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con resultados m&#225;s favorables para los hombres al percibir su salud en mejores t&#233;rminos<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">2</span></a> y vivir un mayor n&#250;mero de a&#241;os sin discapacidad<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">3</span></a>&#46; El incremento de la esperanza de vida tambi&#233;n ha modificado las relaciones de pareja en las personas mayores&#44; aumentando la duraci&#243;n de los matrimonios&#44; creando nuevas uniones fruto de rupturas anteriores y transformando el comportamiento sexual&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Partiendo de estas premisas&#44; Lindau y Gavrilova<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> calculan la esperanza de vida sexual activa &#40;EVSA&#41;&#44; que se define como el n&#250;mero promedio de a&#241;os de permanencia de vida sexual activa de los individuos&#46; Si el indicador esperanza de vida es un reflejo de la mejora del estado de salud y del nivel social y econ&#243;mico de una poblaci&#243;n&#44; la EVSA se interpreta como indicador de las transformaciones acontecidas en el comportamiento sexual&#46; El aumento de la actividad sexual de los individuos se relaciona con el incremento de la esperanza de vida en buena salud y el retraso de la viudez<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">5&#44;6</span></a>&#44; un cambio de valores desde la II Guerra Mundial<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a>&#44; una actitud y un comportamiento sexual m&#225;s diversificado que en &#233;pocas anteriores<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a>&#44; y la reducci&#243;n del prejuicio tradicional contra la sexualidad en la vejez<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">5</span></a>&#46; Otros estudios concluyen que existe una disminuci&#243;n en la frecuencia de la actividad sexual en la vejez&#44; que se correlaciona con la edad y el sexo<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">9&#8211;12</span></a>&#44; y con el peor estado de salud<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a> como consecuencia de las enfermedades cr&#243;nicas<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a> y de la toma de medicamentos<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a>&#46; Atendiendo a la metodolog&#237;a que proponen Lindau y Gavrilova<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> para el c&#225;lculo de la EVSA&#44; el objetivo de este an&#225;lisis es medir este nuevo indicador en la poblaci&#243;n espa&#241;ola para estimar la edad promedio a la que finaliza la actividad sexual&#44; considerando las relaciones coitales a partir de los 30 a&#241;os y hasta los 80 o m&#225;s a&#241;os&#44; puesto que interesa observar a la poblaci&#243;n mayor&#46; Asimismo&#44; se han atendido circunstancias que pueden alterar la continuidad sexual en la vejez&#44; como son el estado autopercibido de salud<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">11&#44;16</span></a> y de salud sexual<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">17&#44;18</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><p id="par0015" class="elsevierStylePara elsevierViewall">Para responder al objetivo marcado se ha utilizado la tabla de mortalidad espa&#241;ola que proporciona la Human Mortality Database<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> para el a&#241;o 2009 y la Encuesta Nacional de Salud Sexual<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a> elaborada por el Centro de Investigaciones Sociol&#243;gicas y realizada tambi&#233;n en 2009&#44; que aporta datos sobre comportamiento sexual&#44; as&#237; como del estado de salud y de salud sexual&#46; Su principal caracter&#237;stica es no plantear un l&#237;mite superior de edad<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a>&#44; y adem&#225;s los datos son m&#225;s recientes y con muestra representativa de la poblaci&#243;n espa&#241;ola&#46; Este estudio cuenta con una muestra total de 7511 individuos de 30 a 80 o m&#225;s a&#241;os&#44; con una distribuci&#243;n equitativa por sexo&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Con los datos de la Encuesta Nacional de Salud Sexual se ha construido una nueva variable dicot&#243;mica