Ukungasebenzi kwezesondo e-United States: Ukunyamekela nokuQala kwangaphambili (1999)

UMBUZO: Le yayi Uvavanyo lokuqala olusekwe kubemi bokungasebenzi ngokwesondo kwisiqingatha senkulungwane ukusuka eKinsey (1948). Baphonononge icandelo lokuwela kwamadoda, ubudala be-18-59. Uvavanyo lwenziwa kwi-1992, uphando olupapashwe kwi-1999. Kuphela yi-5% yamadoda axele ukungasebenzi kakuhle kwe-erectile, kunye ne-5% yaxela umnqweno wesini ophantsi. Thelekisa oko kwizifundo ezivela kwi-2013-2015, apho iirhafu zamadoda aselula eyi-30-54%. Kukho into etshintshileyo.

Igalelo loqobo | Februwari 10, 1999

U-Edward O. Laumann, PhD; Anthony Paik, MA; URaymond C. Rosen, PhD

[+] Unxibelelaniso lwababhali

KWI-ABSTRACT

Ukungasebenzi ngokwesondo kubonakaliswa kukuphazanyiswa komnqweno wesini kunye notshintsho lweengqondo kunye nomlo ohambelana nomjikelezo wokuphendula ngesondo kumadoda nabasetyhini.¹ Ngaphandle kokunyuka kwesidingo seenkonzo zeklinikhi kunye nefuthe elinokubakho kwezi ziphazamiso kulwalamano lwabantu kunye nomgangatho wobomi,^2,3 Idatha yezifo ezibonakalayo ayiqaphelekanga. Ngokusekwe kwizifundo ezimbalwa ezikhoyo zoluntu, kubonakala ngathi ukungasebenzi kakuhle ngokwesondo kuxhaphake kakhulu kwisini, ukusukela kwi-10% ukuya kwi-52% yamadoda kunye ne-25% ukuya kwi-63% yabasetyhini.^4- 6 Idatha evela kwi-Massachusetts Indoda yokuDala yokuDala⁷ (I-MMAS) ibonise ukuba i-34.8% yamadoda aneminyaka eyi-40 ukuya kwi-70 iminyaka yayine-moderate yokugqiba ukungasebenzi kwe-erectile, eyayinxulumene nobudala, imeko yezempilo, kunye nomsebenzi weemvakalelo. Ukungasebenzi kakuhle kwe-erectile kuchazwe njengengxaki ebalulekileyo yezempilo yoluntu liZiko leSizwe leZiko loVumelwano lwezeMpilo,⁸ ichonge isidingo esingxamisekileyo sedatha esekwe kubemi malunga nokuxhaphaka, ukumisela, kunye neziphumo zolu phazamiseko. Nokuba incinci kangakanani iyaziwa malunga nokuba sisifo sokudakumba kwabasetyhini ngokwesondo.

Ubungcali kunye nomdla kawonkewonke ekungasebenzi gwenxa ngokwesondo kutsha nje kukhuthazwe ziimeko kwiindawo ezininzi. Okokuqala, ukuqhubela phambili okukhulu kwenzekile ekuqondeni kwethu iinkqubo ze-neurovascular of reaction yezesondo kumadoda nabasetyhini.^9- 11 Iiklasi ezininzi ezintsha zamachiza zichongiwe ezibonelela ukubakho kokunyanga okubalulekileyo kunyango lwesifo se-erectile yamadoda,^12- 14 ngelixa ezinye iiarhente ziye zacetyiswa kwiminqweno yesini kunye nokuphazamiseka kwe-orgasm.^15,16 Ukufumaneka kwala machiza kunokunyusa kakhulu inani labaguli abafuna uncedo lwezo ngxaki. Idatha ye-Epidemiologic iya kuba yexabiso elibonakalayo ekuphuhliseni ukuhanjiswa kweenkonzo ezifanelekileyo kunye nemodeli yolwabiwo lwezixhobo. Ukongeza, ukutshintsha kwesimo senkcubeko kunye nokutshintsha kwenani labemi kuqaqambise ukuxhaphaka kweenkxalabo zesini kuwo onke amaqela obuhlanga naweminyaka.

Uphononongo lwangoku lujongana nale micimbi ngokuhlalutya idatha ekungasebenzi kakuhle ngokwesondo kwi-National Health and Social Life Survey (NHSLS), isifundo sokuziphatha kwabantu abadala ngokwesondo eUnited States.¹⁷ Ukwenza isampulu, ukuqokelelwa kwedatha, kunye nohlalutyo lwempendulo zonke beziqhutywa phantsi kweemeko ezilawulwa kakhulu. Lo mthombo wedatha oyingqayizivele ubonelela ngolwazi olubanzi malunga neenkalo eziphambili zokuziphatha ngokwesondo, kubandakanya iingxaki zesondo kunye nokungasebenzi, impilo kunye nendlela yokuphila eguquguqukayo, kunye nolwazelelo lwenkcubeko. Phambi kohlalutyo lokungasebenzi kakuhle ngokwesondo, kusetyenziswa idatha ye-NHSLS, kunikwe umda, ukubonakalisa amanani asisiseko okuxhaphaka kuzo zonke iimpawu zokuphila kunye nezalathi zempilo jikelele kunye nentlalo-ntle.¹⁷(pp368-374) Olu phononongo lwangoku, ngokuchaseneyo, lusebenzisa iindlela zobuchule bokuqikelela umngcipheko osondeleyo (RR) wokungasebenzi ngesondo kwimpawu nganye yabantu kunye nakwimpawu eziphambili zomngcipheko.

