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Sexual Abstinence and Associated Factors Among Young and Middle-Aged Men: A Systematic Review

Open AccessPublished:January 16, 2020DOI:https://doi.org/10.1016/j.jsxm.2019.12.003

      Abstract

      Introduction

      Sexual activity is an essential human need and an important predictor of other aspects of human life. A literature review was conducted to investigate whether sexual abstinence in young and middle-aged men is generally considered a deliberate, healthy behavior and whether it has other causes and consequences.

      Aim

      To review the prevalence and factors associated with sexual abstinence in young (10–24 years) and middle-aged (25–59 years) men.

      Methods

      Studies were retrieved from Science Direct, PubMed, and EBSCOhost published from 2008 to 2019. The selection criteria were original population- or community-based articles, published in the English language, on sexual abstinence, and in young and middle-aged men.

      Main Outcome Measure

      This article reviewed the literature on the proportions of and factors associated with sexual abstinence in young and middle-aged men.

      Results

      A total of 13,154 studies were retrieved, from which data were extracted for 37 population- or community-based studies. The prevalence of sexual abstinence varied from 0% to 83.6% in men younger than 60 years. The prevalence of primary sexual abstinence was 3.4%–83.3% for young men and 12.5%–15.5% for middle-aged men. The prevalence of secondary abstinence for young men ranged from 1.3% to 83.6%, while for middle-aged men, it was from 1.2% to 67.7%. The prevalence of sexual abstinence decreased with increasing age in young men but increased with increasing age in middle-aged men. The significant factors reported were age, single status, poor relationships, low socioeconomic status, sex education, religious practices, caring and monitoring parents, and not using alcohol, cigarettes, or drugs. Although the variations in findings from different studies can be explained by different regions and cultures, the information cannot be generalized worldwide because of a lack of studies in Asian and Australian populations.

      Clinical Implications

      The studies on sexual abstinence in the future should use a consistent and standard definition, cover all sexual behaviors, and investigate all related factors.

      Strength & Limitations

      The restricted timeframe (2008–2019), English language, availability of full text, and variability in definition and time duration may be the sources of bias.

      Conclusion

      Young men had higher proportions of sexual abstinence than middle-aged men, and age, unavailability of a partner, lower educational levels, low socioeconomic status, conservative and religious conditions, and no or less knowledge about sexually transmitted infections were common predictors of sexual abstinence in most of the men. Although determinants of sexual abstinence were identified, further investigation of biological factors in men younger than 60 years is needed.
      Irfan M, Hussain NHN, Noor NM, et al. Sexual Abstinence and Associated Factors Among Young and Middle-Aged Men: A Systematic Review. J Sex Med 2020;17:412–430.

      Key Words

      Background

      Sexual abstinence is defined as refraining from sexual activities for a long period.
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      Determinants of sexual abstinence and condom use among Central American adolescents.
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      Traditional values of virginity and sexual behaviour in rural Ethiopian youth: results from a cross-sectional study.
      behavioral (eg, low sexual desire disorder, asexuality, and homosexuality),
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      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
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      Declining sexual activity and desire in men—findings from representative German surveys, 2005 and 2016.
      psychological (eg, personal beliefs, low sexual self-esteem, feeling nervous, fear to drop out of school or concentrate on education, guilt and feelings of being used, low sexual satisfaction, painful intercourse, performance anxiety, and depression),
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      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
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      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
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      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      family and friends (eg, sexually inactive friends, family encourages abstinence, nonfamilial role model, living alone with single parent or other guardians),
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      Determinants of sexual abstinence and condom use among Central American adolescents.
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      Traditional values of virginity and sexual behaviour in rural Ethiopian youth: results from a cross-sectional study.
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      The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults.
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      Parental youth assets and sexual activity: differences by race/ethnicity.
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      Correlates of sexual initiation among adolescent and youth in Addis Ababa, Ethiopia: a community based cross sectional study.
      religious (eg, prohibition on extramarital and premarital sex),
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      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
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      The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults.
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      Associations between sexual abstinence ideals, religiosity, and alcohol abstinence: a longitudinal study of Finnish twins.
      sexual education (sex education and virginity pledges or less education about birth control and STIs),
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      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
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      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      ,
      • Haglund K.A.
      • Fehring R.J.
      The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults.
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      Ethnic differences in sexual behaviour among unmarried adolescents and young adults in Zimbabwe.
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      • et al.
      New opportunities in teen pregnancy prevention: identifying individual and environmental differences between youth who abstain, use contraception, and use no contraception.
      or socioeconomic (eg, low or no education, parents highly educated, unemployment, low income, high income of parents, avoiding unwanted pregnancies).
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      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Byers E.
      • O'Sullivan L.
      • Brotto L.
      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
      ,
      • Gutierrez Fernandez L.
      • Solorzano R.M.
      • Valverde M.F.
      • et al.
      Determinants of sexual abstinence and condom use among Central American adolescents.
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      Sexual inactivity during young adulthood is more common among U.S. millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18.
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      Normative sexuality development in adolescence: a decade in review, 2000–2009.
      Various population- and community-based studies have been published on the proportions of and factors affecting sexual abstinence in men younger than 60 years, mostly in reference to STIs and unwanted pregnancies, but no systematically reviewed literature was found with respect to men younger than 60 years. The present review was therefore conducted to examine sexual abstinence in young and middle-aged men (younger than 60 years) and its associated factors.

      Methods

       Search Strategy

      The literature was searched using the Science Direct, PubMed and EBSCOhost (EBSCO discovery services) databases with the following keywords: “sexual inactivity,” “sexual inexperience,” and “sexual abstinence.”

       Definition

      For the purpose of this review, primary sexual abstinence was defined as refraining from all sexual activities (intercourse, masturbation, and touching partner's genitals or breasts) forever while secondary abstinence was defined as a sexual inactivity presently.

       Inclusion and Exclusion Criteria

      In this review of the literature, both primary and secondary sexual abstinence were considered. The criteria for eligibility of studies included original population- or community-based studies, published from 2008 to 2019, in the English language and having a quantitative design or part. In this regard, conference abstracts and proceedings, case reports, reviews, and editorials were excluded. Furthermore, studies conducted in a specific diseased cohort of populations were also excluded. Articles that combined the prevalence of sexual abstinence in younger and middle-aged men (younger than 60 years) with elderly men (older than 60 years) were excluded from this systematic review because of the inability to separate the results related to reproductive age. Studies undertaken within the 10-year period are included in the systematic review because they reflect the current state of knowledge.
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      • Hazlina N.H.
      • Asrenee A.R.
      • et al.
      Magnitude and risk factors for postpartum symptoms: a literature review.
      Men from 10 to 24 years of age were categorized as young men as per the criteria of the World Health Organization. Men of 25 to 59 years of age were considered middle-aged men for the purpose of this review.

       Data Extraction

      The studies were carefully reviewed, and information was extracted about the first authors, study types, population characteristics, sampling durations, types of sexual abstinence, definitions of sexual abstinence, and instruments and methods used to assess the prevalence and associated factors. All discrepancies were resolved by discussion.

