Abstract
Background: The postpartum period is considered a vulnerable and stressful period for many women due to various hormonal, physical, and psychosocial changes, such as adapting to parental rules, changes in body and self-image, loss of autonomy, breastfeeding, and taking care of the baby.
Objective: This study aimed to test a conceptual model considering the interrelated role of anxiety, body image satisfaction, sexual function, type of personality, income, and education on women’s marital satisfaction. Also it also aimed to test the mediating role of sexual function and anxiety.
Methods: In this cross-sectional study, 447 lactating women were recruited from January to April 2019. Women answered some questionnaires including a socio-demographic checklist, female sexual function index (FSFI), Body Self-Relation Questionnaire (BSRQ), the Enrich Marital Satisfaction, and the NEO Personality Inventory (NEO PI-R). Data were analyzed using the descriptive test, and Path analysis was done with LISREL software.
Results: Results show that sexual function (β= 0.44), anxiety (β= -0.26), and educational level (β= 0.47) are the main predictors of marital satisfaction (dependent variable). Sexual function and anxiety were two main mediators; variables, such as anxiety (β= -0.35), body image satisfaction (β= 0.19), and extraversion personality (β= 0.19) (independent variables), with an effect through sexual function, can impress marital satisfaction indirectly.
Conclusion: Identifying relationships between anxiety, educational level, sexual function, anxiety, body image, and personality with the quality of life of postpartum women highlights the importance of designing interventions to improve marital satisfaction. Given these relationships, it is recommended that health professionals educate women about body changes during postpartum and find ways to improve mothers' marital satisfaction.
[2]
Dawson, S.J.; Vaillancourt-Morel, M.P.; Pierce, M.; Rosen, N.O. Biopsychosocial predictors of trajectories of postpartum sexual function in first-time mothers. Health Psychol., 2020, 39(8), 700-710.
[http://dx.doi.org/10.1037/hea0000861] [PMID: 32212769]
[http://dx.doi.org/10.1037/hea0000861] [PMID: 32212769]
[3]
Caçador, M.I.; Moreira, H. Fatigue and mindful parenting in the postpartum period: The role of difficulties in emotion regulation and anxious and depressive symptomatology. Mindfulness, 2021, 12(9), 2253-2265.
[http://dx.doi.org/10.1007/s12671-021-01688-4]
[http://dx.doi.org/10.1007/s12671-021-01688-4]
[4]
Makama, M.; Awoke, M.A.; Skouteris, H.; Moran, L.J.; Lim, S. Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers. Obes. Rev., 2021, 22(4), e13167.
[http://dx.doi.org/10.1111/obr.13167] [PMID: 33403746]
[http://dx.doi.org/10.1111/obr.13167] [PMID: 33403746]
[5]
Samadaee Gelehkolaee, K.; Mccarthy, B.W.; Khalilian, A.; Hamzehgardeshi, Z.; Peyvandi, S.; Elyasi, F.; Shahidi, M. Factors associated with marital satisfaction in infertile couple: A comprehensive literature review. Glob. J. Health Sci., 2015, 8(5), 96-109.
[http://dx.doi.org/10.5539/gjhs.v8n5p96] [PMID: 26652079]
[http://dx.doi.org/10.5539/gjhs.v8n5p96] [PMID: 26652079]
[6]
Zaheri, F.; Dolatian, M.; Shariati, M.; Simbar, M.; Ebadi, A.; Hasanpoor Azghadi, S.B. Effective factors in marital satisfaction in perspective of iranian women and men: A systematic review. Electron. Physician, 2016, 8(12), 3369-3377.
[http://dx.doi.org/10.19082/3369] [PMID: 28163850]
[http://dx.doi.org/10.19082/3369] [PMID: 28163850]
[7]
Anzaku, A.S.; Mikah, S. Postpartum resumption of sexual activity, sexual morbidity and use of modern contraceptives among Nigerian women in Jos. Ann. Med. Health Sci. Res., 2014, 4(2), 210-216.
[http://dx.doi.org/10.4103/2141-9248.129044] [PMID: 24761240]
[http://dx.doi.org/10.4103/2141-9248.129044] [PMID: 24761240]
[8]
Thom, D.H.; Rortveit, G. Prevalence of postpartum urinary incontinence: A systematic review. Acta Obstet. Gynecol. Scand., 2010, 89(12), 1511-1522.