a partir de las variables &#171;ha realizado&#187; &#40;P2708&#41; y &#171;le han realizado&#187; sexo vaginal &#40;P2709&#41; en el &#250;ltimo a&#241;o&#44; que agrupa&#44; por un lado&#44; a quienes han mantenido relaciones coitales&#44; y por otro&#44; resta al total de individuos de cada grupo de edad las personas que en ambas opciones responden negativamente&#46; De este modo se entiende por actividad sexual que haya habido pr&#225;ctica coital en el &#250;ltimo a&#241;o&#44; y por abstinencia&#44; la inactividad coital en el mismo periodo de tiempo&#46; Asimismo&#44; para incorporar la dimensi&#243;n de la calidad a la cantidad de a&#241;os sexuales vividos se toman&#44; tambi&#233;n de la Encuesta Nacional de Salud Sexual&#44; las variables de autoevaluaci&#243;n sobre la percepci&#243;n del estado de salud &#40;P44&#41; y de la salud sexual &#40;P45&#41;&#44; ambas con una escala gradual y recodificada de cinco a dos &#237;tems&#58; buena salud &#40;incluye muy buena y buena salud&#41; o mala salud &#40;incluye regular&#44; mala y muy mala salud&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Si la esperanza de vida mide los a&#241;os promedio de vida de una generaci&#243;n de personas desde su nacimiento hasta su muerte&#44; la esperanza de vida en buena salud se interpreta como el promedio de a&#241;os con buena salud que restan a dicha generaci&#243;n&#44; y la EVSA indica el promedio de a&#241;os sexualmente activos&#46; Partiendo de la esperanza de vida proporcionada en la tabla de mortalidad de la Human Mortality Database&#44; y de modo an&#225;logo al c&#225;lculo de indicadores como la esperanza de vida en buena salud<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">2</span></a> o libre de discapacidad<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;3</span></a>&#44; se calcula la EVSA&#44; esto es&#44; siguiendo el m&#233;todo de Sullivan de las proporciones de prevalencia<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">22&#44;23</span></a> &#40;<a class="elsevierStyleCrossRef" href="#sec0090">v&#233;ase el Ap&#233;ndice online</a>&#41;&#46; Si para el c&#225;lculo de la esperanza de vida en buena salud se sustraen de los a&#241;os vividos en una cohorte te&#243;rica de 1000 nacidos los a&#241;os vividos con mala salud&#44; para la EVSA&#44; de los datos sobre la pr&#225;ctica coital&#44; se extraen aquellos vividos en abstinencia&#46; De este modo se calcula el n&#250;mero de a&#241;os con y sin actividad sexual vaginal&#44; teniendo en cuenta el sexo y grupos quinquenales de edad&#46; Este m&#233;todo se detalla de manera te&#243;rica y pr&#225;ctica en el informe de la European Health Expectancy Monitoring Unit<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a>&#46; Con el mismo m&#233;todo se miden la esperanza de vida sexual activa en buena salud &#40;EVSABS&#41; y la esperanza de vida sexual activa en mala salud &#40;EVSAMS&#41;&#44; sustrayendo de los individuos con buena&#47;mala salud los a&#241;os vividos con inactividad coital&#46; Es decir&#44; clasificando la muestra seg&#250;n el estado autopercibido de salud&#44; se calculan estos indicadores descontando los a&#241;os vividos con abstinencia sexual para conocer los a&#241;os de vida con pr&#225;ctica sexual vaginal&#46; De manera an&#225;loga se calculan la esperanza de vida en buena salud sexual &#40;EVSABSS&#41; y la esperanza de vida en mala salud sexual &#40;EVSAMSS&#41;&#44; que consideran tambi&#233;n la percepci&#243;n de un buen o mal estado de salud sexual &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tablas 1 a 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Dado que lo que interesa son las personas mayores&#44; la EVSA&#44; as&#237; como sus variantes&#44; se han calculado a partir de los 30 y hasta los 80 o m&#225;s a&#241;os&#44; agrupados en grupos quinquenales de edad puesto que en las edades longevas las frecuencias son bajas y las tendencias obtenidas son excesivamente oscilantes para una clara interpretaci&#243;n&#46; A este obst&#225;culo se unen limitaciones derivadas de la misma t&#233;cnica<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">1</span></a>&#44; puesto que a trav&#233;s del m&#233;todo de Sullivan solo es posible interpretar la EVSA como los a&#241;os que en promedio pueden esperar vivir con actividad sexual