      Results

       Characteristics of Included Studies

      We retrieved a total of 13,154 studies. After removing duplicates, the remaining studies were screened based on titles and abstracts. The full articles were downloaded for 423 studies, of which 386 were excluded (Figure 1). The information on the number of subjects, duration of the study, type of the study, type of sexual inactivity, tools of assessment, criteria of assessment, and proportions and factors of sexual abstinence were extracted from the finalized 37 population- or community-based studies for the present review. 33 (89.2%) studies were cross-sectional, and 4 (10.8%) were longitudinal in design. Furthermore, 30 (81.1%) studies used random while 7 (18.9%) used nonrandom sampling methods.
      Figure thumbnail gr1
      Figure 1Flow diagram of study selection. Figure 1 is available in color online at www.jsm.jsexmed.org.
      Table 1 shows 37 population- or community-based studies reporting sexual abstinence in young and middle-aged men. These studies were from Africa (n = 8; 21.6%), Asia (n = 5; 13.5%), Australia (n = 2; 5.4%), Europe (n = 8; 21.6%), and North America (n = 14; 37.8%).
      Table 1Population-based studies on sexual abstinence or inactivity in young men (<60 yr)
      Author (year)Sampling durationStudy design/sampling methodAssessment method/instrument validityDefinitionType of sexual abstinencePrevalence (%)Associated factors
      CountryYoung men (<60 yr)SignificantNonsignificant
      TotalAge groups
      Africa
      Yode and LeGrand (2012)
      • Yode M.
      • LeGrand T.
      Association between age at first sexual relation and some indicators of sexual behaviour among adolescents.
      2004CS/PB/RFace-to-face interview/NVNo SI/yrSecondary abstinence79.0
      Mean frequencies.
      14–19 yr: 83.6 (Burkina Faso)--
      NSA data14–19 yr: 76.6 (Malawi)
      14–19 yr: 76.8 (Uganda)
      Congo
      Kayembe et al (2008)
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      2004–2006CS/PB/RIAQ/VNo SI/everPrimary abstinence21.8
      Mean frequencies.
      15–19 yr: 35.2(−)AgeSocioeconomic status
      20–24 yr: 8.3(−)Refused sexLiving with both parents, single parent, alone, friend, or employer
      (+)Living with guardians (aunt, uncle, grandparents)Permissive environment
      (+)Never attended school
      (−)Self-dependent
      (−)Drugs
      (−)Alcohol
      No SI/yrSecondary abstinence67.5
      Mean frequencies.
      15–19 yr: 62.9(−)AgeSocioeconomic status
      20–24 yr: 72(−)Refused sexLiving with both parents, single parent, alone, friend, or employer
      (+)Medium incomeNever attended school
      (+)Living with other parents (aunt, uncle, grandparents)
      (−)Self-dependent
      (−)Drugs
      (−)Alcohol
      (−) Permissive environment
      Ethiopia
      Molla et al (2008)
      • Molla M.
      • Berhane Y.
      • Lindtjorn B.
      Traditional values of virginity and sexual behaviour in rural Ethiopian youth: results from a cross-sectional study.
      2004CS/PB/RFace-to-face interview/VNo SI/everPrimary abstinence5115–24 yr: 51(−) Age
      (−) Alcohol
      (−) Khat chewing
      (−) Primary/above education
      (+) Believe in virginity norms
      Bizuneh (2019)
      • Bizuneh H.
      Correlates of sexual initiation among adolescent and youth in Addis Ababa, Ethiopia: a community based cross sectional study.
      2017CS/CB/RFace to face interview/VNo SI/everPrimary abstinence56.115–24 yr: 56.1(−) AgeSelf and maternal educational status
      (−) Monthly income
      (+) Parental monitoring
      (−) Drinking alcohol
      (−) Perceived peer sexual initiation
      (−) Living alone
      South Africa
      Katz and Low-Beer (2008)
      • Katz I.
      • Low-Beer D.
      Why has HIV stabilized in South Africa, yet not declined further? Age and sexual behavior patterns among youth.
      2002CS/PB/RFace-to-face interview/VNo SI/everPrimary abstinence42.1
      Mean frequencies.
      15–24 yr: 44.4--
      2003KABP data15–24 yr: 35.8
      200515−24 yr: 46.1
      2002No SI/yrSecondary abstinence12.1
      Mean frequencies.
      15−24 yr: 10.2
      200315−24 yr: 13.7
      200515−24 yr: 12.4
      Uganda
      Biraro et al (2009)
      • Biraro S.
      • Shafer L.A.
      • Kleinschmidt I.
      • et al.
      Is sexual risk taking behaviour changing in rural south-West Uganda? Behaviour trends in a rural population cohort 1993-2006.
      1993Lt/Coh/CensusFace-to-face interview/VNo SI/everPrimary abstinence77.2
      Mean frequencies.
      13–19 yr: 71.7(+) Subsequent sampling yearSubsequent sampling year
      200613–19 yr: 82.6
      1997No SI/yrSecondary abstinence20.0
      Mean frequencies.
      13–19 yr: 9.8
      200513–19 yr: 28.9
      200613–19 yr: 21.4
      Zambia
      Kembo (2013)
      • Kembo J.
      Changes in sexual behaviour and practice and HIV prevalence indicators among young people aged 15-24 years in Zambia: an in-depth analysis of the 2001-2002 and 2007 Zambia Demographic and Health Surveys.
      2007CS/PB/RFace-to-face interview/VNo SI/everPrimary abstinence55.315–24 yr: 55.3(−) Urban area (Primary abstinence)
      ZDHS data15–24 yr: 59.7 (Urban)
      15–24 yr: 51.2 (Rural)
      No SI/yrSecondary abstinence27.215–24 yr: 27.2
      15–24 yr: 35.2 (Urban)
      15–24 yr: 20.9 (Rural)
      Zimbabwe
      Sambisa et al (2010)
      • Sambisa W.
      • Curtis S.L.
      • Stokes C.S.
      Ethnic differences in sexual behaviour among unmarried adolescents and young adults in Zimbabwe.
      2005–2006CS/PB/RFace-to-face interview/VNo SI/yr or everAbstinence54.615–24 yr: 59.3 (Shona)(+) Ethnicity: Shona vs NdebeleArea of residence
      ZDHS data15–24 yr: 49.9 (Ndebele)(+) Currently attending schoolHIV-related knowledge
      (+)Secondary or higher schooling
      (+) Christian religion
      (+) Socioeconomic status
      (−) Perception of low self HIV risk
      China
      Kim et al (2009)
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      2002CS/PB/RTAI/NVSexlessness/yrSecondary abstinence9.2
      Mean frequencies.
      25–34 yr: 5.5(+) Age: 45–59 yrQuality of relationship
      35–44 yr: 5.1(−) Education (<Form 6)Working hours
      45–59 yr: 17.0(+) UnemployedExercise/week
      8.5
      Mean frequencies.
      25–34 yr: 4.9
      Good marital status.
      (+) Lack of interest in sexSmoking status
      35–44 yr: 5.3
      Good marital status.
      (+) Erectile difficultiesAlcohol
      45–59 yr: 15.3
      Good marital status.
      (−) Chronic anxiety about sexSubstance abuse
      9.6
      Mean frequencies.
      25–34 yr: 4.3
      Fair marital status.
      (+) Sexual dissatisfactionPhysical health
      35–44 yr: 2.4
      Fair marital status.
      Chronic diseases
      45–59 yr: 22.2
      Fair marital status.
      Sexual knowledge
      19.7
      Mean frequencies.
      25–34 yr: 33.3
      Poor marital status.
      Belief about importance of sex life
      35–44 yr: 16.7
      Poor marital status.
      Family-related stress
      45–59 yr: 9.1
      Poor marital status.
      Financial stress
      Work-related stress
      Sexual orientation
      Low mental health
      Low vitality
      Life satisfaction
      Sex partner unavailability
      Depression
      Huang et al (2014)
      • Huang Y.-P.
      • Chen B.
      • Ping P.
      • et al.
      Asexuality development among middle aged and older men.
      2008–2011Lt/PB/RSAQ/NVNo SI/6 monthsSecondary abstinence76540–51: 58.6(+) AgeBMI
      52–59 yr: 60.1(+) DiabetesWC
      (+) HypertensionExercise
      Alcohol
      Tea
      Smoking
      Dyslipidemia
      BPH
      PLS
      Japan
      Koffi and Kawahara (2008)
      • Koffi A.K.
      • Kawahara K.
      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      2005CS/PB/R/AIS-Cote d’IvoreFace-to-face interview/VNo SI/everPrimary abstinence32.615–16 yr: 47.2(−) AgeEducation
      17–18 yr: 27.7(−) AnimistLiving in Northwest region
      19–20 yr: 15.2(−) No religionArea of residence
      21–22 yr: 6.5(+) Christianity or Islam
      23–24 yr: 3.4(−) Knowing someone has AIDS or died of AIDS
