A Qualitative Assessment of the Sex Education Needs of Married Iranian Women

Despite a comprehensive reproductive health program there is little sex education available in Iran. In this article we present results of a study conducted to identify content area for a proposed sex education program for married Iranian women. Twenty-one married female clients (23–45 years) and 18 reproductive health providers, recruited from urban health clinics in Tehran using non-probability sampling, participated in four focus group discussions. Sexual health information needs related to reproductive tract and sexually transmitted infections, “acceptability” of certain sexual practices such as oral and anal intercourse, and the sexual response cycles and physiology of men and women. Women’s sexual concerns related to communication, incompatibility of sexual interests and desire, and their ability to maintain a strong marriage. Two themes cut across women’s responses to all questions: modesty and maintaining a strong marriage. Results contributed to the design of a sex education program that addressed the specific information needs and concerns of Iranian women.     

Changing family formation in Nepal: marriage, cohabitation and first sexual intercourse

CONTEXT: In Nepal, marriage occurs at a relatively young age and arranged weddings are widespread. However, recent changes in the family formation process and the timing of first sexual intercourse suggest that a transformation may be under way. METHODS: Data on marriage, cohabitation and first sexual intercourse from the 2001 Nepalese Demographic and Health Survey were used to describe the family formation process. The sequence of these events and the intervals between them were explored for currently married men and women. Hazard models were used to identify factors associated with behavioral changes over time. RESULTS: The average age at marriage among women married before age 20 increased from 13.7 years for those born in 1952-1956 to 15.6 years for those born in 1977-1981, while remaining relatively stable for men married before age 25 (17.3 years for the 1942-1946 birth cohort to 17.7 for the 1972-1976 birth cohort). After individual and couple characteristics were controlled for, younger age at interview was associated with greater odds of simultaneous marriage and cohabitation for both genders (odds ratios, 1.3-1.7). Younger age at interview was also associated with premarital sex among men--those aged 39 or younger had significantly higher risks than older men of having had premarital sex, with odds ratios rising from 1.6 among those aged 35-39 to 1.8 among those aged 15-24. CONCLUSIONS: It is important not only to promote education as a means of delaying marriage and childbearing, but also to implement programs and services that prevent reproductive health problems for young married couples.     

Gender Relations and HIV Transmission in North-Central Nigeria

Nigeria’s most recent National HIV/AIDS and Reproductive Health Survey of 2012 shows a decline in the national prevalence rate from 3.6% in 2007 to 3.0% in 2012. Despite this moderate decrease, the rate for the North-central geopolitical zone: (5.7 and 3.4%, respectively) remained higher than the national average for both years. Besides, virtually all of the HIV and AIDS surveys conducted in Nigeria from 1999 till date have consistently shown higher rates among females than males. For instance, it was 4.0 and 3.5% among females; and 3.5 and 3.3% in males in 2007 and 2012 respectively. UNAIDS reported that studies on the mode of transmission in 2008 found the bulk of new infections among cohabiting and married sexual partners who are not engaged in high risk sex (42.2%) compared to casual heterosexual sex (9.1%) and sex workers (3.4%). Higher vulnerability among married females implies higher risk of parent to child transmission, yet married women are perceived as a “low risk” group. Against this backdrop, I studied some gender related socio-cultural factors that influence HIV transmission among married women in two ethnic groups in North-central Nigeria. Results of the qualitative study conducted through 24 in-depth interviews and 36 focus group discussions in six communities indicate that marital consent; women’s poor access to safe sex; double standards in marital sexual practices; gender based violence against women; among others influence the spread of HIV infection in married heterosexual couples. In conclusion, marriage does not necessarily reduce HIV vulnerability in women.     

The relationship between early development and psychosexual behaviors in adolescent females

The relationship between early sexual maturation and the psychosexual behaviors of dating and sexual intercourse was investigated using a national sample of adolescent females aged 15 to 19. Among both black and nonblack subjects, early-maturing girls were more likely to have experienced earlier dating and coital onset than were their later-maturing peers. Blacks experienced menarche and first intercourse at earlier ages, yet dating onset at later ages. Early menarche was also associated with marriage at an early age for nonblacks, but not for blacks. These racial differences were explained in terms of diverse socialization patterns or cultural expectations. For both blacks and nonblacks, those with earlier coital experience were found to have had menarche and dating onset at earlier ages.     

