The aim of this study was to evaluate pregnant women’s sexual function and marital adjustment. The sample of the study included 298 women, and it was evaluated using Golombok Rust Inventory of Sexual Satisfaction (GRISS) Scale and Marital Adjustment Scale. The most important reasons for decreasing the frequency of sexual intercourse included the fear of harming the fetus during intercourse (62.1%), fear of having miscarriage (47.8%) and decreased sexual desire (34.7%). It was found that women with sexual dysfunction had a significantly lower educational level, were living with three or more people in their home, were multiparious, had an unplanned pregnancy, reported pain during sexual intercourse and felt that their sexual life was very affected during pregnancy. The findings of the study showed that women had ⩾5 points for GRISS for the subscales as follows: infrequency (47.3%), non-communication (57.4%), dissatisfaction (15.4%), avoidance (6.4%), non-sensuality (19.1%), vaginismus (28.9%), anorgasmia (29.9%) and sexual dysfunction (17.4%). In conclusion, women who were living with three or more people at home, had lower income level, were smoking and had an unplanned pregnancy scored under 43.5 of MAS. It was found negative and there was a medium correlation between MAS score and total GRISS score.
Sexuality during pregnancy is a sensitive topic and has been influenced by many factors such as physical, anatomical, psychological, social, hormonal and cultural factors (social norms, religious beliefs, values, misperceptions, taboos and myths).1, 2, 3 Increasing levels of estrogen, progesterone, prolactin and human chorionic gonadotropin (HCG) during pregnancy leads to nausea, vomiting, fatigue, weight gain and breast tenderness. The physical complaints may decrease sexual intercourse during pregnancy and the changes and complaints lead to sexual problems.2 Besides, increase of progesterone and congestion in vaginal tissues lead to dyspareunia, increase in vaginal discharge and involuntary urinary incontinence is experienced during the period. Physical, mental and emotional changes caused by hormones negatively affect couples’ sexual life and may lead to women’s feeling of themselves as ugly and unattractive. These changes are the result of the decreases of woman's self-confidence and self-esteem; body image may be adversely affected and cause sexual dysfunction (SD).4
Although earlier studies pointed out that sexual activity in normal pregnant women has no significant adverse effects,1 fear of harming fetus or mother during intercourse,2, 5, 6, 7, 8, 9, 10, 11, 12 belief that having sex during pregnancy period can provoke miscarriage,5, 10, 11, 13 preterm birth5, 9, 10, 11, 12 or preterm membrane rupture13 and belief that coitus during pregnancy is religiously unaccepted7, 10 were found as the most important reasons for decreasing the sexual relationships within the couples. Disgust for her husband's smell,9 cannot find a good position,14, 15 not enjoying sex,14 work overload15 and unattractive appearance of the pregnant partner15 were found as other reasons for decreasing the sexual relationships within the couples.
SD is an important public health problem and some factors such as stress, anxiety and unhappiness in marriage may influence sexual relationship of couples.16 Sexual health problems negatively affect couples’ mental, family and social health. Sexuality is regarded as a private issue, is not talked about generally both in communities and between people and health-care providers. Therefore, sexual information and advice given to women during pregnancy is confined to the time of onset of sexual intercourse. It should be given to couples counseling about sexual changes during pregnancy by health-care providers. However, couples should be encouraged during antenatal care about the problems experienced in marriage and sexuality. Because sexual problems experienced during pregnancy are the basis of sexual problems after birth and life in future periods.3 As sexual intercourse is about two people, the male part is as important as the female. It is important to distinguish whether the problem in sexuality is due to only the woman, only the man or the response of one side to the other. When a woman has SD, her husband may feel rejected and frustrated and even secondary impotence may develop in response to the wife’s behavior.17
Sexuality is a complex issue differing from person to person. In published studies, several studies have evaluated SD by using Female Sexual Function Index (FSFI) in pregnant women1, 2, 4, 10, 18, 19, 20, 21 and one study evaluated in non-pregnant women sexual function by using GRISS,16 but no study so far has used GRISS for SD during pregnancy. To our knowledge, the present study is the first to use GRISS to assess pregnant women’s sexual function. However, there are limited studies on association with sexual function during pregnancy and marital adjustment in our country.22 The aim of the study was to assess pregnant women’s sexual function and marital adjustment, to determine relationship between women’s characteristics and sexual function during pregnancy and marital adjustment, and to examine association with sexual function and marital adjustment.