      Secondary abstinence6.715–16 yr: 7.1(+) Faithfulness
      17–18 yr: 14.3(−) Knowing condom use can prevent AIDS
      19–20 yr: 33.3(+) Knowing that sharing food does not spread AIDS
      21–22 yr: 20.2
      23–24 yr: 24.7
      Ghaznavi et al (2019)
      • Ghaznavi C.
      • Sakamoto H.
      • Yoneoka D.
      • et al.
      Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987–2015.
      1987Lt/PB/RSAQ/VNo SI with opposite sex/everPrimary abstinence18–19 yr: 74.9For 25–39 yr (+) Part-time or temporary employmentEducation
      NFS20–24 yr: 41.9(+) UnemploymentBusiness owner
      25–29 yr: 18.9(+) Student
      30–34 yr: 8.8(−) Annual income
      199220.018–19 yr: 74.4(+) Residing in the Kanto, Kinki, and Chubu regions
      20–24 yr: 40.4(−) Residence in a densely inhabited
      25–29 yr: 16.7For 18- to 24-year-old men: (+) Part-time or temporary employment
      30–34 yr: 8.2(+) Unemployment
      35–39 yr: 5.5(−) Annual income
      199719.318–19 yr: 68.3(−) Residence in a densely inhabited
      20–24 yr: 35.2(+) Residing in Kanto region
      25–29 yr: 17.9
      30–34 yr: 9.5
      35–39 yr: 6.2
      200219.518–19 yr: 66.1
      20–24 yr: 34.2
      25–29 yr: 18.7
      30–34 yr: 10.5
      35–39 yr: 6.6
      200520.718–19 yr: 67.8
      20–24 yr: 34.6
      25–29 yr: 18.8
      30–34 yr: 12.5
      35–39 yr: 8.3
      201022.518–19 yr: 72.5
      20–24 yr: 39.7
      25–29 yr: 18.3
      30–34 yr: 12.7
      35–39 yr: 10.2
      201518–19 yr: 75.7
      20–24 yr: 49.0
      25–29 yr: 32.8
      30–34 yr: 26.8
      35–39 yr: 27.1
      Taiwan
      Liu et al (2010)
      • Liu C.C.
      • Juan H.C.
      • Lee Y.C.
      • et al.
      The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men.
      2007–2008CS/CB/NRIAQ/NVNo SI/6 monthsSecondary abstinence7.440–49 yr: 7.1(−) EducationAge
      50–59 yr: 7.4(+) Loss of partnerEmployment status
      (+) EDSexual desire
      (+) ≥2 comorbidities
      Australia
      Holden et al (2014)
      • Holden C.A.
      • Collins V.R.
      • Handelsman D.J.
      • et al.
      Healthy aging in a cross-sectional study of Australian men: what has sex got to do with it?.
      2003CS/PB/RTA/CAI/NVNo SA/MonthSecondary abstinence10.5
      Mean frequencies.
      40–49 yr: 7.0(+) Age
      50–59 yr: 14.0(+) BMI
      7.15
      Mean frequencies.
      40–49 yr: 4.6
      Good health.
      (−) Good health
      50–59 yr: 9.7
      Good health.
      13.2
      Mean frequencies.
      40–49 yr: 9.3
      Bad health.
      50–59 yr: 17.4
      Bad health.
      New Zealand
      Quilter et al (2017)
      • Quilter M.
      • Hodges L.
      • von Hurst P.
      • et al.
      Male sexual function in New Zealand: a population-based cross-sectional survey of the prevalence of erectile dysfunction in men aged 40–70 years.
      2012CS/PB/RPostal SAQ/VNo SI/monthSecondary abstinence21.640–49 yr: 19.0(+) Age
      50–59 yr: 24.4
      Croatia
      Puzek et al (2012)
      • Puzek I.
      • Stulhofer A.
      • Bozicevic I.
      Is religiosity a barrier to sexual and reproductive health? Results from a population-based study of young Croatian adults.
      2010CS/PB/RSAQ/VNo SI/everPrimary abstinence13.518–25 yr: 13.5Parents' education
      KABPTwo-parent family
      Settlement size
      Religious upbringing
      Denmark
      Andersen et al (2008)
      • Andersen I.
      • Heitmann B.L.
      • Wagner G.
      Obesity and sexual dysfunction in younger Danish men.
      2004CS/CB/NRPostal SAQ/NVNo SI/6 monthsSecondary abstinence3.320–45 yr: 3.3
      Christensen et al (2011)
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      2005CS/PB/RSAQ/NVNo SA/yrSecondary abstinence1.7
      Mean frequencies.
      16–19 yr: 1.3(+) Age (in later age)Difficulty paying bills
      20–29 yr: 1.4(−) EducationPlace of residence
      30–39 yr: 1.2(−) EmploymentBMI
      40–49 yr: 1.3(−) IncomeSmoking
      50–59 yr: 3.2(+) Single
      (−) Alcohol
      Europe
      Mean frequencies.
      Corona et al (2010)
      • Corona G.
      • Lee D.M.
      • Forti G.
      • et al.
      Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS).
      NSCS/PB/RIAQ/VNo SA/NSAbstinence6.140–49 yr: 3.0(+) Age
      EMAS50–59 yr: 9.0(+) Depression
      (+) CVD
      Finland
      Kontula et al (2009)
      • Kontula O.
      • Haavio-Mannila E.
      The impact of aging on human sexual activity and sexual desire.
      1992&1999CS/PB/RAt spot or postal SAQ/NVNo SI/yrSecondary abstinence9
      Mean frequencies.
      45–54 yr: 5(+) AgeEducation
      55–64 yr: 13(−) Consider sex life important for happinessIncome
      (−) Number of partnersExercise frequency
      (−) Latest intercourseBMI
      (−) High sexual self-esteemStress
      (−) Pleasant sexual historyDuration of the present relationship
      (−)Satisfaction with sexPartner's orgasm & illness
      (−) EDPhysical closeness
      (+) Illness
      (−) Alcohol use
      Winter et al (2014)
      • Winter T.
      • Karvonen S.
      • Rose R.J.
      Associations between sexual abstinence ideals, religiosity, and alcohol abstinence: a longitudinal study of Finnish twins.
      1990–2000Lt/PB/RPostal SAQ/VNo sexual partner/everPrimary abstinence24 yr: 9 (Total)
      24 yr: 41 (Religious)
      24 yr: 33 (Nonreligious)
      24 yr: 6 (Others)
      Germany
      Beutel et al (2018)
      • Beutel M.E.
      • Burghardt J.
      • Tibubos A.N.
      • et al.
      Declining sexual activity and desire in men—findings from representative German surveys, 2005 and 2016.
      2005CS/PB/RIAQ/NVNo sexual intimation/yrSecondary abstinence8.018–30 yr: 7.5(+) Age (in later age)
      31–40 yr: 7.9(+) Sampling in subsequent year
      41–50 yr: 8.4(+) Nonpartnered
      51–60 yr: 12.8
      2.2n18–30 yr: 0.0
      Partnered.
      31–40 yr: 3.1
      Partnered.
      41–50 yr: 2.9
      Partnered.
      51–60 yr: 9.0
      Partnered.
      18.8p18–30 yr: 11.0
      Single.
      31–40 yr: 20.4
      Single.
      41–50 yr: 23.2
      Single.
      51–60 yr: 27.3
      Single.
      201616.118–30 yr: 20.3
      31–40 yr: 11.9
      41–50 yr: 16.1
      51–60 yr: 22.0
      4.0n18–30 yr: 3.6
      Partnered.
      31–40 yr: 2.6
      Partnered.
      41–50 yr: 5.9
      Partnered.
      51–60 yr: 6.2
      Partnered.
      30.9p18–30 yr: 28.3
      Single.
      31–40 yr: 32.1
      Single.
      41–50 yr: 32.4
      Single.
      51–60 yr: 51.9
      Single.
      United Kingdom
      Wellings et al (2019)
      • Wellings K.
      • Palmer M.J.
      • Machiyama K.
      • et al.
      Changes in, and factors associated with, frequency of sex in Britain: evidence from three National Surveys of Sexual Attitudes and Lifestyles (Natsal).
      1991CS/PB/RCAI/VNo SA/monthSecondary abstinence30.916–24 yr: 50.3
      Natsal25–34 yr: 23.4
      35–44 yr: 20.5
      200126.016–24 yr: 43.0
      25–34 yr: 19.5
      35–44 yr: 19.4
      201229.216–24 yr: 43.4
      25–34 yr: 23.1
      35–44 yr: 22.8
      NORTH AMERICA
      Canada
      Byers et al (2016)
      • Byers E.
      • O'Sullivan L.
      • Brotto L.
      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
      NSCS/NRWeb-based SAQ/VNo SA/few days to yrSecondary abstinence1616–21 yr: 16(+) ReligosityAge
      (+) Sexual coercionSexual esteem
      Sexual distress
      Dysfunctional sexual beliefs
      United States
      Tolma et al (2008)
      • Tolma E.L.
      • Vesely S.K.
      • Oman R.F.
      • et al.
      Youth assets and sexual activity: differences based on race/ethnicity.
      2003–2004CS/PB/RCA-SAQ/VQNo SI/everPrimary abstinence69.112–19 yr: 64.8 NHB(−) AgeGood health ptactices
      12–19 yr: 73.2 NHW(+) Parental income (NHB and NHW)
      12–19 yr: 69.4 H(+) 2 parents household (NHB, NHW, and H)
      (+) Parents had bachelor degree or higher (NHB, NHW, and H)
      (+) Nonparental role model
      (+) Peer role models (H)
      (+) Family communication (NHW)
      (+) Use of time (group/sport) (NHW)
      (+) Use of time (Religion) (NHW and H)
      (+) Community involvement (NHW)
