Document Type : Original Article
Authors
1 Department of Midwifery, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
2 Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran;Department of Epidemiology and Biostatistics, Kashan University of Medical Sciences, Kashan, Iran
3 4Reproductive Biotechnology Research Center, Avicenna Research Institute (ACECR), Tehran, Iran
4 5Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
5 6The Iranian National Center for Addiction Studies (INCAS), Institution for Risk Behavior Reduction, Director of Family and Sexual Health Division, Brian and Spinal Cord Injury Research Center, Neuroscience Institution
Abstract
Keywords
In recent years, researchers have focused on the topic of
sexual well-being (
Despite the increasing attention towards sexual well-being
of women in particular, it is noteworthy that not only primary sexual health assessment is being ignored, but also basic sex education is completely absent in females’ health programs in Iran (
"Despite many opportunities available for frank discussion on sexual topics in the context of marriage, penetrating the individuals’ silence was much harder than I expected. Perhaps, I had underestimated the power of the marriage. The crucial point is that open discussion on sexuality and conceptualization of actual sexual activity, were possible only within the context of marriage"(
This argument is also confirmed by results of several Iranian empirical research (
Despite extensive studies, there are some challenges (i.e. the approach that should be used for assessment of sexual behaviors is not clear) in studies undertaken in the field of women’s sexual behaviors (
A study on women’s sexual behavior was conducted by Avasti et al. (
We used this survey to examine women’s sexual behaviors by exploring various aspects of their sexual behaviors and also investigating possible associations between sexual behaviors and demographic variables. The purpose of this study was to explore the components of sexual behaviors and their possible associations with the demographic variables.
This study was a cross-sectional survey (descriptive and analytic) aimed to identify and analyze sexual behaviors among women of reproductive age in Kashan, Iran from June to October 2015. A random sample of 500 women of reproductive age who referred to health centers (14 centers) in Kashan and had the inclusion criteria according to random numbers table was included in this survey. Based on Shirpak et al. (
Inclusion criteria included having Iranian nationality and the ability to read and write, and being within the age range of 15-49 years and married as well as having an active sex life. Exclusion criteria comprised of unwillingness to answer questions because of the high number of questions, as well as having medical and surgical conditions.
Research tool in this study was women’s sexual behavior assessment questionnaire developed by Qoreshi et al. (
Each question has a value of zero to five; So, the minimum and maximum scores for sexual capacity are 0 and 50, for sexual motivation are 0 and 45, for sexual function are 0 and 55 and for sexual script are 0 and 15, respectively. Each of these sub-groups was divided into three parts (<33%, 34-66%, and>67%) based on the obtained scores.
After obtaining written informed consents, the questionnaire was completed by the participants. To analyze the data, R software was used for descriptive statistical analysis to describe the participants and The Kolmogorov-Smirnov test was performed to test the normality of continues variables. Data on capacity, motivation and performance variable were found normally distributed, but not the script variable. Moreover, ANOVA was used to compare outcomes among different groups in terms of capacity, motivation and performance variables and Kruskal-Wallis was used for comparing the means of script variable.
In order to evaluate the correlation between the subscales, the Pearson correlation coefficient was used. In addition, we applied the linear regression model to examine the effect of variables on sexual capacity, function and motivation. Also, Bonferroni method was used the post-hoc test with alpha error correction. For checking whether the data fit the model, we examined the normality of residuals. In addition, R2 values were mentioned for each of the models (R2 was 0.66 for capacity, 0.78 for motivation and 0.58 for performance). For modeling, first we evaluated the relationship of each risk factor (the age of spouse, level of education and other demographic variable) with the outcome variables, variables with a P<0.3 were used in the regression model. The final model was obtained using backward method considering the P<0.05.
This study was approved by Ethic Committee of Tehran and Shahroud University of Medical Sciences in 2015 (IR.SHMU.REC.2015.44 and TUMS 34262-159-01-96). It should be mentioned that we received informed consent from all participants.
