Iran Journal of Nursing

Introduction
Lack of sexual satisfaction has many consequences for women. It is unclear whether the occurrence of physical and mental fatigue in women is related to their sexual dissatisfaction. Due to cultural factors and the traditional context in cities like Yasouj in Iran, there are restrictions for women to talk about sexual issues. Women do not express their sexual dissatisfaction during their visit for receiving care at the reproductive age. Still, sometimes they express symptoms of physical and mental fatigue, which seems to be due to marital burnout. The long-term conflicts between couples associated with the loss of interest, intimacy, and attachment can cause symptoms such as disappointment and fatigue, which is called marital burnout. Decreasing interest and increasing aggressive behaviors caused by marital burnout can destroy families. This study aims to determine the relationship between sexual satisfaction and marital burnout. 

Methods
This is a cross-sectional study that was conducted on 300 married women referred to four comprehensive health centers in Yasouj, Iran, who were selected by a random sampling method from April to September 2019. Data were collected using a demographic form, the Married women’s sexual satisfaction questionnaire (MWSSQ), and the couple burnout measure (CBM). The MWSSQ has 27 items and four components, including antecedents of sexual satisfaction with eight questions (13, 15, 16, 17, 18, 20, 25, 26), mental and physical barriers to sexual satisfaction with nine questions (3, 4, 5, 9, 10, 14, 21, 23, 27), dominant cultural values with five questions (1, 2, 7, 11, 12), and factors related to the husband with five questions (6, 8, 19, 22, 24). The items are scored on a five-point Likert scale from never (1 point) to always (5 points). Items 3, 6, 9, 10, 14, 19, 21, 23, 24 and 27 have reversed scoring. The total score is between 27 and 135. Higher scores indicate higher sexual satisfaction. 
The reliability of this tool using Cronbach's alpha coefficient was 0.91, and its test-retest reliability was 0.93. The CBM has 21 items and three components of physical exhaustion (fatigue, weakness, sleep disorder), emotional exhaustion (depression, disappointment, and falling into the trap), and mental exhaustion (worthlessness, frustration, and anger towards the spouse). The items are rated on a seven-option Likert scale from 1=Never to 7= Always. A score <2 shows a good relationship, a score of 2-5 shows danger of burnout, and a score of 5 and above shows severe burnout. In Iran, Navidi reported the reliability of this scale using Cronbach's alpha as 0.86. Mean and standard deviation was used to describe the quantitative variables, while frequency and percentage were used for qualitative variables. Independent t-test and Pearson correlation test were used to analyze the variables by SPSS software version 22. 

Results
The mean total score of MWSSQ was 57.50±9.25 (out of 100). The dominant cultural values component of MWSSQ showed the highest score (80.95±16.20). The mean score of CBM was 2.8±1.05. The highest mean score was related to the component of physical exhaustion (3.03±1.17). There was a negative significant relationship between the components of MWSSQ and CBM, except for the component of “mental and physical barriers to sexual satisfaction”, which had a positive significant relationship with the total score of CBM (r=0.488, P<0.001). The strongest relationship was found between the component of “antecedents of sexual satisfaction” and the total CBM score (r=-0.624, P<0.001). 

Conclusion
 Sexual satisfaction among married women in Yasouj City is moderate, and their marital burnout is more related to physical exhaustion than emotional and mental exhaustion. Higher mental and physical barriers to sexual satisfaction can lead to higher marital burnout in these women. In contrast, with the increase in the antecedents of sexual satisfaction, the factors related to the husband, and the dominant cultural values, their marital burnout decreases. It seems that mental exhaustion is more important for women in causing marital burnout. Considering the cultural contexts in Yasouj City, more detailed studies are needed to explain and identify the concepts of sexual satisfaction and marital burnout in three domains of physical, emotional, and mental exhaustion, especially qualitative studies, to reveal how the dimensions of marital burnout affect the sexual satisfaction of women.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC1397.702).

Funding
This paper was extracted from the master’s thesis of Soghra Moteshafie. The study was funded by Iran University of Medical Sciences. 

Authors' contributions
Conceptualization and Supervision: Mansoureh Jamshidimanesh; writing original draft, review & editing, and data collection: Soghra Moteshafi; data analysis: Shima Haghani.  

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the women participated in this study, the Deputy for Research of Yasuj University of Medical Sciences and Iran University of Medical Sciences, and the staff of comprehensive health centers in Yasuj, including Shahid Sedoughi, Shahid Ashrafi Esfahani, Shahid Dastgheib, and Shahid Shafiei, for their cooperation and support in this research.


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