Original Article

Exploring Factors of Sexual Function and Journal of Psychosexual Health

5(4) 208–215, 2023
© The Author(s) 2024
Sexual Satisfaction Among Nonworking Article reuse guidelines:
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Women: A Qualitative Study DOI: 10.1177/26318318231221932
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Anu Anns Pious1,2 and Anekal C. Amaresha1,3

Abstract
Background: Sexual function and satisfaction are 2 important components of sexual health. Both sexual function and satis-
faction of women are influenced by various internal and external factors over their life cycle. This study aims to explore the
factors of sexual function and satisfaction among nonworking married women in Bengaluru using a qualitative exploratory study.
Materials and Methods: This is a qualitative exploratory research study that adopted an inductive thematic data analysis.
In-depth qualitative interviews were conducted with 11 nonworking working married women of Bengaluru. The inter-
views were audio recorded, and the transcribed data were analyzed with ATLAS.ti software. The results were presented
thematically.
Results: It was found that somatic and personal factors such as health and appearance, pregnancy and postpregnancy issues,
compatibility between couples, and spousal qualities; psychological factors such as stressors and stabilizers that related to
emotional and mental health; and situational and extrinsic factors such as pressure to conceive, child-rearing, types of fam-
ily, traditional beliefs and practices, societal stigma and taboo, daily schedules of couples, and ambiance and privacy were
influencing the sexual function and satisfaction of women.
Conclusion: The study could find positive and negative factors of sexual function and satisfaction. These factors need
further exploration with larger studies from other cultures and groups.

Keywords
Sexual function, sexual satisfaction, sexuality, women

Received 04 February 2023; accepted 02 November 2023

Introduction emotional intimacy, poor communication, romantic attachment,

body appreciation, partner performance, partner-prescribed
Sexual health is a part of well-being and is described as the sexual perfectionism, partner’s personality traits (optimism),
state of physical, emotional, mental, and social well-being con- emotional support from partner, and relationship satisfaction.5–8
cerning sexuality, and not merely the absence of disease and Restricted upbringing, disturbed family relationships, level of
dysfunction.1 It is having a respectful sexual relationship with a education, and socioeconomic status also indirectly influence
pleasurable sexual experience, free of coercion and violence, sexual function.5,9
and protecting the sexual rights of an individual.1 Sexual func-
tion and satisfaction are 2 important indicators of sexual health
that determine the quality of relationship between the married 1
Department of Sociology and Social Work, CHRIST (Deemed to be
couple.2 The normal sexual function among women includes 5 University), Bangalore, Karnataka, India
2
Indian Institute of Psychology and Research (IIPR), Bangalore, Karnataka,
dimensions: desire and subjective arousal, lubrication, orgasm, India
satisfaction, and pain/discomfort.3 3
Current affiliation: Department of Psychiatric Social Work, Lokopriya
The literature on sexual functioning reports that psycho- Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
logical and interpersonal factors influence sexual function. Corresponding author:
Psychological factors of sexual function in adults are stress, Anekal C. Amaresha, Department of Psychiatric Social Work, Lokopriya
depression, anxiety, guilt, fear of intimacy, unreasonable Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam
expectation, impaired self-image, and attachment anxiety.4-6 784001, India.
Interpersonal factors of sexual function of adults were poor E-mail: [email protected]

