Clinicians routinely assess physical activity, diet, and sleep when evaluating health; however, sexual life is rarely discussed. This overlooked dimension may offer meaningful insight into overall health status. Sexual activity is not only an intimate matter but also a reflection of an individual’s physical, mental, and social well-being.

Data from Spain’s Center for Sociological Research (CIS) showed that 1 in 4 individuals reported no sexual activity in the past year. Reported reasons included lack of interest or desire in 16.3%, widowhood in 13.5%, and illness affecting the individual or their partner in 11.2%.

Absence of sexual activity is not a clinical problem. However, these findings indicate that underlying factors, including disease, mental health conditions, or loneliness, may be present and often remain unaddressed during clinical consultations.

Clinical Perspective

In a press release, Luis Montoya, MD, specialist at the Sexology Unit of Hospital Quirónsalud Málaga, Málaga, Spain, emphasized the need to approach sexuality from a comprehensive health perspective. He noted that 30%-70% of individuals experience some form of sexual difficulty or distress during their lifetime, yet only 1%-10% take initiative to seek care. “The World Health Organization defines sexual health as a state of physical, emotional, mental, and social well-being. It is not only about sexual activity but about quality of life,” he said.

The concept of quality of life has gained importance over time. Clinical focus historically centered on disease rather than the individual, which often overlooked how illness affects daily living, including sexual life. This gap is receiving increasing attention.

Speaking with El Médico Interactivo, part of the Medscape Professional Network, Sonia García, psychologist and clinical sexologist, said, “It is very important to understand the context in which the lack of sexual relations occurs before assigning a clinical label or prescribing treatment.”

An article published in 2010 in The Journal of Sexual Medicine reported that both direct and indirect effects of chronic diseases on sexual health are common and complex. The authors highlighted the lack of clear guidelines on optimal management and called for further research on prevalence, pathophysiology, and treatment of sexual dysfunction linked to chronic illness.

García noted that such concerns are common in clinical practice. “Addressing sexuality in the presence of disease is essential to educate individuals that there are many ways to connect sexually with a partner. If a condition limits or prevents certain practices, there is no need to give up sexual intimacy as a couple,” she said. She recommended alternative ways to maintain intimacy.

Despite this, recent evidence indicates that sexual health remains an underdiscussed and often stigmatized topic in consultations with medical professionals.

According to a 2024 study conducted in Germany and published in Deutsches Ärzteblatt International, 2531 individuals (46.7% men and 53.3% women) aged 14-95 years were surveyed. Among participants with at least one chronic illness associated with functional limitation, 76.2% of women and 76% of men also reported sexual dysfunction, highlighting the clinical relevance of this bidirectional relationship.

The study reported that various aspects of sexual health in the context of chronic illness are rarely documented in medical records. It also highlighted that clinical consultations provide an opportunity to address this topic with less embarrassment, particularly in relation to disease-related limitations and the potential adverse effects of medications.

Findings from the survey conducted by the CIS further showed that a substantial proportion of individuals not only lack an active sex life but also live alone, highlighting an additional dimension that warrants attention from a socio-health perspective.

García explained, “Loneliness is becoming a health problem. In consultation, I see many individuals with anxiety, depression, low self-esteem, and even suicidal ideation linked to feelings of loneliness and lack of social connection with friends or partners. Loneliness and lack of affection and attention directly affect well-being.”

Evidence published in the American Journal of Lifestyle Medicine showed that social connections strongly influence health and longevity, whereas lack of social connection is associated with an increased risk for premature death. These social determinants often remain overlooked in clinical practice.

In this context, sexual activity may serve as an indicator of an individual’s social and emotional reality that influences both mental and physical health. It also presents an opportunity for preventive intervention.

Desire Drivers

According to a survey conducted by the CIS, lack of sexual desire, reported by 16.3% of respondents, is another clinically relevant dimension.

García stated, “Sex itself is not essential for quality of life, but life without sex is poorer, and overall satisfaction declines.”

She explained that mental health conditions can reduce sexual desire. At the same time, relationship-related factors, including lack of connection with one’s partner, limited shared quality time, or daily interpersonal conflict, can also lower sexual desire and activity, which may in turn contribute to mental health conditions.

García noted that stress, anxiety, low mood, and reduced self-esteem, commonly encountered in psychological consultations, can hinder the emergence of sexual desire because attention shifts away from pleasure toward managing distress. She added that even in individuals receiving both psychotherapy and psychopharmacologic treatment, certain medications may adversely affect sexual response.

In 2026, a study published in BMC Public Health further analyzed this association and found that psychological variables, including depression and perceived stress, were stronger predictors of sexual function in women than in men. The findings highlighted the need to incorporate psychological assessment, particularly depression and stress, when evaluating sexual function, with specific attention to female patients.

Clinical Framing

Lack of sexual activity should not be pathologized. Sexual life, like other aspects of life, goes through multiple stages and moments that should not always be viewed clinically but rather from the perspective of life itself.

However, sexuality remains a key factor in well-being. Addressing it in clinical practice may provide insight into broader health and help identify underlying issues that might otherwise remain undetected.

García reported having no relevant conflicts of interest.

This article was translated from El Médico Interactivo on Univadis.