The status of sexual health in Iranian families / By:(Seyed Kazem Forutan) (Mohamad Hussein AkhawanTaqawi)
By: Seyed Kazem Forutan
Mohamad Hussein AkhawanTaqawi
As the sole strong foundation of society, family is the prime social institution playing a unique role in the preservation of the health of individuals and society. The survival, development, strength, and effectiveness of this holy institution depend on a number of factors members of family, society, and states must pay special attention to. Among these factors, we may mention sexual health and its proper function within the boundary of family according to Sharia, custom, and law. The sexual desire and its proper satisfaction are one of the purposes and results of forming a family. Obviously, the best and balanced function of this human instinctive derive in accordance with the regulations set by rationality and Sharia guarantees the continuation and success of the holy bound of matrimony. The motto “sexual health” meant to fortify the institution of family or to mend broken marriage ties cannot be realized except through implementing reviving precepts of Islam about healthy sexual education before and after coming of age and marriage. It requires preparation of grounds individually, socially, and scientifically which in turn depends on joint interdisciplinary comprehensive research on sexual health in Iranian Islamic culture by experts in Sharia law, common law, education, psychology, sociology, medicine, and the like. In this paper, we address the role of sexual health in Iranian families and the elements endangering it proposing solutions for such problems based on Iranian-Islamic culture.
Key words: Iranian culture, sexual health, marriage, matrimony, family
As the oldest social institution and the smallest unit constituting society, family plays the greatest role in the creation and continuation of society. Therefore, family has been the focus of attention by scientists and experts in different scientific fields such as sociology, psychology, pedagogy, law, and jurisprudence from the time immemorial. In recent decades, attention has been paid to sexual health of family. Now, it is conceded that stable sexual relation between married couples is instrumental to the strength and stability of family. Available statistics relevant to divorce and its causes show that the direct or indirect cause of divorce in many cases in Iran consists of sexual disorders and problems couples suffer from. Statistical data tells us stable sexual relations between couples not only secure their psychological and physical health but also contribute to the well-being of children. Nowadays, experts in the field of family believe that, in the majority of cases, the illegal relations married individuals enter into without the framework of family and marriage have their root in instability and chaos in their sexual relations with their official partners. Considering the importance of family and the factors contributing to its strength and stability, I think it is necessary to explain how Islam and the Islamic Republic of Iran look at family and matrimonial life and to see how sexual health contributes to the stability of family and to discern the elements that threat sexual health. In this way, we can arrive at strategies and programs officials of the government can adopt in order to enhance the sexual health of Iranian families.
Sociologists define family as a man and a woman joined together on the basis of sexual relationship they both need. This need is so strong to convince two individuals of opposite sexes that they can attain tranquility in the company of one another. It paves the ground for raising children. According to this theory, family is composed only of a man and a woman. But some psychologists hold a different view. They think that family is composed of a couple plus their child or children. Advocates of both definitions agree that family has long been considered as the kernel and prime origin the ultimate unit of human society. Therefore, it is believed that human society cannot form except as the aggregate of families. Islam attaches much importance and value to family as an institution. There are many verses in different Suras of the Quran such as Baqareh, Nisa, Anfal, Nur, Furqan, Ahzab, and Talaq speaking about family. From the Islamic perspective, man and woman are created from one and the same origin. They are tied by historical and blood relations. Through marriage, the tie between man and woman assumes the form of a very strong impact. Islamic family established on the basis of lawful marriage is so highly respected in Islam that the holy Prophet of Islam says, “The institution of marriage is the most respected in the eyes of God.” Islam sees the institution of family as the locus of the flourishing of human natural instinctive dispositions. Therefore, Islam renders the health, freshness, and development of this institution of utmost importance. Established according to the Islamic precepts, Islamic Republic of Iran considers family particularly important. The constitution of the Islamic Republic of Iran says in its introduction, “Family is the most fundamental unit of society and the principal locus of human growth and movement towards perfection. Ideological congruence and consistency of the ideals cherished by members of the family are all instrumental to the success of family as a means of human evolution towards perfection. Islamic state is responsible for providing the requirements of achieving this goal.” The 10th Clause of the Constitution of the Islamic Republic of Iran states, “Since family is the most fundamental unit of Islamic society, all rules and regulations as well as plans should be made in a manner facilitating the formation of family and guarding the stability and sacredness of family relationship on the basis of Islamic law and ethics.” Hence, Islamic Republic of Iran attaches the same value to formation of family which Islam has given.