More than half of the women participated in this study (51.9%) were in the age range of 26 to 35 years old. The majority of women (82.8%) were homemaker; also, the majority of them (39.9%) had a high-school education. About half of the women (54.6%) had a middle economic level. The mean duration of marriage was 10.2 ± 7.7 (
Demographic characteristics of individuals participated in this study
Variable | n (%) | |
---|---|---|
Education | ||
Elementary | 129 (25.7) | |
High school | 200 (40) | |
University | 172 (34.4) | |
Employment status | ||
Homemaker | 414 (82.8) | |
Employed | 86 (17.2) | |
Level of education of the spouse | ||
Elementary | 147 (29.3) | |
High school | 179 (35.7) | |
University | 175 (35.0) | |
Employment status of the spouse | ||
Self-employed | 266 (53.2) | |
Worker | 104 (20.9) | |
Employee | 117 (23.3) | |
Retired | 13 (2.7) | |
Socioeconomic status | ||
Very bad | 22 (4.4) | |
Bad | 57 (11.5) | |
Intermediate | 273 (54.6) | |
Good | 113 (22.7) | |
Very good | 35 (7.1) | |
Age (Y), mean ± SD (30.5 ± 7.3) | ||
15-25 | 148 (29.6) | |
26-35 | 260 (51.9) | |
36-45 | 92 (18.5) | |
Age of spouse (Y), mean ± SD (34.8 ± 7.9) | ||
20-25 | 48 (9.6) | |
26-35 | 254 (50.7) | |
36-45 | 150 (30) | |
46-55 | 42 (8.4) | |
>56 | 7 (1.3) | |
Duration of marriage (Y), mean ± SD (10.2 ± 7.7) | ||
≤- 5 | 174 (34.8) | |
6-10 | 128 (25.5) | |
11-15 | 91 (18.2) | |
>15 | 108 (21.6) | |
The scores of sexual behavior in terms of different subgroups. Most women obtained a medium score in terms of sexual capacity and sexual motivation but a low score for sexual function (<18.3 out of 55) (
The scores of sexual behavior according to the subgroups
Subgroups of sexual behavior (minimum score-maximum score) | n (%) | Mean ± SD | |
---|---|---|---|
Sexual capacity (0-50) | |||
<16.6 | 39 (7.8) | 29.4 ± 8.1 | |
16.7-33.2 | 302 (60.4) | ||
33.3- 50 | 159 (31.8) | ||
Sexual performance (0-55) | |||
<18.3 | 317 (63.4) | 16.5 ± 6.6 | |
18.4-36.6 | 182 (36.3) | ||
36.7-55 | 1 (0.2) | ||
Sexual motivation (0-45) | |||
<15 | 28 (5.5) | 25.7 ± 6.6 | |
16-30 | 366 (73.3) | ||
31-45 | 106 (21.2) | ||
Sexual script (0-15) | |||
<5 | 28 (5.5) | 12.2 ± 3.4 | |
6-10 | 366 (73.3) | ||
11-15 | 106 (21.2) | ||
Sexual behavior (0-165) | |||
<55 | 29 (5.7) | 85 ± 1.6 | |
56-110 | 442 (88.6) | ||
111-165 | 29 (5.7) | ||
Pearson correlation test showed a significantly positive correlation between the scores of sexual capacity, motivation and sexual (P<0.001). This means with an increase in one score, the scores of other domains also increase.
The majority of participants agreed with three questions of sexual script (
The results of the regression model that assessed the association between sexual capacity, motivation and performance and independent variables (
Distribution of answers to questions of sexual script
Numbers of questions | Items | Mean ± SD | I don’t know n (%) | None n (%) | Low n (%) | Medium n (%) | High n (%) | Very high n (%) |
---|---|---|---|---|---|---|---|---|
31 | Sexual-religious idea | 3.9 ± 1.4 | 28 (5.9) | 19 (4) | 19 (4) | 57 (12) | 106 (22.3) | 247 (51.9) |
32 | A right idea regarding sexual relationship | 4.3 ± 1.1 | 7 (1.4) | 11 (2.3) | 24 (4.9) | 35 (7.2) | 115 (23.6) | 296 (60.7) |
33 | Traditional andmale-centered idea | 3.9 ± 1.5 | 24 (4.9) | 44 (9) | 13 (2.7) | 46 (9.4) | 97 (19.9) | 264 (54.1) |
*; P<0.05 was considered significant statistically.