[http://dx.doi.org/10.3109/00016349.2010.526188] [PMID: 21050146]
[http://dx.doi.org/10.3109/00016349.2010.526188] [PMID: 21050146]
[9]
Güleryüz, A.; Altay, B. Relationship between sexual quality of life and life satisfaction in women with urinary incontinence: A cross-sectional survey. Urologia, 2023, 03915603231184088.
[http://dx.doi.org/10.1177/03915603231184088] [PMID: 37421246]
[http://dx.doi.org/10.1177/03915603231184088] [PMID: 37421246]
[10]
Badreddine, J.; Pope, R.; Sheyn, D. Impact of urinary incontinence on postpartum sexual function. Urogynecology, 2022, 28(11), 753-762.
[http://dx.doi.org/10.1097/SPV.0000000000001247] [PMID: 36288114]
[http://dx.doi.org/10.1097/SPV.0000000000001247] [PMID: 36288114]
[11]
Schoenfeld, E.A.; Loving, T.J.; Pope, M.T.; Huston, T.L.; Štulhofer, A. Does sex really matter? Examining the connections between spouses’ nonsexual behaviors, sexual frequency, sexual satisfaction, and marital satisfaction. Arch. Sex. Behav., 2017, 46(2), 489-501.
[http://dx.doi.org/10.1007/s10508-015-0672-4] [PMID: 26732606]
[http://dx.doi.org/10.1007/s10508-015-0672-4] [PMID: 26732606]
[12]
Montan, G; Carollo, M; Torres, L; Buzzaccarini, G; Giannini, A; Etrusco, A Androgens and female sexuality: Molecular insights, neuroendocrine crosstalk and future therapeutic directions. CEOG., 2023, 50(7), 141.
[13]
Gutzeit, O.; Levy, G.; Lowenstein, L. Postpartum female sexual function: Risk factors for postpartum sexual dysfunction. Sex. Med., 2020, 8(1), 8-13.
[http://dx.doi.org/10.1016/j.esxm.2019.10.005] [PMID: 31837965]
[http://dx.doi.org/10.1016/j.esxm.2019.10.005] [PMID: 31837965]
[14]
Hajimirzaie, S.S.; Tehranian, N.; Razavinia, F.; Khosravi, A.; Keramat, A.; Haseli, A.; Mirzaii, M.; Mousavi, S.A. Evaluation of couple’s sexual function after childbirth with the biopsychosocial model: A systematic review of systematic reviews and meta-analysis. Iran. J. Nurs. Midwifery Res., 2021, 26(6), 469-478.
[PMID: 34900644]
[PMID: 34900644]
[15]
Zare, Z.; Golmakani, N.; Shareh, H.; Khadem, N. Factors related to marital satisfaction in primiparous women during postpartum period. J. Midwifery Reproductive Health., 2014, 2(2), 120-127.
[16]
Barnes, D.L. Postpartum depression: Its impact on couples and marital satisfaction. J. Syst. Ther., 2006, 25(3), 25-42.
[http://dx.doi.org/10.1521/jsyt.2006.25.3.25]
[http://dx.doi.org/10.1521/jsyt.2006.25.3.25]
[17]
Odinka, J.I.; Nwoke, M.; Chukwuorji, J.C.; Egbuagu, K.; Mefoh, P.; Odinka, P.C.; Amadi, K.U.; Muomah, R.C. Post-partum depression, anxiety and marital satisfaction: A perspective from Southeastern Nigeria. S. Afr. J. Psychiatry, 2018, 24, 1109.
[http://dx.doi.org/10.4102/sajpsychiatry.v24i0.1109] [PMID: 30263209]
[http://dx.doi.org/10.4102/sajpsychiatry.v24i0.1109] [PMID: 30263209]
[18]
Burgio, S; Polizzi, C; Buzzaccarini, G; Laganà, AS; Gullo, G; Perricone, G Psychological variables in medically assisted reproduction: A systematic review. Menopause Rev., 2022, 21(1), 47-63.
[http://dx.doi.org/10.5114/pm.2022.114404]
[http://dx.doi.org/10.5114/pm.2022.114404]
[19]
Sayehmiri, K.; Kareem, K.I.; Abdi, K.; Dalvand, S.; Gheshlagh, R.G. The relationship between personality traits and marital satisfaction: A systematic review and meta-analysis. BMC Psychol., 2020, 8(1), 15.
[http://dx.doi.org/10.1186/s40359-020-0383-z] [PMID: 32033583]
[http://dx.doi.org/10.1186/s40359-020-0383-z] [PMID: 32033583]
[20]
Kasalova, P.; Prasko, J.; Holubova, M.; Vrbova, K.; Zmeskalova, D.; Slepecky, M.; Grambal, A. Anxiety disorders and marital satisfaction. Neuroendocrinol. Lett., 2018, 38(8), 555-564.
