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Abstract

Background Woman’s orgasm plays a vital role in sexual compatibility and marital satisfaction. Orgasm in women is a learnable phenomenon that is influenced by several factors. Objective The aim of this study is exploring obstacles to orgasm in Iranian married women. Materials and Methods This qualitative study with directed content analysis approach was conducted in 2015-2016, on 20 Iranian married women who were individually interviewed at two medical clinics in Tehran, Iran. Results Orgasm obstacles were explored in one category, 4 subcategories, and 25 codes. The main category was “Multidimensionality of women’s orgasm obstacles”. Subcategories and some codes included: Physical obstacles (wife’s or husband’s boredom, vaginal infection, insufficient vaginal lubrication), psychological obstacles (lack of sexual knowledge, shame, lack of concentration on sex due to household and children problems), relational obstacles (husband’s hurry, having a dispute and annoyance with spouse) and contextual obstacles (Irregular sleep hours, lack of privacy and inability to separate children’s bedroom from their parents, lack of peace at home). Conclusion For prevention or treatment of female orgasm disorders, attention to physical factors is not enough. Obtaining a comprehensive history about physical, psychological, relational and contextual dimensions of woman’s life is necessary.
Int J Reprod BioMed Vol. 15. No. 8. pp: 479-490, August 2017
Original article
Women’s orgasm obstacles: A qualitative study
Maryam Nekoolaltak1 M.D., Zohreh Keshavarz2 M.D., Ph.D., Masoumeh Simbar3 Ph.D., Ali
Mohammad Nazari4 Ph.D., Ahmad Reza Baghestani5 Ph.D.
1. Student Research Office, Depatment
of Midwifery and Reproductive
Health, School of Nursing and
Midwifery, Shahid Beheshti
University of Medical Sciences,
Tehran, Iran.
2. Depatment of Midwifery and
Reproductive Health, School of
Nursing and Midwifery, Shahid
Beheshti University of Medical
Sciences, Tehran, Iran.
3. Midwifery and Reproductive Health
Research Center, Shahid Beheshti
University of Medical Science,
Tehran, Iran.
4. Department of Nursing and
Midwifery, Shahrood University of
Medical Science, Shahrood, Iran.
5. Department of Biostatistics, School
of Allied Medical Science, Shahid
Beheshti University of Medical
Sciences, Tehran, Iran.
Corresponding Author:
Zohreh Keshavarz, School of Nursing
and Midwifery, Shahid Beheshti
University of Medical Sciences, Cross
of Vali-Asr and Neiaiesh Highway,
Vali-Asr Ave., Tehran, Iran, Postal
Code: 1996835119.
Email: keshavarzzohre57@gmail.com;
z.keshavarz@sbmu.ac.ir
Tel: (+98) 21 88252012
Received: 7 September 2016
Revised: 8 January 2017
Accepted: 25 May 2017
Abstract
Background: Woman’s orgasm plays a vital role in sexual compatibility and
marital satisfaction. Orgasm in women is a learnable phenomenon that is influenced
by several factors.
Objective: The aim of this study is exploring obstacles to orgasm in Iranian married
women.
Materials and Methods: This qualitative study with directed content analysis
approach was conducted in 2015-2016, on 20 Iranian married women who were
individually interviewed at two medical clinics in Tehran, Iran.
Results: Orgasm obstacles were explored in one category, 4 subcategories, and 25
codes. The main category was “Multidimensionality of women’s orgasm obstacles”.
Subcategories and some codes included: Physical obstacles (wife’s or husband’s
boredom, vaginal infection, insufficient vaginal lubrication), psychological obstacles
(lack of sexual knowledge, shame, lack of concentration on sex due to household
and children problems), relational obstacles (husband’s hurry, having a dispute and
annoyance with spouse) and contextual obstacles (Irregular sleep hours, lack of
privacy and inability to separate children’s bedroom from their parents, lack of
peace at home).
Conclusion: For prevention or treatment of female orgasm disorders, attention to
physical factors is not enough. Obtaining a comprehensive history about physical,
psychological, relational and contextual dimensions of woman’s life is necessary.
Key words: Female, Orgasm, Obstacles, Sexual satisfaction, Qualitative study.
This article extracted from a Ph.D. thesis
(Maryam Nekoolaltak)
Introduction
rgasm is a temporary peak of
pleasant sexual sensation that is
associated with some physiological
changes in the body. Orgasm in men typically
accompanies ejaculation that makes this
phenomenon more recognizable. However,
reaching the orgasm in women is not as easy
as in men and for some women, it is difficult to
know if orgasm has occurred or not (1). There
are different approaches in dealing with
sexual issues; one of which is
“Biopsychosocial” approach presented by
Rossi in 1994. The foundation of this
approach is the interactions and influences of
the three biological, psychological and social
dimensions on human sexual affairs. In this
framework, it is possible to classify those
factors that can affect orgasm (2).
Biological factors, including variations in
physiology and neuroanatomy of the clitoris
and anterior vaginal wall, thickness of
urethrovaginal space and the distance
between clitoris and urethral meatus may
justify why some women reach orgasm more
easily and some others with more difficulty.
Also, Drugs, particularly selective serotonin
reuptake inhibitors (SSRIs), are associated
with a delay in orgasm (3-6). Psychological
and relational factors such as introversion,
emotional instability, lack of openness to new
experiences, feeling guilty for being joyous,
sexual myths, anxiety and depression and
anti-masculine feelings can affect female
orgasm (7-10).
Relational factors and inability to talk about
sexual activities with a spouse can be
observed in women with orgasm problems
(11, 12). Similarly, the degree of reproach and
less receptivity has been reported more
frequently in marital relationships of women
with orgasm disorder (13). Instead, those
couples with a larger number of sexual
relationships and more diverse sexual
activities together will experience higher
sexual satisfaction and a better orgasm (14).
Social concepts, sociocultural factors and the
O
Nekoolaltak et al
480 International Journal of Reproductive BioMedicine Vol. 15. No. 8. pp: 479-490, August 2017
existing sexual myths in a society can have an
impact on female orgasm (8,15, 16). Woman’s
orgasm impacts on her sexual compatibility
with the spouse, sexual satisfaction and
happiness in marital life (17-20).
