Sexpectations: The overlooked piece of the health puzzle

Dear Dr. G,

I am a 57-year-old mother who has a bone to pick with you. I am disappointed to see how you have focused your articles throughout June on issues of sexual frequency.

Surely, the frequency of sex is not a major concern for most people, as many other important matters deserve attention.

I believe your articles can be misleading and send the wrong message in a conservative community like Malaysia.

While sex may be important to those with a Western upbringing, I genuinely believe that most couples prioritise physical health, career, financial stability, and mental health over sexual health.

I also think that couples in different age groups may focus less on their sexual relationship compared to when they were younger.

Therefore, I’d like to put Dr G on the spot for a rebuttal: Is a sexual relationship truly that important in a couple’s priorities in life?

 Has any study been conducted on this matter, especially in Asian countries compared to the West?

Do you really think sexual health is as crucial as overall health?

Yours truly,  

Priority Pamela

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When people are asked what matters most in life, the answers are often predictable: good health, family happiness, financial security, meaningful relationships, and career success usually top the list. However, sexual health—a factor closely linked to all these elements—rarely receives the same level of attention. The Asia-Pacific Sexual Health and Overall Wellness (AP SHOW) Survey provides evidence that sexual well-being may be one of the most overlooked determinants of quality of life. This study involved nearly 4,000 adults from 13 countries across the Asia-Pacific region and explored attitudes towards sex, relationships, health, and overall well-being. Participants were asked to prioritise physical health, family wellness, financial stability, career progression, mental health, and sexual relationships.

The findings revealed an interesting paradox: while two-thirds of men and more than half of women considered sex to be very important or essential in their lives, sexual health generally ranked lower than physical health, family life, financial security, and emotional well-being. This hierarchy reflects the prevalent cultural values throughout much of Asia. In many societies, responsibilities such as caring for ageing parents, raising children, and maintaining financial stability are considered primary duties, while personal fulfilment—including sexual satisfaction—is often viewed as secondary. Countries like Malaysia, Indonesia, and the Philippines tend to prioritise collective family well-being, while populations in Australia and New Zealand are generally more open in discussing sexual well-being as part of a healthy lifestyle.

Participants who reported greater satisfaction with their sex lives were significantly more likely to indicate better overall health, stronger relationships, higher self-esteem, and a more positive outlook on life. Conversely, those experiencing sexual difficulties often reported poorer physical and psychological well-being. These findings suggest that sexual health is not merely an outcome of good health but may also be an important contributor to it.

The relationship between sexual health and physical health is particularly striking. Conditions such as erectile dysfunction, reduced libido, and sexual dissatisfaction often coexist with chronic illnesses like diabetes, hypertension, obesity, and cardiovascular disease. For men, erectile dysfunction can precede the diagnosis of heart disease by several years, acting as an early warning sign of deteriorating vascular health. Similarly, sexual dysfunction can be linked with depression, anxiety, sleep disorders, and chronic stress.

Despite these associations, many individuals remain reluctant to seek help. Cultural taboos, embarrassment, fear of judgment, and the misconception that sexual problems are a normal part of ageing often prevent people from discussing their concerns with healthcare professionals. Consequently, opportunities for early intervention may be lost. What begins as a sexual complaint may actually be the first indication of a more serious underlying medical condition.

The implications extend beyond individual experiences. Relationship satisfaction is strongly influenced by intimacy and sexual well-being. Couples who experience persistent sexual difficulties are more likely to report emotional distance, communication issues, and reduced relationship satisfaction. As mental health and social connectedness increasingly gain recognition as public health priorities, sexual well-being deserves similar attention. As populations across the Asia-Pacific continue to age, the importance of healthy ageing must encompass discussions about intimacy and sexual health. The AP SHOW Survey found that even among adults over the age of 60, more than half of men and a substantial proportion of women continued to regard sex as an important aspect of life, challenging the misconception that sexuality becomes irrelevant in later years.

The World Health Organisation defines sexual health as a state of physical, emotional, mental, and social well-being in relation to sexuality, rather than merely the absence of disease. This definition acknowledges that sexual health is deeply intertwined with overall wellness. Yet, public health policies, workplace wellness programs, and healthcare systems often treat it as a peripheral issue.

The most important lesson from the Asia-Pacific experience is that while sexual health may not rank as the highest priority in life, it significantly influences many of the priorities people value most. Healthy relationships, emotional well-being, self-confidence, and even physical health are all connected to sexual well-being. Rather than viewing sexual health as a luxury, societies should recognise it as an integral component of holistic health and quality of life. Ultimately, sexual health may not always appear at the top of life’s priorities, but it is increasingly clear that it plays a significant role in improving overall quality of life.