Survey

I-NHSLS, eqhutywa ngo-1992, sisampulu yesizwe enamadoda ali-1410 kunye nabafazi abali-1749 abaphakathi kweminyaka eli-18 nama-59 ubudala abahlala kumakhaya eUnited States. Inika ingxelo malunga ne-97% yabemi kweli banga lobudala-phantse i-150 yezigidi zabantu baseMelika. Ayibabandakanyi abantu abahlala kwiindawo zokuhlala ezifana neendawo zokuhlala, iikholeji zeekholeji, kunye neentolongo, kunye nabo bangasazi kakuhle isiNgesi ngokwaneleyo ukuba baxoxwe. Umgangatho wokugqitywa kwesampulu wawungaphezulu kwe-79%. Ukutshekishwa kunye nezinye iisampulu ezikumgangatho ophezulu (umzekelo, uPhando lwaBantu lwase-US lwaBantu ngoku) lubonise ukuba i-NHSLS iphumelele ekuveliseni isampulu yabemi yokwenyani. Umntu ngamnye ophenduliweyo wavavanywa buqu ngabavavanyi abanamava, ababethelekisa abaphenduli kwiimpawu ezahlukeneyo zentlalo, kudliwanondlebe olulinganiselwa kwimizuzu engama-90. Ingxoxo ebanzi yoyilo lwesampulu kunye novavanyo lwesampulu kunye nomgangatho wedatha zifunyenwe kwincwadi kaLaumann et al.¹⁷(pp35-73,549-605)

Ukudakumba ngokwesondo kwaboniswa kolu phando ngokwezinto zokuphendula ze-7 dichotomous, nganye yokulinganisa ubukho beempawu ezinobunzima okanye ingxaki kwiinyanga ezidlulileyo ze-12.¹⁷(p660) Izinto zokuphendula zibandakanyiwe: (1) ukuswela umnqweno wesondo; (I-2) ubunzima bemvuselelo (okt, iingxaki zokwakhiwa kwamadoda, ubunzima be-lubrication kubafazi); (3) ukungakwazi kufezekisa uvuthondaba okanye ukuqaqambisa; (4) ixhala malunga nokusebenza ngokwesondo; (5) ukuvuthwa okanye ukukhupha ngokukhawuleza kakhulu; (6) iintlungu zomzimba ngexesha lokwabelana ngesondo; kunye (7) ukungafumani sondo luyolo. Izinto zokugqibela ze-3 zabuzwa kuphela kubaphenduli abebesabelana ngesondo ngexesha le-12 yenyanga engaphambili. Zidibene kunye, ezi zinto zigubungela imiba ephambili yengxaki ekubhekiswa kuyo kwi Uvavanyo lweNcwadi kunye neNcwadi yeNgxelo yeNkcazo yeengxaki zeNgqondo, Okwesine Edition¹ ukwahlula-hlulwa kwezesondo. Iingxelo zokuzazisa malunga nokuxakeka kwezesondo, ngakumbi udliwanondlebe nobuso, zixhomekeke kurhatyelo olungachanekanga oluvela kwinkxalabo yobuqu malunga nokubekwa amabala eluntwini. Ngapha koko, kunokubakho ucalucalulo olucwangcisiweyo ekunikezeleni ngokungaphantsi okunxulumene neempawu ezithile zabaphenduli. Umzekelo, abafazi abadala okanye abangafundanga kangako okanye amadoda amancinci aseSpanish banokuba madolw 'anzima ukuchaza iingxaki zesondo. Ukunqongophala kwemfihlo ngexesha lodliwano-ndlebe kungakhokelela ekungqinelweni. Nangona kunjalo, uhlalutyo (olungachazwanga apha) lubonisa ukuba ingxelo yokuxelwa ngenxa yokungabikho kobumfihlo ayinakuthelekiswa nedatha ye-NHSLS.¹⁷(pp564-570)