Materials and methods
Sample of study
This cross-sectional study was conducted to investigate sexual function and marital adjustment among pregnant women who applied to the outpatient clinic of the obstetric department of Celal Bayar University Hafsa Sultan Hospital, which is located in the western region of Turkey, for antenatal care from 1 May 2014 to 31 October 2014.
According to the registration records during data collection period, the total study population consisted of 1308 women. Some women attended to the clinic more than once during the period but were included only once in the study. The sample of the study included pregnant women who were aged ⩾18 and 32 weeks of gestational age or over, who had a health pregnancy and no psychiatric problem. Women’s gestational age was determined by using last menstrual period and ultrasound. All pregnant women had a heterosexual relationship with one partner and no women had used a drug or alcohol during pregnancy. Women who had threatened miscarriage, hemorrhage or premature rupture of membranes, twin pregnancy and chronic diseases such as hypertension, diabetes mellitus and so on were excluded from the study. The aim of the study was to reach at least 298 women with 99.0% confidence level, 5% deviation and 50% unknown prevalence, by using the Epi info 2000 statistical software (CDC, Atlanta, GA, USA). Between the dates, 348 pregnant women applied to the clinic for antenatal care. Overall, 28 pregnant women had maternal/fetal complications and 22 pregnant women did not want to participate in the study. The sample of the study included 298 pregnant women.
A three-part questionnaire was used to collect data. The first part comprised questions about the women’s characteristics, such as age, level of education, perceived income level, type of marriage, place of residence, parity and so on.
The second part included the Golombok Rust Inventory of Sexual Satisfaction (GRISS) scale, which provides an objective assessment of sexual functioning and covers the most frequently occurring SD of heterosexual persons with a steady partner according to the following subscales: vaginismus, anorgasmia, avoidance, non-sensuality, non-communication, infrequency and dissatisfaction.23 The Turkish version was validated by Tugrul et al.24 The GRISS questions are answered on a five-point Likert-type scale (always, usually, sometimes, hardly ever, never), included 28 items and the possible scores ranged from 28 to 140. The scale was used to assess existence and severity of sexual problems in the pregnant women. The scores of the subscale of GRISS range from 1 to 9, with scores of 1–4 indicating normal sexual function and scores of 5–9 indicating increased degrees of SD. The reason of choosing the GRISS was its simplicity and clarity of assessment of results. Another reason was that the study was planned to evaluate and compare couples’ sexual function during pregnancy. However, some of the pregnant women’s partners did not want to participate in the study and many of the pregnant women applied to hospital for antenatal control without their partners. Because of this reason we did not assess husbands’ sexual function.
The third part contained the Marital Adjustment Scale25 (MAS), which was developed by Locke and Wallance in 1959 and was adapted for Turkish by Tutarel-Kışlak26 in 1999. In the study, Cronbach’s α coefficient of MAS was determined as 0.799. The MAS that includes 15 questions measures couples’ marital happiness, one question is related to general compliance and a single item scored as 0 (very unhappy) to 6 (perfectly happy). Eight questions about agreement scored on a 6-point Likert scale ranged from 0 (always disagree) to 5 (always agree). Six questions helped to evaluate the conflict resolution, commitment and communication. According to the MAS total score, women were classified into two groups: women who had MAS total score <43.5 (incompatible marriage) and women who had MAS total score ⩾43.5 (compatible marriage).