In a qualitative study by khoei and
colleagues, orgasm components from Iranian
women's views were explored and the
concept of “Romantic Love“ was considered
as the main interpretation of sexual pleasure
by Iranian women (21). Qualitative researches
on orgasm among Iranian women are
necessary and important for the following
reasons: Woman’s orgasm is a subjective
experience; each woman experiences orgasm
differently and she may experience a variety
of orgasms over her course of life, therefore a
qualitative research is an appropriate method
to identify this unique experience (22). On the
other hand, a large number of Iranian women
treat sexual issues with silence due to shame
and sexual taboos. Safe and confident
conditions of an in-depth qualitative research
can help these women to speak of their untold
sexual issues.
Moreover, there are several subcultures in
Iran. As cultural context affects sexual issues,
including female orgasm, culture-based
qualitative research in this field seems
necessary. Besides, by the growth of social
media, the fact of orgasm has been obscured
for people and therapists in an aura of
exaggeration by porn movies and it is
essential to make clarifications in this respect
through qualitative researches. Therefore, in
order to prevent and treat orgasm disorders, it
is necessary to analyze female orgasm
obstacles in her real life by performing
qualitative researches.
This qualitative research aims to explore
the factors affecting Iranian women's orgasm
and to identify obstacles to female orgasm. It
is hoped that the results of the current
research will improve women's orgasm and
promote their sexual satisfaction and family
stability.
Materials and methods
During the last 10 years, family researchers
have conducted qualitative studies in addition
to quantitative studies. Emphasizing the
complexity of the issues, instead of analyzing
numbers, they have focused on rich
descriptions. Also based on pluralism,
combining qualitative and quantitative
research (Mixed method study) is increasing
(23). This qualitative research is part of a
mixed method study. In the first phase, the
participants stated that reaching orgasm in
sexual relationship greatly affects their sexual
satisfaction and compatibility. Therefore, in
the next step, the factors influencing orgasm
were considered by the researchers.
Procedure
The researcher had obligation to observe
all ethical principles such as secrecy,
anonymity, and allowing the participants to
leave the study at any desired time. Research
setting included two medical clinics in Tehran.
Purposive sampling was started and
continued until data saturation occurred (24).
All the interviews were performed by the same
person (the first author). Duration of the
interviews varied from 20-90 min, depending
on the participants’ interest. Semi-structured
interviews were conducted with guiding
questions (25). The main guiding questions
were as follows: How is your sexual
relationship with your spouse? In your sexual
relationships, what factors affect reaching
orgasm?
Participants
The participants in this study included 20
married women from different ages,
occupations, educational level, years of
marriage, and numbers of children. These
women were referred to medical clinics and
had been visited by a general practitioner for
non-sexual reasons and then, they were
invited and directed to participate in this
research.
The Inclusion criteria were: being female
and married, living in Tehran, having at least
one year of marital life with a spouse, having
fluency in the Persian language, being
interested in participation and being able to
establish a relationship and express her
sexual life experiences. The exclusion criteria
included: individual’s self-report on her
physical or mental disease or using drugs that
would affect her sexual performance. The
youngest participant was 19 years old and the
oldest was 48. Their duration of marriage
varied from 1-30 yr. The number of children
was between 0 and 3. The lowest educational
level was illiterate and the highest was a
Ph.D. degree. Table I shows the socio-
Women’s orgasm obstacles
International Journal of Reproductive BioMedicine Vol. 15. No. 8. pp: 479-490, August 2017 481
demographic characteristics of the
participants.
Ethical consideration
The ethical code is SBMU2.REC.1394.73.
Verbal or written informed consent was taken
from all the participants.
Data analyzing
The interviews were recorded and
transcribed verbatim. First, the audio
interviews were typed carefully and imported
into the MAXQDA-10 software. The
participants’ sentences formed the meaning
units. Data analysis began with frequent
reading and a general sense perception,
continued with codes extraction and putting
them in the subcategories and ended in the
derivation of the main category. In order to
name the subcategories, a literature review
was used.
According to prior researches on orgasm
and within the framework of biopsychosocial
theory, the factors affecting sexual affairs
including orgasm were divided into physical,
psychological and contextual factors. Then the
codes extracted from the meaning units were
placed in the subcategories derived from
literature review. This method is called
directed content analysis that is applied when
previous theories or research on a
phenomenon are not complete and
comprehensive and it needs further details
(27). In this study, prior theories or studies on
female orgasm in Iranian culture were not
thorough and further description was
necessary.
Guba and Lincoln criteria, including
credibility, transferability, confirmability and
dependability were used (28, 29). Member-
checking and peer- checking were done to
ensure the credibility of the research data. For
member-checking, during the interview, the
participant’s words were fed-back to herself to
confirm them. On the other hand, 2
participants checked the transcripts and
emerging codes from the interviews. In peer-
checking, coding and categorizing process
was checked by the other members of the
research team and discussion about
disagreement parts continued until agreement
was obtained. Also, long-term engagement,
adequate time allocation and proper
communication with participants were carried
out.
In order to reach transferability, detailed
and thick descriptions about the environment,
participants and their non-verbal behaviors
were written by the researcher. Also,
demographic information of the participants
was reported and sampling with maximum
variation was done to increase the
transferability. Confirmability was established
through external checking and verifying the
coding and categorization process by two
experts in the field of qualitative research and
sexual health. In order to evaluate the
consistency and dependability, study process
was explained in detail and research memo
was written exactly.
Results
In this study, 20 married women from
different ages, occupations, educational
levels, years of marriage and numbers of
children, spoke about the factors obstruct their
orgasm. Following the content analysis, the
obstructive factors of female orgasm among
Iranian woman were developed in 1 category,
4 subcategories, and 23 codes. Tables II
demonstrates the category, subcategories,
and codes obtained in this study. In this study,
8 women had a history of lack of orgasm: one
woman (Participant 10) had never
experienced orgasm in sexual relationship
with her husband, 3 women (Participant 5,
Participant 20, Participant 13) had secondary
orgasmic disorder and 4 women (Participant
1, Participant 4, Participant 7, and Participant
14) had improved primary orgasmic disorder.
Obstacles to women’s orgasm
In response to this question "In your sexual
relationships, what factors affect reaching
orgasm?” participants mentioned facilitator
factors and obstructer factors. This article is
about factors that play as obstacles to
women’s orgasm. These obstacles can be
classified in 4 subcategories of physical,
psychological (individual and relational) and
contextual factors.
