Iran Journal of Nursing

Introduction
Sexual compatibility with spouse is a crucial factor in maintaining family structure and married life. Sexual compatibility is associated with marital compatibility and sexual satisfaction, while sexual incompatibility can result in sexual disorders and problems. Such incompatibility is often due to dissatisfaction with sexual relationships. Sexual compatibility is a multidimensional and subjective concept, influenced by numerous factors including age, duration of sexual relationships, and frequency of sexual intercourse. This study aims to examine the factors associated with sexual compatibility among married women in Tehran, Iran.

Method
This cross-sectional study was conducted on 300 married women enrolled from 14 comprehensive health centers affiliated with Iran University of Medical Sciences. The study was conducted over five months, from May to September 2022. The inclusion criteria were: age 18-50, being married, being Iranian, being at reproductive age, residing in Tehran, at least one year of marriage, and living with spouse. Exclusion criteria were polygyny of husband, physical or mental conditions interfering with sexual function, consumption of drugs affecting sexual function (self-reported or according to medical records), experiencing severe family conflicts in the past three months, or getting a divorce. The minimum required sample size was determined to be 284 based on Kolivand’s study in 2020, in which the mean score of women’s sexual compatibility score was 101.98±4.03. Considering a potential 10% dropout rate, the sample size increased to 300. The sampling was done using a convenience sampling method. From each health center, 15-22 participants were recruited. Eligible women had electronic health records. 
The data collection tools were two questionnaires: a demographic form and a sexual compatibility questionnaire. The demographic form surveyed women’s age/education/occupation, husbands’ age/education/occupation, history of drug abuse or smoking, availability of a private bedroom at home, frequency of sexual intercourse per week, and living with others (parents, siblings) in addition to the spouse. The sexual compatibility questionnaire had 35 items and four components: Prerequisites for sexual compatibility (18 items), agreement on how to have sexual relations (7 items), inhibitors of sexual compatibility (5 items), and consequences of sexual compatibility (5 items). The items were scored on a 4-point Likert scale. Higher scores indicate greater sexual compatibility with the spouse. 
Data were analyzed in Stata software, version 14. Descriptive statistics included frequency and percentage for qualitative variables, and mean (standard deviation) or median (interquartile range) for quantitative variables. Inferential statistics were the Mann-Whitney U test, the Kruskal-Wallis test, and multiple linear regression analysis.

Results
The majority of women were in the 30-39 age group and were housewives. Also, 49.4% had an academic degree. The majority of husbands were in the 40-50 age group; 42.7% had an academic degree; 56.3% were self-employed, and 16.33% had a history of smoking, hookah use, or substance abuse. The prerequisite of sexual compatibility had a median of 54, agreement on how to have sexual relations had a median of 20, inhibitors and consequences of sexual compatibility had a median of 15, and the total sexual compatibility scale had a median of 104. Based on the Kruskal-Wallis and Mann-Whitney U test results, the variables with a significance difference level of less than 0.2 were entered into the regression model. 
In the multiple linear regression model, it was found that, the mean sexual compatibility score was significantly related to the women’s working at night shifts (B=-14.84, P=0.04, 95% CI: -32.3 to - 2.61) and the husbands’ employment (B=23.12, P=0.01; 95% CI: 2.88-21.28). In other words, the sexual compatibility score of employed women working at night shifts was 14 times lower than that of housewives, and women whose husbands were office workers were 12 times more sexually compatible than those with self-employed husbands. The mean sexual compatibility score was significantly related to women whose husbands had no history of smoking or hookah use (B=6.57, P=0.03; 95% CI: -0.31 to -13.47). The sexual compatibility score of women whose husbands did not have a history of smoking, hookah use, or substance abuse was about 6 times higher than that of women whose husbands had a history. Having a private and separate bedroom was significantly associated with sexual compatibility (B=7.86, P=0.01; 95% CI: 3.87-72.8). The sexual compatibility score of women who had a private bedroom was about 8 times higher than that of women with no private bedroom at home. The frequency of sexual intercourse per week (i.e., 1, 2, 3, 4, and 5 times) was also significantly associated with sexual compatibility (P=0.001). The higher the number of sexual intercourses per week, the higher the sexual compatibility score. The age of women and their husbands and the education of women and their husbands had no significant relationship with sexual compatibility. The results showed that 35% of the variance in sexual compatibility of married women was explained by these factors.

Conclusion
The present study revealed that married women who worked at night shifts or those whose husbands were employed were more likely to experience sexual incompatibility. Additionally, a history of smoking and hookah use in husbands was associated with reduced sexual compatibility. The sexual incompatibility decreased when couples had separate bedrooms and engaged in sexual intercourse more frequently per week. Counselors in midwifery, couple therapy, or family therapy should give special attention to these issues. To enhance sexual compatibility, they should emphasize the importance of preparing a private bedroom and the frequency of sexual intercourse in their counseling sessions. It is also recommended that qualitative studies be conducted to explore effective strategies for reducing the risk of sexual incompatibility in couples facing these challenges.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1398.1125). All ethical principles were considered in this article. The participants were informed about the study objectives and methods. They were assured of the confidentiality of their information and were free to leave the study at any time, and if desired, the research results would be available to them.

Funding
This article was extracted from the master’s thesis of Zahra Gorji at the Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Conceptualization, design, data collection: Zahra Gorji; Design, methodology, data analysis, and supervision: Mansoureh Jamshidimanesh.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all participants for their cooperation in this study.




 

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