Uhlalutyo lweklasi ye-latent (LCA) lwalusetyenziselwa ukuvavanya ukudibana ngokwenyani kweempawu zesini ezizimeleyo. Uhlalutyo lweklasi yondlela yindlela ebalobayo ilungeleleneyo lokuhlelwa kwedatha ngokwamahlelo kwiiklasi ezidlulileyo^18,19 kwaye inezicelo ezininzi zonyango, njengokuvavanywa kweenkqubo zokuxilonga^20- 23 kunye nokuqikelelwa koqikelelo lwe-epidemiologic kusetyenziswa idatha yeempawu.^24,25 Uvavanyo lohlalutyo lweklasi yantlandlolo ingaba yinguqu ye-latent, ecaciswe njengencwadi lweeklasi ezizodwa ezikhethiweyo, iiakhawunti zokuqalwa koviwo phakathi kwezinto ezibonakalayo, eziguquguqukayo ngokwamanqanaba Ingxoxo eneenkcukacha ngale ndlela iyafumaneka ngesicelo esivela kubabhali. Ukusukela ekuthini isifo sokuvavanya ukuphazamiseka kochazo lwesondo kubandakanya ubunzima beempawu, sisebenzise i-LCA kwiimpawu zokuhlela ngokwamaqela. Ezi ndidi, ke, zimela uhlobo lokuphazamiseka kokungaziphathi kakuhle ngokwesondo okufumaneka kubemi baseMelika, kubonisa ukubakho ngokubanzi kunye neentlobo zeempawu.

Sihlalutye kuphela abo baphenduli baxela ubuncinci beqabane le-1 kwithuba elingaphambi kwenyanga ye-12. Abaphenduli abebesabelana ngesondo ngeli xesha lingafakwanga. Le nkqubo inokuthi imise umda kwiziphumo zethu kuba abantu abangaphendulanga bengaphendulanga ngesondo ngenxa yeengxaki zesondo. Nangona kunjalo, le nkqubo yayiyimfuneko yokuqinisekisa ukuba umphenduli ngamnye uphendula zonke izinto ezibonakalayo kuba izinto ze-3 zacelwa kuphela ngabaphenduli ababelana ngesondo. Inani elipheleleyo lamadoda e-139 kunye nabafazi be-238 ababandakanywanga kwesi siseko. Amadoda angabandakanywanga ayenokungatshati kwaye anamanqanaba emfundo asezantsi. Silindele ukuba oku kuzothatha inyani kuqikelelo lwethu lokuxhaphaka kokungaziphathi ngokwesondo ezantsi ekubeni amadoda angathathi ntweni ngokwabelana ngesondo ngokubanzi axele amanqanaba aphezulu eempawu. Abafazi abangabekwanga babathanda ukuba badala kwaye bangatshatanga. Ukukhuselwa kwaba bantu basetyhini kungenzeka ukuba kukhethwe ngokuqikelelwayo kokuxhaphaka kokungaziphathi ngokwesondo ngaphezulu ekubeni la mabhinqa ebethanda ukunika ingxelo ephantsi.

Uhlalutyo olwenziwe kolu phononongo lwenziwa ngokusetyenziswa kokuhlengahlengiswa kwamalungiselelo kunye nolwazelelo oluninzi. Ukuvavanya ukuxhaphaka kweempawu kwiimpawu zedemokhrasi, senze ulungelelwaniso lwezinto ezibonakalayo kwimpawu nganye. Le ndlela ivelise uhlengahlengiso lwezinto ezingahambelaniyo (i-ORs), ezibonisa ukungangqinelani kwamalungu eqela elinikiweyo (umzekelo, ongazange atshate) uxele iimpawu ezinxulumene neqela ekubhekiswa kulo (umzekelo, ngoku utshatile), ngelixa ulawula ezinye iimpawu zedemokhrasi. Iimpawu zedemokhrasi zibandakanya ubudala bomphenduli, inqanaba lomtshato, inqanaba lokufumana imfundo, ubuhlanga kunye nobuhlanga. Okulandelayo, ngelixa silawula ezi mpawu, siqikelele ii-ORs ezilungelelanisiweyo zisebenzisa ukubuyela umva kwezinto ezinobungozi kwiiseti ezi-3 zomngcipheko, nganye imodare ngokwahlukeneyo ngendlela engafakwanga. Imiba yomngcipheko enxulunyaniswa nempilo kunye nendlela yokuphila ibandakanya ukusela utywala, ukuthothisa kwangaphambili izifo ezosulela ngokwabelana ngesondo (STDs), ubukho beempawu zomchamo, ulwaluko, imeko yezempilo, kunye namava eengxaki ezinxulumene noxinzelelo. Izinto eziguquguqukayo kubume bezentlalontle zibandakanya utshintsho kwinqanaba lomvuzo kunye nokuziqhelanisa nokuqhelaniswa nesiqhelo, kuboniswe indlela inkululeko okanye yabaphenduli abanesimo sengqondo sokujonga isini. Imiba yomngcipheko enxulunyaniswa namava ezesondo ibandakanya inani lamaqabane okwabelana ngesondo ubomi bakho, ubuninzi bezesondo, ukuba abantu abaphendulayo bacinga kangakanani malunga nokwabelana ngesondo, ukuphinda-phinda ukuphulula amalungu esini, ukunxibelelana ngesini esifanayo, kunye namava kweziganeko ezinokubangela ukwenzakala njengokunxibelelana nabantu abadala, ukunyanzelwa kokunxibelelana ngokwesondo, ukuxhatshazwa ngokwesondo, kunye nokuqhomfa. Okokugqibela, siqhube iseti yokuhlengahlengiswa kwezinto ezazisebenzisa iindidi zokungasebenzi kakuhle ngokwesondo njengezinto ezixelwa kwangaphambili. Ezi modeli zilinganise unxibelelwano phakathi kwamava odidi lokungasebenzi kunye nomgangatho wobomi, oquka ukoneliseka buqu nakubudlelwane. Sigxininisa ukuba iziphumo ezihambelanayo azinakunxulunyaniswa nesiphumo sokungasebenzi kakuhle ngokwesondo. Uhlalutyo lweklasi lwamva lwenziwa kusetyenziswa ubuninzi bohlalutyo lobume besakhiwo.²⁶ Lonke uhlengahlengiso lwenkcitho olusetyenzisiweyo STATA inguqulelo 5.0.²⁷ Ulwazi malunga nolwakhiwo oluguquguqukayo, iindlela ze-LCA, kunye nomgangatho wedatha ziyafumaneka kubabhali.