Physical obstacles
Physical fatigue of the husband or wife
Participant 9 stated, “if my husband was
less tired and could rest more, our relationship
was more satisfactory and I could reach
orgasm more easily”. Participant 2 also said
Nekoolaltak et al
482 International Journal of Reproductive BioMedicine Vol. 15. No. 8. pp: 479-490, August 2017
“taking care of my 2-month and 3-year old
babies make me really tired, fatigue has
affected the frequency of our sexual
relationships and the degree of our pleasure”.
Vaginal infection
Participant 16 stated, “whenever I have a
vaginal infection, I cannot reach orgasm”.
Insufficient vaginal lubrication
Participant 5 said: "Six months after my
delivery, we still have not made a sexual
relationship. After giving birth, I don’t have
vaginal lubrication and I have no desire for
sex".
Psychological obstacles
Lack of sexual knowledge
Participant 1 expressed a lack of sexual
knowledge as the main cause of not reaching
orgasm during the first 6 months of her
marriage: “I think the cause of my failure to
reach an orgasm, was insufficient sexual
knowledge and being inexperienced”.
Participant 7 said: “After one year of marriage,
we found an audio file from a doctor, who
explained about sexual relationships, after
hearing it and understanding how to make a
sexual relationship and its arousing acts, we
achieved sexual pleasure. Maybe if we had
prior knowledge or we've seen a training
movie about sex processes, we could
understand the joy of sex sooner.
Shame
Shame and failure to express her sexual
demands have been an obstacle to orgasm
for Participant 18: “It was 10 years after our
marriage that I finally put away the shame and
talked about some of my sexual demands with
my husband. Since then, I have enjoyed my
sex with my husband”. Participant 8 also said:
“After 4 years of marriage, when I had a child,
I could talk about my sexual needs more
easily, and then we reached a desirable
sexual compatibility. Before that, my husband
tried, but I did not have complete satisfaction.
If I was not shy and I spoke earlier, I had
better conditions". Participant 14 had been
embarrassed to perform some sexual
behaviors: "Early in the marriage, I was
ashamed of doing some sexual behaviors, but
now I am not because I have a more intimate
relationship with my husband."
Lack of concentration
Concerns about the household and
children problems.
Participant 19, Participant 16 and
Participant 20 mentioned the lack of
concentration as an obstacle to reaching
orgasm: Participant 19 stated that “It rarely
happens that I don’t reach the climax and that
is when I have been involved in everyday
activities.” In this regard, Participant 16 said,
“Thinking about my child’s academic problems
make me uninterested in sex and orgasm.”
Participant 20 said, “When I am mentally
involved, for example, when I’m worried about
the economic condition of our household or
some problems that my child are facing, I
don’t feel relaxed and I’m not in the mood for
sex and if I have an intercourse, I will not
enjoy it.”
Concerns about children’s imagination
about parent's sex
Participant 10 and Participant 20 minimized
their sex with their spouse due to fear of their
children’s imagination and do not reach
orgasm most of the times. Participant 10 said:
“Now at home, we have 2 bedrooms, but just
like before, we sleep next to the children in the
living room, the kids have grown up and they
may think that why our parents are not
sleeping next to us anymore? Why do they go
to a private bedroom? What do they
do?!.However, I have never enjoyed my
sexual life.Participant 20 also said: “We have
a private bedroom and we sleep there, but we
do not close the door of the bedroom,
because my son is 22 years old and I fear that
he will be promiscuous, he may think what my
parents are doing?
Wife’s concerns about her husband’s
satisfaction
Worrying about her husband’s satisfaction
has prevented Participant 14’s from having
pleasure: During the first year of our
marriage, I hardly reached the climax because
I frequently was thinking if my husband is
satisfied with me or not”.
Fear of sexual intercourse at the beginning
of marriage
Fear of sexual intercourse during the early
days of marriage was an obstacle for
Participant 1, Participant 12 and Participant 4
Women’s orgasm obstacles
International Journal of Reproductive BioMedicine Vol. 15. No. 8. pp: 479-490, August 2017 483
to reach an orgasm. Participant 1 said in the
early days of marriage, I was afraid of sex. I
was afraid that my hymen was going to be
deflowered and it could be painful”. Participant
12 also stated that “At the beginning of the
marriage, I was really afraid of sex and I did
not enjoy it”. Participant 4 has seen a sexy
movie in her adolescence and was afraid of
sex. This fear was problematic for her during
the early years of her marriage: "When I was
in high school, one day, in my friend's house, I
saw a sexy movie. When I saw that scene, I
was really afraid of marriage and sex.”
Fear of pregnancy
For Participant 3, fear of pregnancy during
the first year of marriage was a major obstacle
that did not let her enjoy her sexual
relationship: Over the first year of marriage,
we had a withdrawal method of contraception
and many times we left the relationship
unfinished due to fear of getting pregnant so
that I could not experience the climax”.
Anxiety of orgasm failure recurrence
Participant 1, who did not experience
orgasm during the first six months of marriage
and was able to reach the climax after
referring to a consultant, stated: During the
early days of therapy, I was afraid that I will
not reach an orgasm again, however, with
focusing on positive thoughts I could
overcome this anxiety and gradually our
pleasurable relationships grew more and
more.”
Relational obstacles
Husband’s hurry
Husband’s hurry has been an important
obstacle to orgasm for Participant 13: “It
would be better if I did not respond to his
every need from the very beginning. It would
be better if I made him take a shower, put on
perfume and then make love, but I satisfied
his needs immediately and he became cold
when I just started to feel my needs.
Definitely, our relationship had problems that
made me so disillusioned. My husband does
not know a woman’s need and how to caress.
He just wants to establish a quick
intercourse.”
Having a dispute and annoyance with
spouse
Quarrel and annoyance at the spouse did
not let Participant 17, Participant 20 and
Participant 15 perceive their sexual pleasure.
Participant 17 said, “If I have emotional
problems or conflicts with my husband, I do
not reach the climax.” Participant 20 also
expressed “If I have a dispute or quarrel with
my husband during the day, my mind will be
engaged and I cannot reach an orgasm at
night.” Participant 15 also said, Quarrel and
annoyance at my husband will mitigate my
sexual pleasure.” While dispute with a spouse
was an obstacle for Participant 17, Participant
20 and Participant 15 to perceive orgasm,
Participant 16 totally would experience
orgasm easily and if she was annoyed with
her spouse, she did not avoid sex with her
husband and even reached orgasm in the
case of annoyance. If Participant 4 was
annoyed with her husband, she did not usually
make sexual relationship with her husband
and if she did, she could not reach an orgasm.