Sexual health as contributive to stability of family
Natural sexual desire means feeling attraction between two people and the ensuing voluntary behavior they both enjoy accompanied by arousal of sexual organs and void of anxiety and feeling sinful. Sexual health means a situation in which a married couple enjoys appropriate normal and healthy sexual affair feeding satisfaction as the result. According to the definition proposed by World Health Organization, sexual health names a harmony between mind, feeling, and body conducive to the growth of rational and social aspects of human personality leading to love and relationship.
The approach adopted by the Quran and Islamic traditions toward sexual issues is not suppressive or repressive. Islam recognizes the sexual faculty as a reality which ought to be properly administered and controlled on the correct path. The general policy Islam adopts in the field of sexuality has two wings; facilitating lawful satisfaction and preventing the liabilities to sin hence protection and control of sexual drive. Thus, the Quran recommends that the faithful facilitate marriage and avoid deferring it so that spouses find comfort in matrimony (Sura Rum, Verse 21). Elsewhere in the Quran, the same idea is conveyed through drawing a simile; “Spouses are like clothes for one another,” (Sura Baqarah, Verse 87). The Quran orders husbands to treat their wives with respect and affection: “Treat them with courtesy,” (Sura Nisa, Verse 19). There are many traditions that emphasize this point. A saying is related to the holy Prophet of Islam addressing women: “Do not prolong your prayers in order to keep you husbands away.” Another tradition relates to Him saying: “Wives should use perfumes and show their readiness to their husbands at all times.” Imam Baqer says, “In the same way that husbands like their wives makeup, wives, too, enjoy seeing their husbands decorous.” Imam Kazem says, “To henna and to beatify oneself help keep women decent. Verily, the reason why women deviate is that husbands do not prepare themselves for their wives.” According to a widely-accepted fatwa, it is obligatory for a husband to sleep with his wife at least every one out of four nights.
Numerous researches have been carried out about the importance of stable sexual relation between married couples and its influence on the health of the couple and on the strength and stability of family. We shall mention some of them here. Hamidreza Aqamohammadian et al studied the cases of 60 married and divorced women and found out that the lack of sexual satisfaction plays a crucial role in divorce. Another research carried out by Mansureh Amirian et al about women who referred to psychologists as well as the court in the city Shiraz showed a significant correlation between sexual disorders and attempts at divorce. A third research carried out by Mohamad Reza Forutani et al about couples who filed complaints at the Family Court in the city Larestan in the period between 1380 to 1383 showed that sexual dissatisfaction formed the main reason for divorce. The fourth study conducted by Masumeh Saberian et al showed that quantitatively or qualitatively improper sexual relations often accompany domestic violence in forms of bad temper, argumentativeness, wrath, and the like. Mahnaz Ali Akbari Dehkordi et al concluded in a study about married women between the age 18 to 50 that proportionate to the amount of sexual satisfaction, the strength of marriage bound and mutual contentment increase. A study by Najmeh Aganj et al showed that sexual education helps improve happiness in matrimonial life and diminish the chances of sexual dissatisfaction and probability of ensuing divorce. In a seperate study about married women in Tehran, Nasir Dastan et al concluded that the more sexual satisfaction of the couple increases, the more the quality of their family life improves. Available statistics tell us that one of very important and principal causes of divorce is sexual satisfaction disorder of spouses. Forutan et al found out that 66.7 percent of the men and 68.4 percent of women who referred to the branches 1 and 2 of the Family Court in the capital Tehran complained about their dissatisfaction in their sexual life with their partners.
The sexual instinct is one of the strongest human needs which leads to profound and lasting disorders in relations between spouses and sometimes eventually to the collapse of family life if unmet properly. The findings of the aforementioned studies converge on one important point; one of the principal pillars of family life of married couples consists in sexual relation resulting in mutual satisfaction. The theory of sexual maladjustment tells us that sexual dissatisfaction occupies the prime place as a factor in family problems specially those that wind up in separation. When a couple enjoys satisfaction in their sexual relation, they can tolerate the majority of problems they face in their shared life. On the contrary, the dissatisfaction in their sexual relation often leads to the augmentation of minute issues between them making grave crises out of them. Proper sexual performance results in psychological serenity, growth of self-confidence, feeling happy, vitality, elegance, reduction of everyday life tensions, and feeling more friendly and sincere with one's partner. In the same way, any kind of disorder in sexual relations may lead to the feeling of deprivation, frustration, sadness, psychological insecurity, anger, jealousy, mistrust, suspicion, anxiety, lack of concentration, finding fault, violence, reproaching one's partner for everyday life problems, feeling of contempt, exaggerated tensions, and finally, hatred towards one’s spouse. The result of all these would be either collapse of family life altogether or at least the domination of indifference and spiritless atmosphere on family life.