Protected or Unprotected Sex: The Conceptions and Attitudes of the Youth in Bolgatanga Municipality,Ghana

The youth in Bolgatanga municipality in Ghana have relatively less knowledge of sexual and reproductive health (SRH) compared to the youth in other parts of Ghana. More fundamental knowledge is needed of the factors that influence young people to have protected and unprotected sex in specific social and cultural contexts, in order to protect them from adverse consequences, such as sexually transmitted diseases (STIs), HIV/AIDS and unintended pregnancies. This study therefore analyzed the conceptions and attitudes of the youth toward protected and unprotected sex, and particularly condom use, in Bolgatanga municipality. Semi-structured and focus group interviews were held with 71 young males and females and 17 adults. The results indicated that many of them lack a comprehensive knowledge of STIs, contraceptives and pregnancy, while a group of them had a negative attitude towards contraceptives. Not all parents, schools and organisations provide young people with a comprehensive education about SRH, and some even discourage such education because they believe it would encourage young people to have sex before marriage. In addition, young people also inform each other about SRH issues, sharing stories and personal experiences with their peers. The information they exchange is not always correct, however; sometimes it merely reflects their own personal preferences. The unequal power in the sexual relationships of young people—related to the traditional value system that gives men, but not women, “sexual freedom, both in and outside marriage”—is another determining factor for unprotected sex.     

Attitudes toward premarital sex and family planning for single-never-pregnant teenage girls

Black AFDC clients who attended a family planning day at a rural Georgia county public health department were polled on their attitudes toward premarital sex, family planning for single-never-married teenage girls, and illegitimacy. The sample was only 50 women and the poll has the limitations of a small sampling. Younger and unmarried or separated women tended to approve of premarital sex more than older and married women. Dichotomized by age and by marital status, the differences were statistically significant at the p less than .001 level. None of the respondents approved of illegitimate pregnnacy, and 92% favored providing contraceptives for never-pregnant teenage girls who engage in sexual relations. There was no correlation with age or marital status in the approval of providing contraception. Results of this poll indicate that if family planning advice is supplied, the rate of illegitimate pregnancy among teenagers in this group of the population (black and low-income) will fall.     

Coital behaviors, attitudes, and knowledge of students who experience early coitus

The purpose of this study was to investigate coital behavior, contraceptive practices, and attitudinal and knowledge differences between "early coital initiators" (subjects having initial coitus at 16 years or younger) and "late coital initiators" (subjects having initial coitus from 17 to 20 years of age). Data were compiled from the results of a questionnaire administered to 929 students enrolled in personal health courses at 14 colleges and universities. The sample used for analysis included only the never-married coitally experienced males and females aged 20 and older (N = 396). The results suggested that late coital initiators: were more effective contraceptors during initial coitus; had more committed relationships with their initial sex partners; engaged in more discussion about and planning for contraceptive use; and used more authoritative and reliable sources for contraceptive information than their younger counterparts. Both groups scored very low on basic knowledge questions concerning fertility, contraception, and sexually transmitted diseases. These results mandate greater public concern and involvement to delay early coital experiences and prevent unprotected sexual intercourse.     

Embracing Complexity and Seeking Simplicity in Interpersonal Relationships: A Defense of the Subordination-Reactivity Hypothesis

In the target article (Wanic and Kulik 2011), we proposed in the subordination-reactivity hypothesis that women??s (typically) subordinate role in marital relationships renders them physiologically more vulnerable to martial conflict, which may explain partly the finding that marriage generally benefits the health of men more than women. In that article, we noted that our hypothesis should be considered in conjunction with other ??non-mutually exclusive?? relationship processes that also may contribute to the greater health benefit of marriage for men. The accompanying commentaries take issue with our article on the grounds that a) interpersonal relationships and health are multidimensional and complex; b) our subordination-reactivity hypothesis diverges from existing interpersonal theory and research; and c) it is ??almost always?? unwise to ??pit?? one explanation or theory against another. In this response we argue a) the indisputable point regarding the complexity of interpersonal relationships and health does not challenge the validity of our hypothesis; b) our hypothesis, as stated, is not logically inconsistent with the prior interpersonal theory and research cited, and c) there is considerable value to pitting explanations against each other when possible, and arguments to avoid doing so are at odds with fundamental scientific practices.     

Covenantal and contractual values in marriage: Marital Values Orientation toward Wedlock or Self‐actualization (Marital VOWS) Scale

Cultural constructions of marriage have developed to form 2 marital values orientations. These marital values can be understood along a continuum from covenantal at 1 pole to contractual at the other pole. Covenantal marital values prioritize individual sacrifice for the marriage to promote marital health, commitment, and vow taking to resolve conflict, the collective dyad as the primary unit of the marriage, and often spiritual intervention as a primary means of restoring order. Contractual marital values prioritize individual self‐actualization to promote marital health, negotiation, and mutual agreement to resolve conflict, the individual as the primary unit of the marriage, and clinical and psychological interventions as a primary means of restoring order. The authors developed a 26‐item scale to measure contractual and covenantal marital values. In 3 studies examining a total of 786 student and community participants, the factor structure of the scale was evaluated, and convergent and discriminant construct validity, item internal consistency, and 4‐week test–retest reliability were examined.     