Ukuvela kwengxaki zesondo

Ukusetyenziswa kwedatha ye-NHSLS kuvumela ukubala uqikelelo lwesifo esivelisayo seengxaki zesondo kwabasetyhini nabantu abadala. Ngelixa idatha ye-NHSLS kwiimpawu ezibuthathaka ingabandakanyi ingcaciso yekliniki yokungasebenzi kakuhle ngokwesondo, ukuxhaphaka kwabo kubonelela ngolwazi olubalulekileyo malunga nobungakanani babo kunye nokusabalalisa okwahlukileyo phakathi kwabemi base-US. 1 Table kwaye 2 Table hlalutya iingxaki ezikhoyo zesondo kwiimpawu ezikhethekileyo zedemokhrasi. Abasetyhini, ukuxhaphaka kweengxaki zesondo kuvame ukuncipha ngokunyuka kweminyaka ngaphandle kwalabo bafaka iingxingongo zokuthambisa. Ukonyuka kweminyaka yamadoda kunxulunyaniswa ngokuqinisekileyo namava eengxaki ze-erection kunye nokuswela umnqweno wesini. Eyona cohort yakudala yamadoda (iminyaka eyi-50-59 iminyaka) ingaphezulu kwamaxesha e-3 njengoko kunokwenzeka ukuba ive iingxaki ze-erection (i-95% yokuphumla kokuzithemba [CI], i-1.8-7.0) kunye nokuxela umnqweno ophantsi ngokwesondo (95% CI, 1.6-5.4 ) ngokuthelekisa kumadoda aneminyaka eyi-18 ukuya kwiminyaka ye-29. Ukuxhaphaka kweengxaki zesondo kuyahluka kakhulu kwimeko yomtshato. Iimpawu zaphambi komtshato kunye nasemva komtshato (uqhawulo-mtshato, umhlolokazi, okanye ohlukanisiweyo) zidibene nomngcipheko ophakamileyo wokufumana iingxaki zesini. Abafazi abangatshatanga banamaxesha angama-112 ingakumbi okuba neengxaki zentlungu (95% CI, 1.0-2.1 kunye 1.2-2.3, ngokulandelanayo) kunye noxinzelelo ngokwesondo (95% CI, 1.0-2.4 kunye ne-1.1-2.4, ngokulandelanayo) kunabafazi abatshatileyo. Ngokufanayo, amadoda angatshatanga anika ingxelo ephezulu kakhulu yeempawu ezininzi zokungasebenzi kakuhle ngokwesondo kunamadoda atshatileyo. Ke, abafazi abatshatileyo kunye namadoda ngokuqinisekileyo basemngciphekweni ophantsi wokufumana iimpawu zesini kunabahlobo babo abangatshatanga.

Ukufikelela kwimfundo ephezulu kunxulunyaniswa ngokungalunganga namava eengxaki zesondo kwabo bobabini isini. Lo mahluko uphawulwa ngokukodwa phakathi kwabasetyhini abangenazo iidiploma zamabanga aphakamileyo kunye nalabo abaneedyunivesithi. Ukulawulwa kwezinye iimpawu zedemokhrasi, abasetyhini abaphumelele kwiikholeji abakumgangatho ophantse babe ngamava anomdla wokufumana isondo (i-95% CI, 0.3-0.8), iingxaki zokufezekisa i-orgasm (95% CI, 0.3-0.7), iintlungu zesondo (95% I-CI, i-0.3-1.0), kunye noxinzelelo ngokwesondo (95% CI, 0.3-1.0) njengabasetyhini abangazange baphumelele kwisikolo samabanga aphakamileyo. Abaphumelele kwikholeji yamadoda kuphela kwisithathu (i-95% CI, i-0.4-1.0) ngokunokwenzeka ukuba banike ingxelo ngokuxineka kakhulu kunye nesiqingatha semeko yokuxela isondo olungafezekanga (95% CI, 0.2-0.9) kunye nexhala lezesondo (95% CI, 0.3- I-0.8) kunamadoda angenazo iidiploma zamabanga aphakamileyo. Lilonke, abasetyhini kunye namadoda aneemfuno eziphantsi zokufumana ingxelo anika amava amnandi ezesondo kwaye aphakamisa amanqanaba ezesondo.