[PMID: 29504737]
[PMID: 29504737]
[21]
Crisp, C.C.; Vaccaro, C.M.; Pancholy, A.; Kleeman, S.; Fellner, A.N.; Pauls, R. Is female sexual dysfunction related to personality and coping? An exploratory study. Sex. Med., 2013, 1(2), 69-75.
[http://dx.doi.org/10.1002/sm2.16] [PMID: 25356290]
[http://dx.doi.org/10.1002/sm2.16] [PMID: 25356290]
[22]
Saberi, N.; Akbari, S.A.A.; Mahmoodi, Z.; Nasiri, M. Model for the relationship between sexual function and social determinants of health: path analysis. Koomesh, 2018, 20(2)
[23]
Gillen, M.M.; Markey, C.H. A review of research linking body image and sexual well-being. Body Image, 2019, 31, 294-301.
[http://dx.doi.org/10.1016/j.bodyim.2018.12.004] [PMID: 30584001]
[http://dx.doi.org/10.1016/j.bodyim.2018.12.004] [PMID: 30584001]
[24]
Allen, M.S.; Robson, D.A. Personality and body dissatisfaction: An updated systematic review with meta-analysis. Body Image, 2020, 33, 77-89.
[http://dx.doi.org/10.1016/j.bodyim.2020.02.001] [PMID: 32113010]
[http://dx.doi.org/10.1016/j.bodyim.2020.02.001] [PMID: 32113010]
[25]
Fata, L.; Birashk, B.; Atefvahid, M.; Dabson, K. Meaning assignment structures/schema, emotional states and cognitive processing of emotional information: comparing two conceptual frameworks. Majallah-i Ravanpizishki va Ravanshinasi-i Balini-i Iran, 2005, 11(3), 312-326.
[26]
Kaviani, H.; Mousavi, A. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran Univ. Med. J., 2008, 66(2), 136-140.
[27]
Mohammadi, K.; Rahnama, P.; Montazeri, A.; Foley, F.W. The multiple sclerosis intimacy and sexuality questionnaire-19: Reliability, validity, and factor structure of the Persian version. J. Sex. Med., 2014, 11(9), 2225-2231.
[http://dx.doi.org/10.1111/jsm.12531] [PMID: 24739056]
[http://dx.doi.org/10.1111/jsm.12531] [PMID: 24739056]
[28]
Joshanloo, M.; Daemi, F.; Bakhshi, A.; Nazemi, S.; Ghafari, Z. Construct validity of NEO-personality inventory-revised in Iran. Majallah-i Ravanpizishki va Ravanshinasi-i Balini-i Iran, 2010, 16(3), 220-230.
[29]
Banaei, M.; Azizi, M.; Moridi, A.; Dashti, S.; Yabandeh, A.P.; Roozbeh, N. Sexual dysfunction and related factors in pregnancy and postpartum: A systematic review and meta-analysis protocol. Syst. Rev., 2019, 8(1), 161.
[http://dx.doi.org/10.1186/s13643-019-1079-4] [PMID: 31277721]
[http://dx.doi.org/10.1186/s13643-019-1079-4] [PMID: 31277721]
[30]
Radmehr, Y.; Kakoujoybari, A. The relationship between sexual beliefs and sexual function with marital satisfaction in married women. New Ideas Psychol., 2020, 6(10), 1-14.
[31]
Pauls, R.N.; Occhino, J.A.; Dryfhout, V.L. Effects of pregnancy on female sexual function and body image: A prospective study. J. Sex. Med., 2008, 5(8), 1915-1922.
[http://dx.doi.org/10.1111/j.1743-6109.2008.00884.x] [PMID: 18547388]
[http://dx.doi.org/10.1111/j.1743-6109.2008.00884.x] [PMID: 18547388]
[32]
Levy, S.; Handelzalts, J.E.; Yadid, L.; Geller, S. Personality and postpartum sexual functioning in israeli women: The mediating role of body image. Psychol. Rep., 2018, 123(2), 33294118809935.
[PMID: 30426836]
[PMID: 30426836]
[33]
Jawed-Wessel, S.; Herbenick, D.; Schick, V. The relationship between body image, female genital self-image, and sexual function among first-time mothers. J. Sex Marital Ther., 2017, 43(7), 618-632.