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Pious and Amaresha 209

Sexual satisfaction is an effective response arising from but there is a dearth of literature on nonworking married
one’s subjective evaluation of positive and negative dimen- women. Hence, to explore this gap, we have adopted an explor-
sions associated with one’s sexual relationship,10 and it is atory research with the inductive thematic analysis.24
closely related to and depends on the sexual function and
relationship of couples.2 Studies reported several factors of
sexual satisfaction, such as intrapersonal, interpersonal, clin- Study Setting and Participants
ical, sociocultural, and family factors. Intrapersonal factors
include sexual motives, psychological well-being, meno- The study was conducted in Bangalore Urban and Rural dis-
pausal symptoms, poor sexual self-esteem, poor sexual func- tricts among nonworking married women who were above 18
tion, relationship satisfaction, and no previous information years old and living with their spouses. The women who had
about sexuality.11-14 It was also observed that aging, the age any clinical conditions, reached menopause, were divorced or
difference between couples, diabetes, rheumatoid arthritis, separated, and were married for less than 6 months were
menopause, urinary incontinence, genital tract surgeries, excluded for the study. The study’s information was dissemi-
obesity, infertility, depression, anxiety, miscarriage/recurrent nated through social media and the personal contacts of the
pregnancy loss, and substance abuse are significant factors of first author. Initially, 2 participants were purposively selected
sexual satisfaction among adults.15,16 Interpersonal factors of from Bangalore Rural and Urban districts based on the inclu-
sexual satisfaction of adults were poor partner communica- sion criteria. Subsequently, these 2 participants were asked to
tion,12 good interpersonal communication skills, social skills, introduce or provide contacts of nonworking married women
conflict resolution skills, mutual pleasure, marital satisfac- who potentially met the selection criteria. When a participant
tion, frequency of sex, and relationship adjustment.12,14,15,17 introduced or provided the contact information of another
Sociocultural and family factors of sexual satisfaction are potential study participant, the first author screened them to
beliefs and attitudes about sex, sociocultural taboos, lower rule out any of the exclusion criteria. Women who had been
economic level, number of children, family responsibilities, diagnosed with physical or mental illnesses were excluded
perception of sexual talk as taboo, educational status, and from the study, as were their spouses if they had also been
working status.13,15,18 diagnosed with any physical or mental illnesses. A total of 13
Studies found that there is a high prevalence of sexual participants were eventually screened and 2 were excluded
health-related problems in India, especially among women.19,20 for not meeting the criteria. Initially, 2 participants were pur-
Some researchers have recommended that there is a need for posively selected from both Bangalore Rural and Urban dis-
more studies to explore factors of sexual function and satis- tricts based on the inclusion and exclusion criteria. Later,
faction among women.5,15,21 A few studies have reported that additional samples from each category were chosen through
the working status has a significant impact on sexual function their contacts. We used 2 criteria to determine data saturation.
and satisfaction.15,22 Hence, this study aims to explore various The first criterion involved the frequency count of codes,
factors of sexual function and satisfaction among nonworking where a code repeated a total of 3 times during the coding
married women. process.25 The second criterion was an a priori stopping point
for data saturation.26 According to this criterion, once all
codes were adequately explored (with a minimum frequency
Materials and Methods count of 3), we conducted an additional 2 interviews to con-
clude the data collection. Data saturation was reached after
Ethics the ninth participant, but we collected 2 more samples as per
the data saturation criteria outlined in the “Data Analysis”
This study is approved by the Institutional Review Board section. Subsequently, further data collection was discontin-
(CU: RCEC00075/7/19). Written informed consents were ued. The sociodemographic characteristics of the participants
sought from all the participants before the study. Participants are given in Table 1.
were given the right to withdraw from the study at any point
during the study. Participants’ identities were anonymized
during the data storage and transcription by giving pseudo-
nyms, and the data were stored in a password-protected drive Procedures
that has access only to the authors. An in-depth interview guide was developed based on the
review of the literature and consultation with experts working
in the field. It included a set of semistructured and open-ended
Study Design questions about the various determinants of sexual function
and satisfaction of women.27 However, it has not been restricted
This is a qualitative exploratory study. It has adopted inductive to only the interview guide, but the emerging issues during the
thematic data analysis.24 Though there are studies21,23 exploring interview were explored through the dialogue between the
the sexual function and satisfaction among clinical population, interviewer and interviewee. The study was conducted during
210 Journal of Psychosexual Health 5(4)

