|Year : 2014 | Volume
| Issue : 1 | Page : 19-23
Sexual satisfaction among Turkish obese women
Mehtap Omac Sonmez1, Feyza Nazik2, Sermin Timur Tashan3, Mustafa Asim Caglar4
1 Department of Nursing, School of Health, Kahramanmaras Sutcu Imam University, 46000 Kahramanmaras, Turkey
2 Family Health Center, Family Physicians, Aladag, 0179 Adana, Turkey
3 Department of Nursing, School of Health, Bingol University, 12000 Bingol, Turkey
4 Department of Family Health, Family Health Center, Family Physicians, Aladag, 0179 Adana, Turkey
|Date of Web Publication||25-Jul-2014|
Mehtap Omac Sonmez
Kahramanmaras Sutcu Imam University, Saglik Yuksekokulu Bahcelievler Kampusu PK: 46000, Kahramanmaras
Source of Support: None, Conflict of Interest: None
Objective: The aim was to assess the sexual functions and satisfaction among obese women. Materials and Methods: This study was conducted among 176 married women from Aladag region, Turkey in 2010. Grade of obesity was assessed by body mass index (BMI) and waist/hip ratio, while sexual satisfaction was assessed by Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Results: The average score of GRISS scale is 47.35 5.83. A significant correlation has been discovered between BMIs and GRISS total scores of the women (r = 0.339, P = 0.000). GRISS, strongly correlated with high BMI in women. Furthermore, there is a significant correlation between the sub-scales of GRISS. There was a strong and inverse correlation between BMI and communication (r = −0.148, P = 0.005), satisfaction (r = −0.382, P = 0.000) and positive correlation avoidance (r = 0.406, P = 0.000) and BMI. Conclusion: This study revealed that women with high BMI showed less sexual satisfaction, which requires further studies in this regard.
Keywords: Obesity, sexual dysfunction, sexual satisfaction, women
|How to cite this article:|
Sonmez MO, Nazik F, Tashan ST, Caglar MA. Sexual satisfaction among Turkish obese women. Saudi J Obesity 2014;2:19-23
| Introduction|| |
According to the World Health Organization (WHO), body mass index (BMI) of 25-29.99 kg/m 2 is used to define overweight, while a value 30 kg/m 2 is used to define obesity.  The per cent of obese people in the developed countries is 10-30% across the world. , In fact, it is considered that 1/3-2/3 of the people living in those countries are overweight.  According to Turkish nutrition and health research-2010 reported obesity as 30.3% of Turkish population. 
Being obese or overweight is a major risk factor for many chronic diseases such as diabetes, hypertension, osteoarthritis, sleep problems, and cancer.  It is considered that there is a relation between obesity and sexual dysfunctions, which cause anxiety and major problems between two partners. , However, it has been rarely stated in the literature.  On the other hand, it is difficult to explain the independent effects between obesity and sexual dysfunctions separately. That is to say, obesity is known as directly related to sexual dysfunctions and an independent risk factor for such diseases as depression, diabetes mellitus, hypertension, and dyslipidemia.  Therefore, it can be considered that the effects of obesity on sexual functions emerge in addition to the diseases with the independent risk factor.  Female sexual dysfunctions are defined as the dysfunctions in one or several stages of physiological processes during sexual desire, arousal and orgasm stages of human sexual response cycle or dyspareunia.  There are studies conducted on both genders regarding sexual functions. According to a study carried out in US, 10% of men and 20% of women receive medical assistance due to sexual dysfunctions and women (43%) have more sexual dysfunctions compared to men (31%).  There are many studies discussing obesity and erectile dysfunction (ED) which revealed positive relationship between obesity and ED. ,,, In a population-based study on Dutchmen, the results showed that ED occurred significantly more often in men with high BMI (>30 kg/m 2 ) than in men with lower BMI (<25 kg/m 2 ) (adjusted odds ratio = 3.0 [1.7-5.4]). 
