Volume 17, Issue 1 (4-2020)
J Res Dev Nurs Midw 2020, 17(1): 39-51 |
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Rezaie-Chamani S, Rahnavardi M, Sabetghadam S, Mahbubinejad S, Farshbaf-Khalili A, Rezaie N. Prevalence of Sexual Dysfunction in Healthy Women and its Predictors: A Cross-Sectional Study. J Res Dev Nurs Midw 2020; 17 (1) :39-51
URL: http://nmj.goums.ac.ir/article-1-1194-en.html
URL: http://nmj.goums.ac.ir/article-1-1194-en.html
Sedighe Rezaie-Chamani1 
, Mona Rahnavardi1 , Shadi Sabetghadam1 , Sahar Mahbubinejad1 , Azizeh Farshbaf-Khalili 2, Nazanin Rezaie3
, Mona Rahnavardi1 , Shadi Sabetghadam1 , Sahar Mahbubinejad1 , Azizeh Farshbaf-Khalili 2, Nazanin Rezaie3
1- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
2- Physical Medicine and Rehabilitation Research Centre, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, IR Iran. , farshbafa@tbzmed.ac.ir
3- School of Nursing and Midwifery, khoramabad, Iran.
2- Physical Medicine and Rehabilitation Research Centre, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, IR Iran. , farshbafa@tbzmed.ac.ir
3- School of Nursing and Midwifery, khoramabad, Iran.
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Abstract
Background: Sexuality is an important and inseparable part of the life of every woman. Female sexual dysfunction (FSD) has a major influence on quality of life and can lead to personal distress and anxiety. This study aimed to determine the prevalence of sexual dysfunction and predisposing factors in women.
Methods: This cross-sectional study was carried out on 400 outpatient women aged 15-49, who had a health record in the health care centers of Rasht, Iran during 2015-2016. Samples were selected through multi-stage cluster sampling method. Data collection tool included demographics and reproductive information, the standard questionnaire of female sexual function index (FSFI). Multivariate linear regression analysis was used to determine the predictors of sexual dysfunction in SPSS 13.
Results: The mean±SD score of total FSFI was 28.14±3.82, ranging from 2 to 36. The frequency of sexual dysfunction was 34.3% in total. Multivariate linear regression analysis showed a significant correlation between FSFI and some factors including age, education level, age at menarche, frequency of sex, and knowledge on sexual function. These factors accounted for 12% of the variance in the sexual function index of women.
Conclusions: Considering the critical impact of sexual function on the health of couples, paying attention to sexual function in women and its predictors are important to help and plan prevention programs.
Keywords: Sexual dysfunction, Women, Predictor, Community health centers
Sexuality is an important and inseparable part of the life of every woman (1). Female sexual dysfunction (FSD) has a significant impact on quality of life and can lead to personal distress, anxiety and interpersonal difficulty (1-3).
According to the World Health Organization (WHO), and International Classifications of Diseases-10 (ICD-10), FSD is defined as “a syndrome that includes the various ways in which adult people may have difficulty in experiencing personal satisfaction in non-compulsory sexual activities. Sexual response is a complex interaction between psychological, interpersonal, social, cultural and physiological factors; so that disturbance in one or more of these factors may affect any stage of the sexual response. In order to diagnose sexual dysfunction, it must: 1) occur frequently, although it may be absent on some occasions; 2) be present for at least several months; and 3) be associated with clinically significant distress. “(4). FSD is included disorders of desire/libido, arousal, pain, and inhibited orgasm (5).
FSD is affected by several psychological, biological and sociocultural factors (6). The result of a review study showed that the low sexual desire was the most prevalent dysfunction among both premenopausal and postmenopausal women. Low sexual desire regularly enhances with increasing age. The overall frequency of reported low sexual desire ranged from 10% to 64% in different studies (7).
Sexual dysfunction is considered as a widespread problem in Iranian women. One study showed that the prevalence of sexual dysfunction is 31.5% in Iran. This study showed that some factors, such as lower marriage age, financial dependency, lower educational level, lower physical activity and multi-parity increase prevalence of sexual dysfunction. The prevalence of FSD may vary due to cultural, racial and health variables among the countries (2). Therefore, an assessment is needed for any plan to promote healthy behaviors of a society (8). Investigating the rate of sexual dysfunction and factors influencing for these conditions are very important to help to do risk assessment and plan treatment and prevention programs in sexual medicine (9). Epidemiology can be defined as a population survey in the development of disease and health, with the ultimate goal of preserving and preventing it (7). Understanding the prevalence and risk factors of sexual dysfunction is important for prevention efforts (6, 9). According to the authors' search, no study was found on the prevalence of sexual dysfunction and its risk factors in women in Rasht. Therefore, we aimed to determine the prevalence of sexual dysfunction in women referred to health centers in Rasht - Iran and its predictors.
This cross-sectional study was carried out on 400 outpatient women aged 15-49, who were referred to a visit at health care centers of Rasht-Iran, 2016. The inclusion criteria were: referring to the health centers in Rasht and having health care records, willingness to participate in the research, being married, lack of speech and hearing problems and no mental illnesses or chronic diseases according to patient's report and information in the health care records.
The study was approved by the Ethics Committee at Guilan University of Medical Sciences (code: IR.GUMS.REC.1394.120).
Sample size was calculated 357 women based on the main variable of sexual dysfunction according to the results of a study by Jaafarpour et al. (10), considering mean = 23.89, d= 0.05, SD= 9.2, design effect=1.5 and a significant level of 95%. Finally, with the probable dropout rate of 10%, 400 persons were estimated for this study.
Data collection tool included 2 parts; demographics and reproductive information, the standard questionnaire of female sexual function index (FSFI). FSFI multidimensional self-report instrument was developed by Rosen et al., in 2000 for the assessment of female sexual function (5). The reliability of the questionnaire of female sexual function index has been approved by Mohammadi et al., in Iran (11). Cronbach's alpha for the total sexual function index was calculated as 0.92, and it ranged from 0.70 (sexual desire) to 0.91 (orgasm) for its dimensions. The FSFI is a questionnaire consists of 19 items investigating the subjects in 6 domains of desire, arousal, lubrication, orgasm, pain, and satisfaction. Higher score reflects better sexual function (12).
The FSFI total score is calculated by the summing of the scores of six sub-scales. The total sexual function score ranges from 2 to 36 with the score less than 28 as cut-off for sexual dysfunction in Iran. The sexual desire score ranges from 1.2 to 6, satisfaction score ranges from 0.8 to 6 and the rest of the sub-scales (lubrication, orgasm, sexual arousal and pain) ranges from 0 to 6. Cut off for different domains defined as: desire 3.3, arousal 3.4, lubrication 3.4, orgasm 3.4, satisfaction 3.8 and pain 3.8. Scores less than cutoff are considered as dysfunction for each domain (11, 13).
Knowledge score on sexual infections was determined by the questionnaire of knowledge regarding STIs which have 37 three-choice items including true (score=1), false and I don’t know (score=0). The scores ranged between zero and 100. The questionnaire prepared by Farshbaf-Khalili and et al. in 2014 and its validity was determined that the amount of content validity index (CVI) and content validity ratio (CVR) was obtained 0.72 and 0.81, respectively. The reliability of the questionnaire was determined through intra-class correlation coefficient (ICC) with 95% confidence interval that was calculated 0.98 (0.99-1.0) (14).
At first, a list of all the health care centers in Rasht was provided. Then, sampling was conducted in two stages by using multi-stage cluster sampling. Firstly, 10 centers randomly were selected among the 59 health care centers. In the next stage, according to the total sample size, the proper numbers of women proportionate to population in reproductive age covered by each center (31-48 women) were randomly selected, and their phone number and general information were recorded through their health records. After a phone call to the women and explaining about the study, the researcher surveyed the eligibility criteria and if they met the criteria, they were invited and asked to fill a questionnaire on a specified day in a suitable room at health care centers. Sampling in both stages was conducted randomly via the website www.randomizer.org. Before data collection, informed consent form was signed by participants after explaining about the study.
We used the SPSS ver. 13 for data analysis. The normal distribution of continuous data was investigated using kolmogorov-smirnov which was normal except for satisfaction domain of FSFI. Descriptive statistics including frequency and percentage as well as mean, median, standard deviation and Q25, Q75were used to describe the social-demographic characteristics, knowledge of sexual function and the status of sexual function. Bivariate statistical tests such as chi-square, independent-t and one-way ANOVA, pearson and spearman correlation, Mann-Withney, and Kruskal-Wallis tests were used to analyze the relationship between sexual function and socio-demographic characteristics and knowledge. Afterward, the independent variables with p<0.2 in the bivariate tests were entered into the multi-variate linear regression model through backward strategy, adjusted for the confounding factors and measure the respective effects of the independent variables (knowledge, socio-demographic characteristics) on the sexual function.
The mean (SD) age of women and their husbands were 30.6 (5.8) and 34.6 (6.6), respectively. The mean (SD) age at marriage in women was 21.60 (4.03).The mean (SD) family size was 3.51 (0.74). Nearly half of women (50.0%) and their husbands (50.65%) had diploma. Majority of women (90.41%) were housekeeper versus majority of husbands (61.07%) occupied in private sector (Table 1).
The variables marked as * were reported as mean (SD). The others were reported as n (%).
a. Pearson
b. One-way ANOVA
Almost one third of women (36%) stated that they use condoms in their sexual relations. Seventy seven (19%) of the subjects had oral sex as well as 47 women (11%) declared having anal sex. One hundred sixteen women (29%) had used a condom in their last sexual relationship; the suggestion of condom use in 56% of cases was made by women and in 44% of cases, it was done by their spouses (Table 2).
*These variables were reported as mean (SD). IUD: Intra Uterine Device. TL: Tubal Ligation
a. Pearson
b. One-way ANOVA
C. Independent t-test
The mean (SD) score of total sexual function among subjects was 28.14 (3.82). The mean (SD) score of sub-scales (domains) of desire, arousal, lubrication, orgasm and pain were 3.75 (1.09), 4.26 (0.85), 4.92 (0.94), 4.75 (0.86), 4.95 (1.16), respectively. The median (Q25, Q75) sub-scale of satisfaction was 6 (5.2, 6.0). The prevalence of sexual dysfunction among participants was 34.3%. The frequency of sub-scales disorders was as below: desire disorders by 27.7%, arousal by 13.9%, lubrication by 7.1%, orgasmic disorders by 7.8%, satisfaction by 3.5%, and pain disorders by 19% (Table 3).
The mean (SD) score of knowledge on sexual infections was 76.85 (12.73). A significant relationship was seen between the mean score of total sexual function with age, education level, husband’s age, parity, age at menarche, number of sex and mean score of knowledge on sexual infections (p<0.05). (Table 1, 2)
Variables of age, education level, husband’s age, parity, age at menarche, frequency of sex and mean score of knowledge on sexual infections, age of marriage, unwanted pregnancy had p<0.2 in the bivariate analysis, were entered in the backward multivariate linear regression. A significant relationship was observed between age, education level, age at menarche, number of sex and knowledge on sexual infections with sexual function. Taken together, they could predict 12% of the variance of sexual function in women (Table 4).
This study aimed to determine the prevalence of sexual dysfunction and predisposing factors in women the results showed that the mean (SD) score of total sexual function among subjects was 28.14 (3.82) that with regard to cut-off point for sexual function index, it was in a borderline level. This result is very alarming for families and health authorities, because various studies have revealed a significant positive correlation between the sexual function and quality of life and interpersonal relationships (15, 16). Also sexual dysfunctions can severely lead to disrupted woman’s self-esteem (2). Therefore, despite the necessity of sex education in Iran, we could not reach a conclusion about the whole country from the data we obtained here.
To date, a few large-scale studies have evaluated the prevalence of FSD in Iran. In our research, sexual dysfunction was detected as a desire problem in 27.7% of women, an arousal problem in 13.9%, a lubrication problem in 7.1%, an orgasm problem in 7.8%, a satisfaction problem in 3.5% and a pain problem in 19% and the prevalence rate of total sexual dysfunction was 34.3% in women. Study by Nappi et al. showed the prevalence of an arousal problem in 22.3%, a lubrication problem in 19.1%, an orgasm problem in 22.5%, a satisfaction problem in 22.9%, a pain problem in 20.2% and a desire problem in 21.2% of subjects (17). In a study conducted in Greece, prevalence of sexual dysfunction was reported 69.31% (1). In another survey conducted by Amidu et al. on 400 healthy women between 18 and 58 years old, prevalence of sexual dysfunction was revealed 72.8% (18). Mercer et al., who conducted a survey on sexual function problems and help seeking behavior in Britain found that 53.8% of women had at least one sexual problem lasting at least one month in the previous year (19), While other studies have reported lower rates (up to 25%) (5). There is a large difference in the prevalence of sexual dysfunction between countries. It is difficult to compare the results of studies because in different countries, many factors may affect the prevalence of sexual dysfunction. However, this phenomenon might be explained by characteristics of the population, lack of validated FSD Questionnaire, definition of sexual dysfunction in various populations, using different methods, culture and the social environment. All of these factors, and many others, probably affect the prevalence of sexual function. Additionally, the variation in the levels of normal sexual function and sexual function importance to individuals and cultural attitudes also complicate determination of FSDs (1).
Our findings indicate that the factors of age, education level, age at menarche, number of sex and knowledge were predictors of sexual function. Several studies have shown that age is the most important risk factors for FSD (20-22). Oksuz et al reported similar results (23). Smith et al found that women with 60 years of age and older, had the highest incidence of sexual problems (24); they also reported a decrease in sexual desire (25), likely due to the hormonal changes of menopause.
A sexual function decrement with increasing age has also been observed in longitudinal and cross-sectional studies (26-28). Also, the experience of sexual problems was decreased with higher educational levels in women and men (29). In fact, it seems that higher education provide more opportunity to have more reproductive health information and to use health care services effectively. Research showed that risk factors for FSD include age, sexually transmitted disease, lower educational attainment, physical health, and life-style (23).
Female sexual dysfunction (FSD), a multifactorial disorder, is a combination of psychological, biological and individual components (22, 30, 31). Sexuality is not only influenced by family, societal and religious beliefs but also is affected by aging, health status and personal experience as well as socio-economic status (18).
In this study, subjects were selected randomly from health care centers. The predictors of sexual function were determined in reproductive women and therefore, generalization of the results to other age groups should be undertaken with caution. It is recommended to do complementary studies on menopausal women. Besides, a similar study can be performed in women referring to the private sector. Researches on men can also be performed. Another recommendation is to present necessary educational interventions on sexual matters for couples and investigating its effect on sexual behavior.
According to the results, sexual function of the women in this study was in a borderline level. Considering the critical impact of sexual function on the health of couples, sexual function predictors are significant to help and plan prevention programs.
Hereby, we would like to appreciate the Research Deputy of Guilan University of Medical Sciences, Faculty of Nursing and Midwifery, authorities and staff of Health Centers and all of the women who patiently assisted us in collecting data.
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Methods: This cross-sectional study was carried out on 400 outpatient women aged 15-49, who had a health record in the health care centers of Rasht, Iran during 2015-2016. Samples were selected through multi-stage cluster sampling method. Data collection tool included demographics and reproductive information, the standard questionnaire of female sexual function index (FSFI). Multivariate linear regression analysis was used to determine the predictors of sexual dysfunction in SPSS 13.
Results: The mean±SD score of total FSFI was 28.14±3.82, ranging from 2 to 36. The frequency of sexual dysfunction was 34.3% in total. Multivariate linear regression analysis showed a significant correlation between FSFI and some factors including age, education level, age at menarche, frequency of sex, and knowledge on sexual function. These factors accounted for 12% of the variance in the sexual function index of women.
Conclusions: Considering the critical impact of sexual function on the health of couples, paying attention to sexual function in women and its predictors are important to help and plan prevention programs.
Keywords: Sexual dysfunction, Women, Predictor, Community health centers
Introduction
Sexuality is an important and inseparable part of the life of every woman (1). Female sexual dysfunction (FSD) has a significant impact on quality of life and can lead to personal distress, anxiety and interpersonal difficulty (1-3).
According to the World Health Organization (WHO), and International Classifications of Diseases-10 (ICD-10), FSD is defined as “a syndrome that includes the various ways in which adult people may have difficulty in experiencing personal satisfaction in non-compulsory sexual activities. Sexual response is a complex interaction between psychological, interpersonal, social, cultural and physiological factors; so that disturbance in one or more of these factors may affect any stage of the sexual response. In order to diagnose sexual dysfunction, it must: 1) occur frequently, although it may be absent on some occasions; 2) be present for at least several months; and 3) be associated with clinically significant distress. “(4). FSD is included disorders of desire/libido, arousal, pain, and inhibited orgasm (5).
FSD is affected by several psychological, biological and sociocultural factors (6). The result of a review study showed that the low sexual desire was the most prevalent dysfunction among both premenopausal and postmenopausal women. Low sexual desire regularly enhances with increasing age. The overall frequency of reported low sexual desire ranged from 10% to 64% in different studies (7).
Sexual dysfunction is considered as a widespread problem in Iranian women. One study showed that the prevalence of sexual dysfunction is 31.5% in Iran. This study showed that some factors, such as lower marriage age, financial dependency, lower educational level, lower physical activity and multi-parity increase prevalence of sexual dysfunction. The prevalence of FSD may vary due to cultural, racial and health variables among the countries (2). Therefore, an assessment is needed for any plan to promote healthy behaviors of a society (8). Investigating the rate of sexual dysfunction and factors influencing for these conditions are very important to help to do risk assessment and plan treatment and prevention programs in sexual medicine (9). Epidemiology can be defined as a population survey in the development of disease and health, with the ultimate goal of preserving and preventing it (7). Understanding the prevalence and risk factors of sexual dysfunction is important for prevention efforts (6, 9). According to the authors' search, no study was found on the prevalence of sexual dysfunction and its risk factors in women in Rasht. Therefore, we aimed to determine the prevalence of sexual dysfunction in women referred to health centers in Rasht - Iran and its predictors.
Methods
This cross-sectional study was carried out on 400 outpatient women aged 15-49, who were referred to a visit at health care centers of Rasht-Iran, 2016. The inclusion criteria were: referring to the health centers in Rasht and having health care records, willingness to participate in the research, being married, lack of speech and hearing problems and no mental illnesses or chronic diseases according to patient's report and information in the health care records.
The study was approved by the Ethics Committee at Guilan University of Medical Sciences (code: IR.GUMS.REC.1394.120).
Sample size was calculated 357 women based on the main variable of sexual dysfunction according to the results of a study by Jaafarpour et al. (10), considering mean = 23.89, d= 0.05, SD= 9.2, design effect=1.5 and a significant level of 95%. Finally, with the probable dropout rate of 10%, 400 persons were estimated for this study.
Data collection tool included 2 parts; demographics and reproductive information, the standard questionnaire of female sexual function index (FSFI). FSFI multidimensional self-report instrument was developed by Rosen et al., in 2000 for the assessment of female sexual function (5). The reliability of the questionnaire of female sexual function index has been approved by Mohammadi et al., in Iran (11). Cronbach's alpha for the total sexual function index was calculated as 0.92, and it ranged from 0.70 (sexual desire) to 0.91 (orgasm) for its dimensions. The FSFI is a questionnaire consists of 19 items investigating the subjects in 6 domains of desire, arousal, lubrication, orgasm, pain, and satisfaction. Higher score reflects better sexual function (12).
The FSFI total score is calculated by the summing of the scores of six sub-scales. The total sexual function score ranges from 2 to 36 with the score less than 28 as cut-off for sexual dysfunction in Iran. The sexual desire score ranges from 1.2 to 6, satisfaction score ranges from 0.8 to 6 and the rest of the sub-scales (lubrication, orgasm, sexual arousal and pain) ranges from 0 to 6. Cut off for different domains defined as: desire 3.3, arousal 3.4, lubrication 3.4, orgasm 3.4, satisfaction 3.8 and pain 3.8. Scores less than cutoff are considered as dysfunction for each domain (11, 13).
Knowledge score on sexual infections was determined by the questionnaire of knowledge regarding STIs which have 37 three-choice items including true (score=1), false and I don’t know (score=0). The scores ranged between zero and 100. The questionnaire prepared by Farshbaf-Khalili and et al. in 2014 and its validity was determined that the amount of content validity index (CVI) and content validity ratio (CVR) was obtained 0.72 and 0.81, respectively. The reliability of the questionnaire was determined through intra-class correlation coefficient (ICC) with 95% confidence interval that was calculated 0.98 (0.99-1.0) (14).
At first, a list of all the health care centers in Rasht was provided. Then, sampling was conducted in two stages by using multi-stage cluster sampling. Firstly, 10 centers randomly were selected among the 59 health care centers. In the next stage, according to the total sample size, the proper numbers of women proportionate to population in reproductive age covered by each center (31-48 women) were randomly selected, and their phone number and general information were recorded through their health records. After a phone call to the women and explaining about the study, the researcher surveyed the eligibility criteria and if they met the criteria, they were invited and asked to fill a questionnaire on a specified day in a suitable room at health care centers. Sampling in both stages was conducted randomly via the website www.randomizer.org. Before data collection, informed consent form was signed by participants after explaining about the study.
We used the SPSS ver. 13 for data analysis. The normal distribution of continuous data was investigated using kolmogorov-smirnov which was normal except for satisfaction domain of FSFI. Descriptive statistics including frequency and percentage as well as mean, median, standard deviation and Q25, Q75were used to describe the social-demographic characteristics, knowledge of sexual function and the status of sexual function. Bivariate statistical tests such as chi-square, independent-t and one-way ANOVA, pearson and spearman correlation, Mann-Withney, and Kruskal-Wallis tests were used to analyze the relationship between sexual function and socio-demographic characteristics and knowledge. Afterward, the independent variables with p<0.2 in the bivariate tests were entered into the multi-variate linear regression model through backward strategy, adjusted for the confounding factors and measure the respective effects of the independent variables (knowledge, socio-demographic characteristics) on the sexual function.
Results
The mean (SD) age of women and their husbands were 30.6 (5.8) and 34.6 (6.6), respectively. The mean (SD) age at marriage in women was 21.60 (4.03).The mean (SD) family size was 3.51 (0.74). Nearly half of women (50.0%) and their husbands (50.65%) had diploma. Majority of women (90.41%) were housekeeper versus majority of husbands (61.07%) occupied in private sector (Table 1).
Table 1. Socio-demographic characteristic of participants and their relation with total score of sexual function (n=400)
| Statistical indicators |
Sexual function Mean (SD) |
N (%) |
Variable |
| aP<0.001 r=-0.230 | 28.14 (3.82) | 30.60 (5.83) * | Age |
| ap=0.001 r=-0.159 | 28.14 (3.82) | 34.64 (6.64) * | Husband’s age |
| ap=0.063 r=-0.209 | 28.14 (3.82) | 21.60 (4.03) * | Marriage age |
| ap=0.049 r=-0/99 | 28.14 (3.82) | 3.51 (0.74) * | Number of family |
| bP=0.001 F=5.085 df=4 |
32.30 (0.00) 27.04 (4.08) 28.95 (2.55) 27.00 (3.00) 29.02 (3.00) |
2 (0.51) 19 (4.82) 48 (12.18) 197 (50.0) 128 (32.49) |
Education Illiterate Primary school Secondary school High school & Diploma Academic |
| bp=0.464 F=0.857df=3 |
28.55 (3.92) 29.26 (2.62) 28.02 (2.43) |
358 (90.41) 26 (6.56) 12 (3.03) |
Occupation housekeeper employee privacy sector |
| bp=0.886 F=0.343 df=5 |
27.71 (4.66) 27.76 (3.29) 28.97 (1.78) 28.04 (3.92) 28.14 (3.92) |
8 (2.03) 12 (3.05) 21 (5.33) 91 (23.09) 262 (66.50) |
Income (1000 Rial) <2000 2000-4000 4000-8000 8000-16000 >16000 |
| bP=0.457 F=0.953 df=6 |
32.30 (0.00) 27.67 (3.27) 27.89 (3.39) 27.86 (3.88) 28.38 (3.89) 28.72 (3.83) |
2 (0.51) 23 (5.82) 44 (11.14) 204 (50.65) 38 (9.62) 84 (21.26) |
Husband’s education Illiterate Primary school Secondary school High school & Diploma Associate degree Bachelor of science |
| bP=0.487 F=0.862 df=4 |
28.50 (2.59) 28.55 (3.58) 27.91 (3.63) 28.04 (3.96) |
3 (0.76) 97 (24.68) 53 (13.49) 240 (61.07) |
Husband’s occupation Unemployed Employee Worker private sector |
a. Pearson
b. One-way ANOVA
Almost one third of women (36%) stated that they use condoms in their sexual relations. Seventy seven (19%) of the subjects had oral sex as well as 47 women (11%) declared having anal sex. One hundred sixteen women (29%) had used a condom in their last sexual relationship; the suggestion of condom use in 56% of cases was made by women and in 44% of cases, it was done by their spouses (Table 2).
Table 2. Obstetric characteristic of participants &some effective factors and their relation with the total score of sexual function (n=400)
| Statistical indicators | Sexual function Mean (SD) | N (%) | Variable |
| bP=0.016 F=3.070df=4 |
29.16 (2.36) 28.57 (3.84) 27.29 (3.87) 28.10 (335) |
7 (1.78) 229 (58.12) 124 (31.47) 34 (8.63) |
Parity 0 1 2 3 and more |
| CP=0.069 t=3.316 df=1 |
27.70 (3.88) 28.42 (3.75) |
154 (39.09) 240 (60.91) |
Unwanted pregnancy Yes No |
| CP=0.628 t=0.465 df=2 |
28.17 (3.81) 27.33 (4.06) |
374 (95.41) 18 (4.59) |
Use of contraception Yes No |
| bP=0.430 F=1.007df=8 |
28.36 (3.66) 27.69 (4.21) 28.23 (4.16) 26.39 (3.71) 26.75 (2.94) 28.91 (4.21) |
165 (44.11) 52 (13.91) 95 (25.40) 9 (2.41) 29 (7.75) 24 (6.42) |
Contraception method Withdrawal Hormonal method Condom IUD* TL* Withdrawal & Condom |
| ap=0.009 r=-0.131 | 28.14 (3.82) | 13.18 (1.33) | Age at menarche* |
| aP=0.003 r=0.149 | 28.14 (3.82 | 76.85 (12.73) | Knowledge score on* sexual infections (0-100) |
| bP<0.001 F=5.696 df=4 |
27.78 (2.17) 25.54 (3.77) 27.97 (3.86) 29.94 (3.02) |
5 (1.28) 18 (4.63) 316 (81.24) 50 (12.85) |
Frequency of sex Never Less than once/month 1-2/week 3 or more/week |
| CP=0.341 t=1.153 df=2 |
27.88 (4.33) 28.28 (3.51) |
144 (36.92) 246 (63.08) |
Use of condom Yes No |
| CP=0.519 t=-0.646df=391 |
27.80 (3.56) 28.18 (3.86) |
(11.93)47 (88.07)347 |
Anal intercourse Yes No |
a. Pearson
b. One-way ANOVA
C. Independent t-test
The mean (SD) score of total sexual function among subjects was 28.14 (3.82). The mean (SD) score of sub-scales (domains) of desire, arousal, lubrication, orgasm and pain were 3.75 (1.09), 4.26 (0.85), 4.92 (0.94), 4.75 (0.86), 4.95 (1.16), respectively. The median (Q25, Q75) sub-scale of satisfaction was 6 (5.2, 6.0). The prevalence of sexual dysfunction among participants was 34.3%. The frequency of sub-scales disorders was as below: desire disorders by 27.7%, arousal by 13.9%, lubrication by 7.1%, orgasmic disorders by 7.8%, satisfaction by 3.5%, and pain disorders by 19% (Table 3).
Table 3. Mean (SD) score of sexual function and its dimensions, and frequency of sexual dysfunction among studied women.
| Components | Mean (SD) | Median (Q25, Q75) | Sexual dysfunction |
| Total score (2-36) | 28.14 (3.82) | 28.90 (26.50, 30.70) | 34.3% |
| Sexual desire (1.2-6) | 3.75 (1.09) | 4.20 (3.0, 4.20) | 27.7% |
| Sexual arousal (0-6) | 4.26 (0.85) | 4.20 (3.90, 4.80) | 13.9% |
| Lubrication (0-6) | 4.92 (0.94) | 5.10 (4.27, 5.70) | 7.1% |
| Orgasm (0-6) | 4.75 (0.86) | 4.80 (4.40, 5.60) | 7.8% |
| Satisfaction (0.8-6) | 5.49 (0.80) | 6 (5.20, 6.0) | 3.5% |
| Pain (0-6) | 4.95 (1.16) | 5.20 (4.0, 6.0) | 19% |
The mean (SD) score of knowledge on sexual infections was 76.85 (12.73). A significant relationship was seen between the mean score of total sexual function with age, education level, husband’s age, parity, age at menarche, number of sex and mean score of knowledge on sexual infections (p<0.05). (Table 1, 2)
Variables of age, education level, husband’s age, parity, age at menarche, frequency of sex and mean score of knowledge on sexual infections, age of marriage, unwanted pregnancy had p<0.2 in the bivariate analysis, were entered in the backward multivariate linear regression. A significant relationship was observed between age, education level, age at menarche, number of sex and knowledge on sexual infections with sexual function. Taken together, they could predict 12% of the variance of sexual function in women (Table 4).
Table 4. Personal and Socio-demographic predictors of sexual function in subjects (n=400)
| Variable | Β (%95 CI) | p |
| Age | -0.11 (-0.18 to -0.05) | 0.001 |
| Education Illiterate Primary school Secondary school High school Academic |
2.73 (-2.44 to 7.89) -1.38 (-3.16 to 0.41) -0.06 (-1.38 to 1.26) -1.15 (-1.88 to -0.42) reference |
0.300 0.130 0.93 0.002 reference |
| Age at menarche | -0.26 (-0.54 to 0.02) | 0.071 |
| Number of sex Never Less than once/month 1-2/week 3 or more/week |
-1.88 (-5.25 to 1.49) -2.68 (-4.73 to -0.63) -1.16 (-2.22 to -0.09) reference |
0.274 0.010 0.032 reference |
| Knowledge on sexual infections | 0.05 (0.02 to 0.08) | 0.02 |
Discussion
This study aimed to determine the prevalence of sexual dysfunction and predisposing factors in women the results showed that the mean (SD) score of total sexual function among subjects was 28.14 (3.82) that with regard to cut-off point for sexual function index, it was in a borderline level. This result is very alarming for families and health authorities, because various studies have revealed a significant positive correlation between the sexual function and quality of life and interpersonal relationships (15, 16). Also sexual dysfunctions can severely lead to disrupted woman’s self-esteem (2). Therefore, despite the necessity of sex education in Iran, we could not reach a conclusion about the whole country from the data we obtained here.
To date, a few large-scale studies have evaluated the prevalence of FSD in Iran. In our research, sexual dysfunction was detected as a desire problem in 27.7% of women, an arousal problem in 13.9%, a lubrication problem in 7.1%, an orgasm problem in 7.8%, a satisfaction problem in 3.5% and a pain problem in 19% and the prevalence rate of total sexual dysfunction was 34.3% in women. Study by Nappi et al. showed the prevalence of an arousal problem in 22.3%, a lubrication problem in 19.1%, an orgasm problem in 22.5%, a satisfaction problem in 22.9%, a pain problem in 20.2% and a desire problem in 21.2% of subjects (17). In a study conducted in Greece, prevalence of sexual dysfunction was reported 69.31% (1). In another survey conducted by Amidu et al. on 400 healthy women between 18 and 58 years old, prevalence of sexual dysfunction was revealed 72.8% (18). Mercer et al., who conducted a survey on sexual function problems and help seeking behavior in Britain found that 53.8% of women had at least one sexual problem lasting at least one month in the previous year (19), While other studies have reported lower rates (up to 25%) (5). There is a large difference in the prevalence of sexual dysfunction between countries. It is difficult to compare the results of studies because in different countries, many factors may affect the prevalence of sexual dysfunction. However, this phenomenon might be explained by characteristics of the population, lack of validated FSD Questionnaire, definition of sexual dysfunction in various populations, using different methods, culture and the social environment. All of these factors, and many others, probably affect the prevalence of sexual function. Additionally, the variation in the levels of normal sexual function and sexual function importance to individuals and cultural attitudes also complicate determination of FSDs (1).
Our findings indicate that the factors of age, education level, age at menarche, number of sex and knowledge were predictors of sexual function. Several studies have shown that age is the most important risk factors for FSD (20-22). Oksuz et al reported similar results (23). Smith et al found that women with 60 years of age and older, had the highest incidence of sexual problems (24); they also reported a decrease in sexual desire (25), likely due to the hormonal changes of menopause.
A sexual function decrement with increasing age has also been observed in longitudinal and cross-sectional studies (26-28). Also, the experience of sexual problems was decreased with higher educational levels in women and men (29). In fact, it seems that higher education provide more opportunity to have more reproductive health information and to use health care services effectively. Research showed that risk factors for FSD include age, sexually transmitted disease, lower educational attainment, physical health, and life-style (23).
Female sexual dysfunction (FSD), a multifactorial disorder, is a combination of psychological, biological and individual components (22, 30, 31). Sexuality is not only influenced by family, societal and religious beliefs but also is affected by aging, health status and personal experience as well as socio-economic status (18).
In this study, subjects were selected randomly from health care centers. The predictors of sexual function were determined in reproductive women and therefore, generalization of the results to other age groups should be undertaken with caution. It is recommended to do complementary studies on menopausal women. Besides, a similar study can be performed in women referring to the private sector. Researches on men can also be performed. Another recommendation is to present necessary educational interventions on sexual matters for couples and investigating its effect on sexual behavior.