      (+) Future aspirations (NHW and H)
      (+) Responsible choices (NHW and H)
      Eisenberg et al (2009)
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      2002–2003CS/PB/RCAI/VNo SI/everPrimary abstinence13.925–29 yr: 12.5(−) AlcoholAge
      30–34 yr: 15.2(+) Religious servicesRace
      35–39 yr: 13.6(−) Military serviceEducation
      40–45 yr: 15.5(−) IncarcerationMarijuana
      (+) HomosexualityHealth status
      Gutierrez Fernandez et al (2010)
      • Gutierrez Fernandez L.
      • Solorzano R.M.
      • Valverde M.F.
      • et al.
      Determinants of sexual abstinence and condom use among Central American adolescents.
      2004–2008CS/NR/Web-based SAQ/NVNo sex/everPrimary abstinence7210–19 yr: 72(−) Age
      (−) Residents of Guatemala
      (−) Employed
      (−) Pressure to have sex
      (−) Having a partner
      (−) Sexually active friends
      (−) Sexually abused family member
      (−) Alcohol
      (−) Drugs use
      (−) Chronic illness
      (−) Smoking
      (+) Care about others
      (+) Brushing teeth
      (+) Parent recommend to not have sex
      (+) Positive perception of condom use
      (−) Feeling nervous
      Haglund and Fehring (2010)
      • Haglund K.A.
      • Fehring R.J.
      The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults.
      2002CS/PB/RFace-to-face interview/VNo SA/everPrimary abstinence4215–21 yr: 42(+) Religion importantParents promoted abstinence
      (+) Attend religious services frequently
      (+) Religious attitudes on sexuality
      (+) Formal sex education
      (+) Virginity pledge
      (+) 2-parent family system
      Reece et al (2010)
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      2009CS/PB/RWeb-based SAQ/VNo SI/yrSecondary abstinence27.618–24 yr: 40.1(+) Age (in later age)Health status
      NSSHB25–29 yr: 14.4(+) Nonpartnered
      30–39 yr: 14.8
      40–49 yr: 26.5
      50–59 yr: 42.4
      51.9
      Mean frequencies.
      18–24 yr: 56.9
      Single.
      25–29 yr: 46.6
      Single.
      30–39 yr: 39.6
      Single.
      40–49 yr: 48.9
      Single.
      50–59 yr: 67.7
      Single.
      25.3
      Mean frequencies.
      18–24 yr: 26.0
      Partnered.
      25–29 yr: 20.8
      Partnered.
      30–39 yr: 15.6
      Partnered.
      40–49 yr: 29.9
      Partnered.
      50–59 yr: 34.1
      Partnered.
      8.0
      Mean frequencies.
      18–24 yr: 4.2
      Married.
      25–29 yr: 1.6
      Married.
      30–39 yr: 4.5
      Married.
      40–49 yr: 9.1
      Married.
      50–59 yr: 20.6
      Married.
      Schick et al (2010)
      • Schick V.
      • Herbenick D.
      • Reece M.
      • et al.
      Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults.
      2009CS/PB/RCA-SAQ/VNo SI/yrSecondary abstinence42.450–59 yr: 42.4(−) PartneredAge
      NSSHBHealth status
      Tolma et al (2011)
      • Tolma E.L.
      • Oman R.F.
      • Vesely S.K.
      • et al.
      Parental youth assets and sexual activity: differences by race/ethnicity.
      2003–2004CS/PB/RCA-SAQ/VQNo SI/everPrimary abstinence74.6
      Mean frequencies.
      12–19 yr: 63.4 NHB(−) Age (NHB, NHW and H)Family communication (NHB & H)
      12–19 yr: 83.3 NHW(+) Parental income (NHW and H)Relationship with father (NHW & H)
      12–19 yr: 77.1 H(+) Live with no parents (NHB)Relationship with mother (H)
      (+) Parental education (NHB and H)
      (+) Relationship with mother/Father (NHB)
      (+) Parental monitoring (NHB, NHW, and H)
      (+) Family communication (NHW)
      (+) Relationship with mother
      Cummings et al (2014)
      • Cummings T.
      • Auerswald C.L.
      • Ott M.A.
      Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high–sexually transmitted infection prevalence communities.
      NSCS/CB/NRCA-IAQ/NVNo sex partner/everPrimary abstinence37.814–17 yr: 37.8(−) AgeHaving partner
      (+) White ethnicityTalking to parents about sex and relationship
      (−) Touching partner genitals/getting genital touch from partnerTouching breast
      (+) Low conventional masculine value
      Wright et al (2015)
      • Wright A.
      • Duffy J.
      • Kershner S.
      • et al.
      New opportunities in teen pregnancy prevention: identifying individual and environmental differences between youth who abstain, use contraception, and use no contraception.
      2011CS/PB/RIAQ/NVNo SI/everPrimary abstinence53.715–19 yr: 53.7(−) AgeRecognition of social problems
      (−) African American ethnicityCommunity protects and provide
      (−) Talked to parents about sex or birth controlSocial engagement
      Ways to get information about sex and birth control
      Sex education
      Peer norms
      Exposure to birth control options
      Kim et al (2017)
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      1988–2002CS/PB/RFace-to-face/CA- interview/VNo SI/yrSecondary abstinence11.2
      Mean frequencies.
      <25 yr: 16.2(−) AgeWork and financial satisfaction
      25–34 yr: 8.2(−) Years of educationSexual attitude (moderate/conservative)
      35–44 yr: 7.7(+) WhiteHappiness
      45–54 yr: 12.6(−) Married
      Sexlessness/5 yrSecondary abstinence6.8
      Mean frequencies.
      <25 yr: 13.6(+) Low household income and contribution
      25–34 yr: 3.4(+) Poor health
      35–44 yr: 3.3(−) Having children
      45–54 yr: 6.7(+) Less socialization
      Twenge et al (2017)
      • Twenge J.M.
      • Sherman R.A.
      • Wells B.E.
      Sexual inactivity during young adulthood is more common among U.S. millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18.
      1972–2014CS/PB/RFace-to-face/CA-interview/VNo sexual partner/yrSecondary abstinence11.0
      Mean frequencies.
      20–24 yr: 8 (Born in 1960)(−) AgeBorn in 1990 vs 1960
      20–24 yr: 14 (Born in 1990)(−) College education
      (+) East region
      (+) Religious services
      (+) White ethnicity
      Harris et al (2019)
      • Harris A.L.
      • Fantasia H.C.
      • Castle C.E.
      Father 2 son: the impact of African American father–son sexual communication on African American adolescent sons’ sexual behaviors.
      2015CS/CB/NRWeb-based SAQ/NVNo Sexual partner/everPrimary abstinence38.516–24 yr: 38.5
      No SA/monthSecondary abstinence44.816–24 yr: 44.8
      Landor and Simons (2019)
      • Landor A.M.
      • Simons L.G.
      Correlates and predictors of virginity among heterosexual African American young adults.
      1998–2011Lt/PB/RCAI/NVNo SI/everPrimary abstinence14.2
      Mean age.
      10.5–23.5 yr: 14.2
      (+) OverweightSkin tone
      FACHS(−) Physically unattractiveHealth status
      (+) College educationDepression
      (−) Higher cognitive performanceSelf-image
      (+) AnxietyPrevious sexual abuse
      (+) Self-esteemAttitudes toward marriage
      (+) Religion very importantParental quality
      (+) Attended religious servicesIncarceration
      (+) ArrestedSmoking
      (+) Live with 2 parents
      (−) In a relationship
      (−) Antisocial friend
      (+) Living in a neighborhood with social disorder
      AIDS = acquired immunodeficiency syndrome; BMI = body mass index; BPH: benign prostatic hyperplasia; CAI = computer-assisted interview; CB = community-based; CS = cross-sectional; CVD = cardiovascular disease; DSM-IV = Manual of Mental Disorder-IV; ED = erectile dysfunction; EMAS SFQ = European Male Aging Study Sexual Function Questionnaire; H = Hispanic; HIV = human immunodeficiency virus; IAQ = interviewer-assisted questionnaire; Lt = Longitudinal; n = living without partner; NHB = non-Hispanic black; NHW = non-Hispanic white; NR = nonrandom; NS = not stated; NVI nonvalid instrument; p = living with partner; PB = population-based; PLS = primary lateral sclerosis; R = random; SA = sexual activity; SAQ = self-administered questionnaire; SI = sexual intercourse (penile-vaginal); VI = valid instrument; WC = waist circumference; yr = year.
      Mean frequencies.
      Good marital status.
      Fair marital status.
      § Poor marital status.
      Good health.
      Bad health.
      # Partnered.
      ∗∗ Single.
      †† Married.
      ‡‡ Mean age.