In a study carried out in Italy, it has been found that 31% of obese women and men have sexual problems. Moreover, in the study, including the same questions for normal-weight women and men, 14% of men and 15% of women have been reported to have sexual problems.  For both genders, a range of problems including the inability to have orgasm, reduction in the frequency of having sexual intercourse and sexual anorexia may emerge. The studies on the relation between female sexual dysfunctions and obesity are limited. Such dysfunctions as dyspareunia and reduction in vaginal lubrication have been associated with obesity in several studies. 
Despite the strong relationship between sexual dysfunction and obesity due to many hormonal and psychosocial factors. However, this relationship is not always straight forward as other factors such as body image could contribute significantly in this regard. , Furthermore, the relation between the negative body image, sexual activity and obesity has been discussed in some studies and it has been stated that the satisfaction with positive body image increases sexual activities. 
The objective of this study was to assess the association between different grades of obesity and sexual function/satisfaction among women in Aladag region, Turkey.
| Materials and methods|| |
This research was conducted as cross-sectional descriptive study. The research was done among the women registered to Family Health centers in the district of Aladag in Adana in south Turkey between January and June 2010. The women with BMI 30 kg/m2 and above and sexual partners have been involved in the study. The total number of married women is 3803 in the region. When the prevalence of obesity in women is considered as 30% in Turkey, the number of obese women in the region has been calculated as 1140. Among the obese women, the minimum sample size has been calculated and it has been planned to involve 280 women in the research. Follow-up cards of married women were listed. 280 married women with BMI 30 kg/m 2 or over have been selected randomly follow-up cards from the family health centers.
A questionnaire, including socio-demographic characteristics and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) has been used in the research. The women have been given information about the study and their written consents have been obtained. The questionnaires have been given to them in closed envelopes and they have been requested to fill in them. Of 280 questionnaires returned in closed envelopes, 176 questionnaires have been involved in the research.
The women having attended the research have been asked 10 questions regarding their age, education level, and partner's education level, number of children and their families' opinions and attitudes on sexuality.
According to the registers of family health center, the married women with BMI 30 kg/m 2 and above have been involved in the study. However, heights, weights, waist and hip circumferences of women having attended the study have been measured again in order to ensure the standardization. BMI and waist/hip ratios have been calculated. During the recalculations, the women with BMI <30 kg/m 2 haven't been included in the scope of study. According to the data of WHO, BMI 30-34.9 is defined as Class I obesity; BMI 35-39.99 kg/m 2 as Class II obesity and BMI ≥ 40 kg/m 2 as Class III obesity. The waist/hip ratio above 0.85 in women and above 1.0 in men is considered as android-type obesity. 
The women having attended the research have been categorized according to their BMI and waist/hip ratios, obesity classes and whether they are of android-type obesity or not.
Golombok-rust inventory of sexual satisfaction
The scale aiming to measure the quality of sexual intercourse and sexual dysfunctions in heterosexual women and men was developed by Rust and Golombok. Tugrul et al. carried out the standardization of the scale for Turkish.  The scale consists of 28 items and seven sub-scales. The sub-scales of the female form include sexual frequency, communication, satisfaction, avoidance, touching, vaginismus, and anorgasmia. The items are answered through the options "rarely, sometimes, usually, always" and each item obtains an increasing score (0-4) or decreasing score (4-0) between 0 and 4. For the assessment of the scale, both total score and the score obtained from the sub-scales can be used. The high score reached refers to dysfunctions in sexual functions and the quality of sexual intercourse. During the adaptation of the scale to the Turkish language, its validity and reliability studies, Tugrul et al. defined cronbach's alpha coefficient as 0.91 for women in terms of the total score. In this study, two halves of validity cronbach's alpha values of the scale were obtained as 0.87 and 0.79.
The percentage distributions, averages and standard deviations of the data have been given. The data have been compared through Chi-square, one-way ANOVA and correlation analysis. P was considered to be significant if it was <0.05.
In order to conduct the research, the required permissions have been taken from the related institutions and ethical committee. Furthermore, the women having attended the study have been informed and consents have been obtained.
| Results|| |
Comparison of some characteristics and BMI classification of the women in the study are given given in [Table 1].