Unxibelelwano phakathi kohlanga kunye nobuhlanga kunye neengxaki zesini ziyahluka kakhulu. Abafazi abamnyama bathambekele ekubeni namazinga aphezulu eminqweno ephantsi yesini kwaye banamava ulonwabo oluncinci xa kuthelekiswa nabasetyhini abamhlophe, abanokuthi babe neentlungu zesini kunabafazi abamnyama. Abafazi be-Hispanic, ngokuchaseneyo, baxela ngokungaguquki ngamanani asezantsi eengxaki zesondo. Umahluko phakathi kwamadoda awuphawulwa kodwa uhambelana ngokubanzi noko kumava ababhinqileyo. Ewe kunjalo, nangona iimpembelelo zobuhlanga kunye nezohlanga zilungelelene phakathi kwezesini zombini, abantsundu babonakala benengxaki yokuba nesini ngelixa i-Hispanics incinci ukuba nengxaki yezesondo, kuwo onke amabakala okuba ukungasebenzi ngokwesondo.

Uhlalutyo lweklasi

Iziphumo ze-LCA zivumela ukuhlalutya imiba yomngcipheko kunye nomgangatho wobomi bobomi ngokunxulumene nezigaba zokungaziphathi kakuhle ngokwesini, endaweni yeempawu ezizimeleyo. Uhlalutyo lunikezelwe 3 Table, 4 Table , yaye 5 Table Sebenzisa iziphumo ze-LCA endaweni yeempawu ezizezinye. Ezi ziphumo zibonisa ukuba ukudityaniswa kweempawu ngokwesifo kunokumelwa ngamanqanaba ama-4 kubafazi nakumadoda. Uhlalutyo lweklasi lwamva luqikelela ubungakanani beklasi nganye njengenxalenye yesampulu, isiphumo esihambelana nokuxhaphaka kweendidi zokungaziphathi kakuhle ngokwesondo kubemi baseMelika. Okokugqibela, i-LCA ichonga iimpawu zeklasi nganye, ibonisa ukuba kunokwenzeka ukuba abaphenduli kuloo klasi babonakalise uphawu olunikiweyo, ngaloo ndlela banike abaphandi ulwazi malunga nokuba zeziphi izinto ezibonisa udidi ngalunye. Nangona ingalingani nokuxilongwa kweklinikhi, le ndlela ibonelela ngokwamanani okungasebenzi kakuhle ngokwesondo.

Abafazi, iindidi ze-4 ezichongwe yi-LCA ziphantse zihambelana nokuphazamiseka okukhulu kokungasebenzi ngokwesondo njengoko kuchaziwe kwi Uvavanyo lweNcwadi kunye neNcwadi yeNgxelo yeNkcazo yeengxaki zeNgqondo, uHlelo lwesine.¹ Oku kubandakanya iqela elingakhuselekanga (i-58% ukwanda), udidi lomnqweno wesini ophantsi (i-22% ukwanda), udidi lweengxaki zokuvuka (14% ukwanda), kunye neqela elineentlungu zesondo (i-7% ukwanda). Kwangokunjalo, inani elikhulu lamadoda (i-70% yokwanda) lenza inani labantu abangaqeshwanga. Iindidi ezisaleleyo zibandakanya ukubakho ngaphambili (i-21% ubukho), ukungasebenzi kakuhle kwe-erectile (i-5% ukwanda), kunye nomnqweno ophantsi wesini (i-5% ukwanda). Ngokubanzi, iziphumo ze-LCA zibonisa ukuba inani elipheleleyo lokungasebenzi kakuhle ngokwesondo liphezulu kubantu basetyhini kunamadoda (43% vs 31%).

Izinto zobungozi

3 Table kwaye 4 Table Ukubuyela kulungelelwaniso lwengxelo zamazwe amaninzi kwizigaba zokungasebenzi kakuhle ngokwesondo. Ii-Ors eziLungisiweyo zibonisa umngcipheko osondeleyo wokufumana udidi olunikiweyo lokungasebenzi ngokwesondo vs ukuxela akunangxaki kwinto nganye yomngcipheko, ngelixa ulawula ezinye iimpawu. Ngokuphathelele kwimiba yempilo kunye nendlela yokuphila, abo bafumana iingxaki ngokweemvakalelo okanye ezinxulumene noxinzelelo banokufumana amava okusebenza kwesondo achazwe kwicandelo ngalinye. Ngokwahlukileyo, iingxaki zempilo zichaphazela ngendlela eyahlukileyo abasetyhini kunye namadoda. Amadoda anempilo enkenenkene aphakamise umngcipheko kuzo zonke iindidi zokungasebenzi kakuhle ngokwesondo, ngelixa le meko inxulunyaniswa kuphela nentlungu yezesondo kwabasetyhini. Ubukho beempawu zomchamo wokuchama ubonakala buchaphazela ukusebenza ngokwesondo kuphela (umzekelo, ukuqaqanjelwa kunye nentlungu kubafazi okanye ukungasebenzi kwamadoda). Okokugqibela, ukuba une-STD, ulingano ukusela utywala obuphezulu, kwaye ulwaluko ngokubanzi alubonisi kukonyuka okungahambiyo kokungaziphathi kakuhle ngokwesini.

