Hirayama, R. & Walker, A.J. (2011).

When a partner has a sexual problem: gendered implications for psychological well-being in later life. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 66(6), 804813, doi:10.1093/geronb/gbr102. Advance Access published on September 14, 2011.

When a Partner Has a Sexual Problem: Gendered Implications for Psychological Well-being in Later Life
Ryo Hirayama and Alexis J. Walker
Department of Human Development and Family Sciences, Oregon State University, Corvallis.
Objectives. Guided by symbolic interactionism, we examined (a) whether the psychological well-being of older adults might be threatened if they feel bothered by an intimate partners sexual unresponsiveness and (b) whether such sexual unresponsiveness of a partner might be compensated by perceived supportiveness of significant others. We explored these questions separately by gender, anticipating that sexual unresponsiveness might affect men and women differently and that support from a partner might be more important for men and support from others more important for women. Method. Using data from 1,346 participants in the National Social Life, Health, and Aging Project, we conducted multiple group regression analysis and estimated models separately but simultaneously for women and men. Results. Although feeling bothered by the sexual unresponsiveness of an intimate partner was significantly associated with both womens and mens depressive symptoms, the moderating effect of the partners supportiveness was significant only for women. Discussion. The results suggest that gender is a key dimension for understanding the relations among negative feelings about sexual relationships, socioemotional support from significant others, and psychological well-being in older age. Key Words: GenderSexual behaviorSocial support.

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ECENT research has questioned the conventional wisdom of asexual older age. Evidence shows that both women and men are sexually active well into later life (e.g., Lindau et al., 2007; Nicolosi et al., 2004). At the same time, because sexual ability is closely related to health status that declines with age, considerable numbers of older adults have concerns about their sexual functioning (e.g., Laumann, Das, & Waite, 2008; Laumann et al., 2005). Findings from our previous study suggest that social relationships can help older adults handle negative feelings about their own sexual dysfunction in the relationship with spouse or partner (Hirayama & Walker, 2011). To maintain partnerships, however, it also is critical for older adults to manage the situation in which their partner faces sexual dysfunction. In fact, it has been reported that older adults are struggling to adjust their intimate relationships to not only their own but also their partners sexual functioning (Gott & Hinchliff, 2003). Our aim in this study is to explore whether and how social relationships may protect the psychological well-being of older adults when their partners sexual dysfunction makes it difficult to have a sexual relationship. Although social relationships have been consistently shown to influence health and well-being in later life (e.g., Antonucci, 2001; Moren-Cross & Lin, 2006), the role of social partners (i.e., social network members, especially those to whom one feels close) has been understudied in the literature on sexual health among older adults, where medical perspectives predominate. Linking social relationships research to 804

the field of sexual health in later life, our study will help clarify how older adults, with their social partners, can better negotiate intimate ties when partners face aging-related sexual problems. Self, Perceived Partner Responsiveness, and Well-being Symbolic interactionism posits that individuals develop a sense of the self through reflection of the views of others (Tice & Wallace, 2003). That is, we observe how others respond to us and then incorporate those responses into our self-view (i.e., looking glass self; Cooley, 1902). The theory presumes that significant others, typically the spouse or intimate partner in adulthood, are most influential in the process of self-construal (Mead, 1934). Across the life span, individuals rely most on significant others for affirmation of their ideas and behavior. By receiving such affirmation from others, individuals internalize and reinforce the belief that they are worthy and capable persons (Tice & Wallace, 2003). Aligned with this perspective, researchers on social relationships have theorized how and why perceiving others to be supportive enhances individuals psychological wellbeing (Lakey & Cohen, 2000). When individuals perceive that their significant others would satisfy their needs willingly, individuals develop a sense of self-worth and selfefficacy, which then helps them see their lives as manageable and thus protects their psychological well-being even in challenging situations (Antonucci, 2001).

The Author 2011. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Received August 29, 2010; Accepted July 8, 2011 Decision Editor: Merril Silverstein, PhD