Participant 10 has always been angry and
annoyed with her opium addicted husband
and did not make sexual relationship because
of fear of their children’s imagination but when
she made a relationship under duress, she
pulled her own hair and hit her head and
permanently told him “hurry up, end it…!” As
such, she had never experienced an orgasm
in her sexual life with her spouse.
Speaking near orgasm moment that
distracts the mind
Participant 1 mentioned talking during sex:
Talking and expressing romantic words in the
beginning of a sexual relationship will make
the partners arouse and improve the sexual
relationship but near an orgasm moment,
talking prevents from focusing on pleasure. It
is better to use sign language or sounds”.
Contextual obstacle
Irregular sleeping hours
Participant 2 said: "Taking care of children
and breastfeeding are the causes of my
fatigue and irregular sleep pattern that has
affected the number of times we make a
sexual relationship and its subsequent
pleasure”. Participant 18 said: "One of my
sons sleeps late, also my sleeping hours are
not matched with those of my husband and
consequently we can not make a relationship
comfortabl.”
Lack of privacy at home
Small house without a private bedroom
Nekoolaltak et al
484 International Journal of Reproductive BioMedicine Vol. 15. No. 8. pp: 479-490, August 2017
Due to economic problems, Fariba cannot
afford a larger house with a private bedroom:
"It's so hard, we can only have sex when the
kids are not at home and when we have sex,
fear of the kids’ arrival makes us have a quick
and hurried sexual relationship. That’s why I
have never enjoyed our relationship ."
Infant sleeping in the parents' bedroom
Participant 5 said: “Our house has 2
bedrooms, but my baby sleep in our bedroom
for breastfeeding, for this reason, I cannot
have sex easily and I cannot reach the
climax”.
Dedicate the only bedroom of house to the
children
Participant 11 says: "When we went to the
houses of our relatives, my 5-year old son
saw that his peers had separate bedrooms, so
we gave the only bedroom of our house to our
son because we were afraid that he will feel a
sense of lack of the relatives’ kids. Now, we
sleep in the living room at night, .... so our
relationships are reduced in number with less
pleasure”.
Lack of peace at home
This factor was an obstacle to orgasm for
Participant 13: “In order to be satisfied, I
should make a relationship at an appropriate
time and place, when complete peace and
safety governs our house, not in the bathroom
or when our children are watching cartoons or
we have guests in the house”.
Table I. Participant's socio-demographic characteristics
Age (Year)
Educational level
Occupation
Duration of
marriage
Participant 1
19
Theology student
Housewife
1
Participant 2
27
Bachelor’s degree
Housewife
7
Participant 3
28
High school Diploma
Nurse-Aid
2
Participant 4
28
High school Diploma
Housewife
5
Participant 5
28
Associate’s degree
Housewife
8
Participant 5
31
High school Diploma
Housewife
8
Participant 7
32
Master’s degree
Housewife
4
Participant 8
33
Bachelor’s degree
Housewife
12
Participant 9
34
PhD student
Teacher
13
Participant 10
36
Illiterate
Housewife
20
Participant 11
38
Bachelor’s degree
Teacher
7
Participant 12
38
Bachelor’s degree
Consultant
17
Participant 13
38
Bachelor’s degree
Employee
19
Participant 14
40
Master’s degree student
Consultant
18
Participant 15
41
Master’s degree
Employee
16
Participant 16
41
Master’s degree student
Housewife
21
Participant 17
43
Master’s degree
Teacher
19
Participant 18
43
Bachelor’s degree
Employee
15
Participant 19
44
Bachelor’s degree
Teacher
24
Participant 20
48
High school Diploma
Housewife
30
Table II. Codes, subcategories, and categories derived from the results of the present study
Category
Subcategory
Code
Multi dimensionality of
women’s orgasm obstacles
Physical obstacles
Physical fatigue of the husband or wife
Vaginal infection
Insufficient vaginal lubrication
Psychological
obstacles
Lack of sexual Knowledge
Shameof expressing her sexual demands
Shameof doing some sexual behaviors
Lack of concentration on sex
Concern about the household and children problems
Concern about children' s imagination about parents’ sex
Wife’s concern about her husband’s satisfaction
Fear of sexual intercourse
Fear of pregnancy
Anxiety of orgasm failure recurrence
Relational obstacles
Husband’s hurry
Having a dispute and annoyance with the spouse
Speaking close to the orgasm moment that distracts the mind
Contextual obstacles
Irregular sleeping hours
Lack of privacy at home
Small house without bedroom
Infant sleeping in the parents' bedroom
Dedicating the only bedroom of the house to the children
Lack of peace at home
Women’s orgasm obstacles
International Journal of Reproductive BioMedicine Vol. 15. No. 8. pp: 479-490, August 2017 485
Discussion
This study explores the obstacles
impacting orgasm among Iranian women.
Orgasm obstacles include a wide range of
physical, psychological, relational and
contextual factors.
Physical obstacles to women's orgasm
In this study physical fatigue of the
husband or wife, vaginal infection and vaginal
dryness were mentioned as physical
obstacles. In this research, physical fatigue
due to daily works was listed as woman’s
orgasm obstacles. Another Iranian study also
reported more fatigue in women with the
orgasmic disorder (10). The related literature
mainly refers to the impact of fatigue on
sexual performance such as fatigue arising
from chronic diseases (30) or babysitting (31).
Anyhow, fatigue, whether as a result of
chronic diseases or daily activities, has an
obstructive effect on sexual performance and
consequently orgasm.
Like the present study, in other studies,
women’s orgasm was obstructed by vaginal
infections. In the study of Lopez on 399
women with vaginal infection, 21 percent
reported orgasm failure (32).
Vaginal dryness may be caused by
atrophic vaginitis due to hypostrogenemic
conditions in menopause or after
breastfeeding (33). Vaginitis atrophic,
especially during its early incidence, can be
treated (34). Despite the frequent recourse of
women to healthcare specialists, women
usually do not talk about a sexual issue unless
they are asked (35). As a result, asking about
women’s sexual status, providing knowledge
and training for breastfeeding or menopausal
women and treatment of atrophic vaginitis can
be considered essential sexual interventions
after delivery or near the menopause age.
