A Review of Marital Intimacy-Enhancing Interventions among Married Individuals

Coping with sexual violence as a post-assault formed couple: A dyadic phenomenological interview analysis

Increasing evidence shows that survivors of sexual violence frequently experience relationship difficulties following their victimization. Little is known regarding how couples which formed post-assault cope with the impact of the prior assault. Hence, the aim of the current study was to gain insight into post-assault formed couples' experiences in coping with the impact of sexual violence. To this end, an interview study was conducted with five female survivors and their male partners who began their romantic relationship post-assault. A dyadic phenomenological interview analysis revealed that sexual victimization is a dyadic stressor but is not always considered as such by the couple. In addition, disclosure is described as a potential bonding experience. Flexibility and creativity from both partners are required as they adapt to the post-assault impact. In addition, meaningful communication and considering the perspective of one's partner seemed to be key to dyadically cope successfully. The current study also identified challenges couples had to manage, including caregiver burden and role confusion. Results suggest that interventions supporting couples in their continuous efforts toward mutual understanding can foster trust and growth.

The experiences of Chinese colorectal cancer survivors in marital intimacy after ostomy creation: A qualitative study

Background

Colorectal cancer (CRC) ranks as the third most prevalent cancer globally. The disease and its treatment significantly impact marital intimacy, particularly among individuals who have undergone ostomy creation. Therefore, it is necessary to explore their experiences.

Objective

This study aimed to explore the experiences of colorectal cancer survivors in marital intimacy after ostomy creation and clarify the domain and sub-domain of marital intimacy in CRC survivors with ostomy.

Method

This study used a qualitative descriptive design, and participants were selected by purposive sampling from two hospitals in Henan province, China. Sixteen patients participated in this research, and the data were collected through an in-depth interview from June 27 to September 27, 2023. Colaizzi's method was used to analyze the data.

Results

Five themes emerged from data analysis, including physical intimacy, psychological intimacy, social intimacy, spiritual intimacy, and operational intimacy.

Conclusion

By profiling the experiences of CRC survivors in marital intimacy after ostomy creation, the domain and sub-domain of marital intimacy were clarified in this cohort and revealed that ostomy had a severe effect on marital intimacy among colorectal cancer survivors. The results from this study could be used by nurses, midwives, and other healthcare professionals to design specific interventions covering all aspects of marital intimacy. Also, the findings will guide the development of a particular instrument for marital intimacy in CRC survivors with ostomy.

The male-focused marital relationship enrichment and sexual well-being interventions: A scoping review

Background

There is an increasing need for sexual well-being and health promotion strategies that effectively engage men. Researchers have evaluated the efficacy of sexual and reproductive health-related and marital enhancement interventions in male-dominated societies. However, few have focused on culturally appropriate and gender-specific program effects.

Objective

This review aims to evaluate evidence of existing interventions aimed at enriching marital relationships and sexual well-being in adult men.

Materials and Methods

This scoping review was conducted by searching various databases (CINAHL, PsycINFO, EMBASE, Google Scholar, PubMed, Scopus, SID, and Noormags), and other available resources in both English and Persian languages. We located all publications up to January 2023 with no time restriction. Inclusion criteria were studies targeting men in the enrichment of marital and sexual relationships, which focus on marital/sexual enrichment, sexual and reproductive health (SRH) program, passionate relationship, or sexual satisfaction as the main outcomes. PRISMA guidelines were utilized in this review.

Results

Of records 34,405 retrieved by searching, after removing duplicate articles, 8 articles were included based on the inclusion criteria. SRH program was the main focus of 6 articles. Marital and sexual enhancement were common areas of focus in 2 studies. Research methods included 2 semi-experimental, 3 clinical trials, 1 systematic review, 1 content analysis, and a mixed method. According to the assessment result, 4 articles were moderate and 4 were of high quality.

Conclusion

Our findings reveal that a small number of interventions specifically offering SRH or marital and sexual enhancement programs to men should be conducted. As the majority were heterosexual couples, we recommend male-focused programs recognizing men's sexuality.

Strategies to meet marital intimacy needs in women infected with coronavirus 2019: A framework qualitative content analysis research

Background

Separating women with the coronavirus 2019 from family can affect marital life. Considering psychological vulnerability of women for anxiety and depression disorders, these women may experience more stress due to the loss of work at this time or special reproductive health conditions such as pregnancy, having a baby, or other medical conditions.

