), and exercising (7 percent).

Viagra holds little promise for most women

You can find it on the Internet. Or perhaps in your husband's medicine cabinet. Maybe a friend has offered it, enticing you with the promise of better sex. You wonder, "If it helps men so much, can it help me?"

Not so fast. A woman's use of the erectile dysfunction (ED) drug sildenafil (Viagra) actually holds little promise for most. But some women who take certain antidepressants and suffer sexual problems as a side effect may be helped, a recent study suggests. And even then, other strategies should be considered first.

Twice as many women as men take antidepressants, and many of them stop taking the drugs, often because of sex-related side effects. Such reactions are especially common with a class of drugs known as selective serotonin reuptake inhibitors (SSRIs) and serotonin- and norepinephrine-reuptake inhibitors (SNRIs). This class includes citalopram (Celexa and generic), fluoxetine (Prozac and generic), paroxetine (Paxil and generic), sertraline (Zoloft and generic), and venlafaxine (Effexor and generic). And evidence has shown that stopping those drugs can be a concern because it puts patients at risk for a relapse.

But before talking to your doctor about possibly turning to Viagra or the related drugs tadalafil (Cialis) and vardenafil (Levitra), there are important reasons to try other measures. First, only one well-designed, randomly controlled study has indicated the possible benefit of Viagra in women taking those antidepressants. And that study, published in the Journal of the American Medical Association, lasted only eight weeks and included just 98 premenopausal women. So the evidence is still preliminary and both the short- and long-term risks and benefits remain unknown.

Second, the Food and Drug Administration has not approved Viagra or similar drugs for use in women. So while doctors can prescribe it "off label," there are no formal instructions for use in women.

For those reasons, our medical consultants say that women experiencing sexual side effects from antidepressants should first ask their doctor about changing their dose or switching to a different medication. One good choice could be bupropion (Wellbutrin and generic), another type of antidepressant that may cause fewer sexual side effects. And generic bupropion is also a Consumer Reports Best Buy Drug for antidepressants.

If that doesn't work, or you and your doctor decide that it's more important to stick with your current antidepressant, then Viagra may be worth trying. The study in JAMA cited dosages of 50 and 100 mg. Also important to note is that Viagra or other ED medications should not be used if you have a history of heart disease or are at high risk of heart disease, have diabetes, kidney or liver disease, or take nitrates.

"For certain women, they should work with a physician who knows the other medications they're taking and their overall depression status before they try it," says Julia Heiman, Ph.D., director of the Kinsey Institute for Research in Sex, Gender and Reproduction, and co-author of the JAMA study.

Sexual dysfunction in women—and sexual arousal—as discussed in a recent New York Times Magazine article, "What Do Women Want?," is the subject of intense controversy and scrutiny. And while one study shows about 43 percent of women report some form of sexual dysfunction, only about 12 percent say they are upset by it.

Viagra and related drugs are unlikely to help women whose main problem is decreased libido or a lack of sexual desire, which, according to recent evidence, is actually the most common sexual complaint among women. As in men, the drug works by increasing blood flow to the genitals. While blood flow can play an important role in arousal and the ability to achieve orgasm, it doesn't directly improve diminished libido. Nor does it necessarily help with painful intercourse due to various reasons, including vaginal dryness, which can stem from declining estrogen levels after menopause.

Some other conditions can diminish sexual drive, including pituitary and thyroid problems, anxiety, incontinence, diabetes, or high blood pressure. Many common medications can have sexual side effects too: antianxiety drugs, antipsychotics, high blood pressure medications, some oral contraceptives, and recreational drugs, including alcohol. And issues like poor relationships or family stress, an ill partner, a job loss, or other crises can diminish sexual function in women as well.

As in men, studies of women taking Viagra have shown some side effects. Those include headaches, hot flashes, abdominal pain, nausea, vision problems, dizziness, and clitoral discomfort. In the JAMA study, 43 percent of the women who took Viagra experienced headaches. If there's no physical or drug-related reason for your sexual dissatisfaction, the safest bet is to identify and address the possibility of other underlying causes in consultation with a medical professional, rather than experiment with Viagra or other prescriptions, or dietary supplements.

Some final warnings: Never buy Viagra, or any other drug, from an untrusted online pharmacy, since it may contain expired, incorrect, or dangerous ingredients. Purchase medications only from pharmacy Web sites that post the symbol of the National Association of Boards of Pharmacy's VIPPS (Verified Internet Pharmacy Practice Sites). And Viagra and similar drugs should be taken only under the supervision of a doctor.

This off-label drug use report is made possible through collaboration between Consumer Reports Best Buy Drugs and the American Society of Health-System Pharmacists. This is the first in a series based on professional reports prepared by ASHP.

Consumer Reports Best Buy Drugs is supported in part by a grant from the U.S. Attorneys General with the goal of regularly communicating independent drug safety and effectiveness information to consumers.

If you think you have experienced an adverse event with this drug or any drug, especially if it is of a serious nature, it is important to tell your doctor immediately, and report the event to the Food and Drug Administration via the FDA's MedWatch Web site or by calling 800-332-1088.

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