Insufficient vaginal lubrication in the
participants of the present study had occurred
mainly following postmenopausal or
breastfeeding changes. Perhaps insufficient
foreplay before the intercourse is the cause of
vaginal dryness in some women, that should
be taken into account in couple’s training (36).
Drugs are biological factors that affect
women’s orgasm. In the present study,
participants did not use any drug that would
affect their sexual function, but according to
the literature, some medications can obstruct
women’s orgasm and selective serotonin
reuptake inhibitors (SSRIs) are the most
important drugs that delay or obstruct female
orgasm (37, 38). Although some medications
have been studied for improvement of female
orgasm, there is still controversy about their
effectiveness and safety (39). A review of the
literature from 1970 to 2014 indicated that 90
percent of the interventions for orgasmic
disorder were non-pharmacological (40). In
the last literature review, conducted by “up-to-
date website”, medications had no place in the
treatment of primary female orgasm disorder
and orgasm disorder therapy mainly included
education and psychosocial interventions; So
gathering enough psychosexual history and
knowledge about possible causes or
contributing factors in the context of patients’
real life are essential (6).
Psychological obstacles of woman’s
orgasm
Psychological obstacles in this study
included lack of sexual knowledge, shame,
lack of concentration on sex, fear of sexual
intercourse, fear of pregnancy, and anxiety of
orgasm failure recurrence.
Lack of knowledge and embarrassment
were the orgasmic obstacles in the present
study. Similarly, in another study in Iran, lack
of sexual knowledge and shyness were higher
in the orgasmic disorder group (10). In
another Iranian study, fear of sex and the
need for more training and experience were
reported among the newly married women
(41). The reason for fear of sexual intercourse
might be having a history of sexual trauma
(rape and sexual harassment, female genital
mutilation) or the cultural beliefs that would
lead to having a feeling of shame and guilt for
having sex (42). Fear of sexual intercourse in
the present study was mainly due to lack of
knowledge and cultural teachings . Some of
these psychological obstacles that are rooted
in cultural beliefs can be removed through
increasing sexual education for couples.
Woman’s lack of concentration and inability
to focus on the sexual relationship were the
major psychological obstacle to orgasm in the
Nekoolaltak et al
486 International Journal of Reproductive BioMedicine Vol. 15. No. 8. pp: 479-490, August 2017
present study. In another Iranian study that
was carried out by Bokaie et al, intrusive
thoughts caused problems in the sexual
response cycle and orgasm (43). It appears
that teaching relaxation and mindfulness
techniques are effective in improving women’s
orgasm in Iran.
In a study among medical students in
Germany, contraception was an important
factor affecting female sexual function index
(44). In young Chinese women, the pressure
for getting pregnant and not using
contraceptive methods was associated with
female sexual dysfunction (45). Similarly, in
the present study, fear of unwanted
pregnancy was one of the causes of not
reaching an orgasm; so contraceptive
methods consultation tailored to the age and
lifestyle can be effective in improving women’s
orgasm.
Increased anxiety is associated with an
increased difficulty in reaching an orgasm and
decreased anxiety is one of the important
components of the treatment for the orgasmic
disorder (46-47). In the present study, some
participants (Participant 1 and Participant 4)
reported anxiety for recurrence of not reaching
orgasm at the beginning of the treatment that
had been gradually resolved through focusing
on positive thoughts.
An Indonesian researcher pointed out that
some women, due to cultural teachings
believed that they should be a sexual servant
to their husband and should not care for and
value their own pleasure. This ideology can be
overcome by establishing an equal and
symmetrical relationship between the husband
and wife (48). In this study, only one of the
participants was worried about her husband’s
dissatisfaction during the early days of
marriage that had been removed gradually
following the promotion of couple’s intimacy.
So training the couples about equal and
intimate relationships can help overcome this
problem.
Relational obstacles to women’s orgasm
The method of interaction between the
husband and wife would affect woman’s
orgasm. In the present study, the husband’s
hurry, dispute and annoyance with him and
talking at the moments just before orgasm that
distracted their focus were counted as
relational obstacles. It seems that
psychological and relational (dispute and
annoyance with husband) factors had a more
significant effect on orgasm than physical,
physiological and reflexive factors and despite
the performance of appropriate stimulation
they have made reaching an orgasm difficult
or sometimes even impossible. This finding is
consistent with Basson’s model for female
sexual response. From Basson’s point of
view, women’s sexual response is more
complicated than that of men, which is
affected by various sexual and non-sexual
grounds such as satisfaction with marital
relationship, emotional intimacy and sexual
arousal (49). Mary and Kelly mentioned some
relational factors that would obstruct female
orgasm, like blaming and less receptivity (13).
Other researchers also have considered
orgasm as a learnable experience and
according to the culture and norms in Iranian
society, couple’s therapy and sexual skills
training, from among the existing therapies for
female orgasmic disorders, were considered
more appropriate treatments for orgasm
disorders (40).
Contextual obstacles to women’s orgasm
Contextual obstacles to women’s orgasm in
the present study mainly were related to the
lifestyle, including irregular sleeping hours,
and lack of privacy and peace at home. Other
studies also emphasized that in addition to
physical factors, psychological, cultural and
social factors, would influence female orgasm
too (50-52). In a study in Singapore, in
addition to physiological factors, sociocultural
factors and lifestyle, were also effective in the
sex life (53). The impact of lifestyle on sexual
performance has been reported in the middle-
aged women 53,54). Similarly, in the present
study, the impact of lifestyle was greater in
middle-aged women (Participant 13.,
Participant 20, Participant 10).
Concerning sleeping hours, other studies
have reported that longer sleep duration was
related to increased sexual desire during the
next day. Sufficient sleep hours is so
important in sexual desire and arousal that
sleep disorder may be considered as a risk
factor for sexual dysfunction in future (55). In
Women’s orgasm obstacles
International Journal of Reproductive BioMedicine Vol. 15. No. 8. pp: 479-490, August 2017 487
the present study, complaints about irregular
sleep hours were mainly reported by
breastfeeding mothers. Helping these mothers
with their motherhood duties, even if it only
adds one extra hour to the mother's hours of
sleep, can improve female sexual function.