Table 1. Sociodemographic Characteristics of Participants Subsequently, the second author rechecked the codes against
(n = 11). the transcriptions to ensure the retention of the participants’
narratives’ essence. Any deviations from the participants’ nar-
Sociodemographic
Characteristics of Participants Frequency Percentage ratives were identified, discussed, and resolved between the
authors. Therefore, 2 rounds of code revisions were con-
Age categories
ducted before finalizing all the codes and merging redundant
18–30 years 4 36.4
31–45 years 7 63.6 codes with those having similar meanings. Later, these codes
Duration of marital life were grouped according to their meanings and collated with
1–10 years 8 72.7 other codes to derive themes. These themes were reviewed,
11–20 years 3 27.3 defined, and named based on their specific and distinct char-
Place of living acteristics. Finally, the themes and codes were checked
Bangalore Rural district 6 54.5 against transcriptions to see whether the essence is retained.
Bangalore Urban district 5 45.5 Later, the themes were presented with participants’ excerpts.
Education
To report the study and its findings, standards for reporting
Postgraduate or professional 3 27.3
degree
qualitative research guidelines were followed.29
Graduate degree 6 54.5
Higher secondary certificate 2 18.2
Results
the COVID-19 pandemic lockdown in June and July 2020. Three global themes were found from data analysis: (a)
Telephonic interviews were conducted with the participants on somatic and personal factors, (b) psychological factors, and
the prior schedule by following the guidelines proposed by (c) situational and extrinsic factors with specific organizing
Whiting with an audio recording.28 The duration of the inter- and basic themes.
views ranged from 30 to 45 minutes.

Somatic and Personal Factors

Data Analysis
These factors are related to one’s own body and the character-
The audios were listened to multiple times to get familiarity istics of couples which have either positive or negative influ-
with the language. They were transcribed and translated by ence or direct or indirect influence on their sexual function and
the first author. Later, they were checked for consistency by satisfaction. Under this global theme, 2 organizing themes
the second author. The inductive thematic analysis was con- were found: physical factors and couple’s characteristics that
ducted24 using ATLAS.ti (Student Licensed) qualitative data are purely intrinsic.
analysis software. The first author listened to the audio and
transcribed the recordings into text in a verbatim format. The Physical Factors
second author trained the first author in managing transcrip-
The participants described various physical factors of their sex-
tions using the software and the coding process before data
ual function and satisfaction and grouped them under personal
analysis. The second author cross-checked the audios against
health and appearance and pregnancy and postpregnancy issues.
the transcriptions to ensure the retention of the essence of the
participants’ narratives and to maintain consistency. As the first Personal Health and Appearance
step, a coding framework was developed based on the first
Personal hygiene, physical well-being, physical discomfort,
2 transcriptions. Both the first and second authors read the
menstrual difficulties, infections, and body image were the
first 2 transcriptions line by line together multiple times to
emerged factors under this theme. They narrated that personal
become familiar with the data and generate initial codes.
hygiene and physical well-being are favorable factors,
Factors related to sexual function and satisfaction, prevalent
whereas physical discomforts because of thyroid issues,
in the text segments, were carefully identified and coded. Any
fatigue, and various medications are unfavorable factors.
disagreements related to code names were resolved through
discussions. On the basis of this initial coding framework, the Participant “Vaishnavi,” a 39-year-old woman, said, “Having
first author continued concurrent coding with data collection hygiene is very important. I will never get involved unless I am
for subsequent transcripts. The second author supervised the feeling good enough that I am.”
coding process throughout the data analysis. Data saturation
occurred with the ninth participant, as indicated by a fre- Menstrual difficulties, urinary tract infections, and body
quency count of codes,25 and we concluded data collection image act as the major block to sexual life especially. The
after adding 2 more samples with stopping criteria,26 which analysis pointed out that physical beauty, attractiveness, and
are explained in the “Study Setting and Participants” section. neatness are important in sexual life.
Pious and Amaresha 211