       Definition of Sexual Abstinence

      The definitions for sexual abstinence or/inactivity varied across the studies, although a strong focus on penile-vaginal intercourse was observed. Most of the studies (n = 31; 86.1%) included analyses of possible factors related to sexual abstinence. 22 percent (n = 8) of the studies performed analyses on an inclusive definition of “sexual inactivity or sexlessness” that incorporated a range of specified behaviors within a single construct.
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      • Byers E.
      • O'Sullivan L.
      • Brotto L.
      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Haglund K.A.
      • Fehring R.J.
      The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults.
      ,
      • Corona G.
      • Lee D.M.
      • Forti G.
      • et al.
      Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS).
      • Holden C.A.
      • Collins V.R.
      • Handelsman D.J.
      • et al.
      Healthy aging in a cross-sectional study of Australian men: what has sex got to do with it?.
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      The absence of sexual activities was described for a specific timeframe (eg, a few days, 1 week, 1 month, 3 months, 6 months, 1 year, 5 years) (Table 1).

       Prevalence of Sexual Abstinence in Population-Based Studies

      The authors of the selected studies defined sexual abstinence or inactivity as primary when men had no sexual experience at all or secondary when they had persistent sexual abstinence for a period of 2 weeks to 5 years. The prevalence of sexual abstinence varied from 0% to 83.6% in men younger than 60 years. The overall prevalence for young and middle-aged men ranged from 1.3% to 83.6%
      • Yode M.
      • LeGrand T.
      Association between age at first sexual relation and some indicators of sexual behaviour among adolescents.
      ,
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      • Byers E.
      • O'Sullivan L.
      • Brotto L.
      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Gutierrez Fernandez L.
      • Solorzano R.M.
      • Valverde M.F.
      • et al.
      Determinants of sexual abstinence and condom use among Central American adolescents.
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      • Molla M.
      • Berhane Y.
      • Lindtjorn B.
      Traditional values of virginity and sexual behaviour in rural Ethiopian youth: results from a cross-sectional study.
      ,
      • Koffi A.K.
      • Kawahara K.
      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      • Haglund K.A.
      • Fehring R.J.
      The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults.
      • Tolma E.L.
      • Oman R.F.
      • Vesely S.K.
      • et al.
      Parental youth assets and sexual activity: differences by race/ethnicity.
      ,
      • Sambisa W.
      • Curtis S.L.
      • Stokes C.S.
      Ethnic differences in sexual behaviour among unmarried adolescents and young adults in Zimbabwe.
      • Wright A.
      • Duffy J.
      • Kershner S.
      • et al.
      New opportunities in teen pregnancy prevention: identifying individual and environmental differences between youth who abstain, use contraception, and use no contraception.
      • Twenge J.M.
      • Sherman R.A.
      • Wells B.E.
      Sexual inactivity during young adulthood is more common among U.S. millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18.
      ,
      • Biraro S.
      • Shafer L.A.
      • Kleinschmidt I.
      • et al.
      Is sexual risk taking behaviour changing in rural south-West Uganda? Behaviour trends in a rural population cohort 1993-2006.
      • Cummings T.
      • Auerswald C.L.
      • Ott M.A.
      Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high–sexually transmitted infection prevalence communities.
      • Katz I.
      • Low-Beer D.
      Why has HIV stabilized in South Africa, yet not declined further? Age and sexual behavior patterns among youth.
      • Kembo J.
      Changes in sexual behaviour and practice and HIV prevalence indicators among young people aged 15-24 years in Zambia: an in-depth analysis of the 2001-2002 and 2007 Zambia Demographic and Health Surveys.
      • Tolma E.L.
      • Vesely S.K.
      • Oman R.F.
      • et al.
      Youth assets and sexual activity: differences based on race/ethnicity.
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      and 0%–67.7%,
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      • Schick V.
      • Herbenick D.
      • Reece M.
      • et al.
      Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults.
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      ,
      • Beutel M.E.
      • Burghardt J.
      • Tibubos A.N.
      • et al.
      Declining sexual activity and desire in men—findings from representative German surveys, 2005 and 2016.
      ,
      • Corona G.
      • Lee D.M.
      • Forti G.
      • et al.
      Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS).
      • Holden C.A.
      • Collins V.R.
      • Handelsman D.J.
      • et al.
      Healthy aging in a cross-sectional study of Australian men: what has sex got to do with it?.
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      ,
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      • Liu C.C.
      • Juan H.C.
      • Lee Y.C.
      • et al.
      The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men.
      • Huang Y.-P.
      • Chen B.
      • Ping P.
      • et al.
      Asexuality development among middle aged and older men.
      • Kontula O.
      • Haavio-Mannila E.
      The impact of aging on human sexual activity and sexual desire.
      • Quilter M.
      • Hodges L.
      • von Hurst P.
      • et al.
      Male sexual function in New Zealand: a population-based cross-sectional survey of the prevalence of erectile dysfunction in men aged 40–70 years.
      respectively.

       Primary Sexual Abstinence

      Most of the studies reporting primary sexual abstinence were about adolescent and young men. The overall prevalence of primary sexual abstinence varied greatly across 19 studies. Primary sexual abstinence in young men
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      • Gutierrez Fernandez L.
      • Solorzano R.M.
      • Valverde M.F.
      • et al.
      Determinants of sexual abstinence and condom use among Central American adolescents.
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      • Molla M.
      • Berhane Y.
      • Lindtjorn B.
      Traditional values of virginity and sexual behaviour in rural Ethiopian youth: results from a cross-sectional study.
      ,
      • Koffi A.K.
      • Kawahara K.
      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      • Haglund K.A.
      • Fehring R.J.
      The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults.
      • Tolma E.L.
      • Oman R.F.
      • Vesely S.K.
      • et al.
      Parental youth assets and sexual activity: differences by race/ethnicity.
      • Bizuneh H.
      Correlates of sexual initiation among adolescent and youth in Addis Ababa, Ethiopia: a community based cross sectional study.
      • Winter T.
      • Karvonen S.
      • Rose R.J.
      Associations between sexual abstinence ideals, religiosity, and alcohol abstinence: a longitudinal study of Finnish twins.
      ,
      • Wright A.
      • Duffy J.
      • Kershner S.
      • et al.
      New opportunities in teen pregnancy prevention: identifying individual and environmental differences between youth who abstain, use contraception, and use no contraception.
      ,
      • Biraro S.
      • Shafer L.A.
      • Kleinschmidt I.
      • et al.
      Is sexual risk taking behaviour changing in rural south-West Uganda? Behaviour trends in a rural population cohort 1993-2006.
      • Cummings T.
      • Auerswald C.L.
      • Ott M.A.
      Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high–sexually transmitted infection prevalence communities.
      • Katz I.
      • Low-Beer D.
      Why has HIV stabilized in South Africa, yet not declined further? Age and sexual behavior patterns among youth.
      • Kembo J.
      Changes in sexual behaviour and practice and HIV prevalence indicators among young people aged 15-24 years in Zambia: an in-depth analysis of the 2001-2002 and 2007 Zambia Demographic and Health Surveys.
      • Tolma E.L.
      • Vesely S.K.
      • Oman R.F.
      • et al.
      Youth assets and sexual activity: differences based on race/ethnicity.
      ,
      • Ghaznavi C.
      • Sakamoto H.
      • Yoneoka D.
      • et al.
      Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987–2015.
      • Harris A.L.
      • Fantasia H.C.
      • Castle C.E.
      Father 2 son: the impact of African American father–son sexual communication on African American adolescent sons’ sexual behaviors.
      • Landor A.M.
      • Simons L.G.
      Correlates and predictors of virginity among heterosexual African American young adults.
      • Puzek I.
      • Stulhofer A.
      • Bozicevic I.
      Is religiosity a barrier to sexual and reproductive health? Results from a population-based study of young Croatian adults.
      and middle-aged men ranged from 3.4% to 83.3% and 5.5%–32.8%, respectively.
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      ,
      • Ghaznavi C.
      • Sakamoto H.
      • Yoneoka D.
      • et al.
      Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987–2015.
      Furthermore, the age categorization given in the selected studies showed that the prevalence for 10- to 19-year-old men was the highest (27.7%–83.3%),
      • Gutierrez Fernandez L.
      • Solorzano R.M.
      • Valverde M.F.
      • et al.
      Determinants of sexual abstinence and condom use among Central American adolescents.
      ,
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      ,
      • Koffi A.K.
      • Kawahara K.
      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      ,
      • Tolma E.L.
      • Oman R.F.
      • Vesely S.K.
      • et al.
      Parental youth assets and sexual activity: differences by race/ethnicity.
      ,
      • Wright A.
      • Duffy J.
      • Kershner S.
      • et al.
      New opportunities in teen pregnancy prevention: identifying individual and environmental differences between youth who abstain, use contraception, and use no contraception.
      ,
      • Cummings T.
      • Auerswald C.L.
      • Ott M.A.
      Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high–sexually transmitted infection prevalence communities.
      ,
      • Tolma E.L.
      • Vesely S.K.
      • Oman R.F.
      • et al.
      Youth assets and sexual activity: differences based on race/ethnicity.
      ,
      • Ghaznavi C.
      • Sakamoto H.
      • Yoneoka D.
      • et al.
      Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987–2015.
      followed by 15- to 24-year-old men (3.4%–59.7%)
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      ,
      • Molla M.
      • Berhane Y.
      • Lindtjorn B.
      Traditional values of virginity and sexual behaviour in rural Ethiopian youth: results from a cross-sectional study.
      ,
      • Koffi A.K.
      • Kawahara K.
      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      ,
      • Haglund K.A.
      • Fehring R.J.
      The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults.
      ,
      • Bizuneh H.
      Correlates of sexual initiation among adolescent and youth in Addis Ababa, Ethiopia: a community based cross sectional study.
      ,
      • Katz I.
      • Low-Beer D.
      Why has HIV stabilized in South Africa, yet not declined further? Age and sexual behavior patterns among youth.
      ,
      • Kembo J.
      Changes in sexual behaviour and practice and HIV prevalence indicators among young people aged 15-24 years in Zambia: an in-depth analysis of the 2001-2002 and 2007 Zambia Demographic and Health Surveys.
      ,
      • Ghaznavi C.
      • Sakamoto H.
      • Yoneoka D.
      • et al.
      Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987–2015.
      ,
      • Landor A.M.
      • Simons L.G.
      Correlates and predictors of virginity among heterosexual African American young adults.
      and 25- to 45-year-old men (5.5%–32.8%)
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      ,
      • Ghaznavi C.
      • Sakamoto H.
      • Yoneoka D.
      • et al.
      Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987–2015.
      (Table 1).