Notable findings in the cultural context of
Iran
Lack of sexual knowledge, tiredness, and
bedroom-related problems could be referred
to as some of the findings of the present study
in the cultural context of Iran that worth
thinking, planning and educating. Even though
nowadays, women have higher educational
degrees and access to internet and mass
media, there are lots of couples who lack
knowledge about how to make a sexual
relationshipIt seems that sparse training on
different internet websites and virtual groups
and channels are not enough and the need for
scientific policies and national planning on
sexual health training is felt. In another Iranian
study, Khalesi et al emphasized on sexual
education and sexual health services at
governmental centers (56).
When the participants of the present study
were asked What occasions would make it
more difficult for them to reach an orgasm?”,
they considered tiredness as the first answer.
Fatigue was obvious both in working women
and housewives. Tiredness among working
women is justifiable, but in the housewives, it
seems odd at the first glance. However, the
fact is that with respect to the shrinking of
family dimensions and lack of presence of
grandparents and other close relatives in
today Iranian households, sharing of
responsibilities among family members is less
and all the housekeeping, cooking and
nursing responsibilities are for the wife.
As the father is at work from dawn to dusk
and cannot help his wife, the housewife’s
tiredness is not strange. Women expressed
that when their mother, their sister, a
babysitter, or a maid helped them with the
housework and babysitting, they were less
tired when entering the bedroom and were
more eager to make a sexual relationship with
their spouse and it was more probable for
them to reach the climax. In this study, the
husband’s tiredness had an obstructive effect
on the woman’s orgasm too, probably
because a tired man did not have the physical
and psychological power for romantic foreplay
to prepare his wife sexually. Accordingly, in
couples counseling and education, the
balance between daily work and night’s sleep
and a disciplined lifestyle should be
emphasized to promote the quality of sexual
relationships and reach an orgasm.
Exclusive finding of this study
The exclusive results of the present study
which had no similarity in previous studies
included the problems related to the bedroom
and the inability to allocate a privacy of the
parents and children. One of the requirements
for having a good sex is to have privacy and a
suitable bedroom. Some of the families, due
to economic conditions, lived in a small house
without any bedroom so that it was too difficult
for them to make a sexual relationship.
However, some participants had one or two
bedrooms, but the couple failed to use them
properly. As long as their children were infants
and being breastfed, the parent’s concern with
the baby’s conditions was a reason for their
failure to use a private bedroom. When the
children grew older, fear of children’s
imagination of sex between their parents was
an obstacle. A separate sleeping place for
children must be stressed in couples’ training.
Moreover, this culture should be promoted
that if there is only one bedroom in the house,
it should be dedicated to the parents. The holy
Quran also emphasizes on a specific privacy
for the parents and the necessity of asking for
permission by the children to enter their
parents’ bedroom (Surah Noor, verse 59).
Likewise, parents should be taught that
they are responsible for making a relationship
out of their children’s sight, although the
children’s imagination is beyond parent’s
control. In those families with mature and
young children, a private bedroom with a
closed door for parents may make children
believe that their parents have an intimate and
warm relationship. This issue can leave
positive impacts on the children’s future
marital life.
Nekoolaltak et al
488 International Journal of Reproductive BioMedicine Vol. 15. No. 8. pp: 479-490, August 2017
Limitations
As talking about sexual issues and
particularly orgasm was considered a taboo in
Iranian society, it was a time-consuming task
to attract the participants’ trust and assure
them about the confidentiality of their
information.
Conclusion
The current paper explained different
physical, psychological, relational and
contextual aspects affecting female orgasm
from the standpoints of Iranian women.
Among physical obstacles, wife’s or
husband’s fatigue was impressive. Lack of
sexual knowledge, shame, and lack of
concentration on sex due to household and
children's problems were the major
psychological obstacles to a woman’s orgasm.
Husband’s hurry was mentioned as one the
relational obstacles. Lack of privacy and
inability to separate children’s bedroom from
their parents were the main contextual
obstacles to women’s orgasm. Many of these
obstacles can be adjusted by training and
counseling of couples before and during the
marriage, practicing in mindfulness techniques
and making some changes in the lifestyle of
the couples. Concerning the major
contribution of non-physical orgasm obstacles
and the greater success of non-
pharmacological treatments compared to
pharmacological therapies, further studies
related to psychological, relational and
contextual obstacles based on the culture of
each society seems necessary in order to
prevent or treat female orgasm disorders.
Acknowledgments
The authors acknowledge the research
deputy of school of nursing and midwifery
affiliated with Shahid Beheshti University of
Medical Sciences, Iran. The authors
acknowledge Dr. Seyed Ali Azin for their
Valuable comments. Also, the participation of
women for taking part in this study is
appreciated.
Conflict of interest
The authors announce that they have no
conflict of interests.
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Purpose: This study aims to describe gender harmonization in al Mu'āsharah's manuscript by Sheikh Abdul Laṭīf Syakūr. This concept is considered as Syakūr's understanding of gender equality, as one of the 17 goals in Sustainable Development Goals (SDGs), from an Islamic perspective. Methodology: The analysis of this manuscript uses a descriptive-analytic method to bring up the facts in the manuscript which are then analyzed according to the targets and indicators contained in SDGs 5 formulation on gender equality. Main Findings: This research presents the concept of gender relations in al Mu’āsharah leading to Islamic gender equality as an elaboration of rights and obligations between husband and wife. The existence of women in career and the sustainability of education is fairness according to Shakūr. Likewise, in sexual relations, Syakūr stressed the importance of women getting the same thing as men. Through this research, it is found that there is gender harmonization presented by Shakūr in al mu’āsharah with the concept of fastabiqulkhairat as a form of gender relations in an Islamic family towards real gender equality. Implications/Applications: This research provides an overview of the role of gender harmonization in SDG. Novelty/Originality of this study: Gender equality, which is the goal of the SDGs 5 to achieve gender equality and empower all women and girls, has relevance to ancient manuscripts of the archipelago. This study highlights that gender equality can be enjoyed by the people of the archipelago following the evolving culture and customs. Just like the actual gender equality goals of the SDGs, women should be honored and respected, to create a gender equality discourse.
... Previous studies suggest that drugs use, particularly in women, can lead to: orgasm delay, decrease in sexual sensations, decrease in sexual desire, dissatisfaction, sexual arousal disorder, anorgasmia, menstrual disorders and vaginal dryness, among other symptoms (Cabello-Santamaría, 2010;Nekoolaltak et al., 2017). Although the relationship between drugs use and female sexual dysfunction is poorly understood, the study of Anil et al. should be highlighted. ...