Ubume bezinto eziguquguqukayo, ezilinganisa imeko yezentlalo noqoqosho kunye nokuma kwesiqhelo xa kuthelekiswa nabanye abantu, kuvavanya ukuba imeko yezenkcubeko ichaphazela njani umsebenzi wesondo. Ukudodobala kwesimo soqoqosho, esalathiswa kukuwa kwengeniso yekhaya, ngokubanzi kunxulunyaniswa nokunyuka okuthe chu komngcipheko kuzo zonke iindidi zokungaziphathi kakuhle ngokwesondo kwabasetyhini kodwa kuphela kukungasebenzi kakuhle kwamadoda. Ukuziqhelanisa nokuqhelanisa okuqhelekileyo akubonakali ngathi kunefuthe kukungasebenzi gwenxa kwabasetyhini; Amadoda aneendlela zokuziphatha ezikhululekileyo malunga nokwabelana ngesondo, ngokuchaseneyo, aphantse abe li-134 amaxesha okuba namava okufumana i-ejaculation ngaphambi kwexesha (95% CI, 1.2-2.5).

Okokugqibela, iinkalo ezahlukeneyo zamava ezesondo zikhokelela kumngcipheko owandayo wokungasebenzi ngokwesondo. Imbali yezesondo, eboniswe ngokuba namaqabane angaphezulu kwe-5 amaxesha okuphila kunye neendlela zokuphulula amalungu esini, ayonyusi mngcipheko wesihlobo kubafazi okanye kumadoda. Abafazi abanomsebenzi ophantsi wezesondo okanye umdla, nangona kunjalo, baye babeka umngcipheko wesifiso esisezantsi sesondo kunye nokuphazamiseka komzimba. Amadoda akabonakalisi ubudlelwane obufanayo. Impembelelo yeziganeko zesini ezinokubangela ukuba ziphawuleke ezahlukileyo kubafazi nakumadoda. Abasetyhini abaphendulayo baxela nayiphi na into eyenziwa ngabesini esifanayo abayona mngcipheko uphakamileyo wokungasebenzi ngokwesondo, ngelixa amadoda kunjalo. Amadoda axela nawuphina umsebenzi wesini esifanayo angaphezulu kabini kunokubakho kwi-ejaculation yangaphambi kwexesha (95% CI, 1.2-3.9) kunye nomnqweno wesini ophantsi (i-95% CI, i-1.1-5.7) kunamadoda angenayo. Isifo sengqondo sokuphazamiseka komzimba kubonakala ngathi sinxulumene kakhulu kwabasetyhini abaye bafumana ukuxhatshazwa ngokwesondo ngokudibana komntwana wabantu abadala okanye ngokunyanzelwa ukuba babelane ngesondo. Ngokunjalo, amaxhoba angamadoda okuqhagamshelwa kwabadala ngabantu abadala ngamaxesha e-3 njengoko enokubakho kumaxinzelelo erectile (95% CI, 1.5-6.6) kwaye malunga nexesha le-2 njengoko kunokwenzeka ukufumana ama-ejaculation ngaphambi kwexesha (95% CI, 1.2-2.9) kunye nomnqweno ophantsi wesondo (I-95% CI, i-1.1-4.6) kunabo bangakhange babe ngamaxhoba onxibelelwano lwabantu abadala. Okokugqibela, amadoda athe axhaphaza abafazi ngokwesondo ngamaxesha e-312 njengokunika ingxelo yokungasebenzi kwe-erectile (95% CI, 1.0-12.0). Ewe, izenzo zesondo ezixhalabisayo ziyaqhubeka nokuvelisa iziphumo ezigwenxa ekusebenzeni ngokwesondo, ezinye iziphumo zihlala iminyaka emininzi ngaphandle kokuvela kwesiganeko sokuqala.