Ethics of the study
The study was approved by the Local Ethics Committee of Celal Bayar University Faculty of Medicine and written informed consents were obtained from all the pregnant women before the participation of the study. The questionnaires were administered by means of face-to-face interview before consultation in the outpatient clinic of the hospital, in a room separated from the clinic and took ~30 min to complete.
Data were analyzed by using SPSS version 17.0 (Chicago, IL, USA). A P-value <0.05 was considered to be statistically significant. χ2 and Fisher’s exact test were used for the relationship between characteristics of the women and their subscale of GRISS and MAS scores. Pearson’s correlation test was used to assess the relationship between the subscale of GRISS and MAS scores.
Characteristics of pregnant women
In the study, the mean age of the women was 27.5±5.2 (18–41) years, 65.1% of the women were under 30 years of age, 37.2% of them were under primary school graduates and 37.9% had arranged (consanguineous) marriages. The mean number of people in the families was 3.3±1.8 (2–14), 14.1% of them lived in an extended family, 64.1% of the women were living with three or more people in their home, 21.8% of them were employed and 20.5% of pregnant women reported low income level.
The findings of the study determined that 45.3% of women were nulliparious, 13.8% of women reported that the current pregnancy was unplanned and 14.4% of women smoked cigarettes. Of the pregnant women, 20.1% were normal weight, 45.3% were overweight, 22.1% were obese and 12.4% were morbid obese (data not shown).
Changes of and beliefs about sexuality during pregnancy
The findings from our study indicated that 30.9% had taken information about sexuality during pregnancy. About one-third of women (33.3%, 36.6% and 30.2%) reported that their sexual life was affected very much, slightly or was not affected, respectively. About one-third of women (33.2%) reported that they had pain during sexual intercourse during pregnancy.
Before pregnancy, 12.1% of women had sex once a week, 34.6% of women had two times a week, 49.6% of them three or more times a week and 3.7% rarely (once every 2 weeks or once a month). During the first trimester, 21.1% of the women stopped having sex, 27.5% of them one, 20.1% two, 17.8% three or more times a week and 13.5% more rarely. In the second trimester, 15.7%, 30.2%, 16.1%, 15.6% and 22.4% of women reported never, one, two, more than three and rarely had coitus during pregnancy, respectively. The frequency of sexual intercourse during the last trimester was 34.9% of respondents said that they had no coitus, 22.8% of them had once a week, 9.7% had twice a week, 6.4% three or more times a week and 26.2% declared rarely.
The pregnant women were asked the question: ‘Is it safe to have sex during pregnancy?’ and answers were as follows: 20.8% did not know, 26.2% found it risky, 24.5% were undecided and 28.5% thought it was safe. More than half of the participants (63.8%) stated they stayed away from sexual intercourse during pregnancy.
The findings of the study showed that the most important reasons for decreasing the frequency of sexual relationships was as follows: fear of harming fetus during intercourse (62.1%), fear of having miscarriage (47.8%), decreased sexual desire (34.7%), having nausea and vomiting (23.6%), having weakness and tiredness (22.1%), physical discomfort (20.5%), not having sex due to doctor’s recommendation (12.6%), fear of hemorrhage (11.0%), fear of preterm delivery (9.5%), disgust from her husband's smell (5.2%), partners’ abstinence from sexual intercourse (4.7%), fear of pain during pregnancy (4.2%), fear of infection (4.2%) and unattractive appearance during pregnancy (0.5%) (data not shown).
Relationship between women’s characteristics and GRISS score
The effect of women’s characteristics on subscales of the GRISS and MAS scores is shown in Table 1. Women with SD had a significantly lower educational level, were living with three or more people at home, were multiparious, had unplanned pregnancy, had pain during sexual intercourse and were women who reported their sexual life was very affected during pregnancy as compared with those without SD (P<0.05). There was no significant relationship between total GRISS score and women’s age, employment status of women, income level, smoking status, type of marriage, body mass index, birthplace, living place, abstinence from coitus and having received information about sexuality during pregnancy.