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This theoretical perspective suggests a link between the perceived sexual responsiveness of the intimate partner and older adults psychological well-being. When older adults perceive their partner to be reluctant or unable to satisfy their needs for sexual intimacy (i.e., sexually unresponsive), their view of the self as a sexual partner is likely to be threatened. Because many adults consider sexual satisfaction as an important component of intimate partnerships (Sprecher & Cate, 2004), a wounded self-view in terms of sexual partnering can deteriorate their psychological well-being. Yet, older adults likely do not judge their partners responsiveness solely by whether the partner is perceived to satisfy their needs for sexual intimacy willingly. Symbolic interactionism suggests that the role of an intimate partner comprises multiple meanings such as confidant and companion (LaRossa & Reitzes, 1993). For example, older adults may perceive their partner to be responsive if the partner listens to them willingly when they have a concern (i.e., responsive partner as a confidant). Furthermore, psychological well-being is thought to be enhanced by an accumulation of multiple forms of perceived supportiveness (Antonucci, 2001). Thus, the psychological well-being of older adults can be secured when they perceive their partner to be unwilling or unable to satisfy their needs for sexual intimacy if they perceive their partner to respond to them in a helpful manner in other nonsexual aspects of intimate partnerships. In addition, individuals can have multiple significant others as sources of socioemotional support including affirmation, although spouse or partner is likely to be the most preferred support provider in adulthood (e.g., Antonucci, 2001; Takahashi, 2005). Gerontological research has indicated that acquiring and maintaining various sources of socioemotional support is a key for aging well (Adams & Blieszner, 1995). Because an accumulation of perceived support from ones close relationships is thought to increase psychological well-being (Antonucci), the sense that other social partners (e.g., relatives, friends) are responsive may have a protective psychological effect for older adults with a less sexually responsive partner. How perceived responsiveness influences such older adults may differ by gender. Extant literature shows that older mens social networks are centered on spousal relationships, whereas women have multiple equally close others in their networks (Antonucci, 2001). Thus, mens wellbeing may be governed more than womens by perceived responsiveness of spouse or partner. Moreover, cultural discourses encourage men to perform well sexually even in older age (Potts, Grace, Vares, & Gavey, 2006). As suggested by symbolic interactionism, individuals views of themselves as a sexual partner will be contingent on how much their partner is responsive sexually. Because of the pressure on men to be continuously sexually competent, their well-being may be damaged more than womens when their partner is sexually disengaged. In summary, perceived

responsiveness of spouse or partner, both sexually and nonsexually, may influence men more than women. By contrast, perceived responsiveness of other social partners, such as relatives and friends, may influence womens wellbeing to a similar extent as responsiveness of spouse or partner. Research Aims Our primary aim is to identify whether perceived sexual unresponsiveness of an intimate partner can be compensated by nonsexual forms of responsiveness of multiple significant others. We hypothesize that (a) perceived sexual unresponsiveness of spouse or partner will have a negative effect on the psychological well-being of older adults and (b) this effect, however, may be moderated by other, nonsexual forms of perceived responsiveness (i.e., perceived support) by close social partners, including not only spouse or partner but also other family members and friends. We also examine whether and how the effect of perceived responsiveness may differ by gender. We consider psychological well-being comprised both positive (e.g., happiness) and negative (e.g., symptoms) mental states that are related but independent (Karademas, 2007). Research has shown that each is differentially associated with health status and functioning (Huppert & Whittington, 2003). Our previous analysis also showed that the effect of social relationships on the positive and negative well-being of older adults facing sexual concerns is inconsistent (Hirayama & Walker, 2011). Including both positive and negative psychological states is necessary to better understand the relation between perceived partner responsiveness and psychological well-being. The related literature suggests the need to consider both (a) the sociodemographic background and (b) the health status of older adults when examining the psychological effects of sexual dysfunction. Research has indicated that attitudes toward sexual relationships vary by such dimensions as birth cohort, race, and social class (e.g., Burgess, 2004). In addition, health has been shown to be associated with both older adults engagement in sexual activity (Lindau et al., 2007) and their psychological well-being (George, 2010). To clarify the relation of perceived sexual unresponsiveness of partner to the psychological well-being of older adults, we take into account their age, racial background, level of education received, and physical health. Method We analyzed data from the National Social Life, Health, and Aging Project (NSHAP), a population-based survey conducted in 2005 and 2006. This project used a nationally representative sample of 3,005 U.S. community-dwelling adults aged 5785 years. Our analysis was restricted to a subsample of 1,346 adults who (a) were married or had an intimate partner and (b) engaged in sexual activities with