Objective

Considering a limited number of qualitative studies on the need for marital intimacy, this study was conducted to meet marital intimacy needs in women with coronavirus 2019.

Materials and Methods

Framework qualitative content analysis was conducted through participation of 13 key informants (sex therapist, couple therapist, psychologist, and midwifery counselor) and 18 infected women from Yazd, Iran in July 2020 who were selected purposefully and interviewed through the semi-structured in-depth interviews.

Results

3 main categories were: 1) mutual resilience (subcategories: 1. coping strategies; 2. value of marital life; 3. compassionate conflict resolving). 2) skillful relationship (subcategories: 1. assertiveness in sexual expression; 2. self-efficacy in the distance physical connectivity). 3) synergy (subcategories: 1. reframing spirituality closeness; 2. empowering aesthetic creativity; 3. management of family function, and 4. prioritizing).

Conclusion

Findings revealed sex and couple therapists, health providers, and policymakers should emphasize on using new forms of digital communication in these couples. Teaching skills that increase partners' creativity and empathy, enable women to fulfill their mental, sexual and reproductive health needs, and lead to more partners responsibility and loyalty, and maintenance of family function. In times of crisis, counseling should be considered in women treatment programs and care guidelines.

Promoting appetitive learning of consensual, empowered vulnerability: a contextual behavioral conceptualization of intimacy

Vulnerability is emphasized in a number of theoretical models of intimacy (e.g., Intimacy Process Model), including from behavioral and contextual behavioral perspectives. Vulnerability is generally defined as susceptibility to harm and involves behaviors that have been historically met with aversive social consequences. From these perspectives, intimacy is fostered when vulnerable behavior is met with reinforcement. For example, interventions have trained intimacy by building skills in emotional expression and responsiveness with promising results. Vulnerability has divergent functions, however, depending on the interpersonal context in which it occurs. Functional intimacy is explored through the lens of functional relations, which play a key role in interpersonal processes of power, privilege, and consent. This conceptualization suggests that vulnerability must be under appetitive functional relations, consensual, and empowered for safe intimacy to emerge. The responsibility to promote appetitive learning of consensual, empowered vulnerability to foster intimacy falls to the person with more power in a particular interaction and relationship. Recommendations are offered for guiding this process.

Multidisciplinary approach to the treatment of sexual dysfunction in couples using a biopsychosocial model

BACKGROUND

Given the complexity of the psychological and biological pathologies associated with sexual dysfunction, which affects at least a third of adult women and men worldwide, a multidisciplinary approach has been advocated.

AIM

To assess sexual functioning, relationship satisfaction, and mood stability pre- and post- treatment at the Loyola University Sexual Wellness Program.

METHODS

Couples attending the 6-week multidisciplinary Sexual Wellness Program provided consent and completed pre- and post- intervention assessments. Linear mixed effects models were used to estimate the mean change from baseline to first follow-up. A covariance matrix was used to account for dependency.

OUTCOMES

All patients completed self-reported surveys: Dyadic Adjustment Scale, PROMIS Sexual Function and Satisfaction Measures Brief Profile (Patient-Reported Outcomes Measurement Information), and International Index of Erectile Function.

RESULTS

There were 85 respondents: 42 men and 43 women. The mean age was 49.82 years (range, 25-77). The largest improvement was on the total Dyadic Adjustment Scale score, which increased by approximately 5.18 points (95% CI, 2.55-7.81). PROMIS scores for global satisfaction with sex life, erectile function, and interest in sexual activity significantly increased from baseline, while the vaginal discomfort score significantly declined. Overall the score for global satisfaction with sex life increased from baseline by approximately 5.57 points (95% CI, 3.03-8.10). On average, men reported a 4.33-point increase (95% CI, 0.04-8.62) in their International Index of Erectile Function score from baseline.

CLINICAL IMPLICATIONS

A multidisciplinary treatment approach focused on the couple positively affects a couple's relationship, including global satisfaction with sex life, relationship satisfaction, interest in sexual activity, and erectile function.

STRENGTHS AND LIMITATIONS

This study is one of the few to document the effects of a multidisciplinary treatment approach for both members of a heterosexual couple-male and female. Limitations include the narrow demographics and lack of a control group in our population. Furthermore, this was completed at 1 academic center.

CONCLUSION

These findings emphasize that multidisciplinary sexual therapy programs aimed at the couple can help address multiple aspects of sexual well-being.

Mental healthcare-seeking behavior of women in Bangladesh: content analysis of a social media platform

BACKGROUND

Mental health remains a highly stigmatized area of healthcare, and people often conceal their concerns rather than seek assistance or treatment. The Women Support Initiative Forum (WSIF) is a social media platform established in 2018 to provide expert and peer-led psychosocial support services to women of all ages in Bangladesh. The anonymous nature of the forum means that mental health concerns can be aired without fear of identification.

METHOD

A content analysis was conducted on the anonymous posts retrieved from the WSIF platform between 8^th March 2020 and 7^th July 2022. Around 1457 posts were initially selected for analysis which was reduced to 1006 after removing duplicates and non-relevant posts, such as queries about the addresses of the doctors and other non-mental health-related issues. A thematic analysis of the data was conducted using an inductive approach.

RESULT

The 1006 posts generated four themes and nine sub-themes. All the women mentioned mental health symptoms (n = 1006; 100%). Most also mentioned reasons for seeking mental healthcare (n = 818; 81.31%), healthcare-seeking behavior (n = 667; 66.30%), and barriers to seeking mental healthcare (n = 552; 54.87%). The majority of women described symptoms of stress, depression, and anxiety-like symptoms, which were aggregated under common mental health conditions. Mental health symptoms were ascribed to various external influences, including marital relationship, intrafamilial abuse, and insecurities related to the COVID-19 pandemic. A large proportion of posts were related to women seeking information about mental healthcare services and service providers (psychologists or psychiatrists). The analysis found that most women did not obtain mental healthcare services despite their externalized mental health symptoms. The posts identified clear barriers to women accessing mental health services, including low mental health literacy, the stigma associated with mental healthcare-seeking behavior, and the poor availability of mental health care services.

CONCLUSION

The study revealed that raising mass awareness and designing culturally acceptable evidence-based interventions with multisectoral collaborations are crucial to ensuring better mental healthcare coverage for women in Bangladesh.

The Impact of Couple Therapy Based on Relationship Enrichment Approach on Couples’ Intimacy and Sexual Function

Background: Intimacy is one of the basic and psychological needs of couples and is a motivating factor in their sexual participation. Objectives: To determine the impact of couple therapy based on the relationship enrichment approach on the intimacy and sexual function of the couples consulting healthcare centers. Methods: This research was a quasi-experimental study and was performed on 60 couples referring to Comprehensive Health Centers in the southeast of Iran in 2020. The research instruments included a demographic information questionnaire, three standard questionnaires of intimacy and sexual function of men and women. The educational content was implemented only for the intervention group. Data were collected at baseline, 8th week, and 12th week after the intervention. Data were analyzed using descriptive statistics and two-factor repeated measures ANOVA using SPSS (ver. 21) software. Results: The results showed that the intervention had a significant effect on sexual function and intimacy in the intervention group in three time periods (P < 0.001), whereas in the control group, no significant difference was observed in the three time periods (P > 0.05). Conclusions: The results showed that relationship enrichment counseling can increase intimacy and sexual function of couples.

Factors Influencing Quality of Life in Early Postpartum Women

Postpartum women experience various changes in their physical and psychological health and in their relationships with their spouse and newborn. This study aimed to identify and evaluate the factors that affect the quality of life (QoL) of women within six weeks after childbirth. A prospective, cross-sectional correlational study was used. A convenience sample of 179 postpartum women was recruited from four postpartum care centers in South Korea. Participants completed structured questionnaires on postpartum fatigue, postpartum depression, marital intimacy, breastfeeding adaptation, and quality of life. Marital intimacy (β = 0.466, p < 0.001) was the most influencing factor on the QoL of women during the postpartum period. In descending order, postpartum fatigue (β = -0.192, p = 0.001), postpartum depression (β = -0.190, p = 0.001), breastfeeding adaptation (β = 0.163, p = 0.002), and occupation (β = 0.163, p = 0.004) all had a significant influence on QoL (F = 32.09, p < 0.001), and the overall explanatory power was 63.6%. It is necessary to assess and consider the physical, psychological, relational, and demographic factors of women during the early postpartum period. Comprehensive interventions need to be developed to improve the QoL of women during the postpartum period.