Five participants told “menstrual difficulties, which include Stressors

physical and psychological issues like pain, PMS, mood swings
and anger, etc.” cause, tough times for women and it directly or According to the participants, stressors that act as the nega-
indirectly affects their sexual health. tive factors of sexual function and satisfaction are stress,
Pregnancy and Postpregnancy Issues mood swings, and anger. Six participants of the study strongly
revealed that stress is the major factor that affects their over-
Pregnancy and postpregnancy issues, such as pain, vomiting, all sexual health and indirectly affects their physical and men-
mood swings, and medications, act as obstacles in sexual life. tal health, and it gradually leads to bad sexual health.
Similarly, the drastic changes in the body after pregnancy and
childbirth cause serious concerns about their body image. Participant “Revati,” a 34-year-old woman, said, “Stress and
This leads to a low drive for intimacy and sex for a while. strain are the negative factors in my life which are negatively
influencing my sexual life.”
Couple’s Characteristics
Couples’ characteristics such as compatibility between couples, Stabilizers
spousal qualities, and sexual health awareness among couples Participants narrated that emotional stability and happiness
have a direct or indirect influence on women’s sexual health. are important positive factors in their sexual health. It helps to
Compatibility Between Couples have a healthy life, especially with the sexual relationship and
intimacy with their spouse.
The participants narrated that mutual understanding is an
important factor that means knowing and sticking to each
other’s comfort level, feelings, emotions, and needs. It has
a positive impact on their overall sexual health. Mutual
Situational and Extrinsic Factors
decision-making, interest and consent in sexual life, cordial The third global theme includes the factors present in the environ-
relationship and intimacy, admiring and honesty, and open ment and have any kind of influence on the sexual health of
communication are other important factors highlighted by the women. These are not related to any internal aspects of couples
participants. and are extraneous, grouped into 3 organizing themes such as
family, sociocultural, and environmental factors.
Participant “Swati,” a 30-year-old woman, described that “we
stick to what we know and we stick to each other’s comfort
level. If I am not comfortable, he does not force me to do that. Family Factors
And it goes vice versa. Hence, we decide mutually and we These are the factors related to the immediate or extended
know each other well.”
family of couples who have any influence on their sexual
health, including pressure to conceive, child-rearing, and type
Spousal Qualities of family.
Participants revealed that the husband’s certain qualities such Pressure to Conceive
as compassion and concern about sexual intimacy as positive
According to the participants, pressure to conceive, the intru-
factors and verbal abuse, comparing with others, criticizing in
sion of family members in a couple’s life, and expectations
others’ presence, and lying as negative factors have a direct
and demands from families act as major barriers to their over-
influence.
all sexual health.
Participant “Nithya,” a 25-year-old woman, said “The spouse
should have positive regard for his wife. He should understand Participant “Shahla” a 34-year-old woman, described “after
what the other person is feeling, what is her comfort, all those marriage the pressure for kids was high from both families. The
things are favorable for women.” pressure was too much and a really bad experience that affected
our sexual health.”

Child-rearing
Psychological Factors In this, factors such as parenting responsibilities, changes in
routine owing to children, and tiredness and stress associated
Under this global theme, the participants discussed emo-
with the same have either independent or combined effects on
tional/mental health factors including both stressors and
women’s sexual health. With child-rearing factors, women
stabilizers.
need to be more occupied with and for children and need to
provide more attention and time to children than the initial
Emotional/Mental Health
period of their marital life. This leads to having less personal
The emotional/mental health factors are grouped into stress- time and freedom for the women and becoming more tired
ors (favorable factors) and stabilizers (unfavorable factors). and stressed.
212 Journal of Psychosexual Health 5(4)