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their spouse or partner in the last 12 months because only these adults answered questions regarding whether their partner experienced sexual dysfunction. Because fewer than 0.3% (n = 4) had a sexual relationship with more than one partner, we focused on the primary partner of each participant. In addition, we excluded the four adults with a same-gender partner. Because of our secondary focus on gender differences in the association between perceived partner responsiveness and well-being, we estimated our model separately for women and for men. Our subsample included more men (n = 844) than women (n = 502), and average age differed significantly by gender (women = 65.7; men = 66.5; t = 2.17, p < .05). The participants were relatively highly educated (84.4% completed high school; 27.8% had graduated from college), but more men (31.2%) than women (24.3%) held a bachelors or higher degree (c2 = 12.317, p < .01). Although women live longer than men, older men, especially those of higher socioeconomic status, are more likely than women to have an intimate partner in later life (Burgess, 2004). For this reason, our analytic sample reflects the gender and class composition of the population of partnered older adults. Regarding racial background, 75.4% of women and 73.2% of men were White. Although we included both marital and nonmarital partnerships, married participants predominated (89.0% of women and 87.6% of men). There was no gender difference in racial background or partnerships. Measurement Perceived sexual unresponsiveness of a partner.As noted, guided by symbolic interactionism, we define perceived sexual unresponsiveness of a partner as older adults perception that their partner is reluctant or unable to satisfy their needs for sexual intimacy and that this is a bothersome. Our focus, therefore, is not on the sexual dysfunction of partner per se. Relevant to the symbolic interaction framework is how older adults perceive and are bothered by the sexual problems of their partner, especially their view of the partners problems as a hindrance to their pursuit of sexual intimacy. Because Reis, Clark, and Holmes (2004) suggested that individuals experience negative feelings such as dissatisfaction when perceiving their social partner as not meeting their needs (i.e., partner unresponsiveness), as an index of feeling bothered by the perceived sexual unresponsiveness of a partner, we assessed how much participants were troubled by the sexual inability and disinterest of their spouse or partner. NSHAP participants who engaged in sexual activities with their spouse or partner in the last 12 months reported whether the spouse or partner had any of the following problems with sexual functioning: lack of interest in sex, being unable to climax, climaxing too quickly, not finding sex pleasurable, anxiety about the ability for sexual

performance, erectile dysfunction (for a male partner), and problems with lubrication (for a female partner). These items were originally developed for another project, National Health and Social Life Survey, and cover the major problems in the Diagnostic and Statistical Manual of Mental Disorder (4th ed.) classification of sexual dysfunction (Laumann, Paik, & Rosen, 1999). Participants then answered how much they felt bothered by each problem their partner had using a 3-point scale that ranged from 0 = not at all to 2 = a lot. Half of the participants (n = 674) reported that their spouse or partner faced at least one sexual problem. When participants refused to answer or did not know whether their partner had a given sexual problem, we counted their partner as not having the problem, and thus, these participants were treated as not feeling bothered by the problem (for the reason specified below). Because participants reported how much they felt bothered only regarding problems their partner faced, it was not possible to simply sum scores across problems each participant reported. (The possible range of such a summary index would differ among participants according to the number of partners sexual problems.) To create an index with a consistent range across participants, we averaged the ratings of how bothersome each of the partners sexual problems was to the participant (range = 02). This individually adjusted index captures how much respondents feel troubled by their partners sexual problems regardless of the number and types of partners problems. In other words, this index did not assume (a) the number of perceived sexual problems of the partner is related to the level of feeling bothered or (b) a given type of sexual problem of the partner is necessarily more influential in participants feelings than other types of problems are. We rejected these assumptions for the following reasons. First, results of our subsidiary analysis indicated that greater numbers of partners sexual problems do not necessarily increase reports of how bothersome the problems are to the participant. Specifically, we found that, among respondents whose partner faced more than one sexual problem, there was no significant difference in scores on our individually adjusted index (i.e., average rating of how bothered) by the number of partners sexual problems. Second, our subsidiary analyses also indicated considerable individual differences in which problems troubled participants and to what extent. Simply combining scores of feeling bothered across problems, we examined whether the partners having a given problem made a difference in scores on this combined measure. We found that some types of problems, such as partners inability to climax, were not significantly associated with this combined measure. One might assume, then, that these types of sexual problems would not lead to perceived sexual unresponsiveness of partner. Yet, almost half (45%) of women whose partner was unable to climax reported that they felt bothered somewhat or a lot by this problem. Thus, some types of partners

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sexual problems are less influential in the partnership on average but could have a critical influence on a small number of couples. Accordingly, we consider our individually adjusted index to be an adequate measure for feeling bothered by the perceived sexual unresponsiveness of the partner. Perceived support from significant others.For each of the three types of relationships, the relationship with spouse or partner, family, and friends, NSHAP participants were asked about perceived availability of two types of support: How often they can open up if they need to talk about their worries and how often they can ask for help if they have a problem. The participants answered each item using a 3-point scale ranging from 0 = hardly ever or never to 2 = often. We combined the scores on these two items to create a measure of perceived support from each type of relationship. Correlations of the two items for partnerships, family, and friend relationships were 0.43, 0.45, and 0.52, respectively (all p < .01). Each combined measure ranged from 0 to 4. We scored having no family or having no friend as perceiving support as hardly ever or never available. At the same time, to take account of the possible different influences of objective and subjective social isolation (Cornwell & Waite, 2009), we included dummy variables that indicate whether participants were without family (n = 4) or without friends (n = 41). (These two dummy variables had no significant effect in all models and are not shown in the tables that summarize results.) Psychological well-being.An item about general happiness If you were to consider your life in general these days, how happy or unhappy would you say you are on the whole? served as our measure of positive psychological well-being. Participants answered this item using a 5-point scale ranging from 0 = usually unhappy to 4 = extremely happy. General happiness has been shown to be highly correlated with other constructs of positive well-being such as life satisfaction (Slocum-Gori, Zumbo, Michalos, & Diener, 2009). Furthermore, this single-item measure of happiness has advantages over other multi-item scales of positive well-being, particularly given that few researchers reported the internal consistency of such psychometric measures (see George, 2010 for a review). We assessed negative well-being with the short version of the Center for Epidemiological StudiesDepression scale (CES-D; Radloff, 1977). Because the CES-D has been commonly used to assess the influence of social relationships on the well-being of older adults (e.g., Fiori, Antonucci, & Cortina, 2006), using this scale enhanced our studys comparability with the existing literature. NSHAP participants indicated how often they had each of 11 kinds of thoughts (e.g., I felt everything I did was an effort) in the previous week using a scale ranging from 0 = rarely or none of the time to 3 = most of the time. We used the total score on these 11 items (reliability alpha = .79; range = 033).