       Secondary Sexual Abstinence

      Table 1 shows that the overall prevalence of secondary abstinence reported in 22 studies ranged between 0% and 83.6% in men younger than 60 years (Table 1). The prevalence for young men
      • Yode M.
      • LeGrand T.
      Association between age at first sexual relation and some indicators of sexual behaviour among adolescents.
      ,
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      • Byers E.
      • O'Sullivan L.
      • Brotto L.
      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      ,
      • Koffi A.K.
      • Kawahara K.
      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      ,
      • Twenge J.M.
      • Sherman R.A.
      • Wells B.E.
      Sexual inactivity during young adulthood is more common among U.S. millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18.
      ,
      • Biraro S.
      • Shafer L.A.
      • Kleinschmidt I.
      • et al.
      Is sexual risk taking behaviour changing in rural south-West Uganda? Behaviour trends in a rural population cohort 1993-2006.
      ,
      • Katz I.
      • Low-Beer D.
      Why has HIV stabilized in South Africa, yet not declined further? Age and sexual behavior patterns among youth.
      ,
      • Kembo J.
      Changes in sexual behaviour and practice and HIV prevalence indicators among young people aged 15-24 years in Zambia: an in-depth analysis of the 2001-2002 and 2007 Zambia Demographic and Health Surveys.
      ,
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      ,
      • Harris A.L.
      • Fantasia H.C.
      • Castle C.E.
      Father 2 son: the impact of African American father–son sexual communication on African American adolescent sons’ sexual behaviors.
      ,
      • Wellings K.
      • Palmer M.J.
      • Machiyama K.
      • et al.
      Changes in, and factors associated with, frequency of sex in Britain: evidence from three National Surveys of Sexual Attitudes and Lifestyles (Natsal).
      and middle-aged men
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Schick V.
      • Herbenick D.
      • Reece M.
      • et al.
      Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults.
      ,
      • Beutel M.E.
      • Burghardt J.
      • Tibubos A.N.
      • et al.
      Declining sexual activity and desire in men—findings from representative German surveys, 2005 and 2016.
      ,
      • Holden C.A.
      • Collins V.R.
      • Handelsman D.J.
      • et al.
      Healthy aging in a cross-sectional study of Australian men: what has sex got to do with it?.
      ,
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      ,
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      • Liu C.C.
      • Juan H.C.
      • Lee Y.C.
      • et al.
      The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men.
      • Huang Y.-P.
      • Chen B.
      • Ping P.
      • et al.
      Asexuality development among middle aged and older men.
      • Kontula O.
      • Haavio-Mannila E.
      The impact of aging on human sexual activity and sexual desire.
      • Quilter M.
      • Hodges L.
      • von Hurst P.
      • et al.
      Male sexual function in New Zealand: a population-based cross-sectional survey of the prevalence of erectile dysfunction in men aged 40–70 years.
      ,
      • Wellings K.
      • Palmer M.J.
      • Machiyama K.
      • et al.
      Changes in, and factors associated with, frequency of sex in Britain: evidence from three National Surveys of Sexual Attitudes and Lifestyles (Natsal).
      ranged from 1.3% to 83.6% and 1.2%–67.7%, respectively.
      Furthermore, age categorization in the selected studies showed that the prevalence of secondary sexual abstinence for 10- to 19-year-old men ranged from 1.3% to 83.6%,
      • Yode M.
      • LeGrand T.
      Association between age at first sexual relation and some indicators of sexual behaviour among adolescents.
      ,
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      ,
      • Koffi A.K.
      • Kawahara K.
      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      ,
      • Biraro S.
      • Shafer L.A.
      • Kleinschmidt I.
      • et al.
      Is sexual risk taking behaviour changing in rural south-West Uganda? Behaviour trends in a rural population cohort 1993-2006.
      while for 15- to 24-year-old men, it ranged from 10.2% to 50.3%.
      • Byers E.
      • O'Sullivan L.
      • Brotto L.
      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
      ,
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      ,
      • Koffi A.K.
      • Kawahara K.
      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      ,
      • Twenge J.M.
      • Sherman R.A.
      • Wells B.E.
      Sexual inactivity during young adulthood is more common among U.S. millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18.
      ,
      • Katz I.
      • Low-Beer D.
      Why has HIV stabilized in South Africa, yet not declined further? Age and sexual behavior patterns among youth.
      ,
      • Kembo J.
      Changes in sexual behaviour and practice and HIV prevalence indicators among young people aged 15-24 years in Zambia: an in-depth analysis of the 2001-2002 and 2007 Zambia Demographic and Health Surveys.
      ,
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      ,
      • Harris A.L.
      • Fantasia H.C.
      • Castle C.E.
      Father 2 son: the impact of African American father–son sexual communication on African American adolescent sons’ sexual behaviors.
      ,
      • Wellings K.
      • Palmer M.J.
      • Machiyama K.
      • et al.
      Changes in, and factors associated with, frequency of sex in Britain: evidence from three National Surveys of Sexual Attitudes and Lifestyles (Natsal).
      Based on the age categories given in the selected studies, the prevalence of secondary sexual abstinence was 0%–50.3% for men from 18 to 30 years old,
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Beutel M.E.
      • Burghardt J.
      • Tibubos A.N.
      • et al.
      Declining sexual activity and desire in men—findings from representative German surveys, 2005 and 2016.
      ,
      • Harris A.L.
      • Fantasia H.C.
      • Castle C.E.
      Father 2 son: the impact of African American father–son sexual communication on African American adolescent sons’ sexual behaviors.
      ,
      • Wellings K.
      • Palmer M.J.
      • Machiyama K.
      • et al.
      Changes in, and factors associated with, frequency of sex in Britain: evidence from three National Surveys of Sexual Attitudes and Lifestyles (Natsal).
      ,
      • Andersen I.
      • Heitmann B.L.
      • Wagner G.
      Obesity and sexual dysfunction in younger Danish men.
      1.2%–46.6% from 25 to 45 years old,
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Beutel M.E.
      • Burghardt J.
      • Tibubos A.N.
      • et al.
      Declining sexual activity and desire in men—findings from representative German surveys, 2005 and 2016.
      ,
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      ,
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      ,
      • Wellings K.
      • Palmer M.J.
      • Machiyama K.
      • et al.
      Changes in, and factors associated with, frequency of sex in Britain: evidence from three National Surveys of Sexual Attitudes and Lifestyles (Natsal).
      1.3%–58.6% for 40 to 50 years old,
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Beutel M.E.
      • Burghardt J.
      • Tibubos A.N.
      • et al.
      Declining sexual activity and desire in men—findings from representative German surveys, 2005 and 2016.
      ,
      • Holden C.A.
      • Collins V.R.
      • Handelsman D.J.
      • et al.
      Healthy aging in a cross-sectional study of Australian men: what has sex got to do with it?.
      ,
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      • Liu C.C.
      • Juan H.C.
      • Lee Y.C.
      • et al.
      The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men.
      • Huang Y.-P.
      • Chen B.
      • Ping P.
      • et al.
      Asexuality development among middle aged and older men.
      ,
      • Quilter M.
      • Hodges L.
      • von Hurst P.
      • et al.
      Male sexual function in New Zealand: a population-based cross-sectional survey of the prevalence of erectile dysfunction in men aged 40–70 years.
      and 3.2%–67.7% for men from aged 45 to 59 years
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Schick V.
      • Herbenick D.
      • Reece M.
      • et al.
      Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults.
      ,
      • Beutel M.E.
      • Burghardt J.
      • Tibubos A.N.
      • et al.
      Declining sexual activity and desire in men—findings from representative German surveys, 2005 and 2016.
      ,
      • Holden C.A.
      • Collins V.R.
      • Handelsman D.J.
      • et al.
      Healthy aging in a cross-sectional study of Australian men: what has sex got to do with it?.
      ,
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      ,
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      • Liu C.C.
      • Juan H.C.
      • Lee Y.C.
      • et al.
      The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men.
      • Huang Y.-P.
      • Chen B.
      • Ping P.
      • et al.
      Asexuality development among middle aged and older men.
      • Kontula O.
      • Haavio-Mannila E.
      The impact of aging on human sexual activity and sexual desire.
      • Quilter M.
      • Hodges L.
      • von Hurst P.
      • et al.
      Male sexual function in New Zealand: a population-based cross-sectional survey of the prevalence of erectile dysfunction in men aged 40–70 years.
      (Table 1).

       Methods of Assessment of Abstinence

      Table 2 shows that 40.5% (n = 15) of the studies used a self-administered questionnaire to assess sexual abstinence. 22 remaining studies reported conducting an interview or interviewer-assisted questionnaire. Most of the studies (n = 24; 64.9%) used a valid instrument for the assessment of sexual abstinence. The studies using self-administered questionnaires reported relatively higher proportions of the primary and secondary sexual abstinence. The range of the proportions of secondary sexual abstinence widened with increased duration of sexual abstinence, being lowest for 1 month (4.6%–50.3%),
      • Holden C.A.
      • Collins V.R.
      • Handelsman D.J.
      • et al.
      Healthy aging in a cross-sectional study of Australian men: what has sex got to do with it?.
      ,
      • Quilter M.
      • Hodges L.
      • von Hurst P.
      • et al.
      Male sexual function in New Zealand: a population-based cross-sectional survey of the prevalence of erectile dysfunction in men aged 40–70 years.
      ,
      • Harris A.L.
      • Fantasia H.C.
      • Castle C.E.
      Father 2 son: the impact of African American father–son sexual communication on African American adolescent sons’ sexual behaviors.
      ,
      • Wellings K.
      • Palmer M.J.
      • Machiyama K.
      • et al.
      Changes in, and factors associated with, frequency of sex in Britain: evidence from three National Surveys of Sexual Attitudes and Lifestyles (Natsal).
      followed by 6–8 months (7.1%–60.1%)
      • Liu C.C.
      • Juan H.C.
      • Lee Y.C.
      • et al.
      The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men.
      ,
      • Huang Y.-P.
      • Chen B.
      • Ping P.
      • et al.
      Asexuality development among middle aged and older men.
      ,
      • Andersen I.
      • Heitmann B.L.
      • Wagner G.
      Obesity and sexual dysfunction in younger Danish men.
      and 1 year (0%–83.6%).
      • Yode M.
      • LeGrand T.
      Association between age at first sexual relation and some indicators of sexual behaviour among adolescents.
      ,
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Schick V.
      • Herbenick D.
      • Reece M.
      • et al.
      Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults.
      ,
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      ,
      • Koffi A.K.
      • Kawahara K.
      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      ,
      • Twenge J.M.
      • Sherman R.A.
      • Wells B.E.
      Sexual inactivity during young adulthood is more common among U.S. millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18.
      ,
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      ,
      • Katz I.
      • Low-Beer D.
      Why has HIV stabilized in South Africa, yet not declined further? Age and sexual behavior patterns among youth.
      ,
      • Kembo J.
      Changes in sexual behaviour and practice and HIV prevalence indicators among young people aged 15-24 years in Zambia: an in-depth analysis of the 2001-2002 and 2007 Zambia Demographic and Health Surveys.
      ,
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      ,
      • Kontula O.
      • Haavio-Mannila E.
      The impact of aging on human sexual activity and sexual desire.
      Table 2Summary of tools and/method used for the assessment of sexual abstinence in population-based studies