Non-communication scores were higher in women with unemployment, primary school graduated, having unplanned pregnancy, having arranged marriage and not receiving information about sexuality. Women who had low income, smoked and unplanned pregnancy had received higher score of dissatisfaction subscale. Women who had pain during pregnancy (7.1%) had ⩾5 score of avoidance than women who had no pain (2.0%). Non-sensuality scores were increased in women with lower educational level, unemployment, living with ⩾3 people in home, smoked, multiparious, had unplanned pregnancy, having pain during sexual intercourse, not receiving information about sexuality, women who reported sexual life was very affected and women who believed sexual intercourse was risky during pregnancy and women who said they did not know whether it was risky or not. Anorgasmia was determined in women with lower educational level, unemployment, lower income, unplanned pregnancy and not taking information about sexuality (P<0.05).
In the study, all subscales were evaluated to determine sexual problems and it was determined that infrequency (n=141, 47.3%), non-communication (n=171, 57.4%), dissatisfaction (n=46, 15.4%), avoidance (n=19, 6.4%), non-sensuality (n=57, 19.1%), vaginismus (n=86, 28.9%), anorgasmia (n=89, 29.9%), avoidance (n=19, 6.4%) and SD (n=52, 17.4%) scores of 5 or above were the result (Figure 1).
Relationship between women’s characteristics and MAS score
As can be seen in Table 1, women who were living with three or more people at home, with lower income level, smoked and having unplanned pregnancy had scores under 43.5 of MAS. There was a significant difference between the groups (P<0.05).
The relationship between MAS and subscales of GRISS were presented in Table 2. In the analysis of the relationship between GRISS subscales and MAS scores, a relationship was observed between MAS scores and dissatisfaction, non-sensuality, vaginismus and SD. There was a significant relationship between the groups (P<0.05).
Correlation between subscales of GRISS and MAS
Assessing the correlation between the overall score of GRISS, MAS and each subscale was showed in Table 3. A negative and medium correlation between MAS score and total GRISS score was found (r=−0.384, P=0.000).
Sexual dysfunction showed the strongest correlation with non-communication (r=0.6090. P=0.000), dissatisfaction (r=0.728, P=0.000), avoidance (r=0.615, P=0.000), non-sensuality (r=0.807, P=0.000) and anorgasmia (r=0.746, P=0.000). In addition, SD was moderately correlated with infrequency (r=0.494, P=0.000) and vaginismus (r=0.456, P=0.000).
Women with anorgasmia were more likely to have dissatisfaction (r=0.506, P=0.000), non-sensuality (r=0.504, P=0.000) and non-communication (r=0.378, P=0.000). Non-sensuality also increased with increased non-communication (r=0.468, P=0.000), dissatisfaction (r=0.496, P=0.000) and avoidance (r=0.464, P=0.000).
In the study, we evaluated sexual function and marital adjustment in pregnant women. There were some limitations in the study. First, the study included pregnant women who applied to the outpatient clinic because of this the findings of this research cannot be generalized to all women in Turkey. Second, the topic is very sensitive and women may feel ashamed and therefore their responses may be biased. Subjective aspects of sexual response might never have been exactly quantified or determined. Third, sexual functions were evaluated by using GRISS. In the literature, although Golombok scale was pointed valid,27 previous researches used the FSFI for evaluating sexual function during pregnancy. Because of this, we had some difficulties in comparing our findings with previous studies. There is clearly a need for developing a scale specific to the pregnancy period to evaluate sexual satisfaction and dysfunction, both for women and men.