Controls.We controlled for five variables: participants age, level of education, racial background, and physical health. Education levels were included as an ordered variable consisting of four categories: 0 = less than high school, 1 = high school, 2 = some college, and 3 = bachelors or more. Race was classified into four categories (White, Black, Non-Black Hispanic, and Other) with White as the reference category in the analysis. Physical health was included using participants self-rated health, ranging from 0 = very poor to 4 = excellent. Despite its simplicity and subjectivity, self-rated health has been shown to be a powerful predictor of morbidity and mortality (Burstrm & Fredlund, 2001). We initially considered but did not include (a) the health status of the partner as perceived by participants and (b) participants beliefs about sexual functioning and activities such as how much they view sexual dysfunction to be typical in the aging process and how important they think sexual activities are to maintaining partnerships. We anticipated that these variables might influence participants perception of the sexual problems of their partner. For example, we expected that older adults might accept their partners sexual problems if they perceive their partner to be in poor health and/or if they consider sexual dysfunction to be typical in the aging process. We also expected that, if older adults believe sexual relationships to be necessary to maintain partnerships, perceived sexual unresponsiveness of partner might likely threaten the psychological well-being of participants. Yet, our expectations were not supported. Specifically, the association between perceived sexual unresponsiveness of partner and psychological well-being did not differ by perceived health status of partner or by beliefs about sexual functioning and activities (i.e., the interaction between sexual unresponsiveness and each of these variables was not significantly associated with psychological well-being; results available upon request). Furthermore, whether or not we included these variables in our models, there was no change in the results regarding the relation among perceived sexual unresponsiveness of partner, perceived supportiveness of significant others, and psychological well-being. Thus, in the final analyses, we did not include perceived health status of partner or participants belief about sexual functioning and activities. Analytic Strategy To handle missing data, we first conducted multiple imputation using the ice program in Stata (Royston, 2005). There were no missing data on the sociodemographic variables we used. The number of participants with missing data was fewer than 20 for our independent and dependent variables (e.g., perceived supportiveness, general happiness, depressive symptoms) except for perceived sexual unresponsiveness of partner. To infer missing data on a variable, we relied on nonmissing responses for the other variables

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that were included in the analytic models (Allison, 2002). By doing so, we generated five imputed data sets from which to compute pooled estimates for our results (Acock, 2005). We concluded that our results are robust to imputation by comparing our findings to the results using listwise deletion. Specifically, whether we used multiple imputation or listwise deletion made little difference in the direction or magnitude of regression coefficients in our analytic models; only a few coefficients for the control variables failed to reach significance when excluding incomplete cases. We did not impute missing responses on whether the partner had a sexual problem. Doing so would also require us to infer how much participants were bothered by the problem. When participants did not report whether their partner had a sexual problem (i.e., dont know or refused to answer), we treated them as not being bothered by the problem. Our focus is not on partners sexual problems per se (i.e., whether partner face sexual problems) but on participants perception of partners problems (i.e., how much they are troubled by their partners sexual problems). When participants dont know whether their partner faces a sexual problem, it seems reasonable to assume that they do not feel troubled by this problem. Such an assumption might be problematic for participants who refused to answer, but fewer than 5% of participants did so for each item regarding sexual problems. Furthermore, excluding those who refused to answer changed only the significance of the coefficients of independent variables, with little change in their magnitude or direction. Thus, we concluded that counting participants who dont know and refused to answer whether the partner has a sexual problem as not feeling bothered by the problem has little impact on the overall results. Because gender is a key dimension of our study, it is important to note a gender difference in missing responses on partners sexual problems. We found no gender difference in the number of respondents who refused to answer items about any sexual problem of partner. For two types of climaxing problems, however, more men than women didnt know whether their partner experienced these problems: 96 (11.4%) men and 23 (4.6%) women didnt know whether their partner was unable to climax; 80 (9.5%) men and 19 (3.8%) women didnt know whether their partner climaxed too quickly. This gender difference suggests that men may be less sensitive than women to partners climaxing problems, and thus, freer from perceived sexual unresponsiveness of partner if their partner experiences only these types of problems. After creating the imputed data sets, we conducted multiple group hierarchical regression analyses in which the model was estimated separately but simultaneously for women and for men. Each of the two types of psychological well-being, general happiness and depressive symptoms, were regressed separately on the same sets of independent variables. The first block of independent variables involved feeling bothered by the perceived sexual unresponsiveness of a partner,