[http://dx.doi.org/10.1080/0092623X.2016.1212443] [PMID: 27420566]
[http://dx.doi.org/10.1080/0092623X.2016.1212443] [PMID: 27420566]
[34]
Hipp, L.E.; Kane Low, L.; van Anders, S.M. Exploring women’s postpartum sexuality: Social, psychological, relational, and birth-related contextual factors. J. Sex. Med., 2012, 9(9), 2330-2341.
[http://dx.doi.org/10.1111/j.1743-6109.2012.02804.x] [PMID: 22672428]
[http://dx.doi.org/10.1111/j.1743-6109.2012.02804.x] [PMID: 22672428]
[35]
Barnes, G.E.; Malamuth, N.M.; Check, J.V.P. Personality and sexuality. Pers. Individ. Dif., 1984, 5(2), 159-172.
[http://dx.doi.org/10.1016/0191-8869(84)90048-5]
[http://dx.doi.org/10.1016/0191-8869(84)90048-5]
[36]
Allen, M.S. The role of personality in sexual and reproductive health. Curr. Dir. Psychol. Sci., 2019, 28(6), 581-586.
[http://dx.doi.org/10.1177/0963721419862293]
[http://dx.doi.org/10.1177/0963721419862293]
[37]
Austin, M.P.V.; Hadzi-Pavlovic, D.; Priest, S.R.; Reilly, N.; Wilhelm, K.; Saint, K.; Parker, G. Depressive and anxiety disorders in the postpartum period: how prevalent are they and can we improve their detection? Arch. Women Ment. Health, 2010, 13(5), 395-401.
[http://dx.doi.org/10.1007/s00737-010-0153-7] [PMID: 20232218]
[http://dx.doi.org/10.1007/s00737-010-0153-7] [PMID: 20232218]
[38]
Dehle, C.; Weiss, R.L. Associations between anxiety and marital adjustment. J. Psychol., 2002, 136(3), 328-338.
[http://dx.doi.org/10.1080/00223980209604160] [PMID: 12206281]
[http://dx.doi.org/10.1080/00223980209604160] [PMID: 12206281]
[39]
Mukai, T.; Kishi, T.; Matsuda, Y.; Iwata, N. A meta-analysis of inositol for depression and anxiety disorders. Hum. Psychopharmacol., 2014, 29(1), 55-63.
[http://dx.doi.org/10.1002/hup.2369] [PMID: 24424706]
[http://dx.doi.org/10.1002/hup.2369] [PMID: 24424706]
[40]
Concerto, C.; Chiarenza, C.; Di Francesco, A.; Natale, A.; Privitera, I.; Rodolico, A.; Trovato, A.; Aguglia, A.; Fisicaro, F.; Pennisi, M.; Bella, R.; Petralia, A.; Signorelli, M.S.; Lanza, G. Neurobiology and applications of inositol in psychiatry: A narrative review. Curr. Issues Mol. Biol., 2023, 45(2), 1762-1778.
[http://dx.doi.org/10.3390/cimb45020113] [PMID: 36826058]
[http://dx.doi.org/10.3390/cimb45020113] [PMID: 36826058]
[41]
Paquette, A.F.; Carbone, B.E.; Vogel, S.; Israel, E.; Maria, S.D.; Patil, N.P.; Sah, S.; Chowdhury, D.; Kondratiuk, I.; Labhart, B.; Morrow, A.L.; Phillips, S.C.; Kuang, C.; Hondmann, D.; Pandey, N.; Biederer, T. The human milk component myo -inositol promotes neuronal connectivity. Proc. Natl. Acad. Sci., 2023, 120(30), e2221413120.
[http://dx.doi.org/10.1073/pnas.2221413120] [PMID: 37433002]
[http://dx.doi.org/10.1073/pnas.2221413120] [PMID: 37433002]
[42]
Davide, G.B.; Jacopo, F.; Zaki, S.; Maurizio, N.D.; Luigi, D.C.; Gaspare, C.; Giuseppe, G. Inositols administration: Further insights on their biological role. Ital. J. Gynaecol. Obstet., 2023, 35, 30-36.
[43]
Mirghaforvand, M.; Alizadeh, S.; Asghari, M.; Tavananezhad, N.; Karkhaneh, M. Individual-Social predictor of marital satisfaction in women of reproductive age in Tabriz. Majallah-i Zanan, Mamai va Nazai-i Iran, 2013, 16(72), 1-12.
[44]
Rahmani, A.; Khoei, E.M.; Gholi, L.A. Sexual satisfaction and its relation to marital happiness in Iranians. Iran. J. Public Health, 2009, 38(4), 77-82.