The results of the regression model (outcome: sexual capacity, performance, motivation)
Standardized coefficients | Unstandardized coefficients | P value | |||
---|---|---|---|---|---|
Std. error | Beta | Beta | |||
Sexual capacity | |||||
Education (constant) | 1.528 | - | 29.416 | <0.001 | |
Elementary (base line) | - | - | - | - | |
High school | 1.094 | 0.172 | 2.854 | 0.000 | |
University | 1.152 | 0.259 | 4.392 | <0.001 | |
Age of spouse (Y) | |||||
20-25 (base line) | - | - | - | - | |
26- 35 | 1.411 | -0.127 | -2.064 | 0.14 | |
36-45 | 1.507 | -0.239 | -4.300 | 0.000 | |
>45 | 1.907 | -0.144 | -4.021 | 0.03 | |
Sexual performance | |||||
Age of spouse (Y) (constant) | 1.043 | - | 18.405 | <0.001 | |
20-25 (base line) | - | - | - | - | |
26- 35 | 1.146 | -0.138 | -1.763 | 0.12 | |
36-45 | 1.206 | -0.184 | -2.560 | 0.034 | |
>45 | 1.465 | -0.196 | -4.090 | 0.000 | |
Sexual motivation | |||||
Age (Y) (constant) | 1.098 | - | 26.598 | <0.001 | |
20-25 (base line) | - | - | - | - | |
26- 35 | 1.325 | -0.044 | -0.565 | 0.67 | |
36-45 | 1.572 | -0.236 | -3.383 | 0.030 | |
>45 | 2.438 | -0.322 | -7.610 | 0.000 | |
Age of spouse (Y) | |||||
15-25 (base line) | - | - | - | - | |
26-35 | 0.970 | 0.094 | 1.224 | 0.20 | |
36 -45 | 2.930 | 0.194 | 7.012 | 0.01 | |
>45 | 1.531 | 0.138 | 2.450 | 0.11 | |
*; P<0.05 was considered significant statistically.
The main objective of this study was to explore the components of sexual behaviors and their possible associations with demographic variables. Our results showed that the majority of women participating in this study obtained a medium score for sexual capacity and sexual motivation but a low score for sexual function. Different aspects of sexual behavior showed a significant correlation with some demographic characteristics of women.
Our results are consistent with the results reported by Qoreshi et al. (
Since the most important factor of an individual’s sexual function is his/her sexual capacity (
In this study, most participants’ sexual behaviors were originated from right and wrong sexual scripts. The first question (i.e. “giving positive response to the husband’s sexual demands will leads to rewards”) is a religious -sexual question suggesting that women’s sexual script can be affected by religious beliefs. Merghati Khoi et al. (
This emphasizes the importance of religion in sex education. Women’s sexual behaviors seem to change through women’s empowerment and educational interventions based on religious norms. Addis et al. (
The second question of sexual script (i.e. "giving a positive response to the husband’s sexual demands creates more intimacy between couples and peace in the family.") is also a right idea regarding sexual relationship that reinforces the relationship between couples. Merghati khoie et al. (
But, the third question of sexual script (i.e. "giving a positive response to the husband’s sexual demands prevents the husband’s extramarital relationships.") represents a traditional cultural scenario created by a restricted and male-dominated sexual script. In the qualitative study of Shirpak et al. (
In this study, there was a significant relationship between sexual script and women’s sexual behaviors. The results of this study indicated the role of social and cultural determinants in shaping sexual behaviors, which is consistent with the social construction theory (
In this study, sexual capacity had a significant association with education level and the age of spouse but it was not associated with woman’s job, economic status and the number of children. In Addis’s study, sexual satisfaction was correlated with age, so that young women were more sexually active and had more sexual satisfaction. In this study, the researcher found that sexual satisfaction reduced with increasing ages (
Herbenick et al. (
Laws and Scwartz (
Finally, premarital sex education is suggested to be implemented for young women to enable them to identify their sexual capacity and sexual motivation, correct the deterrent attitudes and strengthen the reinforcing attitudes for having safe sex. Suitable sexual behaviors can increase marital satisfaction, maintain the foundation of family and ultimately promote the public health.
This study results showed that the participants’ sexual function is not in at a good level; however, sexual capacity and sexual motivation are reported to be at an acceptable level. This might be due to the role of sexual scripts dominating the participants’ sexual interactions in this study. Premarital education can familiarize women with different dimensions of sexual motivation, sexual capacity and sexual function by taking into account cultural-sexual scenarios. Finally, we suggest assessment of sexual behaviors in other age groups such as adolescents and designing an educational program for promotion of sexual behaviors.