The mean age of the women having attended the study is 43.79 ± 12.6. Most of the women are housewives; 98.9% of the women are housewives; nearly 72.22% of them have working husbands. About 78% of them are high-school graduates; 88.2% of them are married for 16 years and more; all of them have income for 1000 TL and more; 82.4% of them have two children at most. About 74.5% of women with android-type obesity fall into BMI Class II; 31.5% of them are in Class I.
The comparison of GRISS total scores and sub-scores obtained by the women in the study and BMI classification is shown in [Table 2].
|Table 2: The comparison of women according to GRISS total score and sub-scale scores in BMI classification|
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The mean score of GRISS scale is 47.35 ± 5.83. In the comparison of GRISS total score and BMI classes, Class III women have significantly the highest GRISS total scores (P < 0.005). Class III women also have significantly high score in the sub-scales of frequency and avoidance (P < 0.005). Class II increases the level of significance regarding sub-scale of communication. In Class I, the scores of satisfaction and touch sub-scales have been found significantly high. For the sub-scales of vaginismus and anorgasmia, there is no significance in any classes. However, the scores of this sub-scale are higher in Class III compared to other groups.
A significant correlation has been found between BMIs and GRISS total scores (r = 0.339, P = 0.000). Also there is a significant correlation between the sub-scales of GRISS. There was a strong and inverse correlation between BMI and communication (r = −0.148, P = 0.005), satisfaction (r = −0.382, P = 0.000) and positive correlation avoidance (r = 0.406, P = 0.000) and BMI. A significant correlation between waist/hip ratios and GRISS total scores of the women in the study has not been found. However, there is a significant correlation between some of the GRISS sub-scales and waist/hip ratios. The sub-scales considered significant are the following: Positive correlation; communication (r = 0.252, P = 0.001), touch (r = 0.253, P = 0.002), and negative correlation; avoidance (r = −0.418 P = 0.000) [Table 3].
|Table 3: Correlation between GRISS score and BMI, waist/hip ratio in the population of women (n=176) in this study|
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| Discussion|| |
In this study, about 61% of women have Class I obesity while 10% have Class III obesity. Between 2000 and 2006, studies conducted in USA and Turkey, revealed that the prevalence of obesity among women were 35.3% and 34.5%, among men were 33.3% and 21.8% respectively, which are similar to findings of this study. ,, In Europe, the various studies carried out on adults, the obesity and overweight prevalence ranges between 5-23% and 32-79% in men and 7-36% and 28-78% in women. 
The increase in GRISS total score refers to dysfunction in the quality of sexual activities and intercourse. The scale produced five sub-scale scores. Five or more points in every GRISS sub-scales refers that there is a problem in the sub-scale. In this study, GRISS total score is higher in Class III group. Also, the scores of all sub-scales are five or more, except the sub-scales of frequency and communication.
In the study conducted by Esposito et al. to address the relation between sexual functions and body weight in women, the scores that overweight women obtained from female sexual dysfunctions scale were found significantly high compared with normal-weight women.  Kadioglu et al. assessed sexual functions in obese and control groups by using female sexual function index (FSFI) in their study. A significant difference was not found between two groups in terms of FSFI total scores and sub-scores.  In the study conducted by Hisli Sahin et al., the total average score of GRISS scale in men and women with sexual dysfunctions was higher than the control group in women with sexual dysfunctions. GRISS total mean score of the women with sexual dysfunctions and without sexual dysfunctions was reported as 60.38 and 26.15. 
Tugrul and Kabakci have reported that women with vaginismus of GRISS total score and sub-scales significantly are high. In this study, Class III for scores of "vaginismus", "avoidance," and "anorgasmia" sub-scales and total scores of GRISS were found statistically higher than the other groups' scores. Dogan and Saracoglu have found out in their study that women with lifelong vaginismus have significantly higher score in the sub-scales of satisfaction, touch and anorgasmia compared with control group. 
In their study Kolotkin et al. found that there was significant inverse relationship between quality of sexual life and BMI.  However, Adolfsson et al. found no diffrence in sexual satisfaction between obese and nonobese women. 