perceived support from close social partners, and controls. This block was primarily intended to examine the association between bothersome perceived sexual unresponsiveness of the partner and psychological well-being. Then, we added the second block that consisted of three interaction terms combining bothersome perceived sexual unresponsiveness of the partner with perceived support from each of the three types of close relationships (i.e., partnerships, family, and friend relationships). These interactions were included to identify whether perceived support from significant others could moderate the influence of bothersome sexual unresponsiveness of the partner on well-being. We used chi-square difference tests to examine (a) whether the effects of bothersome perceived responsiveness might differ for women and for men and (b) whether the effects of bothersome perceived responsiveness might differ by type of relationship. We ran the models in which coefficients were constrained to be equal and then compared the constrained model with the original one in which coefficients were freely estimated. If the model chi-square statistic for the constrained model was significantly larger than that for the unconstrained model, we would conclude that the effects were different (a) between women and men and (b) across relationship types. Results

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Gender Differences in Independent and Dependent Variables Table 1 summarizes descriptive statistics of our variables of interest except those for sociodemographic background. There was no significant gender difference in variables related to spouse or partner. Among both women and men, feeling bothered by partners sexual problems was low because half of the participants reported that their intimate partner experienced no sexual dysfunction. Both women and men perceived their intimate partner to be relatively highly supportive. Perceived support from other relationships differed by gender: Women perceived both their family and friends to be more supportive than men. Regarding psychological well-being, there was no significant gender difference in general happiness, whereas depressive symptoms were higher among women than among men. There was no significant gender difference in perceived self-rated health status.
Effects of Perceived Sexual Unresponsiveness and Support on Positive Well-being Table 2 presents the results of multiple group hierarchical regression analysis for general happiness. Feeling bothered by partners sexual problems did not have a significant effect on either mens or womens general happiness. In addition, no interaction term was significant; thus, the effect of feeling bothered by partners sexual problems on general

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Table 1. Descriptive Statistics of Variables by Gender

Men (n = 844) Range Independent variables Bothered by partners sexual problemsa Perceived supportiveness of partner Perceived supportiveness of family Perceived supportiveness of friends Dependent variables General happiness Depressive symptoms (CES-D) Control Self-rated physical health statusb 02 04 04 04 04 033 04 M 0.31 3.64 2.68 2.10 2.85 4.03 2.51 SD 0.52 0.73 1.18 1.22 0.82 4.22 1.02 Women (n = 502) M 0.28 3.63 3.12 2.56 2.77 4.86 2.47 SD 0.51 0.75 0.98 1.23 0.79 5.03 1.04 Gender differences t = 1.09 t = 0.16 t = 9.06** t = 6.80** t = 1.73 t = 3.08**

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t = 0.61

Note: CES-D = Center for Epidemiological StudiesDepression. a Index of feeling bothered by partners sexual unresponsiveness. b 0 = poor; 4 = excellent. **p < .01.

happiness was not moderated by perceived support from any relationship. We also examined whether the effects of perceived support might differ across relationship types. Our major focus was on the moderating effects of perceived support, which did not reach significance for either women or men. Nevertheless, we also analyzed whether its direct effects on well-being differed across relationship types to test our hypotheses about gender differences; that is, whether men

are more likely than women to prioritize their intimate partner over other close relationships. Results of the chi-square difference tests showed that which relationship type influenced well-being differed by gender (results not shown in Table 2). The direct effect of perceived support from friends was significant only for women, and its magnitude differed significantly between women and men (c2 = 16.85, p < .001). Among both women and men, the magnitude of the direct effect of perceived