los individuos de una sociedad en un momento dado y a una edad concreta si se mantienen las condiciones de mortalidad y comportamiento sexual constantes&#46; Asimismo&#44; no se dispone de datos transversales que permitan observar la evoluci&#243;n de la EVSA&#44; limitando el an&#225;lisis a su medici&#243;n para el a&#241;o 2009 y sin posibilidad de mencionar una tendencia de desplazamiento creciente o decreciente&#46; En este sentido&#44; dada la escasez de estudios con un objeto similar&#44; se ha tomado como referencia comparativa el an&#225;lisis de Lindau y Gavrilova<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> en poblaci&#243;n estadounidense&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Esperanza de vida y esperanza de vida sexual activa</span><p id="par0035" class="elsevierStylePara elsevierViewall">Las tablas de vida calculadas para la EVSA indican que los a&#241;os de vida sexuales disminuyen progresivamente en paralelo al incremento de la edad&#44; tal como ocurre con la esperanza de vida&#44; aunque los valores de esta son m&#225;s elevados&#44; especialmente en las mujeres &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Sugieren tambi&#233;n que los varones disponen de un mayor n&#250;mero de a&#241;os sexualmente activos en todas las edades&#44; puesto que presentan una mayor EVSA&#46; La distancia entre la esperanza de vida y la EVSA a los 30-34 a&#241;os es de 19&#44;1 a&#241;os en los hombres y de 27&#44;9 a&#241;os en las mujeres&#59; diferencias que se reducen al ritmo que avanza el ciclo vital&#58; 12&#44;9 a&#241;os y 21&#44;1 a&#241;os para 55-59 a&#241;os&#44; y 7&#44;4 y 9&#44;8 a&#241;os para 75-79 a&#241;os&#44; respectivamente&#46; La EVSA de los hombres disminuye alrededor de 1 a&#241;o de grupo en grupo de edad hasta los 75-79 a&#241;os&#44; cuando desciende 7&#44;1 a&#241;os&#46; En las mujeres&#44; el decrecimiento de la EVSA es m&#225;s pausado&#58; desciende 1 a&#241;o hasta los 55-59 a&#241;os&#44; 2 a&#241;os hasta los 65-69 a&#241;os y 3 a&#241;os a partir de los 70-74 a&#241;os&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">La esperanza de vida sexual activa en buena y mala salud general</span><p id="par0040" class="elsevierStylePara elsevierViewall">La introducci&#243;n de la autopercepci&#243;n del estado de salud en el an&#225;lisis de la longevidad sexual muestra la variaci&#243;n en la EVSA cuando se considera una buena o mala salud &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2 y 3</a>&#41;&#58; la EVSA aumenta al considerar la buena salud y disminuye en los hombres cuando se considera la mala salud &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Al incorporar la buena salud en la EVSA&#44; esta aumenta de manera divergente entre sexos&#58; en los hombres de 30-34 a&#241;os suma 3&#44;2 a&#241;os&#44; en los de 55-59 a&#241;os agrega 2&#44;6 a&#241;os y en los de 75-79 a&#241;os a&#241;ade 0&#44;9 a&#241;os&#59; en las mujeres&#44; el incremento es de alrededor de 1 a&#241;o hasta los 70-74 a&#241;os&#46; Las distancias entre la EVSA y la EVSABS se incrementan en ambos sexos tal como avanza el ciclo vital&#44; pero la buena salud aporta un mayor n&#250;mero de a&#241;os sexualmente activos a los hombres&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La EVSAMB de los hombres es menor que su EVSA&#44; especialmente en las edades adultas&#46; La mala salud reduce la EVSA en 4&#44;1 a&#241;os a los 30-34 a&#241;os&#44; en 2&#44;7 a&#241;os a los 55-59 a&#241;os y en 1 a&#241;o a los 75-79 a&#241;os&#46; En las mujeres&#44; la EVSAMS es ligeramente superior a la EVSA&#44; aportando menos de 1 a&#241;o sexualmente activo en todos los grupos de edad&#46; La EVSAMS de los hombres se aproxima a la EVSA de las mujeres&#44; puesto que la mala salud les resta a&#241;os de vida&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">La esperanza de vida sexual activa en buena y mala salud sexual</span><p id="par0055" class="elsevierStylePara elsevierViewall">La autopercepci&#243;n del estado de salud sexual afecta a la EVSA de un modo similar a como lo hace el estado de salud&#44; aunque con m&#225;s intensidad&#46; La EVSABSS pronostica un mayor n&#250;mero de a&#241;os sexualmente activos que la EVSABS&#44; y la EVSAMSS resta m&#225;s a&#241;os que la EVSAMS&#44; tendencia observable para