At the beginning of the study, we used GRISS to assess the sexuality during pregnancy in the woman and her husband; however, we could not evaluate Turkish men’s SD during the pregnancy period. Turkish men tend not to explain feelings openly about sexuality and many of them did not want to take part in the study. In Muslim countries such as Turkey, sexuality is a sensitive topic and it is difficult to assess couples together. In spite of MAS questionnaire, male SD might also influence present results, and this is an important limitation to our study. Because of this reason, it is important to provide information to couples about sexuality during pregnancy. Last, sexuality during pregnancy is a complex situation and depression or anxiety affects it, but we did not evaluate these factors in the present study. Despite these limitations, the study has number of strengths, for example, the topic was firstly investigated by using GRISS in Manisa, Turkey and there have been no published studies that have investigated the relationship between sexual function and marital adjustment among women during pregnancy. The study findings may contribute to important information about sexuality during pregnancy and also health-care providers consider the topics during antenatal care of women.
Changes of sexuality during pregnancy
Among the respondents, one-third stated that their sexual life was very affected during pregnancy and fearing about potential harmful obstetric outcomes was the primary cited reason for avoidance of sexual activity during pregnancy. It is widely believed that having sexual intercourse can be harmful to the baby or mother during pregnancy and may cause miscarriage, preterm labor and fetal injuries. The findings were similar with those of previous studies.1, 2, 5, 6, 7, 8, 9, 10, 11, 12 The reason for decreasing sexual intercourse may be due to women’s beliefs about sexuality during pregnancy or husband’s fears or shyness may affect to initiate sexual activity. Increase of abdominal circumference can cause difficulty to have sexual intercourse and some physical changes can lead to decrease of frequency of sexual intercourse. Health professionals should give education about sexual health during pregnancy to couples. In some cultures, sexuality is accepted as a taboo topic and couples cannot talk about sex during pregnancy with health professionals because of shame and sin.7
Frequency of sexual intercourse per week before pregnancy and in all trimesters was evaluated. The findings of the study showed that there was a significant decrease of frequency of intercourse during pregnancy, especially in the third trimester. The findings from our study determined that in the last trimester only 6.4% of women had sexual intercourse three or more times a week. It was not surprising that in the last trimester sexual activity was decreased owing to the growth of the abdominal circumference, which made coitus difficult. Similarly to the present study, many studies have reported that coital frequency was reduced by half during pregnancy period compared with the time before pregnancy.1, 4, 9, 22 In Turkey, one study detected that 44.0% of women had had sexual intercourse 3–4 times a week before pregnancy. Many of them (61.4%) reported that sexual intercourse was decreased to 1–2 times a month during pregnancy.22 Yangin and Eroğlu7 found that half of the women had had sex two or three times a week, 27% three or four times a week and 16% everyday before pregnancy. In Taiwan, one study evaluated sexual function of women by using FSFI and found that overall sexual function and sexual intercourse/activity score were significantly lower during the last trimester than first or second trimester and sexual desire did not change throughout the trimesters of pregnancy.4 In Egypt, total score of FSFI was significantly reduced during all periods of pregnancy and lowest score was found during the third trimester.1
In the present findings as in others, having nausea and vomiting (23.6%), having weakness and tiredness (22.1%) and having pain during coitus (33.2%) were other reasons for decreasing sexual intercourse. In Iran, one study evaluated changes in sexual desire and activity during pregnancy and 81.8% of women reported that they had engaged less frequently coitus and 69.7% of participants said a decrease in sexual desire because of the lack of interest, pain during sex, nausea or fatigue.9 In the study of Kisa et al.,22 30% of pregnant women experienced problems during their sexual intercourse and 50.0% had had pain during coitus. One study stated that 92% of the women stopped having sex in the third trimester and more than half of women had pain during coitus in the last month of pregnancy.7
Sexuality is an accepted taboo generally for religious reasons or social pressures in Turkey. Multidiscipline approach is useful for couples, especially nurses are a key person for pregnant women for making direct relation to make them confident and providing them training and counseling about changes of sexuality during all trimesters.