      Tool/method
      No. (%) of studiesSexual abstinencePrevalence (%)
      Sexual abstinencePrimary sexual abstinenceSecondary sexual abstinencePrimary sexual abstinenceSecondary sexual abstinence
      Interview or interviewer-assisted questionnaire22 (59.5)12 (63.2)13 (59)0–83.63.4–82.60–83.6
      Self-administered questionnaire15 (40.5)7 (36.8)9 (41)1.2–83.35.5–83.31.2–67.7

       Factors in Sexual Abstinence

      In accordance with Table 1, a total of 31 studies reported the factors in sexual abstinence in men. A statistically significant relationship between demographic factors and sexual inactivity was found in 22 studies (61.1%): age in 20 studies (55.5%), partner and relationship status in 9 studies (25.0%), employment status and income in 11 studies (30.5%), and residence status in 3 studies (8.3%).
      The other factors found to be associated with sexual abstinence were health and disease in 12 (33.3%) studies; self-esteem, beliefs, and perceptions about abstinence also in 12 studies (33.3%); social aspects and families in 11 studies (30.5%); religious aspects in 9 studies (25.0%); smoking and substance abuse in 6 studies (19.4%); and sex education in 3 studies (9.7%) (Table 1).

       Age

      The prevalence of sexual abstinence decreased significantly with increased age in young men
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Gutierrez Fernandez L.
      • Solorzano R.M.
      • Valverde M.F.
      • et al.
      Determinants of sexual abstinence and condom use among Central American adolescents.
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      • Molla M.
      • Berhane Y.
      • Lindtjorn B.
      Traditional values of virginity and sexual behaviour in rural Ethiopian youth: results from a cross-sectional study.
      ,
      • Koffi A.K.
      • Kawahara K.
      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      ,
      • Tolma E.L.
      • Oman R.F.
      • Vesely S.K.
      • et al.
      Parental youth assets and sexual activity: differences by race/ethnicity.
      ,
      • Bizuneh H.
      Correlates of sexual initiation among adolescent and youth in Addis Ababa, Ethiopia: a community based cross sectional study.
      ,
      • Wright A.
      • Duffy J.
      • Kershner S.
      • et al.
      New opportunities in teen pregnancy prevention: identifying individual and environmental differences between youth who abstain, use contraception, and use no contraception.
      ,
      • Twenge J.M.
      • Sherman R.A.
      • Wells B.E.
      Sexual inactivity during young adulthood is more common among U.S. millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18.
      ,
      • Cummings T.
      • Auerswald C.L.
      • Ott M.A.
      Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high–sexually transmitted infection prevalence communities.
      ,
      • Tolma E.L.
      • Vesely S.K.
      • Oman R.F.
      • et al.
      Youth assets and sexual activity: differences based on race/ethnicity.
      but increased with increasing age in middle-aged men.
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Beutel M.E.
      • Burghardt J.
      • Tibubos A.N.
      • et al.
      Declining sexual activity and desire in men—findings from representative German surveys, 2005 and 2016.
      ,
      • Corona G.
      • Lee D.M.
      • Forti G.
      • et al.
      Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS).
      • Holden C.A.
      • Collins V.R.
      • Handelsman D.J.
      • et al.
      Healthy aging in a cross-sectional study of Australian men: what has sex got to do with it?.
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      ,
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      ,
      • Huang Y.-P.
      • Chen B.
      • Ping P.
      • et al.
      Asexuality development among middle aged and older men.
      • Kontula O.
      • Haavio-Mannila E.
      The impact of aging on human sexual activity and sexual desire.
      • Quilter M.
      • Hodges L.
      • von Hurst P.
      • et al.
      Male sexual function in New Zealand: a population-based cross-sectional survey of the prevalence of erectile dysfunction in men aged 40–70 years.
      4 studies reported that, in adolescence, age was unrelated to primary or secondary sexual abstinence.
      • Byers E.
      • O'Sullivan L.
      • Brotto L.
      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
      ,
      • Schick V.
      • Herbenick D.
      • Reece M.
      • et al.
      Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults.
      ,
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      ,
      • Liu C.C.
      • Juan H.C.
      • Lee Y.C.
      • et al.
      The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men.

       Race

      2 studies reported that race (white, black, Hispanic, or Asian) was not a significant predictor of primary abstinence in men in the United States.
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      ,
      • Landor A.M.
      • Simons L.G.
      Correlates and predictors of virginity among heterosexual African American young adults.
      However, 4 reported that being white was a significant predictor of sexual abstinence as compared with being African American.
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Wright A.
      • Duffy J.
      • Kershner S.
      • et al.
      New opportunities in teen pregnancy prevention: identifying individual and environmental differences between youth who abstain, use contraception, and use no contraception.
      ,
      • Twenge J.M.
      • Sherman R.A.
      • Wells B.E.
      Sexual inactivity during young adulthood is more common among U.S. millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18.
      ,
      • Cummings T.
      • Auerswald C.L.
      • Ott M.A.
      Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high–sexually transmitted infection prevalence communities.
      Single white men had significantly higher odds of sexual abstinence than black men, but vice versa in the case of married men.
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      A study conducted on the Zimbabwean population reported that significantly more men who belonged to the Shona ethnicity were abstinent than the Ndebele ethnicity.
      • Sambisa W.
      • Curtis S.L.
      • Stokes C.S.
      Ethnic differences in sexual behaviour among unmarried adolescents and young adults in Zimbabwe.

       Marital Status

      In men of all ages, not having a partner was a significant predictor of primary and secondary sexual inactivity.
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Schick V.
      • Herbenick D.
      • Reece M.
      • et al.
      Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults.
      ,
      • Gutierrez Fernandez L.
      • Solorzano R.M.
      • Valverde M.F.
      • et al.
      Determinants of sexual abstinence and condom use among Central American adolescents.
      ,
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      ,
      • Liu C.C.
      • Juan H.C.
      • Lee Y.C.
      • et al.
      The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men.
      ,
      • Landor A.M.
      • Simons L.G.
      Correlates and predictors of virginity among heterosexual African American young adults.
      However, one study showed that, in adolescent males, not having a partner was not associated with abstinence.
      • Cummings T.
      • Auerswald C.L.
      • Ott M.A.
      Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high–sexually transmitted infection prevalence communities.
      The quality of the relationship was also a determinant of sexual abstinence. One-third of adolescents avoided sex because of a negative relationship, not being comfortable with their partner, not wanting the relationship to progress too quickly, or having a partner who did not enjoy sexual activity.
      • Byers E.
      • O'Sullivan L.
      • Brotto L.
      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
      The perceived practice of faithfulness among sexually active, unmarried men significantly increased the likelihood of sexual abstinence among male youths.
      • Koffi A.K.
      • Kawahara K.
      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      However, the duration of the current relationship was not associated with sexual abstinence in middle-aged men.
      • Twenge J.M.
      • Sherman R.A.
      • Wells B.E.
      Sexual inactivity during young adulthood is more common among U.S. millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18.
      Similarly, a positive attitude toward marriage was not associated with primary sexual abstinence in young men.
      • Landor A.M.
      • Simons L.G.
      Correlates and predictors of virginity among heterosexual African American young adults.