ambos sexos y en todos los grupos de edad &#40;<a class="elsevierStyleCrossRefs" href="#tbl0020">tablas 4 y 5</a>&#44; y <a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">En los hombres de 30-34 a&#241;os&#44; la buena salud sexual aporta 6&#44;3 a&#241;os a la EVSA&#44; en los de 50-54 a&#241;os a&#241;ade 5&#44;2 a&#241;os y en los de 75-79 a&#241;os suma 3&#44;7 a&#241;os&#59; en las mujeres a&#241;ade&#44; respectivamente&#44; 5&#44;5&#44; 4&#44;3 y 2&#44;9 a&#241;os&#46; Por lo tanto&#44; la buena salud sexual aporta un mayor n&#250;mero de a&#241;os con actividad coital a los hombres&#46; No obstante&#44; la EVSABSS de las mujeres supera a la EVSA de los hombres hasta los 50-54 a&#241;os&#44; edad a partir de la cual transitan en paralelo&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La mala salud sexual resta a&#241;os sexuales activos en ambos sexos&#44; pero especialmente en los hombres y en las edades adultas&#58; a los 30-34 a&#241;os elimina 7&#44;3 a&#241;os de la EVSA en los hombres y 5&#44;3 en las mujeres&#59; a los 55-59 a&#241;os resta 2&#44;9 y 1&#44;3 a&#241;os&#44; respectivamente&#59; y a los 75-79 a&#241;os sustrae 0&#44;2 y 0&#44;1 a&#241;os&#44; respectivamente&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">Son varios los estudios que han abordado la sexualidad en la vejez<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10&#8211;12&#44;25&#44;26</span></a>&#44; pero este es el primero en el que se mide la EVSA en poblaci&#243;n espa&#241;ola&#46; Al igual que en los estudios citados&#44; los resultados confirman la presencia de actividad sexual a edades longevas&#44; adem&#225;s de la asociaci&#243;n de la salud y de la salud sexual en el comportamiento sexual a estas edades&#46; Los datos se&#241;alan que los hombres viven una proporci&#243;n significativamente mayor de su vida sexualmente activa&#44; y que tanto la salud como la salud sexual interfieren en su comportamiento sexual en mayor medida que en las mujeres&#58; con buena salud incorporan m&#225;s a&#241;os sexualmente activos&#44; y con mala salud restan m&#225;s a&#241;os de actividad coital que las mujeres&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La mayor esperanza de vida se traduce tambi&#233;n en un aumento de la EVSA&#44; a pesar de su disminuci&#243;n seg&#250;n avanza el ciclo vital y de las diferencias entre sexos&#46; No obstante&#44; la tendencia que presentan la esperanza de vida y la EVSA se invierte en funci&#243;n del sexo&#58; mientras la esperanza de vida es mayor en las mujeres&#44; la EVSA es mayor en los hombres&#44; se incluyan o no elementos como la salud o la salud sexual&#46; De este modo&#44; nos encontramos ante la paradoja de que la longevidad diferencial por sexo se invierte al abordar el comportamiento sexual&#44; lo que se traduce en una trayectoria sexual m&#225;s prolongada en los hombres y un periodo m&#225;s extenso de vida en abstinencia sexual en las mujeres&#46; Los c&#225;lculos de la EVSA realizados en los Estados Unidos por Lindau y Gavrilova<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> muestran un aumento en la EVSA y una trayectoria sexual m&#225;s larga en los hombres&#58; estiman&#44; para ellos&#44; una esperanza de vida en 30-34 a&#241;os de 44&#44;8 a&#241;os y una EVSA de 34&#44;7 a&#241;os&#44; y para ellas&#44; de 50&#44;6 a&#241;os y 30&#44;7 a&#241;os&#44; respectivamente&#59; y en 55-59 a&#241;os&#44; de 23 a&#241;os y 14&#44;9 a&#241;os&#44; y de 27&#44;4 a&#241;os y 10&#44;6 a&#241;os&#44; respectivamente&#46; Comparando estos datos con los obtenidos en la presente investigaci&#243;n&#44; se observa que&#44; mientras la poblaci&#243;n espa&#241;ola vive un mayor n&#250;mero de a&#241;os&#44; la poblaci&#243;n estadounidense presenta una trayectoria vital con pr&#225;cticas coitales m&#225;s prolongada&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La EVSA se ha calculado teniendo en cuenta tambi&#233;n la autopercepci&#243;n del estado de salud y de salud sexual&#46; El padecimiento de limitaciones f&#237;sicas y de dolor interviene en la valoraci&#243;n subjetiva de la salud<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">14&#44;15&#44;26</span></a>&#44; y el padecimiento de discapacidad y de problemas sexuales interviene en la autopercepci&#243;n de la salud