Prevalence of SD
SD is defined as disorders related to both getting sexual desire and satisfaction. In the sample of pregnant women, the prevalence of SD was found as 17.4% by using GRISS. These findings were contrary to those of previous results about prevalence of SD during pregnancy. Previous studies evaluated SD by using FSFI and found SD prevalence as 63.4% in Turkey,2 79.1% in Iran,10 68.8% in Egypt1 and 61% in Brazil.18 It was determined that prevalence of sexual desire, sexual arousal, lubrication, orgasm and sexual satisfaction disorder in pregnant women in Turkey by using FSFI was found as 88.9%, 86.9%, 42.8%, 69.6% and 48%, respectively.2 These studies evaluated SD during pregnancy by using FSFI and this may be the reason for the higher rate. In Ghana, one study investigated incidence of SD in non-pregnant women (n=400) who were 18–58 years old by using GRISS and found the prevalence of SD as 72.8%.16 In the current study, the most prevalent domains of sexual problems were non-communication and infrequency and more than half of pregnant women reported non-communication problems during pregnancy. Lack of communication in marriage may lead to many problems in sexual life. Sexual infrequency (half of about women had lived) was found the main problem in the pregnant women and the problem may be influenced by both psychosocial factors and beliefs about the sexuality during pregnancy. Anorgasmia and dissatisfaction were determined during pregnancy as 29.9% and 15.4%, respectively. Women with anorgasmia were more likely to have dissatisfaction and non-sensuality. The prevalence of the other subscale was: avoidance of intercourse (6.4%) and non-sensuality (19.1%). Anorgasmia was reported in earlier studies as follows: in Spain (43%),28 in Ghana for non-pregnant women (74.9%)16 and in Turkey (69.6 and 47.3%).2, 6 In one study from Iran, 69.7% of women reported a reduction in the frequency of orgasm.9 Women in another study from Portugal stated that sexual satisfaction was unchanged or decreased 48.4% and 27.7%, respectively.5 Sexual dissatisfaction was reported as 48% in Turkey.2 A reduction in the intensity of sexual arousal was reported in Iran by 63.6% of women.9 Previous studies found higher rates of anorgasmia and sexual dissatisfaction scores than the present study.
Association between characteristics of women and sexuality during pregnancy
Sexual satisfaction is an integral part of life and human wellbeing. In the study, total GRISS score was found higher in women with lower educational level, living with three or more people in home, being multiparious, unplanned pregnancy, having pain during sexual intercourse and women who reported their sexual life were very affected during pregnancy. It was pointed out in earlier studies that long duration of marriage,1, 2 advanced age,1, 2, 13 having many children,1, 2 women with arranged marriage,2 women with low education and income level2 and employed women4, 19 negatively affected sexual function. Other studies in Egypt and Brazil determined that there was no relationship between SD and the level of women’s education.1, 18 In a study conducted in Brazil, there was no relationship between SD and women’s age, education and income level, body mass index and the number of births.18
In the present study, women who had arranged marriages had higher non-communication scores than women with having a love marriage. Kisa et al.22 noted that the quality of sexual life was lower among pregnant women who were unwillingly married, who experienced sexual problems and who did not have pleasure in sexual intercourse. As can be seen in Tosun Güleroğlu and Gördeles Beşer (2014) study,2 couples with arranged marriage may feel embarrassment and shyness because of not knowing each other very well. During pregnancy period couples should have an effective communication about sexuality as this may positively affect their sexual relationship. In Turkey, most of the people do not feel comfortable talking about sexual issues. Because of this reason, health-care providers should be trained about sexual health for providing couples sexual problems before, during and after pregnancy period.2
There was no relationship between women’s characteristics and vaginismus score, and the only significant relationship was between vaginismus subscale and seeing the sexual intercourse as risky during pregnancy. Means of communication, dissatisfaction, non-sensuality, anorgasmia, SD and MAS scores were found higher in women who had unintended pregnancy. The finding is similar to Tosun Güleroğlu and Gördeles Beşer (2014) study findings.2