Factors detrimental to sexual relations between married couples
There is a strong correlation between a couple’s sexual satisfaction and matrimonial contentment. Couples’ sexual relation is negatively influenced by the slightest disagreement, diminished commitment, sincerity, affection, trust, loyalty, or honesty. The domain of mutual rights, obligations, and expectations in matrimonial family life is so wide and important that any degree of disorder there directly harms healthy sexual relation between marriage partners. Therefore, the sexual relations between spouses remain warm so long as a strong emotional relation continues between them. For this reason, one important prerequisite for successful marriage is sufficient mutual understanding between the two individuals before marriage. Another condition is their being on a par and equal so far as their economic level of life, their cultural and political affiliations, and their emotional status are concerned. If these conditions are met, marriage bound would be strengthened and preserved.
Wrong visions and beliefs
When a man or woman holds wrong beliefs and visions about the sexual function the other party is supposed to have, their sexual relation is threatened. Some more common wrong beliefs detrimental to healthy sexual relations between spouses are as follows: man exclusively enjoys the right to have sexual intercourse whenever he wishes irrespective of circumstances; couples must have sexual intercourse on the first night of the wedding; only man enjoys the right to orgasm and woman has to yield to man's wishes; love affairs exclusively belong to the period when people are engaged; sexual arousal is similar in man and woman; in family life sexual relation is secondary and issues such as employment, financial affairs, raising children, and the like are principal; reducing sexual relations between spouses to intercourse; utilizing sexual relations as a means of revenge or exercise of one's power. All these mistakes put regular, healthy, and satisfactorily sexual relationship between marriage partners in jeopardy.
Sexual disorders include a wide range of rational or structural disorders of male or female sexual organs. In general, a sexual cycle in man or woman is composed of desire, arousal, orgasm, and resolution. Sexual disorder means a bad response to sexual stimuli at any one of the above stages. Among very common sexual disorders in men are erectile dysfunction, premature ejaculation, and in women vaginismus (meaning diminished sexual arousal or hypo-active desire disorder), and anorgasmia, i.e., failing to experience orgasm. There are some special and relatively rare male sexual diseases like dry ejaculation, chordee, Peyronies disease, and micropenis. Disparonia is a sexual disorder seldom seen in women. Any of these diseases can seriously damage the sexual relationship between marriage partners. It is not possible to discuss all these diseases in length here. We cast a passing glance at very common sexual disorders, and refer different readers to reference books of medicine and sexual therapy.
Erectile dysfunction, whether acute or chronic, is a common male sexual disorder known as impotency. As a result of this disease, patients fail to achieve an erection long enough for intercourse at least for a period of three months. The prevalence of this kind of impotency increases as men get older. Men younger than 40 years of age are 1-9 percent susceptible to this disease while they are 50-75 per cent susceptible to it between the ages 70-80. There are two main psychological and organic causes for this disorder. Scientists and researchers believe that in 25% of cases, the cause of the disease is psychogenic, in 25%, it is organic, and in 45%, both causes are present. The cause of the disease is not yet known in 5% of the cases. Among organic reasons, diabetes is the most common. Seven per cent of Iranian people suffer from this disease. Sexual disorder is seen three times more in people suffering from diabetes. Sexual impotency is a principal cause of decline in sexual relationship and in the increase of the cases where married women remain virgin and marriage fails. Nowadays, it is possible to diagnose this disease and cure it by medication.
Premature ejaculation is another common male sexual disorder. Different definitions are proposed for this term. One of the valid definitions says that if a man can normally sleep with his wife but is not capable of preventing ejaculation for at least 2 minutes after penetration he is said to be suffering from premature ejaculation. This problem is mainly caused by psychosexual factors. Different theories have been presented to explain it. Around 30% of men suffer from this problem. It is among the most common reasons for wives failing to experience orgasm hence their lack of interest in sexual relationship.
Vaginismus is a kind of common sexual disorder among women. It is caused by involuntary contraction of vagina’s lateral muscle. This compression is so great that prevents penetration or causes the penetration to be painful. It is common among women especially among the literate. It can be cured by different techniques without any need to medication. It is one of the causes of married women remaining virgin. Unfortunately, false beliefs and wrong behaviors wind up in this disease and in the failure of matrimonial life.
Hypo-active desire disorder and failing to experience orgasm in women are two very common widespread sexual disorders. Statistics show a sway between 4–41 percent proportionate to the stage of the disease. Psychological factors are often the main cause.