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Female anorgasmia, which the DSM-5 defines as a marked delay, marked infrequency or absence of orgasm, occurs in the orgasm phase of sexual response being the second most frequent sexual dysfunction in women. It is widely accepted that drugs usage has devastating consequences on sexual response. The aim of this study was to analyze the relationship between drug use and anorgasmia and sexual satisfaction, and other variables that can affect sexual response. An ex post facto study was conducted. Two groups of women were selected through cluster sampling from 28 drug rehabilitation centers belonging to the same institution throughout Spain: drug-using females (n=129) and non-drug-using females (n=129). They completed questionnaires about sexual function, sexual satisfaction, anxiety and sexual attitudes. Female drug users presented higher percentages of anorgasmia (13.18%>2.33%), sexual dissatisfaction (34.10%>3.87%), sexual avoidance (47.28%>17.05%), infrequency (59.68%>44.96%) and less erotic foreplay (3.10%>0.77%) compared to the control group. Moreover, higher scores were obtained in state anxiety (23.82>14.56) and trait anxiety (30.93> 16.95), while lower scores were obtained in erotophilia (84.93< 95.81). Female drug users reported significant impairments in sexual satisfaction, orgasm and sexual attitudes, concurrently with greater infrequency, avoidance and anxiety compared with the control group of non-drug-user females.
... Woman's orgasm plays a vital role in sexual compatibility and marital satisfaction. Orgasm in women is a learnable phenomenon that is tempted by several genes [10]. The physiological changes during each trimester of pregnancy have a substantial impact on women's sexual behavior. ...
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Sexuality is an important component of health and well-being in a woman's life. In accordance with the World Health Organization, sexuality should be considered as a biological reaction to visual, auditory, or tactile stimuli, and a consequence of physical, emotional, mental, and social well-being [1]. Sexual activity during pregnancy is a topic insufficiently addressed in clinical practice and in the literature. Many studies evaluating sexual activity during pregnancy were performed decades ago. Further, many of these surveys have limitations and study design shortcomings such as small sample size, retrospective data, incomplete sexual histories, and recall bias and typically only included healthy, uncomplicated pregnancies. In summation, the effects are inconsistent with the published research [2]. In other words, sexuality during pregnancy is a sensitive matter and has been influenced by many factors such as physical, anatomical, psychological, social, hormonal and cultural elements [3]. Although earlier studies pointed out that sexual activity in normal pregnant women has no significant adverse effects, fear of harming fetus or mother during intercourse [4] belief that having sex during pregnancy period can provoke miscarriage, preterm birth [5] or preterm membrane rupture [6] and belief that coitus during pregnancy is religiously unaccepted [7] were found as the most important reasons for diminishing the sexual relationships within the braces. Disgust for her husband's smell, cannot find a good office, [4] not enjoying sex, [8] work overload and unattractive appearance of the pregnant partner was found as other reasons for diminishing the sexual relationships within the braces [4]. Various surveys have evaluated sexual dysfunction (SD) by using the Female Sexual Function Index (FSFI) in pregnant women and one study measured in non-pregnant women sexual function by using GRISS, 16 but no study so far has used Golombok Rust Inventory of Sexual Satisfaction (GRISS) for SD during pregnancy [9]. The climax is a temporary point of pleasant sexual sensation that is tied in with some physiological changes in the physical structure. Woman's orgasm plays a vital role in sexual compatibility and marital satisfaction. Orgasm in women is a learnable phenomenon that is tempted by several genes [10]. The physiological changes during each trimester of pregnancy have a substantial impact on women's sexual behavior. Orgasm decreased significantly with the progression of gestation. Alterations in the domains of arousal, lubrication, and orgasm were particularly notable in primiparae in the third trimester of pregnancy [11]. Pregnancy contributes to strong hormonal changes, which can raise a stronger sexual drive, and may completely cut a woman's libido. The increased excitability of pregnant adult females is considered quite a natural process, as the woman begins to increase the uterus, the clitoris, and the blood circulation in the small pelvis increases [12].
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Bodily sensations, such as pain, hunger, itches, or sexual feelings, are commonly characterized in terms of their phenomenal character. In order to account for this phenomenal character, many philosophers adopt strong representationalism. According to this view, bodily sensations are essentially and entirely determined by an intentional content related to particular conditions of the body. For example, pain would be nothing more than the representation of actual or potential tissue damage. In order to motivate and justify their view, strong representationalists often appeal to the reliable causal covariance between bodily sensations and certain kinds of bodily conditions or to the corresponding biological function that these bodily sensations are supposed to fulfill. In this paper, I argue on the basis of recent empirical research that arguments from reliable causal covariance and biological function cannot motivate the introduction of corresponding intentional content. In particular, I argue that bodily sensations are caused by a heterogeneous class of physiological and psychological factors and their biological functions are too diverse to be reduced to the representation of a particular bodily condition. Responses are available to strong representationalists, but they either require substantial alterations to their core assumptions or incur a significant empirical burden. Publication: https://www.tandfonline.com/doi/full/10.1080/09515089.2020.1858476
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Background: Infertility makes an essential challenge to the sexual life of couples, especially infertile women. When pregnancy does not happen, infertile women think that sexual intercourse is not fruitful and sexual desire became reduce gradually. Infertile women progressively forget that their sexual relationship is also a response to their natural need. Objective: This qualitative study was conducted to explore the infertility consequences in the sexual behavior of infertile women. Materials and Methods: This was a qualitative content analysis study; and it was part of a widespread study, used a sequential mixed-method and conducted from August 2014 until February 2015. A purposeful sampling was used to recruit infertile women who had referred to Yazd Research and Clinical Center for Infertility. Data gathering techniques employed in this research included in-depth semi structured open face-to-face interviews and field notes. Credibility, transferability, confirm ability, and dependability were assessed for the rigor of the data collection. Results: Totally, 15 infertile women and 8 key informants were interviewed. Data analysis showed four themes about impact of infertility on female sexual behavior: 1/ Impact of infertility drugs on couple sexual behavior, 2/ Impact of assisted reproductive technologies on female sexual behavior, 3/ Timed intercourse during infertility and 4/ The psychological impact of infertility on sexual behavior. Conclusion: Some of Iranian infertile women could cope with their problems, but some of them were very affected by infertility drugs and assisted reproductive technologies procedures. Psychosexual counseling before medical treatment could help them to have a better sexual life.