Table 2. Summary of Multiple Group Regression Analysis Predicting General Happiness From Feeling Being Bothered by Partners Sexual Unresponsiveness and Supportiveness
Men (n = 844) I B Agea Educationb Racec Black Hispanic, non-Black Other Self-rated physical health statusd Bothered by partners sexual problemse Partner supportivenessf Family supportivenessf Friends supportivenessf Interaction Partner Bothersome Family Bothersome Friends Bothersome Intercept R2 0.01 0.02 0.05 0.11 0.25 0.18 0.12 0.24 0.04 0.02 SE B 0.00 0.03 0.08 0.09 0.16 0.03 0.05 0.04 0.03 .03 b .09** .03 .02 .04 .05 .23** .08 .21** .06 .03 B 0.01 0.02 0.06 0.10 0.26 0.18 0.13 0.24 0.04 0.01 0.03 0.08 0.09 2.85 II SE B 0.00 0.03 0.08 0.09 0.16 0.03 0.05 0.04 0.03 0.03 b .09** .03 .02 .04 .05 .23** .08 .21** .06 .02 B 0.01 0.03 0.19 0.06 0.00 0.22 0.08 0.29 0.02 0.10 I SE B 0.01 0.04 0.10 0.11 0.22 0.03 0.06 0.04 0.04 0.03 b .08 .04 .08 .02 .00 .29** .05 .27** .02 .16** B 0.01 0.03 0.20 0.05 0.01 0.22 0.10 0.29 0.02 0.11 0.05 0.00 0.06 2.71 Women (n = 502) II SE B 0.01 0.04 0.10 0.11 0.22 0.03 0.07 0.04 0.04 0.03 b .08 .02 .08 .02 .00 .28** .06 .27** .03 .16**

2.85

.03 .134**

0.06 .02 0.05 .06 0.04 .07 0.03 .140**

2.71

0.04 .201**

0.08 .03 0.07 .00 0.05 .05 0.04 .204**

Notes: Underlined coefficients in the same row differ across comparable mens and womens models at p < .05. Whether respondents had no family tie and whether they had no friend tie are controlled in all models but not shown. a Range 028. b 0 = less than high school; 1 = high school; 2 = some college; 3 = bachelor or more. c White is the reference category. d 0 = poor; 4 = excellent. e Index of feeling bothered by partners sexual unresponsiveness; range 02. f Range 04. *p < .05; **p < .01.

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Table 3. Summary of Multiple Group Regression Analysis Predicting Depressive Symptoms From Feeling Bothered by Partners Sexual Unresponsiveness and Supportiveness
Men (n = 844) I B Agea Educationb Racec Black Hispanic, non-Black Other Self-rated physical health statusd Bothered by partners sexual problemse Partner supportivenessf Family supportivenessf Friends supportivenessf Interaction Partner Bothersome Family Bothersome Friends Bothersome Intercept R2 0.01 0.24 1.14 0.25 0.59 0.96 1.16 0.71 0.17 0.08 SE B 0.02 0.14 0.42 0.47 0.84 0.14 0.26 0.19 0.13 0.13 b .02 .06 .09** .02 .02 .23** .14** .12** .05 .02 B 0.01 0.22 1.12 0.22 0.57 0.96 1.03 0.69 0.18 0.08 0.37 0.29 0.11 3.86 II SE B 0.02 0.14 0.42 0.47 0.84 0.14 0.27 0.19 0.13 0.13 b .02 .06 .09** .02 .02 .23** .13** .12** .05 .02 B 0.07 0.41 0.44 0.33 1.07 2.00 0.68 1.28 0.66 0.08 I SE B 0.03 0.21 0.61 0.66 1.33 0.20 0.38 0.27 0.21 0.18 b .10* .08 .03 .02 .03 .42** .07 .19** .13** .02 B 0.07 0.41 0.37 0.16 0.87 2.00 0.92 1.32 0.72 0.11 1.05 0.64 0.48 5.11 Women (n = 502) II SE B 0.03 0.21 0.61 0.65 1.32 0.20 0.40 0.26 0.21 0.18 b .08* .08 .02 .01 .03 .42** .09* .20** .14** .03

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3.88

0.17 .134**

0.31 .04 0.24 .04 0.22 .02 0.16 .138**

5.14

0.24 .272**

0.50 .08* 0.39 .06 0.31 .06 0.24 .287**

Notes: Underlined coefficients in the same row differ across comparable mens and womens models at p < .05. Whether respondents had no family tie and whether they had no friend tie are controlled in all models but not shown. a Range 028. b 0 = less than high school; 1 = high school; 2 = some college; 3 = bachelor or more. c White is the reference category. d 0 = poor; 5 = excellent. e Index of feeling bothered by partners sexual unresponsiveness; range 02. f Range 04. *p < .05; **p < .01.