Hooking Up and Emerging Adults’ Relationship Attitudes and Expectations

The dating landscape has changed markedly in recent years, with many emerging adults taking a less committed approach to relationships and sex (e.g., “hooking up”). Delayed marital transitions and declining rates of marriage have led to concerns that the rise of the “hookup culture” is associated with a devaluing of marriage. Previous research on associations between sexual attitudes or overall sexual experience and marital attitudes has produced inconsistent findings and is not representative of modern union formation and sexual norms. Using a sample of 248 emerging adults, we examined associations between engagement in casual sexual behavior (i.e., hooking up) and expectations for future committed relationships and marriage as well as attitudes toward current relationship involvement. Contrary to concerns about the devaluation of marriage, results indicated that level of engagement in hooking up was not associated with expectations for involvement in future committed relationships, including marriage. However, hooking up was associated with less favorable attitudes toward current relationship involvement. These findings suggest that engagement in hooking up is a time-specific behavior that aligns with the self-focused nature of emerging adulthood, rather than indicating a lack of interest in future committed relationships or marriage.     

How do Iranian women from Rafsanjan conceptualize their sexual behaviors?

In Iran, women’s sexual behaviors have not been studied in detail. The aim of this study was to explore the sexual meanings generated through the lived experience of women residing in Rafsanjan, a city in the Kerman province, where interviews and focus group discussions were conducted with 51 Iranian women. Content analysis was adopted to extract the meanings and perceptions. We categorized the findings into three aspects: sexual capacity, motivation, and performance. Sexual desire was the most important concept that women used when they were referring to their sexual capacity. Marriage was the main institution in which women’s motivation for sexual relationships and encounters resided, and “the priority of men’s sexual needs and characteristics” was identified as the core principle of marriage. The concept of sexual performance was more salient and tied to the husband’s sexual initiation. Analyzing the women’s narratives revealed that women’s sexual self-understandings and their sexual behaviors are strongly determined by “androcentricity”, this being relevant both to sexuality education and reproductive health. Recognition of this issue will facilitate understanding of the cultural foundations of sexuality among Iranians and help health providers in suggesting culturally appropriate and compatible forms of health care.     

Gender differences in marital quality and well-being in Chinese married adults

The present study addressed the issue of gender differences in marital quality and well-being in Chinese married men (N= 738) and women (N= 761). The results showed that males had significantly higher scores on the Chinese Dyadic Adjustment Scale and Chinese Kansas Marital Satisfaction Scale. While a longer duration of marriage was associated with higher levels of dyadic consensus and affectional expression in men, the duration of marriage was negatively related to marital adjustment and marital satisfaction in women. The data also showed that women displayed more psychiatric symptoms and midlife crisis problems and they had lower levels of positive mental health and perceived health status than men. While marital quality was positively related to well-being in both men and women, the impact of marital quality on well-being was generally found to be greater in women than in men.     

Relationship factors in the treatment of sexual dysfunction

The role of marital harmony in the development, assessment and treatment of sexual dysfunction is addressed in the present study. Twelve couples with mixed sexual dysfunctions received both sex therapy and marital therapy in a balanced cross-over design. The major variables investigated were therapy outcome on measures of sexual satisfaction and marital adjustment as a function of treatment modality (sexual or marital) and relationship functioning. Findings showed significant differences in outcome between treatment approaches with a strong mediating effect of relationship factors. Limited interpersonal understanding and inaccurate perceptual agreement in relationship functioning characterized those couples who failed to exhibit a differential response to treatment in favour of sex therapy over marriage therapy. Implications of these findings for the assessment and treatment of sexual dysfunction are discussed.     

Semen Loss and Sexual Anxiety Among Young Unmarried Men: Being Young and Vulnerable in Rural India

Premarital sex remains stigmatized even as the unmarried period of life is lengthening in India. This paper examines how young unmarried men in rural central India conceptualize and understand their sexual health and vulnerability. The data is qualitative, derived from four focus group discussions (N = 38 persons) of young unmarried males that were carried out in conjunction with a larger study on male involvement in reproductive health in the central Indian state of Madhya Pradesh in 2005. Young, unmarried rural men experience a wide range of functional situations which are culturally defined as health problems, such as “weakness,” thought to be caused by masturbation, nocturnal ejaculations, and the loss of semen. Despite constraints on communication on sexuality with married men, young unmarried men largely share with them the culturally hegemonic notion of semen loss as a health hazard. All four discussions pointed to the negative image of psycho-physiological changes related to maturation and further, to the belief that the reproductive functions of men can render them vulnerable and even harm them. Sexual anxiety in young men may in part reflect young men’s socially dependent and insecure life situation and social suffering. Young, unmarried rural men see marriage as the only release from sexual health problems although temporary relief is sought from private health care providers. In the future, men’s unmarried life stage is bound to lengthen in rural India, and consequently sexual health prior to the commencement of active intercourse should receive more attention in public health services and sex education.     