During pregnancy hormonal, physical and psychological changes affect the desire to engage in sexual activity. It was revealed that the mean score of avoidance, non-sensuality and SD were significantly higher in pregnant women who had pain during sexual intercourse. Sexual pain may result in SD and fears about sexual activities during pregnancy. Women may experience discomfort during pregnancy because of many reasons such as pain and difficulty of the position during sexual intercourse and some physical complaints. It was revealed in Turkey that some physical complaints such as backache, constipation, breathing difficulty, leg pain and cramps affected sexual function during pregnancy.2 Physical and emotional changes during pregnancy affect a women’s sexual life, which can be affected by gestational week, parity, emotional changes, beliefs about sexuality and diseases.21
Many women in the study tend to disclose their sexual problems and usually they feel an embarrassment. Health-care workers should be encouraged to couples for talking about their sexual problems experienced during this period. In the current study, women who received information about sexuality during pregnancy had lowest score in the non-communication, non-sensuality and anorgasmia domains compared with that in women who did not. Receiving information and education about sexuality during pregnancy and being aware of the changes during pregnancy have improved sexual function and communication within couples. Determination of women’s feelings, perceptions and behaviors about sexual life during pregnancy is so important to assess women’s sexual needs and concerns, to improve couples’ self-esteem and to increase communication and emotional ties between women and her husband.7
Relationship between SD and marital adjustment
In the study, the mean MAS score in pregnant women was determined as 49.0±7.5. Kisa et al.22 evaluated pregnant women’s quality of sexual life and its effect on marital adjustment in Turkey and median total score of MAS was found to be 41.0.22
On the basis of the findings of the study, SD during pregnancy affected the marital adjustment of women. Consistent with the present study, it was indicated that a positive moderate correlation existed between MAS score and the sexual quality of life in women.22, 30
In the study, women who had ⩽43 point of MAS had higher score of dissatisfaction, non-sensuality, vaginismus and SD. Planned education about sexual life during pregnancy is important for antenatal care for couples. Marital satisfaction can be affected by many factors such as couples education and socioeconomic status, length of marriage life and having children.22, 30 Yalçın30 evaluated the relationship between marital adjustment of women and sociodemographic characteristics in Turkey. It was found that women who were 41 years and older age had higher marital adjustment than women aged 21–30 years. Women who reported sexual lives were good with their husband had higher scores of MAS. Many previous published studies indicated that sexual desire, satisfaction and frequency of sexual intercourse were decreased during the pregnancy period,9, 22 and it can be influenced by their marital satisfaction.22
SD during pregnancy is most important problem because it can lead to serious marriage problems. Because of this reason health professionals should explain to women and their partners that psychological changes are as normal as physical changes during pregnancy.9 Communication problems have been underlined as a common complaint presented by couples seeking marital therapy.29, 31 It was determined in one study in Turkey that family education program was effective in increasing marital adjustment and state of emotional reactiveness in the family system; however, it was ineffective in problem solving, communication, roles, affective involvement, behavior control and general function.32
In conclusion, experience of sexual problems during pregnancy increased the risk of negative effects on marital harmony within the couples. The sociodemographic profile of the study in pregnant women illustrated that these were high risk for SD, the majority of whom had significantly lower educational level, living with three or more people in home, multiparious, had unplanned pregnancy, having pain during sexual intercourse and women who reported their sexual life were very affected during pregnancy. The women should be identified by health-care professionals, as this would help pregnant women subjected to SD to speak out and receive specialized help. Open discussion about SD is important for pregnant women and may help reduce the stigma associated with sexual problems and encourage women to seek help. Early diagnosis and treatment of SD is crucial for decreasing severity of SD and improving couples relationship within the marital life.
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The authors declare no conflict of interest.
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Yanikkerem, E., Goker, A., Ustgorul, S. et al. Evaluation of sexual functions and marital adjustment of pregnant women in Turkey. Int J Impot Res 28, 176–183 (2016). https://doi.org/10.1038/ijir.2016.26
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