support from the partner was significantly larger than both that from family (c2 = 19.05, p < .001 for women; c2 = 16.49, p < .001 for men) and that from friends (c2 = 10.91, p < .001 for women; c2 = 30.31, p < .001 for men). Effects of Perceived Sexual Responsiveness and Support on Negative Well-being As shown in Table 3, feeling bothered by partners sexual problems was significantly associated with both womens and mens depressive symptoms. A chi-square difference test showed no gender difference in the magnitude of this association. For women, however, perceived support from intimate partner moderated this association significantly, although the gender difference in the magnitude of this moderating effect did not reach significance. The coefficient of this moderating effect (B = 1.05) indicates that depressive symptoms are lower among women whose spouse or partner is perceived to be more supportive, when this spouse or partner is also perceived to be sexually unresponsive. Chi-square difference tests indicated that the moderating effects of perceived support did not differ across relationship types for either women or men (results not shown in Table 3). The results for direct effects, however, indicated gender differences by relationship types. For men, only intimate partners supportiveness was significant, and its magnitude was significantly larger than both that of familys

(c2 = 4.29, p < .05) and that of friends (c2 = 6.85, p < .01). For women, however, both intimate partners and familys supportiveness had a significant negative effect on depressive symptoms. Furthermore, the direct effect of these two types of relationships did not differ significantly in magnitude, although the effect of friends supportiveness did not reach significance and its magnitude was significantly smaller than that of intimate partners (c2 = 13.51, p < .001). In summary, mens psychological well-being was associated more strongly with the supportiveness of the intimate partner than with that of family and friends. By contrast, womens well-being was influenced by other relationships as well, although only perceived support from their intimate partner moderated the effect of sexual unresponsiveness on their negative well-being. Discussion Guided by symbolic interactionism, the present study explored whether feeling bothered by the perceived sexual unresponsiveness of an intimate partner is associated with the psychological well-being of older adults and whether this association is moderated by perceived support from multiple significant others. The results indicated a significant association between feeling bothered by partners sexual problems and depressive symptoms. Note that this association was significant even taking into account perceived

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social support and physical health status, both of which have been shown to be consistent predictors of well-being (George, 2010). Furthermore, the association between feeling bothered by partners sexual problems and depression did not differ by gender. Thus, both women and men are likely to experience a negative psychological state when their partners sexual dysfunction makes it difficult to have a sexual relationship. The results suggest that, at least for women, being bothered by an intimate partners sexual unresponsiveness can be compensated by perceived supportiveness of this partner. This moderating effect was significant for womens depressive symptoms, the only well-being variable significantly associated with bothersome perceived sexual unresponsiveness. By contrast, no moderating effect was significant for men. Because chi-square difference tests showed no gender difference in the magnitude of moderating effects, we cannot conclude that womens psychological well-being is more protected than mens by perceived support from their intimate partner. Yet, men may face more difficulty than women when perceiving their intimate partner to be sexually unresponsive because no close relationship moderated the significant association between perceived sexual unresponsiveness of partner and negative well-being. Because neither familys nor friends support had a significant moderating effect, it appears that sexual unresponsiveness of intimate partner cannot be compensated by supportiveness in close relationships other than partnerships. This result is in contrast with our previous findings on the influences of multiple significant others on perceptions of ones own sexual dysfunction (Hirayama & Walker, 2011). In the previous study, we found that confidant friendships as well as partnerships moderate the association between feeling bothered by ones own sexual problems and psychological well-being (Hirayama & Walker, 2011). The results of the present study for women, however, suggest that feeling bothered by ones partners sexual problems can be resolved only within partnerships: Whether women can manage the sexual unresponsiveness of their intimate partner depends on whether this partner responds in a helpful manner in nonsexual aspects of the relationship. At the same time, gender differences in the direct effects of multiple significant others suggest that other close relationships, such as those with family and friends, may influence whether older adults can manage the sexual unresponsiveness of their intimate partner through perceived support from this partner. First, chi-square difference tests indicated no gender difference in the magnitude of the direct effect of sexual unresponsiveness of the spouse or partner or in the magnitude of the direct effect of perceived support from the spouse or partner on psychological well-being. Therefore, the psychological impact of feeling bothered by the perceived sexual unresponsiveness and supportiveness of an intimate partner does not seem to differ by gender. In our results, gender differences emerged in the direct effects of