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Background: In recent years, a growing number of interventions for treatment of female orgasmic problems (FODs) have emerged. Whereas orgasm is a extra biologically and learnable experience, there is a need for practitioners that to be able to select which therapy is the most appropriate to their context. Objective: In this critical literature review, we aimed to assess areas of controversy in the existing therapeutic interventions in FOD with taking into accounted the Iranian cultural models. Materials and Methods: For the present study, we conducted an extensive search of electronic databases using a comprehensive search strategy from 1970 till 2014. This strategy was using Google Scholar search, “pearl-growing” techniques and by hand-searching key guidelines, to identify distinct interventions to women's orgasmic problem therapy. We utilized various key combinations of words such as:" orgasm" OR "orgasmic "," female orgasmic dysfunction" OR Female anorgasmia OR Female Orgasmic Disorder ", orgasmic dysfunction AND treatment, “orgasm AND intervention”. Selection criteria in order to be included in this review, studies were required to: 1 employ clinical-based interventions, 2 focus on FOD. Results: The majority of interventions (90%) related to non-pharmacological and other were about pharmacological interventions. Self-direct masturbation is suggested as the most privilege treatment in FOD. Reviewing all therapies indicates couple therapy, sexual skill training and sex therapy seem to be more appropriate to be applied in Iranian clinical settings. Conclusion: Since many therapeutic interventions are introduced to inform sexually-related practices, it is important to select an intervention that will be culturally appropriate and sensitive to norms and values. Professionals working in the fields of health and sexuality need to be sensitive and apply culturally appropriate therapies for Iranian population. We further suggest community well defined protocols to screen, assessment and management of women’ sexual problems such as FOD in the Iranian settings.
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Offering an authoritative collection of chapters from clinicians and researchers in the United States, Canada, and Europe, this reference comprehensively covers the latest understanding in the etiology, pathophysiology, diagnosis, and treatment of sexual dysfunction.
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Though the public consciousness is typically focused on factors such as psychology, penis size, and the presence of the "G-spot," there are other anatomical and neuro-anatomic differences that could play an equal, or more important, role in the frequency and intensity of orgasms. Discovering these variations could direct further medical or procedural management to improve sexual satisfaction. The aim of this study is to review the available literature of anatomical sexual variation and to explain why this variation may predispose some patients toward a particular sexual experience. In this review, we explored the available literature on sexual anatomy and neuro-anatomy. We used PubMed and OVID Medline for search terms, including orgasm, penile size variation, clitoral variation, Grafenberg spot, and benefits of orgasm. First we review the basic anatomy and innervation of the reproductive organs. Then we describe several anatomical variations that likely play a superior role to popular known variation (penis size, presence of g-spot, etc). For males, the delicate play between the parasympathetic and sympathetic nervous systems is vital to achieve orgasm. For females, the autonomic component is more complex. The clitoris is the primary anatomical feature for female orgasm, including its migration toward the anterior vaginal wall. In conclusions, orgasms are complex phenomena involving psychological, physiological, and anatomic variation. While these variations predispose people to certain sexual function, future research should explore how to surgically or medically alter these.
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A satisfying sex life is an important component of overall well-being, but sexual dysfunction is common, especially in midlife women. The aim of this review is (a) to define sexual function and dysfunction, (b) to present theoretical models of female sexual response, (c) to examine longitudinal studies of how sexual function changes during midlife, and (d) to review treatment options. Four types of female sexual dysfunction are currently recognized: Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder, Genito-Pelvic Pain/Penetration Disorder, and Substance/Medication-Induced Sexual Dysfunction. However, optimal sexual function transcends the simple absence of dysfunction. A biopsychosocial approach that simultaneously considers physical, psychological, sociocultural, and interpersonal factors is necessary to guide research and clinical care regarding women’s sexual function. Most longitudinal studies reveal an association between advancing menopause status and worsening sexual function. Psychosocial variables, such as availability of a partner, relationship quality, and psychological functioning, also play an integral role. Future directions for research should include deepening our understanding of how sexual function changes with aging and developing safe and effective approaches to optimizing women’s sexual function with aging. Overall, holistic, biopsychosocial approaches to women’s sexual function are necessary to fully understand and treat this key component of midlife women’s well-being.
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Background: Sex is one of the basic drives. Genophobia is the fear of sexual intercourse. Like all phobias, the main cause is exposure to severe trauma, especially sexual assaults or abuse. Another possible cause of genophobia is the cultural upbringing and religious teachings that increase the feeling of intense shame and guilt about sex. Aim: The aim of this study was to assess the association between female circumcision and genophobia. Methods: This study was carried out in the Outpatient Gynecology Department, Mansoura University, for 1 year. All patients (166 patients) were examined by a gynecologist to exclude organic causes of genophobia. The remaining patients were referred to a psychiatrist. The patients were diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR) criteria for specific phobia (genophobia). IQ of the patients was assessed using the WAIS-R; anxiety was assessed using the Arabic version of the Hamilton Anxiety Scale; depression was assessed using the Arabic Form of Hamilton Depression Scale; and self-esteem was assessed using the Arabic translation of the Rosenberg Self Esteem Scale and the Arabic version of the Female Sexual Function Index. Results: Anxiety and depression scores were statistically significantly higher in circumcised than in noncircumcised women. In addition, all sexual functions (libido, lubrication, orgasm, satisfaction, and pain) were better in noncircumcised than in circumcised women. Conclusion: Female circumcision increases anxiety and depression and decreases the self-esteem of the women. All these factors could play a vital role in the development of genophobia.
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Confined impinging jets, CIJs, are highly efficient mixers. The scales of mixing in CIJs are controlled by the opposed jets interaction. A mechanistic model is described here, which accurately predicts the impinging position of the opposed jets for a large range of flow rate ratios. The impinging point position is shown to impact the dynamic properties of the flow and the achieved mixing quality. The opposed jets kinetic energy ratio is shown to have a critical impact on mixing, similar to the Reynolds number. A mixing chamber design relation is proposed and verified for the opposed injectors diameters ratio, d1/ d2, which enables to operate CIJs under optimum mixing conditions for large ranges of flow rate ratios, viscosity and density ratios between the opposed streams. Optimum d1/d2 values have asymptotes for large and small Reynolds number depending on the process stoichiometry, viscosity and density ratios of the opposed jet streams.