sexual<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a>&#46; Al incorporar el estado de salud en la EVSA&#44; tanto los hombres como las mujeres con buena salud presentan una mayor expectativa de vida sexualmente activa en comparaci&#243;n con las personas con mala salud&#46; Y esta tendencia es mucho m&#225;s marcada en los hombres tanto si se incorpora la buena salud &#40;sumando muchos m&#225;s a&#241;os sexualmente activos que las mujeres&#41; como si se observa la mala salud &#40;tambi&#233;n se sustraen m&#225;s a&#241;os&#41;&#46; Al a&#241;adir la salud sexual se observa la misma tendencia&#44; aunque con efectos m&#225;s marcados&#58; la buena salud sexual incrementa los a&#241;os de vida sexual&#44; y la mala salud resta un mayor n&#250;mero de a&#241;os sexualmente activos&#44; principalmente en los hombres&#46; El estudio de Lindau y Gavrilova<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> indica que los hombres americanos de 30-34 a&#241;os y con buena salud a&#241;aden 2 a&#241;os a la EVSA&#44; y 3&#44;2 a&#241;os las mujeres&#59; a la edad de 55-59 a&#241;os&#44; los hombres ganan 2 a&#241;os sexualmente activos y las mujeres ganan 2&#44;3 a&#241;os&#46; La mala salud resta en el primer grupo de edad 3&#44;8 a&#241;os en los hombres y 1&#44;6 en las mujeres&#44; y en el segundo grupo de edad resta 3&#44;4 y 0&#44;5 a&#241;os&#44; respectivamente&#46; La comparaci&#243;n de los datos de la poblaci&#243;n estadounidense y la espa&#241;ola&#44; por un lado&#44; confirma la relaci&#243;n entre la salud y el comportamiento sexual&#44; y por otro&#44; unos resultados m&#225;s favorables para la poblaci&#243;n estadounidense al sumar mayor n&#250;mero de a&#241;os a la EVSA en ambos sexos&#59; es decir&#44; la inclusi&#243;n de la buena salud tiene una mayor repercusi&#243;n en la poblaci&#243;n estadounidense&#44; en especial en las mujeres&#46; Dos cuestiones se desprenden de estos datos&#58; la primera&#44; que si bien la EVSA es m&#225;s larga en los hombres&#44; su trayectoria sexual est&#225; m&#225;s condicionada por el estado de salud&#44; ganando m&#225;s a&#241;os al considerar una buena salud&#44; pero perdiendo muchos m&#225;s a&#241;os al incluir la mala salud&#59; y la segunda&#44; que la comparaci&#243;n entre poblaciones confirma una EVSA y una EVSABS m&#225;s largas para los estadounidenses&#44; hecho que podr&#237;a explicarse por una mejor percepci&#243;n de su salud subjetiva&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">El v&#237;nculo entre una buena salud subjetiva y la continuidad de la actividad sexual se confirma en diversos estudios<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;16&#44;17</span></a>&#46; El estudio de Wiley y Bortz<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> en poblaci&#243;n masculina estadounidense mayor de 50 a&#241;os se&#241;ala el efecto negativo de la salud f&#237;sica y emocional&#46; Lindau et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a> afirman que las personas con una salud percibida regular o mala son m&#225;s propensas a ser sexualmente inactivas y a padecer m&#225;s problemas sexuales&#46; Es tambi&#233;n el caso de la investigaci&#243;n de Kontula y Haavio-Mannila<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a>&#44; en la que se especifica adem&#225;s que la buena salud y una trayectoria sexual activa son elementos predictores de la actividad sexual en los hombres&#44; mientras en las mujeres se configuran como variables determinantes el deseo sexual y tener una pareja sana&#46; Gaymu y Delb&#232;s<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a> corroboran que la mala salud subjetiva influye en mayor medida en los hombres que en las mujeres&#46; Los efectos de la mala salud pueden explicarse en los hombres por el padecimiento de enfermedades como las cardiovasculares y las reumatol&#243;gicas&#44; y sus tratamientos&#44; con gran incidencia sobre el comportamiento sexual<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a>&#46; La influencia de la mala salud sexual se vincula con problemas sexuales tales como los de erecci&#243;n&#44; que impedir&#237;an la pr&#225;ctica del coito y tendr&#237;an un efecto sobre la salud emocional<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a>&#46; La incidencia de la salud y de la mala salud en las mujeres