Types of Family The Daily Schedule of Couples

The influencing factors explored under types of families are The lengthy and tiresome days, the work pressure of the
orthodox and heterodox families. The participants from heter- spouse, and exhausting household work are unfavorable to
odox family backgrounds agreed that they got support and the sexual function and satisfaction of women. According to
appropriate knowledge on sexual health at the right time, them, these factors cause physical burden, tiredness, and back
whereas participants from orthodox family backgrounds told, pain that badly affect their physical and mental health and
they did not. According to them, a heterodox family is a gradually lead to bad sexual health. Also, the data reveal that
favorable factor, and an orthodox family is an unfavorable the husband’s work pressure and heavy work, tired or bad or
factor in their sexual life. long days of couples (individually or together), busy life
schedule, unevenness and imbalance in daily life, etc act as
Sociocultural Factors the adverse factors in the sexual life of women.
The sociocultural factors of the sexual health of women Ambiance and Privacy
include traditional beliefs and practices and societal stigma
According to participants, good ambiance and privacy are
and taboos.
favorable factors of sexual function and satisfaction of
Traditional Beliefs and Practices women. The delightful atmosphere and comfortable places
act as the positive factor, and women expect the same in
The religious practices in the family, cultural beliefs and
their life.
practices, the age difference between couples, and early
marriage at the age of 18 to 21 are the major factors under
this theme. According to the participants, cultural and reli-
gious practices have an indirect negative influence on their Discussion
sexual life, as couples have to follow some strict rules and As presented in the results, the study found important factors
regulations. The huge age difference between couples deter- that influence or impact sexual function and satisfaction.
mines the relationship, especially, the way of expressing They are (a) somatic and personal factors, (b) psychological
love and affection to the partner acts as a negative factor in factors, and (c) situational and extrinsic factors.
the sexual life of couples. It is also associated with the fac- Somatic factors such as personal hygiene and physical
tor of early marriage at the age of 18 to 21 years and has a well-being positively influence sexual function. However,
huge negative impact on the sexual health of women.
factors such as menstrual difficulties, urinary tract infections,
body image, and pregnancy and postpregnancy health and
Participant “Bhavya,” a 26-year-old woman described, “I got
married when I was 18, and in our tradition due to caste and cultural body changes emerge as the unfavorable factors. Among the
practices, and being a very orthodox family, they do our marriage somatic factors, urinary incontinence is corroborated with a
within 21 years. At that age I was not prepared, I was studying, previous study.15 All other somatic factors in this study are
didn’t know anything about sexual and marital life, and was not considered novel. Some of the previous studies have reported
prepared for marriage. Intimacy was not there between us because
of all these and I was not interested in leading a sexual life.”
that thyroid-related issues impact sexual function.9,30 But
none of the participants in this study have reported that it
Societal Stigma and Taboo affects sexual function.
The personal characteristics of the couple such as mutual
This theme includes stigma from society toward sex, the cul-
admiration and honesty, consense in sexual life, cordial rela-
tural taboo about sex, and religious stigma toward sex that
tionship, mutual understanding and decision-making, open
have an indirect negative influence on the sexual life of
communication, compassion, and understanding emotions
women as it acts as a barrier to early sexual health education
of each other are considered favorable for sexual function
for girls from family, schools, and religion.
and satisfaction. Some of the previous studies supported that
Participant “Shahla” a 34-year-old woman, told “I didn’t get any various aspects of physical and emotional intimacy between
advice about after marriage and sexual life, instead, I was advised the partners are significant predictors of sexual function and
on how I should treat my husband. The main factor in marital life sexual satisfaction among couples.31,32 Studies found that poor
is sexual life. But, our culture following orthodox beliefs and prac- emotional intimacy, communication, and emotional support
tices is not giving any importance to sexual life. It is something
like you should not talk about sex and talking about sex is bad.”
from the partner were considered adverse factors of sexual
function.5,8 Some of the studies found that poor communica-
tion and lack of prior information about sexuality adversely
impact sexual satisfaction.13,33,34 However, the literature also
Environment Factors
suggests that social skills and conflict resolution among
The daily schedule of couples and ambiance and privacy are couples were identified as favorable factors of sexual satis-
the 2 basic themes that emerged under the third organizing faction.13,15 Among those factors, verbal abuse by the spouse
theme environment. was identified as novel.
Pious and Amaresha 213