The impact of college‐level sex education on sexual knowledge,attitudes, and practices: The knowledge/sexual experimentation myth revisited

In recent years, many persons have opposed sex education believing that such courses will lead to increased participation in sexual intercourse by young people, but their fears are not supported by most previous research. The influence of sex education material integrated into functional marriage and family courses, however, has not been the subject of in‐depth, scientific investigations.

An anonymous questionnaire was administered to never‐married undergraduate students enrolled in a college‐level marriage and family course at a state university. A pretest and post‐test design was utilized with experimental groups of 50 women and 26 men and comparison groups of 60 women and 28 men.

The findings indicate that the sex education content had a significant impact on the experimental groups, especially for women. Substantial increases in knowledge regarding abortion and contraception, more favorable attitudes toward masturbation, and frequency of masturbation were reported by experimental group women as contrasted with comparison group women. Experimental group men indicated increased knowledge about female hygiene and contraception in contrast to comparison group men. From these findings, sex educators should be able to better meet the criticisms of sex education opponents given this greater understanding of the impact of sex education material on the sex lives of their students.     

MILFS and Matrons: Images and Realities of Mothers’ Sexuality

Motherhood and sexual appeal are rarely linked in Western culture. There seems to be a notion that once a woman has children she is first and foremost an example, and must be responsible and conservative in a culturally specific way. Most women become mothers at some point in their lives and this is a major physical, emotional, and role transition, one that many women struggle with privately given societal ideals of a ??good?? mother. Despite its essential role in motherhood and life, and the health benefits known to be associated with sexual activity, public expression of sexuality is still primarily associated with being young, childless, and unmarried. Using a social constructionist perspective, we look at the ways in which acceptable expressions of mothers?? sexuality are defined and negotiated by contemporary women. Based on in-depth interviews with fifty women in their 20s, 30s, and 40s, we discuss women??s images of mothers?? sexuality and the ways in which motherhood impacts women??s experiences of sexuality. We find that for most mothers interviewed, the way they felt about sex, their sexual appeal, and their level of sexual desire changed after having children. Coupled with the fatigue and responsibility associated with being a new mother, women felt disconnected from their sexuality for a period of time.     

Sexual and nonsexual marital aggression: Legal considerations, epidemiology, and an integrated typology of perpetrators

In this paper, the legal history of marital rape and the current status of “marital rape allowances” to sexual assault statutes are reviewed. The prevalence of marital rape and its comorbidity with nonsexual violence, as well as the physical and psychological sequelae found to be specifically associated with sexual aggression in marriage is reviewed. Our current limited theoretical understanding of the relationship between sexual and nonsexual violence in marriage is extended by integrating marital rape and marital violence batterer typology research. Specifically, we offer a four-type batterer typology integration (i.e., family-only, dysphoric/borderline, generally violent/antisocial, and sexually obsessive batterers) that fully describe husbands that are only nonsexually violent, both physically and sexually violent, or only sexually violent. Theoretical and practical implications of this integration are identified. Future research directions are outlined, and the need for greater clinical attention to the phenomena of sexual violence in marriage is highlighted.     

American values and contraceptive acceptance

A number of individual personality factors and social norms may be associated with reproductive confusion and/or irresponsibility. More specifically, the values underlying common American social norms may contribute to ineffective birth planning in the following ways: 1) The traditional roles of women in our society seem to encourage parenthood. The rule has been early marriage, closely spaced children, and few alternate sources of satisfaction or self-esteem. 2) Our culture strongly encourages family life. Children are a symbol of normalcy. 3) The importance of sexual enjoyment per se often conflicts with contraceptive use. Conversely, innocence is also valued and also contributes to unprotected sexual activity. 4) Religious reasons or adherence to concepts of natural law are almost always given by people opposed to contraception. 5) Health is important to Americans, and birth control methods negatively affect health in real and imagined ways. Social norms, though changing, remain essentially congruent with former contraceptive technology and former ideologies, customs, and dreams.The Rev. Jane R. Rzepka is a Unitarian Universalist minister engaged in the Ph.D. program at the Graduate Theological Union in Berkeley. She has been associated professionally with the family planning field since 1972.