Document Type : Original Article
Authors
1 Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad Univer- sity of Medical Sciences, Mashhad, Iran
2 Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Keywords
Infertility is be defined as being unable to become pregnant
after having regular sexual contacts for one year
without using contraceptive methods (
Several studies have been conducted on infertile couples
in Iran. In an epidemiological study in 2004, the
prevalence of infertility was reported 24.9% in Iranian
women of 19 to 49 years old (
The most important causes of sexual dysfunction in women
include lack of desire, excitement disorders, lack of orgasm,
dyspareunia and vaginism. The prevalence rates of
sexual dysfunction are 40 and 19.6% in the US and Sweden
respectively (
Sexual behavior disorders can be a prior cause of infertility.
Generally, infertile couples seek treatment for infertility
instead of searching for deeper problem in their sexual relationships
(
Since fertility is regarded as a value in Iranian culture and notions, infertility questions the individual and social competencies of women, i.e. the feelings of maternity and spousal values); therefore, a women’s entire marital and sexual relationships with her husband will be affected. Given the importance of identifying the factors influencing sexual dysfunction in infertile women, the current study employed a modern approach using statistical models to investigate the subject. This study aimed to identify the above-mentioned factors to make necessary decisions and perform efficient interventions to improve the sexual health of infertile women. This study investigated the factors influencing sexual dysfunction in infertile women in Mashhad, Iran.
In this cross-sectional study, type I error (Za=1.96) and the statistical power (Zß=1.28) were taken into account to select 85 infertile women as the population sample. The following formula was used for sampling:
The convenience sampling method was employed to select the participants from the women visiting Montasarieh Infertility Clinic and Research Center in Mashhad, Iran. The Ethics Committee of Shahid Beheshti University of Medical Sciences approved this study (approval No. 2881/116). All participants received information about the purpose of this study and gave their verbal informed consent to participate.
The participants were aged between 20 and 45 years old. Participants, did not suffer from any physical, mental, or medical problems. They were not addicted to any substances or alcohol. The information collection tools included an informational form with demographic and infertility information and Female Sexual Function Index (FSFI) and at demographic variables included age, mental and physical status, surgery history, medication and drugs, having a child or foster child. Infertility variables were duration of infertility and treatment, cause of infertility, kind of treatment, hope for cure, cost of treatment, and information about sexual relationship sexual. FSFI is one of the gold standard for female sexual dysfunction (FSD) assessment and in this study, the nominal and content validities of FSFI were re-evaluated by obstetricians and gynecologists, psychologists, midwives, and health education experts.
The reliability of this index was determined 0.9 through
a retest. The researcher obtained the information from
participants individually. The standard FSFI includes 19
items regarding sexual desire, sexual excitement, dyspareunia,
and the inability to reach orgasm. Each item has
five choices. According to the scoring system, a score below
28 indicates a poor sexual function, whereas a score
between 28 and 36 shows a desirable sexual function
(
ENRICH Marital Satisfaction Scale includes 47 items regarding
idealistic distortion, marital satisfaction, personality
issues, communication, conflict resolution, etc & with 5-Likert
scale. According to the scoring system, a score below 30
indicates very poor satisfaction, -30-40- poor satisfaction,
-40-60- moderate satisfaction, -60-70- high satisfaction and
above 70 very high satisfaction (
Infertile women were investigated with respect to demographic
characteristics (
Distribution of some demographic variables among infertile women
Variable | n (%) | |
---|---|---|
Education | ||
Primary education | 23 (34.0) | |
High school | 25 (29.4) | |
Higher education | 31 (36.7) | |
Husband education | ||
Primary education | 31 (36.55) | |
High school | 26 (30.6) | |
Higher education | 28 (32.9) | |
Job | ||
Housewife | 60 (70.6) | |
Practitioner | 25 (29.4) | |
Income | ||
Less than 1,700,000,0 Rials | 22 (25.9) | |
Equal to 1,700,000,0 Rials | 62 (72.9) | |
More than 1,700,000,0 Rials | 1 (1.2) | |
"Number and percent" of sexual function among infertile women
Variable | n (%) or mean + SD |
---|---|
Sexual function desirable, | 24 (28.2) |
Sexual function undesirable | 61 (71.8) |
Total score of sexual function | 25.93 + 4.32 |
Distribution of some infertility information
Variable | n(%) | |
---|---|---|
Using of ART | ||
Yes | 67(78.8) | |
No | 18(21.2) | |
ART IUI | ART | |
IUI | 25(30.6) | |
IVF | 21(24.7) | |
Ovulation and intercourse | 20(23.5) | |
None | 18(21.2) | |
Hope for a cure | ||
Yes | 57(67) | |
Somewhat | 26(30.6) | |
No | 2(2.4) | |
The cost problem | ||
Yes | 58(68.2) | |
Somewhat | 21(24.7) | |
No | 6(7.1) | |
ART; Assisted reproductive technology, IUI; Intrauterine inseminations, and IVF;
Regression logistic of related factors of sexual function
Related factor | OR (CI) | P value |
---|---|---|
low | 13.77 (1.74-10.89) | 0.01 |
Average | 4.16 (2.35-7.33) | 0.00 |
High | 1 | - |
No | 3.78 (2.19-6.51) | 0.00 |
Yes | 1 | - |
Sexual satisfaction | ||
No | 5.52 (2.66-11.43) | 0.00 |
Yes | 1 | - |
Primary education | 3.42 (1.70-6.94) | 0.00 |
High school | 1.89 (1.04-3.41) | 0.00 |
After high school | 1 | - |
Primary education | 2.95 (1.40-6.20) | 0.01 |
High school | 3.12 (1.73-5.61) | 0.00 |
After high school | 1 | - |
Less than 1,700,000,0 Rials | 10.31 (3.03-34.99) | 0.00 |
Equal to 1,700,000,0 Rials | 4.20 (1.56-11.31) | 0.00 |
More than 1,700.000.0 Rials | - | - |
No | 5.14 (1.50-17.64) | 0.00 |
Yes | 1 | - |
No | 4.67 (1.75-12.44) | 0.00 |
Yes | 1 | |
Yes | 2.66 (0.39-17.91) | 0.31 |
Somewhat | 8.54 (1.38-52.73) | 0.01 |
No | 1 | |
OR; Odds ratio and CI; Confidence interval
This research indicated that 71.8% of infertile women
were suffering from sexual dysfunction. Regardless of the
duration and causes, infertility causes mental health and
sexual problems and infertile women suffer from these
conditions more than fertile women (
In 2013, Champion and et al. (
Women having happy and exciting relationships with
their husbands experience sexual disorders less often.
They feel more self-confident and think that their husbands
like their bodies; therefore, they feel that they are
more sexually attractive to their husbands. On the other
hand, women having negative attitudes towards their bodies
are nervous in private and romantic relationships with
their husbands. Such women are not sure about having
sexual activities (
Fajewonyomi et al. (
Income is another effective factor (
The finding indicated that some factors such as sexual self-efficacy, marital satisfaction, sexual satisfaction, education, cost of infertility treatment are associated with sexual function in infertile women.