Umgangatho-wobomi boBuqu

Amava okusebenza gwenxa kwezesondo ahambelana kakhulu namava omntu kunye nolwalamano olungenelisi. 5 Table Iqaqambisa ukudityaniswa kwezigaba zokunxibelelana ngokwesini ngokwabelana ngokweemvakalelo nangokwasemzimbeni namaqabane esini kunye neemvakalelo zokonwaba ngokubanzi. Nangona kunjalo, akukho myalelo wokudibana kufuneka uthathwe kuba iimpawu ezisemgangathweni zobomi ziziphumo ezifanayo zokungasebenzi ngokwesondo. Abafazi, lonke udidi lokungasebenzi ngokwesini-umnqweno ophantsi ngokwesini, ukuphazamiseka kwesini, iintlungu zesini-banonxibelelwano olomeleleyo lokuziva unezinto zokwaneliseka ngokwasemzimbeni nangokweemvakalelo kunye neemvakalelo eziphantsi zolonwabo. Kuyafana nabasetyhini, amadoda ane-erectile dysfunction kunye namava aphantsi eminqweno yesini anciphise umgangatho wobomi, kodwa abo banokungaphambi kokuchaphazeleka bangachaphazeleka. Ngamafutshane, amava okusebenza gwenxa ngokwesondo ahlala enxulunyaniswa nomgangatho wobomi obugwenxa; nangona kunjalo, ezi ziphumo zingalunganga zibonakala zibanzi kwaye zinokuba nzima ngakumbi kwabasetyhini kunamadoda. Kuvavanyo lokuziphatha okufuna uncedo (uhlalutyo aluboniswanga apha, kodwa luyafumaneka), sifumanise ukuba i-10% ne-20% yala madoda nabafazi banesifo, ngokulandelelana, bafune ukubonwa kwezonyango ngeengxaki zabo zesini.

Izinto ezinje ngobudala zixela kwangaphambili ngobunzima bezesondo, ngakumbi ukungasebenzi kakuhle kwe-erectile. Iingxaki zesondo zixhaphake kakhulu phakathi kwabasetyhini abasebatsha nakumadoda amadala. Ziliqela izinto ezinokuthi zichaze la mahluko umahluko. Kuba abasetyhini abancinci kunokwenzeka ukuba bangatshati, imisebenzi yabo yokwabelana ngesondo ibandakanya amaqondo aphezulu okuphuma kwamaqabane kunye nexesha lokuphulukana nokungasebenzi ngokwesondo. Oku kungazinzi, kudityaniswa nokungafumani mava, kuvelisa ukudakumba ngokwesini, ukubonelela ngesiseko seentlungu zesondo kunye noxinzelelo. Abafana abachaphazelekayo. Amadoda amadala anokuba nengxaki yokugcina okanye ukufezekisa i-erection kunye nokungafumani mdla ngokwesondo. Inzala ephantsi yezesondo kunye neengxaki zokuzala zizinto ezixhomekeke kubudala, ezinokubangelwa kukutshintsha komzimba okunxulunyaniswa nenkqubo yokwaluphala. Ewe, iziphumo zethu ziyahambelana nezo ziveliswe yi-MMAS, ezamisela ukuba i-9.6% yesampulu yamava ayo angenasiphelo kwaye yabonisa umanyano lobudala olomeleleyo olusuka kwi-5% ukuya kwi-15% phakathi kweminyaka yokufunda ye-40 kunye ne-70.⁷

Eminye imibandela enje ngempilo enkenenkene kunye nendlela yabo yokuphila icingela ngokwentelekelelo kumaqela anabantu abaninzi. Ngelixa imeko yokungatshati inxulunyaniswa nentlalo-ntle ephantsi iyonke, inxalenye yomngcipheko ophezulu wokungasebenzi kakuhle ngokwesondo mhlawumbi ibangelwa kukungafani kubomi besini. Ngokufanayo, umngcipheko ophakamileyo onxulumene nokufumana imfundo ephantsi kunye nenqanaba elincinci lokuqinisekisa ukuba abantu abafundiswe ngcono basempilweni kwaye baneendlela zokuphila eziphantsi koxinzelelo lomzimba nangokweemvakalelo. Ukuqonda imiba ebeka umntu esichengeni sokungasebenzi ngokwesondo, kufuneka sihlalutye imingcipheko.

Idatha ye-NHSLS ibonakalisa ukuba iingxaki ezinxulumene neemvakalelo kunye noxinzelelo phakathi kwabasetyhini kunye namadoda zivelisa umngcipheko ophakamileyo wokufumana ubunzima bezesondo kuzo zonke izigaba zomjikelezo wokuphendula ngesondo. Ngelixa silumkisa ukuba i-odolo yokuya kulwalamano ayiqinisekanga, ezi ziphumo zicebisa ukuba ukuphazamiseka kwengqondo kuchaphazela ukusebenza ngokwesondo. Oku akuthethi ukuba impembelelo yezempilo enkenenkene ayinakuchazeka; enyanisweni, okuchaseneyo kuboniswa ukusukela kwiminyaka yobudala, iingxaki zempilo, kunye nosulelo lomgudu womchamo lubangela umngcipheko ophakamileyo wokufumana ukungasebenzi kakuhle ngokwesondo. Endaweni yoko, zombini iimeko zomzimba nezengqondo ziimpawu ezizimeleyo ezichaphazela ukusebenza ngokwesondo.