Previous studies found psychological factors such as used an inductive approach, importance was given to the
stress and anxiety are considered the negative factors of emergence of themes. Also, the codes were cross-checked by
sexual function and satisfaction that are in tune with our 4 participants and verified for consistency. All these contrib-
results.4,5,9 The current study also found other factors, such as uted to qualitative rigor. However, the study has limitations,
anger, mood swings, emotional stability, and happiness, may such as telephonic interviews where it was difficult to collect
impact sexual function and satisfaction. Some of the previous nonverbal data. Also, the study was conducted during the
studies reported that psychological well-being and stable COVID-19 pandemic, which could potentially influence the
mental health influence the sexual satisfaction of women12 participants’ narratives. Another limitation is that, despite
and psychological stress negatively associated with sexual including participants from both rural and urban areas of
function of women.9 Bangalore, we were unable to conduct subgroup analysis.
Sexual satisfaction also influences the family factors Therefore, future studies could explore differences between
such as the number of children and family responsibili- rural and urban populations, as well as between working and
ties.15 The finding of this review article indicates that the nonworking or homemaking women, to gain valuable
sexual satisfaction of women is negatively affected by the insights. The other limitation is the absence of inter-rater reli-
increase in the number of children and various family- ability for code agreement.
related responsibilities and demands.15 However, the
current study finds that some unique factors, such as pres-
Conclusion
sure to conceive, child-rearing practices, and orthodox
family background, negatively impact both sexual func- In conclusion, the study could identify positive and negative
tion and satisfaction. factors related to sexual function and satisfaction among
Sociocultural factors such as traditional beliefs and prac- nonworking married women. The positive factors of sexual
tices and societal stigma and taboos are identified as the function and satisfaction are personal hygiene, physical and
influencing factors. These findings are in tune with other psychological well-being of women, and mutual interest.
studies.13,15 These studies found that such existing traditional The negative factors are menstrual health issues, verbal
cultural and religious practices and stigma and taboo on the abuse by the spouse, lack of sexual health awareness, and
sex topic were acting as a barrier in the sexual life of couples stress and emotional issues. However, these factors need to
in terms of their satisfaction and relationship. Another empir- be explored further with larger studies from other cultures
ical study observed that fewer beliefs related to sexual desire and groups.
as a sin acted as a favorable factor of sexual function among
heterosexual women.35 Author Contributions
However, this study finds a unique result that age differ-
AAP and ACA have significantly contributed to the study’s concep-
ences between couples and age at the time of marriage are
tion and preparation of the study protocol. AAP collected the audio-
unfavorable factors for both sexual function and satisfac- recorded data and transcribed and translated it. Both AAP and ACA
tion. The situational and extrinsic factors such as the daily participated in the qualitative data analysis. AAP conducted the re-
schedule of couples and ambiance and privacy of sexual func- view of literature and prepared the first draft of the manuscript. Both
tion and satisfaction of women are unique since no literature AAP and ACA read the manuscript and revised and approved the
found similar to these findings. final version.

Declaration of Conflicting Interests

Strength and Limitations The authors declared no potential conflicts of interest with respect to
the research, authorship and/or publication of this article.
Since the interviews were conducted by the first author who
is a female, the participants were comfortable during the Ethics Approval
interviews and could share rich information that was very
This study is a part of the PhD thesis of the AAP. It is conducted ac-
sensitive and personal to them. The researcher’s immersion in
cording to the principles of the Declaration of Helsinki 1964 and its
each phase of the study, especially interview guide develop- latest amendments. The study proposal and related documents were
ment, data collection, data analysis, and reporting, ensured approved by the Institutional Review Board of CHRIST (Deemed
trustworthiness. The study was conducted with rigor—the to be University), Bengaluru, India (Date: July 19, 2019; Ethical
audio recordings were listened to multiple times, transcribed, Approval No. CU: RCEC/00075/7/19). The study has been regis-
and translated. The transcriptions were then cross-checked tered with the Clinical Trials Registry, India. Trial Registration No.
against the audio to ensure consistency and the retention of CTRI/2020/06/025503.
essence. Additionally, both authors participated in the devel-
opment of the coding framework, and the codes were checked Funding
against the transcriptions to ensure consistency and the reten- The authors received no financial support for the research, author-
tion of the essence of the participants’ narratives. As the study ship and/or publication of this article.
214 Journal of Psychosexual Health 5(4)

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of sexual satisfaction in a sample of women age 40-70. J Sex Med.
The participant has consented to the submission of the article to the
journal. 2010;7(2 Pt 2):896–904. doi:10.1111/j.1743-6109.2009.01557.x
13. Zegeye B, Woldeamanuel GG, Negash W, Shibre G. Sexual
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Anu Anns Pious https://orcid.org/0000-0002-1972-8558 Northern Ethiopia. Ethiop J Health Sci. 2020;30(2):169–178.
doi:10.4314/ejhs.v30i2.4
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