Intimacy Mediates the Relation Between Maltreatment in Childhood and Sexual and Relationship Satisfaction in Adulthood: A Dyadic Longitudinal Analysis

Trauma theories suggest that childhood maltreatment (CM) may partly explain intimacy problems in romantic relationships. However, empirical studies have yielded conflicting findings, likely due to the varying conceptualizations of intimacy. Findings that support long-term negative effects of CM on sexual and relationship satisfaction are almost exclusively based on cross-sectional intra-individual data, precluding the examination of mediating pathways and of dyadic interactions between individuals reporting CM and their partners. This study used a dyadic perspective to examine the associations between CM and the different components of intimacy based on the interpersonal process model of intimacy: self-disclosure, perceived partner disclosure, and perceived partner responsiveness. We also tested the mediating role of these intimacy components at Time 1 in the relations between CM and sexual and relationship satisfaction 6 months later. A sample of 365 heterosexual couples completed self-report questionnaires. Results of path analyses within an actor-partner interdependence framework showed that women and men's higher levels of CM did not affect self-disclosure, but was negatively associated with their own perception of partner disclosure and responsiveness. In turn, women and men's perception of partner responsiveness at Time 1 was positively associated with their own sexual satisfaction, as well as their own and their partner's relationship satisfaction at Time 2. Thus, perception of partner responsiveness mediated the associations between CM and poorer sexual and relationship satisfaction. The overall findings may inform the development of couple intervention that targets the enhancement of intimacy to promote sexual and relationship well-being in couples where one partner experienced CM.

Loneliness Mediates the Relationship Between Pain During Intercourse and Depressive Symptoms Among Young Women

Previous research suggests that women who experience pain during intercourse also experience higher rates of depressive symptoms. Loneliness might be one factor that contributes to this relationship. We hypothesized that women who experience more severe and interfering pain during intercourse would report higher rates of loneliness and higher rates of depressive symptoms. Further, we hypothesized that loneliness would mediate the relationship between pain during intercourse and depressive symptoms. A total of 104 female participants (85.6% white, 74.03% partnered, 20.9 [3.01] years old) completed an online survey including demographic information, PROMIS Vaginal Discomfort Measure, PROMIS Depression Measure, and Revised UCLA Loneliness Scale. Pearson correlations and bootstrapped mediation analysis examined the relationships among pain during intercourse, loneliness, and depressive symptoms. Pain during intercourse, loneliness, and depressive symptoms were all significantly correlated (p < .05). Results of the mediation analysis indicated that loneliness was a significant mediator of the relationship between pain during intercourse and depressive symptoms (indirect effect = 0.077; 95% CI 0.05-0.19). After accounting for loneliness, pain during intercourse was not significantly related to depressive symptoms, suggesting that loneliness fully mediated the relationship between pain during intercourse and depressive symptoms. These findings are consistent with previous studies highlighting that pain during intercourse is related to depressive symptoms. The current study adds to that literature and suggests that more frequent and severe pain during intercourse leads to more loneliness, which then leads to increased depressive symptoms. This line of work has important implications for treating women who experience depressive symptoms and pain during intercourse.

Marital Intimacy and Predictive Factors Among Infertile Women in Northern Iran

INTRODUCTION

Infertility is a stressful state that may decrease attachment between spouses. Marital intimacy is a real need in infertile women.

AIM

The aim of this study was to evaluate marital intimacy and predictive factors among infertile women in Northern Iran.

MATERIALS AND METHODS

This cross-sectional study was conducted at Fatemeh Zahra Infertility and Reproductive Health Center of Babol Medical Sciences University in 2014. A total of 221 infertile women participated in this study. The instrument used in this research was Marital Intimacy Need Questionnaire (MINQ). Statistical analyses was performed using linear and logistic regression with p<0.05 indicating statistical significance.

RESULTS

An 88.5% of infertile women had good marital intimacy. The mean and standard deviation of the marital intimacy was 349.11±49.26 and in marital intimacy domains including: emotional (42.28±7.23), psychological (41.84±7.59), intellectual (42.56±7.46), sexual (42.90±7.41), physical (43.59±6.96), spiritual (51.61±8.06), aesthetic (42.66±6.75), and social intimacy (42.59±6.89). The highest mean of marital intimacy domains is related to spirituality in infertile women. Physical and sexual domains had the high mean in infertile women. The lowest mean in marital intimacy domains was psychological intimacy. There was a significant correlation between the domains of marital intimacy. The strongest correlation was between the physical and sexual intimacy (r=0.85). There was a significant inverse association in marital intimacy with the age difference of spouses (p<0.01), and tobacco use (p<0.02). There was a statistically significant association in the marital intimacy with husband's occupation, and cause of infertility (p<0.02).

CONCLUSION

Early screening and psychosocial intervention strategies suggest in the setting of female infertility to identify and prevent the predictive factors that may cause marital conflict.