Ngokunika amandla okubandakanyeka koxinzelelo ngokweemvakalelo kukungasebenzi ngokwesondo, sivavanya i-2 engaphantsi kwemithombo yoxinzelelo lwengqondo: inqanaba lentlalontle kunye nentuthumbo yesini. Idatha ye-NHSLS iphakamisa ngokucacileyo ukuba ukuwohloka kwesimo sentlalontle kuchaphazela ukusebenza kakubi kwezesondo. Ukwehla kwesikhundla soqoqosho kubangela amanqanaba aphezulu koxinzelelo, nto leyo ichaphazela ukusebenza kwezesondo, isiphumo esixhaphake kakhulu phakathi kwabasetyhini kunamadoda. Uphando lwexesha elizayo kufuneka lubhekiswe kwimephu yokwabiwa kwengcinezelo yeemvakalelo.

Ngokubhekisele kumava abuhlungu esini, iziphumo zethu zintsokothile kwaye zibonisa umohluko phakathi kwezesondo kodwa ngokucacileyo zinika ubungqina bokuba la mava angumthombo woxinzelelo lwengqondo. Okokuqala, sifumanise ukuba ifuthe lomsebenzi wesini esifanayo ulungele amadoda kodwa hayi ababhinqileyo. Umthombo wolu mahluko unokubangelwa yintsingiselo yeli zenzo zesondo, kuba ukudibana kwamadoda ukuya kwindoda kuthatha unxibelelwano lwabantu abadala nomntwana. Kuya kufuneka sazi ukuba ezi ziphumo zivavanya iimpembelelo zezehlo zento eyenzeka kubantu besini esifanayo, hayi ubudlelwane phakathi kobungqingili kunye neengxaki zesini. Kwangokunjalo, izikhombisi zokuxhatshazwa ngokwesondo zibonisa iimpembelelo ezomeleleyo kubantu besini esinye. Abafazi, ukunxibelelana komntwana okhulileyo okanye ukunyanzelwa ngokwesini, kokubini okwenziwa ngamadoda, kukhokelela kumngcipheko wokufumana ukuphazamiseka kwengqondo. Ezi ziphumo zixhasa umbono wokuba iinkanuko zesini zibangela ukuphazamiseka kwengqondo okuhlala ixesha elide, ezichaphazela ukusebenza ngokwesondo.²⁸ Kwangokunjalo, amadoda awachukunywayo ngokwesondo ngaphambi kokufikisa nawo anokufumana amava okudakumba ngokwesondo. Ngamafutshane, bobabini ababhinqileyo nababhinqileyo ababhinqileyo besini esingafunekiyo bonisa utshintsho lwexesha elide ekusebenzeni ngokwesondo.

Ngelixa ubudlelwane besizathu phakathi komgangatho wobomi wobomi kunye nokusebenza gwenxa kwezesondo nako kusafuneka kuphandwe, imibutho eqinileyo eqaphelekileyo kwidatha ye-NHSLS iphakamisa ukuba ukungasebenzi ngokwesondo yingxaki enkulu engapholiswanga kodwa ebalulekileyo kwezempilo yoluntu. Ukuqhubela phambili kunyango kunyango lwe-erectile dysfunction kungonyusa umgangatho wobomi kwamanye amadoda. Nangona kunjalo, kuba impilo-ntle ephantsi inxulumana ngamandla neengxaki zesondo zabasetyhini, abaphandi kufuneka bagxile ekuchongeni iziphumo zezi ngxaki nasekuphuhliseni unyango olufanelekileyo. Ngabantu abachaphazelekayo kunqabile ukufumana unyango kunyango lwesondo, imizamo yokuhanjiswa kweenkonzo kufuneka yongezwe ukujolisa kubantu abasemngciphekweni.

Le ngxelo ibonelela ngovavanyo lokuqala olusekwe kubemi lokungazinzi ngokwesondo kule nkulungwane-yamva yeKinsey et al.^29,30 Iziphumo ezivela kwi-NHSLS zibonisa ukuba iingxaki zesini zibanzi eluntwini kwaye ziqhutywa zizinto ezinxulumene nempilo kunye nezengqondo. Indima yomgqibela ichaza ukuba iziganeko zokuphembelela uxinzelelo, ngenxa yomntu okanye imithombo yoluntu, inokuchaphazela ukusebenza ngokwesondo kwabesilisa nabasetyhini. Iipatheni zobunzima bokungasebenzi ngokwesondo kwabonwa kulo lonke ixesha ngokwesini, ubudala, kunye namaqela eedrafic, eqaqambisa imfuno yophando olwenziweyo kwiinkqubo ze-etiologic. Ngobudlelwane obuluqilima phakathi kokungasebenzi kakuhle ngokwesondo kunye nobomi obonakele, le ngxaki iqinisekisa ukwamkelwa njengenkxalabo ebalulekileyo yezempilo yoluntu.

IZALATHISO