       Socioeconomic Status

      Men of all ages with lower educational levels showed significantly lower sexual activity than those with higher educational levels.
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Molla M.
      • Berhane Y.
      • Lindtjorn B.
      Traditional values of virginity and sexual behaviour in rural Ethiopian youth: results from a cross-sectional study.
      ,
      • Sambisa W.
      • Curtis S.L.
      • Stokes C.S.
      Ethnic differences in sexual behaviour among unmarried adolescents and young adults in Zimbabwe.
      ,
      • Twenge J.M.
      • Sherman R.A.
      • Wells B.E.
      Sexual inactivity during young adulthood is more common among U.S. millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18.
      ,
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      ,
      • Liu C.C.
      • Juan H.C.
      • Lee Y.C.
      • et al.
      The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men.
      Similarly, young men who never attended school had significantly increased odds of primary abstinence.
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      However, boys currently attending school may have been abstaining significantly because of fears of dropping out of school and an intention to concentrate on education.
      • Byers E.
      • O'Sullivan L.
      • Brotto L.
      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
      ,
      • Sambisa W.
      • Curtis S.L.
      • Stokes C.S.
      Ethnic differences in sexual behaviour among unmarried adolescents and young adults in Zimbabwe.
      3 studies also reported no association between primary sexual abstinence and the level of education in men.
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      ,
      • Bizuneh H.
      Correlates of sexual initiation among adolescent and youth in Addis Ababa, Ethiopia: a community based cross sectional study.
      ,
      • Ghaznavi C.
      • Sakamoto H.
      • Yoneoka D.
      • et al.
      Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987–2015.
      Parental education was significantly associated with abstinence, but only for young men who had at least one parent with a bachelor's degree; these men had the highest rates of abstinence.
      • Tolma E.L.
      • Oman R.F.
      • Vesely S.K.
      • et al.
      Parental youth assets and sexual activity: differences by race/ethnicity.
      ,
      • Tolma E.L.
      • Vesely S.K.
      • Oman R.F.
      • et al.
      Youth assets and sexual activity: differences based on race/ethnicity.
      However, another study reported that primary abstinence was not associated with maternal education.
      • Bizuneh H.
      Correlates of sexual initiation among adolescent and youth in Addis Ababa, Ethiopia: a community based cross sectional study.
      Men of all age groups (younger than 60 years) whose sexual abstinence was either primary or secondary were less likely to report that they were currently employed
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Gutierrez Fernandez L.
      • Solorzano R.M.
      • Valverde M.F.
      • et al.
      Determinants of sexual abstinence and condom use among Central American adolescents.
      ,
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      ,
      • Ghaznavi C.
      • Sakamoto H.
      • Yoneoka D.
      • et al.
      Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987–2015.
      or self-dependent
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      ,
      • Ghaznavi C.
      • Sakamoto H.
      • Yoneoka D.
      • et al.
      Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987–2015.
      and had lower personal and household incomes or contributions to household income.
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      ,
      • Bizuneh H.
      Correlates of sexual initiation among adolescent and youth in Addis Ababa, Ethiopia: a community based cross sectional study.
      ,
      • Ghaznavi C.
      • Sakamoto H.
      • Yoneoka D.
      • et al.
      Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987–2015.
      Military service and a history of incarceration significantly lowered the odds of primary abstinence in a man.
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      However, another study reported that being arrested was significantly positively associated with primary abstinence but not incarceration.
      • Landor A.M.
      • Simons L.G.
      Correlates and predictors of virginity among heterosexual African American young adults.
      Daily working hours did not affect sexual activity in middle-aged men.
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      Parental income and socioeconomic status were also positively associated with abstinence in young men.
      • Tolma E.L.
      • Oman R.F.
      • Vesely S.K.
      • et al.
      Parental youth assets and sexual activity: differences by race/ethnicity.
      ,
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      ,
      • Tolma E.L.
      • Vesely S.K.
      • Oman R.F.
      • et al.
      Youth assets and sexual activity: differences based on race/ethnicity.

       Area of Residence

      4 studies reported that the area of residence was not associated with male sexual abstinence.
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      ,
      • Koffi A.K.
      • Kawahara K.
      Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.
      ,
      • Sambisa W.
      • Curtis S.L.
      • Stokes C.S.
      Ethnic differences in sexual behaviour among unmarried adolescents and young adults in Zimbabwe.
      In the U.S. population, the trend of sexual abstinence in some young men was largest and most significant in the East, followed by the West and Midwest, and was lowest in the South.
      • Twenge J.M.
      • Sherman R.A.
      • Wells B.E.
      Sexual inactivity during young adulthood is more common among U.S. millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18.
      One study reported that young men from Guatemala had significantly higher odds of primary sexual abstinence than those from Costa Rica and Nicaragua.
      • Gutierrez Fernandez L.
      • Solorzano R.M.
      • Valverde M.F.
      • et al.
      Determinants of sexual abstinence and condom use among Central American adolescents.
      Another study reported that Japanese young men living in the Kanto region had significantly higher odds of sexual abstinence than those from other regions (Kinki, Chubu, Kyushu, Chugoku, Tohoku, and Hokkaido). The middle-aged men from Kanto, Kinki, and Chubu regions had significantly higher odds of primary sexual abstinence than those from the other regions (Kyushu, Chugoku, Tohoku, and Hokkaido).
      • Ghaznavi C.
      • Sakamoto H.
      • Yoneoka D.
      • et al.
      Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987–2015.
      A further study reported that young men living in urban areas had significantly lower odds of primary abstinence than those living in rural areas.
      • Kembo J.
      Changes in sexual behaviour and practice and HIV prevalence indicators among young people aged 15-24 years in Zambia: an in-depth analysis of the 2001-2002 and 2007 Zambia Demographic and Health Surveys.
      It was also reported that living in densely populated areas and in a neighborhood with the social disorder (fight by using weapons) had a significantly negative relationship with primary sexual abstinence in men.
      • Ghaznavi C.
      • Sakamoto H.
      • Yoneoka D.
      • et al.
      Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987–2015.

       Smoking and Substance Abuse

      There was a positive association between frequency of alcohol consumption and blood testosterone levels, sexual activity, and sexual interest in middle-aged men.
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Kontula O.
      • Haavio-Mannila E.
      The impact of aging on human sexual activity and sexual desire.
      Young men who reported never using alcohol, cigarettes or drugs were significantly more likely to be sexually abstinent.
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      • Gutierrez Fernandez L.
      • Solorzano R.M.
      • Valverde M.F.
      • et al.
      Determinants of sexual abstinence and condom use among Central American adolescents.
      • Kayembe K.P.
      • Mapatano M.A.
      • Busangu F.A.
      • et al.
      Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo.
      • Molla M.
      • Berhane Y.
      • Lindtjorn B.
      Traditional values of virginity and sexual behaviour in rural Ethiopian youth: results from a cross-sectional study.
      ,
      • Bizuneh H.
      Correlates of sexual initiation among adolescent and youth in Addis Ababa, Ethiopia: a community based cross sectional study.
      However, Khat (a shrub native to the Horn of Africa and the Arabian Peninsula) chewing was negatively and significantly associated with sexual abstinence,
      • Molla M.
      • Berhane Y.
      • Lindtjorn B.
      Traditional values of virginity and sexual behaviour in rural Ethiopian youth: results from a cross-sectional study.
      but marijuana consumption was not.
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      3 studies reported that smoking and alcohol consumption had no association with sexual abstinence in young and middle-aged men.
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      ,
      • Landor A.M.
      • Simons L.G.
      Correlates and predictors of virginity among heterosexual African American young adults.

       Health-Related Issues

      Body mass index, height, and body weight were not associated with male primary sexual abstinence in young men.
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      ,
      • Kontula O.
      • Haavio-Mannila E.
      The impact of aging on human sexual activity and sexual desire.
      However, a recent study reported that overweight men had significantly increased odds of primary sexual abstinence as compared with underweight men.
      • Landor A.M.
      • Simons L.G.
      Correlates and predictors of virginity among heterosexual African American young adults.
      Poor health was significantly more related to single status in middle-aged men.
      • Schick V.
      • Herbenick D.
      • Reece M.
      • et al.
      Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults.
      The prevalence of sexual abstinence was negatively associated with good health in middle-aged men.
      • Kim J.H.
      • Tam W.S.
      • Muennig P.
      Sociodemographic correlates of sexlessness among American adults and associations with self-reported happiness levels: evidence from the U.S. General Social Survey.
      ,
      • Christensen B.S.
      • Gronbaek M.
      • Osler M.
      • et al.
      Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes.
      ,
      • Holden C.A.
      • Collins V.R.
      • Handelsman D.J.
      • et al.
      Healthy aging in a cross-sectional study of Australian men: what has sex got to do with it?.
      In middle-aged men, depression, erectile dysfunction, cardiovascular disease, diabetes, and hypertension were positively associated with sexual abstinence.
      • Corona G.
      • Lee D.M.
      • Forti G.
      • et al.
      Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS).
      ,
      • Kim J.H.
      • Lau J.T.F.
      • Cheuk K.K.
      Sexlessness among married Chinese adults in Hong Kong: prevalence and associated factors.
      ,
      • Liu C.C.
      • Juan H.C.
      • Lee Y.C.
      • et al.
      The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men.
      In addition, the presence of 2 or more comorbidities in middle-aged men was a significant predictor of sexual abstinence.
      • Huang Y.-P.
      • Chen B.
      • Ping P.
      • et al.
      Asexuality development among middle aged and older men.
      However, in the case of young men, having good health and good health practices (brushing teeth) indicated self-esteem and was positively associated with sexual abstinence.
      • Gutierrez Fernandez L.
      • Solorzano R.M.
      • Valverde M.F.
      • et al.
      Determinants of sexual abstinence and condom use among Central American adolescents.
      There were also 4 studies that reported no association between health status and sexual abstinence in young and middle-aged men.
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      ,
      • Reece M.
      • Herbenick D.
      • Schick V.
      • et al.
      Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.
      ,
      • Kontula O.
      • Haavio-Mannila E.
      The impact of aging on human sexual activity and sexual desire.
      ,
      • Landor A.M.
      • Simons L.G.
      Correlates and predictors of virginity among heterosexual African American young adults.

       Morality and Religious Reasons

      Religious beliefs were positively associated with sexual abstinence in young men.
      • Byers E.
      • O'Sullivan L.
      • Brotto L.
      Time out from sex or romance: sexually experienced adolescents' decisions to purposefully avoid sexual activity or romantic relationships.
      ,
      • Haglund K.A.
      • Fehring R.J.
      The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults.
      ,
      • Landor A.M.
      • Simons L.G.
      Correlates and predictors of virginity among heterosexual African American young adults.
      Men who attended religious ceremonies weekly or more frequently had higher odds of primary sexual abstinence.
      • Eisenberg M.L.
      • Shindel A.W.
      • Smith J.F.
      • et al.
      Who is the 40-year-old virgin and where did he/she come from? Data from the National Survey of Family Growth.
      ,
      • Haglund K.A.
      • Fehring R.J.
      The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults.