Journal of Clinical and Diagnostic Research. 2018 Oct, Vol-12(10): QC16-QC19
1616
DOI: 10.7860/JCDR/2018/37423.12152
Original Article
Obstetrics and Gynaecology
Section
Correlation Between Sexual Satisfaction
and Self-esteem and Stress in Women
of Reproductive Age
INTRODUCTION
Sexual and marital satisfaction is the most important factor for the
sustainability and durability of a mutual life. Marital satisfaction exists
when marital status conforms to the expected situation. If couples
can improve the level of satisfaction in marital life, they will protect
the family [1]. Several studies have shown significant relationships
between sexual satisfaction and gratification with marital interactions
and relationships [2]. Iranian experts believe that 50 to 60 percent of
divorces are caused by sexual problems and disorders [3]. Sexual
dysfunctions occur in all societies that affect the quality of sexual
relationships of married people [4]. Sexually disordered people often
hide this problem, and the lack of proper treatment results in chronic
symptoms, anxiety, individualism, and guilt feeling [5].
The way an individual observes one’s sexual characteristics depends
on self-esteem, which is defined as a series of feedbacks and beliefs
that individuals express in their relationships with the external world.
To put it simply, self-esteem is the value that a person considers for
oneself [6] as one of the important and influential variables on marital
quality [7]. A low self-esteem leads to a relationship in which there
is no trust and intimacy with significant reduction in the relationship
quality [6]. People with low self-esteem suppress their ability to
express sexual desires [8], but a high self-esteem will lead to a
healthy sexual behaviour [9]. A study by Ramezani M et al., indicated
that self-esteem was correlated with sexual satisfaction and people
with low self-esteem levels noted higher sexual dysfunctions [10].
Low self-esteem in individuals gives rise to a variety of psychological
disorders such as anxiety and stress.
Stress is another variable affecting marital satisfaction, the impact of
which is very evident on marital satisfaction. Stress is perhaps the
most common issue of man’s everyday life. Stress is so universal and
widespread that it is considered as a hallmark of human life, such
that all humans are exposed to and affected by high stress levels in
their everyday lives. Studies suggest negative significant relationships
between depression, anxiety, and stress with marital satisfaction. In
fact, married people who suffer from greater depression, anxiety,
and stress are therefore less satisfied with their marital life [7,11,12].
Considering the high prevalence of sexual disorders in women of Iran,
and the lack of relevant studies in Iran, this study was conducted with
an aim to examine sexual satisfaction and its relationship with self-
esteem and stress in reproductive age women.
MATERIALS AND METHODS
This cross-sectional study was conducted using convenience
sampling method on 300 women of reproductive age group who
attended Women’s Healthcare Clinic of Jahrom, Iran from June
to December 2017. The formula was utilized for calculation of the
sample size, in which the power of study considered was 90% and
α=0.05% [13]. According to the formula, the sample size was 255,
and, by adding 20% for drop-outs, the sample size was increased
to 306. Out of the 306 cases, 300 completed the questionnaire, and
6 filled the questionnaire incompletely and were excluded.
The research was approved by the ethics committee of Jahrom
University of Medical Sciences (IR.JUMS.REC.1394.036). The
samples were enrolled in the study according to the inclusion
criteria: age of women between 15-45 years, non-pregnant and
literate with Iranian nationality, no chronic conditions like Mental
illness, hypertention, diabetes, Cardiovascular problems, Chronic
vaginal infection, Renal disorders, no history of smoking, alcohol,
and antidepressants, and no history of stressful events like death
of relatives and divorce in the past six months. The women were
explained the study and informed consent was obtained from
them.
SAFIEH JAMALI
1
, NEDA POORNOWROOZ
2
, ZAHRA MOSALLANEZHAD
3
, MAHSHID ALBORZI
4
Keywords: Marital satisfaction, Self-esteem, Stress, Women
ABSTRACT
Introduction: Marital satisfaction is one of the factors affecting
quality of life, quality of sexual relations, and interpersonal
relationships.
Aim: To determine the relationship between marital satisfactions,
perceived stress, and self-esteem among reproductive age
women in Jahrom City, Iran.
Materials and Methods: This cross-sectional study was
conducted on 300 women who attended Women’s Healthcare
Clinic of Jahrom, Iran from June to December 2017. The
tools used were Larsson sexual satisfaction questionnaire,
Cohen’s perceived stress scale, and Rosenberg self-esteem
questionnaire. Data were analysed using ANOVA, Pearson’s
correlation coefficient, and Spearman test.
Results: The mean age of women was 29.55±6.68 years. In
addition, 3(1%), 27(9%), 138(46%) and 132(44%) of subjects
showed zero, low, moderate, and high levels of sexual satisfaction.
There was a significant correlation between sexual satisfaction
with self-esteem (p<0.05) and stress (p<0.05). In addition, positive
significant correlations were found between sexual satisfaction
with the women’s education (p<0.05 r=0.22), spouses’ education
(p=0.003 r=0.17), Husband Employment status (p=0.04 r=0.11),
and family income levels (p=0.03 r=0.12).
Conclusion: There were significant correlations between
marital satisfaction, self-esteem and stress. Sexual satisfaction
improved in individuals with high self-esteem whereas it
decreased with increasing stress levels. Therefore, health
planners should adopt strategies to increase self-esteem and
reduce stress in reproductive age women.
www.jcdr.net Safieh Jamali et al., Sexual Satisfaction and Self-Esteem and Stress in Reproductive-Age Women
Journal of Clinical and Diagnostic Research. 2018 Oct, Vol-12(10): QC16-QC19
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Sexual Satisfaction Scale
The sexual satisfaction of the samples was measured by the
Larsson sexual satisfaction questionnaire, which has been proven
to be of scientific validity and reliability. The questionnaire contains
25 questions with quintuple-choice answers based on a Likert
scale of 1-5 scores. Scores of 25-50, 51-75, 76-100, and 101-125
denote zero, low, intermediate, and high sexual satisfaction levels,
respectively [14]. In the study of Bahrami N et al., and Azari S et al.,
(in Iran, the reliability of the Larsson sexual satisfaction questionnaire
was calculated by Cronbach’s alpha method and reported to be
93% and 82% respectively [15,16]. Also, in the study of Rahmani
A et al., reliability of the questionnaire was 0.89 using test-retest
methods [17].
Perceived Stress Scale
This test was designed by Cohen et al. for the perceived stress
section. The test has 14 phrases scored 0-4 based on a 5-point
Likert-type scale ranging from 0 (never) to 4 (mostly). Scores
ranged from 0 to 56. A 5-point scale ranging from 0 (mostly) and 4
(never) was used for seven questions. Alsunni A et al., calculated
the internal consistency of this test by Cronbach’s alpha (0.74)
[18]. The validity and reliability of the Perceived Stress Scale in
Iran were confirmed in a study by Ezati A et al., and Asghari F et
al., [19,20].
Self-Esteem Questionnaire
The Rosenberg self-esteem questionnaire contains 10 questions
with agree/disagree choices. A 10-item scale that measures global
self-worth by measuring both positive and negative feelings about
the self. The scale is believed to be uni-dimensional. All items are
answered using a 4-point Likert scale format ranging from strongly
agree to strongly disagree. Items 2, 5, 6, 8, 9 are reverse scored.
Give “Strongly Disagree” 1 point, “Disagree” 2 points, “Agree” 3
points, and “Strongly Agree” 4 points. Sum scores for all ten items.
Keep scores on a continuous scale. Higher scores indicate higher
self-esteem [21].
STATISTICAL ANALYSIS
Data were analysed by SPSS18 using ANOVA, and Pearson and
Spearman correlation coefficients. ANOVA test utilised to compare
level of sexual satisfaction score with stress and Self-esteem score
of the participants. Spearman correlation test was used in order to
correlate between characteristics of the participants with Sexual
Satisfaction and Self-Esteem and Perceived stress. Besides,
p-value <0.05 was considered as statistically significant.
RESULTS
The results showed that the subject’s average age was
29.55±6.68 years and husband’s age was 34.59±7.84 The majority
(50.7%) of women aged in the range of 20-30 years. Most of the
subjects’ education level was diploma 136 (45.5%) and the majority
241(80.3%) were housewives. Most of the subjects’ spouses
121 (40.3%) had diploma educations with the majority being self-
employed 224 (74.7%) [Table/Fig-1].
The results in [Table/Fig-2] indicate that there is a relationship
between stress and self-esteem with women’s sexual satisfaction
(p<0.05). Women with high sexual satisfaction scores have high
self-esteem scores. Moreover, an increase in mean perceived stress
score is observed with a decrease in women’s sexual satisfaction.
It was also found that there were relationships between sexual
satisfaction with the women’s education, spouses’ education,
Husband Employment status and family income levels. Self-esteem
also represented positive significant correlations with the women’s
education levels, occupation, spouses’ education, Husband
Employment status and family income levels [Table/Fig-3].
Variable Mean±SD
Age 29.55±6.68
Duration of marriage 9.22±6.73
Age different between couples 5.59±3.77
Husband age 34.59±7.84
Family income (tuman)
1
1,413500±0.07
Number of deliveries 1.41±1.22
Number of children 1.39±1.18
N (%)
Educational level (degree)
Primary school 17 (5.7)
Secondary school 43 (14.4)
Diploma 136 (45.5)
College or University 104 (34.4)
Husband Educational level
(degree)
Primary school 32 (10.7)
Secondary school 60 (20)
Diploma 121 (40.3)
College or University 87 (29)
Employment status
Housewife 241 (80.3)
Employed 59 (19.7)
Husband Employment status
Employed 224 (74.7)
Unemployed 76 (25.3)
[Table/Fig-1]: Demographic characteristics of the participants (n=300).
Numbers are presented as Mean±SD and N(%)
1
At the time of data collection, US$1=8,200 Tuman
Level of
satisfaction
Variable
High sexual
satisfaction
n=132
Medium
sexual
satisfaction
n=138
Low sexual
satisfaction
n=27
Lack of
sexual
satisfaction
n=3
Self-esteem 6.59±3.54 5.20±4.11 1.18±6.61 1.33±8.32
Perceived stress 24.62±5.70 27.20±5.87 29.51±4.53 37.66±3.21
[Table/Fig-2]: The comparison between level of sexual satisfaction and self-esteem
and stress in study participants.
p-value ANOVA test
Variable
characteristics
Sexual
satisfaction
Perceived
stress
Self-
esteem
Age
Pearson Correlation 0.02- 0.04 0.02
Sig 0.7 0.4 0.6
Educational level
Pearson Correlation 0.22 -0.02 0.22
Sig 0.000 0.88 0.001
Educational of
spouse
Pearson Correlation 0.17 -0.04 0.16
Sig 0.003 0.44 0.01
Employment status
Pearson Correlation 0.05 -0.008 0.21
Sig 0.3 0.8 p<0.05
Employment of
spouse
Pearson Correlation 0.11 0.01 0.12
Sig 0.04 0.73 0.03
Family income
Pearson Correlation 0.12 0.008 0.12
Sig 0.03 0.87 0.03
[Table/Fig-3]: Correlation coefficient between characteristics of the participants
with Sexual Satisfaction and Self-Esteem and Perceived stress in Women.
DISCUSSION
This study aimed to investigate the relationship between sexual
satisfaction with stress and self-esteem among women of
reproductive age. Fortunately, a small percentage of subjects
had disturbed satisfaction in this study, which is consistent with
Bakhshi H et al., [22] but differs from studies by Abedi P et al., and
Amidu N [13,23]. The taboos of sexual issues in Iran as well as
cultural, social, and educational differences prevent women from
easily raising their sexual dissatisfaction issues, which explain the
Safieh Jamali et al., Sexual Satisfaction and Self-Esteem and Stress in Reproductive-Age Women www.jcdr.net
Journal of Clinical and Diagnostic Research. 2018 Oct, Vol-12(10): QC16-QC19
1818
discrepancy between statistics on disturbed sexual satisfaction in
Iran and other countries.
The results of the ANOVA test between sexual satisfaction levels
and self-esteem showed that sexual dissatisfaction was higher in
people with lower self-esteem than those with greater self-esteem.
Shackelford TK also demonstrated significant relationships between
sexual satisfaction with all aspects of self-esteem [24]. Muehrer
RJ et al., have achieved the same results as well [25]. A study by
Taghizadeh M showed that marital dissatisfaction in individual with
low self-esteem is 9 times higher than normal people [26]. All of the
above studies are in line with present findings. Sexual abnormalities
lead to decreased self-esteem and a sense of inefficiency in an
individual.
Stress as a variable can also affect women’s sexual satisfaction.
As seen in this study, women with lower sexual satisfaction levels
had higher stress scores, which agrees with Abedi P et al., and
Bodenman G et al., [13,27]. Similarly, Lee HH et al., conducted a
study on nurses and concluded that occupational stresses could
affect marital satisfaction [28]. High levels of occupational stress
and the resultant negative effects can lead to conflicts, tension, and
distress in family and marital relationships, thereby, increasing the
probability of marital problems such as divorce [29,30].
The results showed significant relationships between sexual
satisfaction and self-esteem with couples’ education levels. The
relationship between sexual dysfunction and low educational level
was highlighted in various studies [31,32] and it is considered as
one of the risk factors for increased sexual dysfunction. This finding
is similar to that of the Nobre PJ et al., [33]. It seems that educated
people are more engaged in studying and thinking, hence, they can
easily look for solutions to their problems resulting in enhanced self-
esteem and consequently improved sexual satisfaction.
The results of this study signifies the relationship between sexual
satisfaction and income, as was pointed out by Zincir H et al., [34]. In
this research, 56.8% of the participants reported to have problems
in sexual relation as well. Ramezani M et al., also reported a high
chance of dissatisfaction event in low-income spouses suggesting
the impact of the economic situation on sexual satisfaction [10].
Apparently, job security and consequently improvements in the
family’s welfare and economic security can reduce economic-
psychosocial stresses on the person and raise the satisfaction of
marital relationship between couples.
CONCLUSION
Considering the importance of marital satisfaction in the family
and the impacts of self-esteem and stress on sexual relations and
satisfaction of couples, health policy makers and family counselors
should provide women with ways to achieve self-esteem along with
training strategies to deal with stress, so that they can take a step
forward towards safe fertility.
STRENGTH AND LIMITATION
One of the strengths of this study is that women of reproductive
ages that were not pregnant, in menopause or lactating period were
examined, because these situations could have different effects on
sexual function. Therefore, it is suggested that effects of stress on
sexual function in the mentioned groups can be studied.
This study was conducted only on women referred to public
health clinics in Jahrom, so the results may not represent the
entire population. Besides, because of the cultural and religious
limitations in our society, people may not be able to speak easily
about their sexual issues, so the potential insecurity of some people
in expressing explicitly their issues was a limitation.
ACKNOWLEDGEMENTS
This study is a research project approved by Jahrom University
of Medical Sciences. The authors hereby appreciate the research
deputy of the university that sponsored the research.
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Journal of Clinical and Diagnostic Research. 2018 Oct, Vol-12(10): QC16-QC19
1919
PARTICULARS OF CONTRIBUTORS:
1. MS, Department of Reproductive Health, Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran.
2. MS, Department of Nursing, Faculty of Nursing, Jahrom University of Medical Sciences, Jahrom, Iran.
3. Professor, Department of Gynaecology and Obstetrics, Jahrom University of Medical Sciences, Jahrom, Iran.
4. Professor, Department of Gynaecology and Obstetrics, Jahrom University of Medical Sciences, Jahrom, Iran.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR:
Dr. Mahshid Alborzi,
Professor, Department of Gynaecology and Obstetrics, Main Campus, Jahrom University of Medical Sciences,
Motahari Bolvard, Jahrom-7414846199, Iran.
E-mail: [email protected]
FINANCIAL OR OTHER COMPETING INTERESTS: None.
Date of Submission: Jun 04, 2018
Date of Peer Review: Jul 19, 2018
Date of Acceptance: Aug 03, 2018
Date of Publishing: Oct 01, 2018
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