Conclusion
According to the results, sexual function of the women in this study was in a borderline level. Considering the critical impact of sexual function on the health of couples, sexual function predictors are significant to help and plan prevention programs.
Acknowledgements
Hereby, we would like to appreciate the Research Deputy of Guilan University of Medical Sciences, Faculty of Nursing and Midwifery, authorities and staff of Health Centers and all of the women who patiently assisted us in collecting data.
References
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5. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191-208. [DOI:10.1080/009262300278597]
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Bibliographic information of this paper for citing:
Rezaie-Chamani S, Rahnavardi M, Sabetghadam SH, et al. Prevalence of Sexual Dysfunction in Women Referred to Health Centers of Guilan-Iran and its Predictors: A Cross-Sectional Study
J Res Dev Nurs Midw, 2020; 17(1): 39-51.
J Res Dev Nurs Midw, 2020; 17(1): 39-51.
Type of Study: Original Article |
Subject:
Psychology and Psychiatry
References
1. Stamatiou K, Margariti M, Nousi E, Mistrioti D, Lacroix R, Saridi M. Female sexual dysfunction (fsd) in women health care workers. Mater Sociomed.2016;28(3):178-82. [DOI: 10.5455/msm.2016.28.178-182] [View at paplisher] [DOI] [Google Scholar]
2. Safarinejad MR. Female sexual dysfunction in a population-based study in Iran: prevalence and associated risk factors. IJIR. 2006;18(4):382-95. [View at paplisher] [DOI] [Google Scholar]
3. Shin H, Min B, Park J, Son H. A 10-year interval study to compare the prevalence and risk factors of female sexual dysfunction in Korea: the Korean internet sexuality survey (KISS) 2014. Int J Impot Res. 2017;29(2):49-53. [DOI:10.1038/ijir.2016.41] [View at paplisher] [DOI] [Google Scholar]
4. World Health Organization: ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) 2018 version. Sexual dysfunctions. Available. [View at paplisher]
5. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191-208. [DOI: 10.1080/009262300278597] [View at paplisher] [DOI] [Google Scholar]
6. McCool-Myers M, Theurich M, Zuelke A, Knuettel H, Apfelbacher C. Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms. BMC Womens Health. 2018;18(1):108. [DOI:10.1186/s12905-018-0602-4] [View at paplisher] [DOI] [Google Scholar]
7. DeRogatis L, Burnett A. The epidemiology of sexual dysfunctions. J Sex Med. 2008;5(2):289-300. [DOI: 10.1111/j.1743-6109.2007.00668.x] [View at paplisher] [DOI] [Google Scholar]
8. Whiteheada D, Russell G. How effective are health education programs-resistance, reactance, rationality and risk? Recommendations for effective practice. Int J Nurs Stud. 2004;41(2):163-72. [DOI:10.1016/S0020-7489(03)00117-2] [View at paplisher] [DOI] [Google Scholar]
9. Aisuodionoe-Shadrach OI. Perceptions of female sexual health and sexual dysfunction in a cohort of urban professional women in Abuja, Nigeria. Niger J Clin Pract. 2012;15(1):80-3. [DOI:10.4103/1119-3077.94104] [View at paplisher] [DOI] [Google Scholar]
10. Jaafarpour M, Khani A, Khajavikhan J, Suhrabi Z. Female Sexual Dysfunction: Prevalence and Risk Factors. J Clin Diagn Res. 2013;7(12):2877-80. [DOI: 10.7860/JCDR/2013/6813.3822] [View at paplisher] [DOI] [Google Scholar]
11. Mohammadi KH, Heydari M, Faghihzadeh S. The female sexual function index (FSFI): validation of the Iranian version. Payesh. 2008;7(3):269-78. [persian] [View at paplisher] [Google Scholar]
12. Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1-20. [DOI:10.1080/00926230590475206] [View at paplisher] [DOI:10.1080/00926230590475206] [Google Scholar]
13. Fakhri A, Pakpour AH, Burri A, Morshedi H, Zeidi IM. The Female Sexual Function Index: translation and validation of an Iranian version. J Sex Med. 2012;9(2):514-23. [DOI:10.1111/j.1743-6109.2011.02553.x] [View at paplisher] [DOI] [Google Scholar]
14. Khalili AF, Shahnazi M, Rezaie S, Pourmehr HS. Awareness about sexually transmitted and other infections of the reproductive tract, risk factors and other predictors in women. Archives of Clinical Infectious Diseases. 2014;9(4). [DOI : 10.5812/archcid.18076] [View at paplisher] [DOI] [Google Scholar]
15. Mirghafourvand M, Charandabi SM-A, Jafarabadi MA, Tavananezhad N, Karkhane M. Predictors of Health-Related Quality of Life in Iranian Women of Reproductive Age. Applied Research in Quality of Life 2016;11(3):723-37. [DOI:10.1007/s11482-015-9392-0] [View at paplisher] [DOI] [Google Scholar]
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