Organic and psychological diseases
There are a great number of diseases, organic or psychological, that contribute to the spread of sexual disorders. Diabetes and cardiovascular diseases are two important causes of sexual disorders especially among men, the latter being more widespread. The findings of a study conducted by Forutan et al on patients who did not suffer from diabetes but suffered from chronic atherosclerosis and were aged over 40 showed that erection dysfunction was common among them. A direct correlation was observed between the stage of the advancement of erectile dysfunction and the number of arteries engaged. Mohamad Reza Rajabi conducted a research on a number of patients who suffered to different degrees from cardiac disorders and found out that 77% of them suffered from medium to sever sexual impotency. Internal glands dysfunction in the form of hyperactivity or hypo-activity of thyroid gland, dysfunctional sexual glands, and excessive production of prolactin all cause sexual malfunction in men and women. Pelvic operations, excessive use of some medicines, spinal cord injuries, and nervous system diseases such as epilepsy, multiple sclerosis, and chronic dysfunction of kidney are among diseases that may result in sexual disorder. In general, sexual diseases related to sexual organs giving rise to arterial, nervous, or hormonal dysfunctions can cause sexual disorders in either of the sexes. Psychological problems like anxiety, depression, bipolar dysfunction, and schizophrenia may deteriorate sexual functions. Side effects of some of the medicines used for the treatment of these diseases may give rise to disorders in sexual performance. As an example, in a separate study conducted by Mohamad Reza Nainian, it was revealed that there is a significant correlation between women's sexual performance and the stage of depression they suffer from.
Since early 1990, many studies have been carried out about matrimonial compatibility. Matrimonial compatibility is a situation in which the married couple feels happy and satisfied with one another most of the time. Matrimonial compatibility and content with one’s marriage influence many dimensions of social and private life of people. Sex is one facet of matrimonial compatibility. In their research, Mahnaz Madanlu et al showed that sexual content increases matrimonial compatibility. It also showed that there is a significant correlation between sexual performance and matrimonial compatibility; as women's sexual satisfaction grows, hopes in the continuation and success of their married life also grow. Joseph Golshani and Hussein Shamekhi concluded from their study that impotency or lack of sufficient sexual performance is a crucial factor contributing to matrimonial incompatibility and dissatisfaction. Nasir Dastan et al also arrived at the same conclusion emphasizing that the betterment of sexual relationship between spouses leads to the betterment of the quality of matrimonial life.
Among the main reasons why marriage partners commit betrayal, we may mention shaky sexual relationship between them, lack of intimacy and affection between them, and lack of care for tendencies and desires of one another. The first of these factors counts as a very important incite for unlawful sexual relationship. In her study about 147 streetwalkers who referred to the centers for rehabilitation affiliated to the organization of Behzisty, Shahla Maozzami found out that 75.2% of these women had never experienced affection or love in their matrimonial life.
Tormenting one’s spouse
Sexual dissatisfaction maybe expressed in the forms of anger, quarrel, and bad temper in husband or wife. A research carried out by Masumeh Sabran et al showed that improper quality or quantity of sexual relationship often incite negative reactions like obstinacy, wrath, moroseness, beating one’s wife, refraining from paying the expenses of the family, attempting at a second marriage, or indulging in illegal sexual relationship with other women. Another study by Mohsen Shokuhi et al revealed that expressing anger has a strong correlation with matrimonial incompatibility and sexual dissatisfaction. These researchers believe contentment in family life positively affects the psychological well-being of married couples while disorders in the satisfaction of sexual desire may leave adverse effects on matrimonial life.
Failure in raising children properly
A great number of researches and papers have shown that security and calm atmosphere at home and in family contribute greatly to the growth and development of children. Sincere relationship between parents and their responsible behavior play a very important role in children's psychological and even sexual health. Bahram Pirasteh studied misdemeanant teenagers and young adults and found out that the incompatibility between parents and their deprivation of love and affection constitute a great factor in their tendency towards crime. The results of this study showed that 47.38% of the cases suffered from the absence of love and affection in family. It is concluded that tension within family leaves adverse effects on children and teenagers. The discord among parents ending up in divorce often deprives children of care and attention by parents or at least one of them. This, in turn, incites wrongdoing and committing crimes. Saeed Rezaii studied the reasons why girl teenagers run way from home. He found out that instability of the family and crisis at home in addition to shaky emotional relationship between parents constitute the most important factor in these girls inclination to leave for good. The majority of girls asked in an interview about the reason why they had run away said that they had escaped the disturbances and chaos in family. The ratio of matrimonial satisfaction in families of these girls was below average, low, or very low.