familys and friends supportiveness in comparison with that of an intimate partners. For women, friends supportiveness was associated with negative well-being in a similar way to that of the intimate partner. By contrast, among men, the direct effect of a partners supportiveness on well-being was greater than that of other relationships. Gerontological research on social relationships has indicated that various types of close relationships are needed to better cope with problems individuals face in the process of aging (Adams & Blieszner, 1995). Indeed, compared with older adults with both active family and nonfamily ties, older adults who engage with their spouse and children without socializing with nonfamily members are at greater risk of mental health problems (Fiori et al., 2006). It is thus suggested that spousal relationships have a protective psychological effect on wellbeing only when one has a close relationship with other social partners. Diverse close social ties may be needed for older adults to manage the sexual unresponsiveness of an intimate partner through perceived support from this partner. In other words, mens exclusive reliance on their intimate partner may make it difficult for them to manage negative feelings about the partners sexual dysfunction, even when their partner is supportive. Overall, gender is a key dimension to explore how older adults, with their social partners, can negotiate intimate partnerships in facing sexual problems. In our previous study (Hirayama & Walker, 2011), we found that confidant partnerships can help men, but not women, handle negative feelings about their own sexual dysfunction. In contrast, the present analysis suggests that supportive partnerships protect womens, but not mens, well-being when feeling bothered by the partners sexual dysfunction. Which relationship is effective for whose sexual problems seems to differ by gender. This complex gendered association among sexual dysfunction, social relationships, and well-being should be considered for researchers and health practitioners to better help older adults with sexual problems. In addition, the results also point to the need to study both positive and negative aspects of well-being. Because the sexual unresponsiveness of ones intimate partner had a significant effect only on depressive symptoms, examining only either positive or negative mental state could lead one to an inappropriate conclusion on the influences of sexual health problems on psychological well-being. Limitations and Future Directions We acknowledge several limitations of our analysis. First, we could not clarify how perceived sexual unresponsiveness of ones intimate partner influences the psychological well-being of older adults. Despite some support from the results especially regarding gender differences, the process we hypothesized from symbolic interactionism remains speculative because NSHAP data do not include an adequate item for our hypothetical mediator, namely, self-view

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in terms of sexual partnering. The process linking the sexual unresponsiveness of ones intimate partner to psychological well-being (e.g., what mediates the association between the two) needs to be clarified. Because we could not find an effective moderator of the association between partners sexual unresponsiveness and the well-being of men, such closer examination of the process may be particularly important to identify how to block the negative psychological influence of feeling bothered by their partners sexual dysfunction for men. Second, because of the cross-sectional nature of our data, we could not identify the causal direction between feelings of being bothered by the perceived sexual unresponsiveness of intimate partner and psychological well-being. Note that our focus was perceived partners responsiveness. Thus, the significant association between sexual unresponsiveness and negative well-being may mean that depressed older adults perceive their partner to be sexually unresponsive. In fact, research has indicated that depressed people seek more positive feedback from close relationships than do nondepressed people (Joiner & Timmons, 2009). Therefore, depressed older adults may tend to perceive their partners behavior as unresponsive when, without such mental health problems, the same behavior could be seen as responsive. Third, our analytic sample was restricted to older adults who engaged in sexual activities with their spouse or partner in the last 12 months because only they reported whether their partner experienced sexual dysfunction. Thus, we may have excluded older adults whose partner had such severe sexual dysfunction that they could not engage in sexual activity. In other words, our results may not be applicable to older couples facing serious or long-term sexual health problems. Fourth, we examined only limited forms of supportiveness of significant others because few such items were available in the data set. There should be many other forms of responsiveness older adults may expect from their social partners. Examining few types of perceived supportiveness might explain why we found no significant moderating effect of significant others for men. The literature on close relationships suggests that women and men find closeness and intimacy in different types of social interactions (Wood, 2000). For example, studies have shown that men are more likely than women to associate close friendships with sharing activities (e.g., Fehr, 2004; Walker, 1995). Thus, men may perceive their social partners to be responsive if these partners share the same interests rather than provide such socioemotional support as we included in the analysis. In summary, considering diverse forms of perceived responsiveness could draw a different, more precise picture of the association among the sexual unresponsiveness of an intimate partner, perceived support from multiple significant others, and psychological well-being, especially in relation to gender. Finally, we urge caution in comparing the results for positive versus negative well-being because of the measurement

imbalance between these two. Whereas our measure of negative well-being (i.e., depressive symptoms) comprised multiple items, positive well-being (i.e., general happiness) was assessed with a single item. Furthermore, because possible variability in positive well-being was limited among respondents, fewer independent variables were significant for positive than for negative well-being. For example, feelings of being bothered by the perceived sexual unresponsiveness of partner were associated only with negative well-being. To clarify whether and how sexual relationships are associated differently with positive and with negative well-being, it would be necessary to assess both types of well-being with comparable measures. Despite these limitations, the results suggest that social gerontology has the potential to make a significant contribution to the growing field of sexual health among older adults. Although the role of medical treatment has received much attention in this field, our findings are consistent with previous research on the health- and well-beingrelated effects of close relationships for older women and men. Existing literature on social relationships will likely help us to identify how older adults, with the support from their social partners, can better manage aging-related sexual problems. Given the association between sexual relationships and well-being in older age, such investigation should help individuals to have a higher quality of later life despite declines in sexual functioning.
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