se vincula con aspectos m&#225;s cualitativos de la sexualidad&#44; es decir&#44; con la insatisfacci&#243;n con la pareja y la falta de deseo<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a>&#44; y no con la frecuencia de pr&#225;ctica<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">33&#44;34</span></a>&#44; y por ello no tiene tanta repercusi&#243;n en la EVSA&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Una dificultad que entra&#241;a cualquier estudio sobre el comportamiento sexual es la propia definici&#243;n de sexualidad<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a>&#44; es decir&#44; c&#243;mo definir qu&#233; pr&#225;cticas sexuales deben considerarse&#44; puesto que tradicionalmente estas se reducen a la genitalidad y el coito&#46; Con el objeto de superar dicha limitaci&#243;n&#44; y como l&#237;neas de investigaci&#243;n futuras&#44; ser&#237;a necesario estimar la EVSA desde una visi&#243;n m&#225;s hol&#237;stica de la sexualidad&#44; esto es&#44; incluyendo besos&#44; caricias y masturbaci&#243;n mutua&#44; que son pr&#225;cticas de mayor frecuencia<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10&#44;32&#44;33</span></a> y que se correlacionan con una mayor satisfacci&#243;n sexual<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a> en las edades longevas&#46; Asimismo&#44; puesto que en las mujeres mayores el mantenimiento de la actividad sexual se vincula a la disposici&#243;n de una pareja<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;5&#44;8</span></a>&#44; elemento no considerado aqu&#237;&#44; lo propio ser&#237;a observar tambi&#233;n la variaci&#243;n en la EVSA que introduce esta variable&#46; A pesar de ello&#44; los datos revelan el mantenimiento de la actividad sexual hasta edades avanzadas y la consecuente obligatoria intervenci&#243;n en la salud sexual de las personas mayores para garantizar su bienestar sexual&#46; La gran influencia de la mala salud sobre la actividad sexual&#44; en especial en los hombres&#44; manifiesta la necesaria actuaci&#243;n en el campo de la salud y de la educaci&#243;n sexual&#44; puesto que las expectativas sobre la duraci&#243;n de la vida sexual activa pueden influir en los comportamientos saludables de los individuos&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Las estimaciones de la actividad sexual en las personas mayores son una fuente de informaci&#243;n para el dise&#241;o de pol&#237;ticas relativas a la expresi&#243;n y a los derechos sexuales de este grupo de poblaci&#243;n&#44; puesto que las expectativas sobre la duraci&#243;n de la vida sexual activa condicionan los comportamientos saludables de los individuos<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a>&#44; pues la EVSA se define como un nuevo indicador con aplicaci&#243;n cl&#237;nica y de salud p&#250;blica&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Editora responsable del art&#237;culo</span><p id="par0110" class="elsevierStylePara elsevierViewall">Mar&#237;a Teresa Ruiz Cantero&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Declaraci&#243;n de transparencia</span><p id="par0115" class="elsevierStylePara elsevierViewall">La autora &#40;garante responsable del manuscrito&#41; afirma que este manuscrito es un reporte honesto&#44; preciso y transparente del estudio que se remite a <span class="elsevierStyleSmallCaps">Gaceta Sanitaria&#44;</span> y que no se han omitido aspectos importantes del estudio&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Contribuciones de autor&#237;a</span><p id="par0120" class="elsevierStylePara elsevierViewall">A&#46; Faus-Bertomeu es la &#250;nica autora del art&#237;culo&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Agradecimientos</span><p id="par0125" class="elsevierStylePara elsevierViewall">Se agradece el apoyo de la catedr&#225;tica Rosa G&#243;mez Redondo&#44; investigadora principal del proyecto I<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>D<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>i y directora de la tesis anteriormente citados&#46; Asimismo&#44; a Ramon Dom&#232;nech Gim&#233;nez por su ayuda en los c&#225;lculos&#44; y a la Dra&#46; Celia Fern&#225;ndez-Carro por la revisi&#243;n y las sugerencias en versiones preliminares&#46; Un trabajo m&#225;s extenso que el expuesto en este