The spread of venereal diseases
Chaos in married couples’ sexual relationship weakens loyalty to family and causes commitment to one's partner to fade away. This contributes to the spread of different venereal diseases such as AIDS, gonorrhea, and syphilis. Speaking to press after her meeting with the director general of UN program for AIDS, Marziyeh Dastjerdi said, “As a result of the alarming increase in unsafe behaviors, we may be on the verge of a volcanic eruption of AIDS in the country. Illegal and immoral sexual relationship makes individuals highly susceptible to AIDS disease. Fifty percent of the prostitutes in Tehran transmit AIDS. Every one of them can transmit this disease to at least five people annually.” The Ministry of health recently declared that the cases of AIDS patients who have received the virus via sex are increasing. Among the principal strategies for the prevention of the spread of the disease, sticking to one partner and loyalty to one's spouse is highly recommended. It goes without saying that loyalty of spouses rest on so many foundations; sense of responsibility, commitment to moral and religious values, honesty, care for each other and firm sexual relationship between married couples stand out.
Among very complicated widespread and grave problems in Iranian society are the tendencies of teenagers and young adults to narcotics and their addiction to such stuff. The tendency to use natural drugs like opium or industrially produced narcotics such as Crystal and other ramifications of amphetamine stems from various sources. One of them is sexual disorders especially premature ejaculation in cases of married couples. According to the report published by the Headquarter for Combating Narcotics, sexual dissatisfaction has long been a reason for the increase of the consumption of narcotics in recent years among married people. Findings of the research conducted by Seyed Ali Mirfakhraii about a number of people who referred to the National Center for the Study of Addiction showed that 73% of these people blamed sexual problems as the initial cause of their problem and 32% blamed sexual problems for their relapse to addiction.
Statistics show that the rate of divorce in the country is soaring. The director general of the Bureau for Information and Statistics affiliated to the Organization for Civil Registration announced that the rate of divorce has increased for 13% only between the year 1387 (2008) and the year 1388 (2009). According to the same announcement, the average age of divorce for men is 34.1 and for women 29.3. This shows that the populace of the divorced is quite young. Among various factors contributing to the failure of matrimonial life we can mention sexual dissatisfaction of married couples. Earlier, we mentioned the study conducted by Forutan et al about the cases of divorce filed with family courts, which showed the real cause of divorce in the majority of these cases were sexual problems though the divorcees present other excuses for separation. The reason is obvious; they are often too shy to state the real reason frankly.
Sexual health is one of the facets of general health. It plays a very important role especially before and during matrimonial life. For sexual health to be realized, it is necessary to plan, make policies, implement, supervise, evaluate, and constantly revise. Therefore, the following six steps should be taken.
- A Council should be formed on national level named the Supreme Council for Family. Its responsibilities would be to coordinate ministries, institutions, and organizations that are in any way related to family life in order that abrupt decisions, arbitrary, or incomprehensive plans and policies be prevented so that the country remains immune of chaos in the field.
- Measures should be taken to cultivate and promote in society the culture of consulting experts before taking the final decisions on marriage. Gradually, premarital consultation must become mandatory in order to prevent matrimonial incompatibility. As this procedure is well-established in society, one major reason for divorce will gradually disappear.
- Promotion of the culture and and habit of consulting experts after marriage should be considered. Improper prejudice and harmful habits that go against Islamic precepts and count as obstacle to rational encounter with family problems should be treated.
- Proper approach to the question of sexual health needs to be taught and promoted in society. There are prerequisites both social and cultural without which no improvement is feasible. It is necessary to establish special departments in universities for undergraduate, graduate, and post graduate studies in order to train experts in the field of family consultation, diagnoses, and treatment of sexual disorders and public education of family health. The motto “family health” need attain its appropriate position in people's mentality.
- The judiciary should take necessary measures to amend the procedures for settlement of family disputes in a manner that guarantees that all possible concealed genuine causes of the crises be understood, addressed, and treated. To achieve this goal, courts must refer the cases to medical consultants first. Treatment of psychological problems emerging in the forms of complaints in court must be included among the tasks of judiciary.
- Special clinics for “family and sexual health” must be established nationwide enabling married couples to refer there for diagnoses and treatment of sexual complexities as a measure for prevention of family disputes and tensions. All techniques useful for prevention of the collapse of remedies are preferable to measures for controlling the repercussions of sexual problems.
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. Urologist and Head of Family Health Clinic of Shahed University.
. Educational & Therapist Fellow, Department of Research on Family Health, Shahed University.