art&#237;culo ser&#225; presentado en el Congreso de la Federaci&#243;n Espa&#241;ola de Sociolog&#237;a &#40;FES&#41;&#44; que se celebrar&#225; en Valencia los d&#237;as 3 a 6 de junio de 2019&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Financiaci&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">El presente estudio se ha financiado mediante una ayuda para contratos predoctorales para la formaci&#243;n de doctores &#40;FPI&#44; BES 2011-045649&#41; vinculada al proyecto I<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>D<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>i &#171;Las transformaciones del envejecimiento&#44; la longevidad y la vejez en Espa&#241;a&#46; De 50 a 100 y m&#225;s&#46; Presente y futuro&#187; &#40;CSO2010-18925&#41;&#44; sufragado por el Ministerio de Ciencia e Innovaci&#243;n&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0135" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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          "identificador" => "xpalclavsec1328111"
          "palabras" => array:5 [
            0 => "Life expectancy"
            1 => "Sexually active life expectancy"
            2 => "Gender and health"
            3 => "Sexual health"
            4 => "Spain"
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    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Medir la esperanza de vida sexual activa &#40;EVSA&#41; para estimar la edad promedio a la que finaliza la actividad sexual en la poblaci&#243;n espa&#241;ola&#44; prestando especial atenci&#243;n a la poblaci&#243;n mayor&#46; Asimismo&#44; se introducen las autopercepciones de la salud y de la salud sexual para observar la variaci&#243;n que producen en la EVSA&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis descriptivo transversal&#46; Con los datos de la Human Mortality Database y de la Encuesta Nacional de Salud Sexual para 2009 se calcula la EVSA&#44; mediante el m&#233;todo de Sullivan&#44; clasificando a la poblaci&#243;n seg&#250;n si ha practicado o no sexo coital en el &#250;ltimo a&#241;o&#46; Tambi&#233;n se introduce la percepci&#243;n de la salud y de la salud sexual&#46; Se calcula de los 30 a los 80 o m&#225;s a&#241;os de edad&#44; considerando el sexo y grupos quinquenales de edad&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los datos pronostican la continuidad de la actividad coital &#40;para 55-59 a&#241;os la EVSA es de 13&#44;3 a&#241;os en los hombres y 8 a&#241;os en las mujeres&#41; as&#237; como su asociaci&#243;n con la salud y la salud sexual&#44; con divergencias en funci&#243;n del sexo y de la edad&#46; Los hombres presentan una trayectoria sexual activa m&#225;s extensa que las mujeres&#44; pero tambi&#233;n m&#225;s influenciada por la buena salud &#40;agrega 2&#44;6 y 1 a&#241;os&#44; respectivamente&#41; y la buena salud sexual &#40;a&#241;ade 5&#44;2 y 4&#44;3 a&#241;os&#44; respectivamente&#41;&#46; La EVSA tambi&#233;n var&#237;a al considerar una mala salud &#40;resta 2&#44;7 a&#241;os y suma 2 a&#241;os&#41; y una mala salud sexual &#40;resta 2&#44;9 y 1&#44;3 a&#241;os&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los datos revelan la necesaria extensi&#243;n de los programas de salud sexual a edades longevas al confirmar la continuidad de las pr&#225;cticas sexuales a estas edades&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todo"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To measure sexually active life expectancy &#40;SALE&#41; estimating the average age at which sexually active life finishes&#44; paying special attention to the older population&#46; Variations in SALE according to self-rated health are examined&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Descriptive analysis with cross-sectional data&#46; SALE was calculated for the population by age group &#40;30 to 80 years old&#41; and sex using the Sullivan Method&#44; with data from the Human Mortality Database and the National Survey of Sexual Health &#40;Spain&#41;&#46; The analysis distinguishes between individuals that have had coital sex in the last year and those who have not&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Coital activity continues in those aged from 55-59 years old&#44; the SALE is 13&#46;3 years in males and 8 in females&#46; Coital activity is related to health and sexual health&#44; diverging depending on sex and age group&#46; The males showed a more extended sexually active trajectory than the females&#44; but were also more influenced by good general health &#40;adding 2&#46;6 and 1 years respectively&#41; and good sexual health &#40;5&#46;2 and 4&#46;3 years&#41;&#46; SALE also varies when poor health &#40;subtracting 2&#46;7 years and adding 2 years&#41; and poor sexual health &#40;subtracting 2&#46;9 and 1&#46;3 years&#41; are considered&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">the results reveal that sexual health programmes must be extended to the older ages&#44; given that it is confirmed that sexual activity continues in old age&#46;</p></span>"
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            "titulo" => "Material suplementario"
            "identificador" => "sec0090"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Esperanza de vida &#40;EV&#41; y esperanza de vida sexual activa &#40;EVSA&#41; en hombres y mujeres de 30 a 80 o m&#225;s a&#241;os &#40;2009&#41;&#46;</p>"
        ]
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        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Esperanza de vida sexual activa &#40;EVSA&#41; en buena salud &#40;EVSABS&#41; y en mala salud &#40;EVSAMS&#41; en hombres y mujeres de 30 a 80 o m&#225;s a&#241;os &#40;2009&#41;&#46;</p>"
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        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Esperanza de vida sexual activa &#40;EVSA&#41; en buena salud sexual &#40;EVSABSS&#41; y en mala salud sexual &#40;EVSABMS&#41; en hombres y mujeres de 30 a 80 o m&#225;s a&#241;os &#40;2009&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">&#37; Abst&#58; porcentaje de individuos con abstinencia sexual&#59; EVSA&#58; esperanza de vida sexual activa&#59; e<span class="elsevierStyleInf">x</span>&#58; esperanza de vida&#59; n&#58; muestra&#59; IC95&#37;&#58; intervalo de confianza del 95&#37;&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; Abst&nbsp;\t\t\t\t\t\t\n
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                  """
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                  """
              ]
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                0 => "xTab2506147.png"
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Esperanza de vida sexual activa en buena salud en hombres y mujeres de 30 a 80 o m&#225;s a&#241;os</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">&#37; Abst&#58; porcentaje de individuos con abstinencia sexual&#59; EVSAMS&#58; esperanza de vida sexual activa en mala salud&#59; e<span class="elsevierStyleInf">x</span>&#58; esperanza de vida&#59; IC95&#37;&#58; intervalo de confianza del 95&#37;&#59; n&#58; muestra&#46;</p>"
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2506146.png"
              ]
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        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Esperanza de vida sexual activa en mala salud en hombres y mujeres de 30 a 80 o m&#225;s a&#241;os</p>"
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      6 => array:8 [
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        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">&#37; Abst&#58; porcentaje de individuos con abstinencia sexual&#59; EVSABS&#58; esperanza de vida sexual activa en buena salud sexual&#59; e<span class="elsevierStyleInf">x</span>&#58; esperanza de vida&#59; IC95&#37;&#58; intervalo de confianza del 95&#37;&#59; n&#58; muestra&#46;</p>"
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2506144.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Esperanza de vida sexual activa en buena salud sexual en hombres y mujeres de 30 a 80 o m&#225;s a&#241;os</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Tabla 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">&#37; Abst&#58; porcentaje de individuos con abstinencia sexual&#59; EVSAMSS&#58; esperanza de vida sexual activa en mala salud sexual&#59; e<span class="elsevierStyleInf">x</span>&#58; esperanza de vida&#59; IC95&#37;&#58; intervalo de confianza del 95&#37;&#59; n&#58; muestra&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
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