In this study, the correlation between BMI and GRISS total score (r = 0.339, P = 0.000) indicates that advanced studies are required to be conducted. However, there was no correlation between waist/hip ratio and GRISS total score, which could be related to multi-factors that affect relationship between obesity and sexual dysfunction. Esposito et al. have found out in their study that there was a strong correlation between FSFI scores and BMIs of the women with sexual dysfunctions (r = 0.72, P = 0.0001). However, there is no correlation between some sub-scales such as pain and desire and BMI. 
| Conclusion|| |
This study revealed that there is association between sexual dysfunction/sexual dissatisfaction and grade of obesity among Turkish women. Almost all components of GRISS were affected with different grade of obesity. Sexual assessment is recommended to be carried out among patients with obesity particularly those with Class III. Further studies on large sample of population are suggested to draw strong conclusion.
| References|| |
|1.||WHO. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity. Geneva: WHO; 1997. |
|2.||WHO. Obesity. Available from: http://www.who.int/topics/obesity/en/. [Last accessed on 2012 May 01]. |
|3.||Turkısh Public Health Institute. Available from: http://www.thsk.saglik.gov.tr/obezite-sismanlik/772-türkiye-de-görülme-sıklıðı.html. [Last accessed on 2014 Apr 22]. |
|4.||Kadıoðlu A, Baºar M, Semerci B, Orhan Ý, Aºçı R, Yaman MÖ, et al., Male and female in sexual health. Turkish Andrology Association; 2004. p. 630-3. |
|5.||Larsen SH, Wagner G, Heitmann BL. Sexual function and obesity. Int J Obes (Lond) 2007;31:1189-98. |
|6.||Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: Prevalence and predictors. JAMA 1999;281:537-44. |
|7.||Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB, et al. Erectile dysfunction and coronary risk factors: Prospective results from the Massachusetts male aging study. Prev Med 2000;30:328-38. |
|8.||Derby CA, Mohr BA, Goldstein I, Feldman HA, Johannes CB, McKinlay JB. Modifiable risk factors and erectile dysfunction: Can lifestyle changes modify risk? Urology 2000;56:302-6. |
|9.||Shiri R, Koskimäki J, Hakama M, Häkkinen J, Huhtala H, Tammela TL, et al. Effect of life-style factors on incidence of erectile dysfunction. Int J Impot Res 2004;16:389-94. |
|10.||Fung MM, Bettencourt R, Barrett-Connor E. Heart disease risk factors predict erectile dysfunction 25 years later: The Rancho Bernardo Study. J Am Coll Cardiol 2004;43:1405-11. |
|11.||Blanker MH, Bohnen AM, Groeneveld FP, Bernsen RM, Prins A, Thomas S, et al. Correlates for erectile and ejaculatory dysfunction in older Dutch men: A community-based study. J Am Geriatr Soc 2001;49:436-42. |
|12.||Marchesini G, Natale S, Tiraferri F, Tartaglia A, Moscatiello S, Marchesini Reggiani L, et al. The burden of obesity on everyday life: A role for osteoarticular and respiratory diseases. Diabetes Nutr Metab 2003;16:284-90. |
|13.||Enzlin P, Mathieu C, Van Den Bruel A, Vanderschueren D, Demyttenaere K. Prevalence and predictors of sexual dysfunction in patients with type 1 diabetes. Diabetes Care 2003;26:409-14. |
|14.||Wild RA. Obesity, lipids, cardiovascular risk, and androgen excess. Am J Med 1995;98:27S-32. |
|15.||Vermeulen A. Decreased androgen levels and obesity in men. Ann Med 1996;28:13-5. |
|16.||Ackard DM, Kearney-Cooke A, Peterson CB. Effect of body image and self-image on women′s sexual behaviors. Int J Eat Disord 2000;28:422-9. |
|17.||Tuðrul C, Öztan N, Kabakçı E. The standardization of Golombuck-Rust inventory of sexual satisfaction. J Turk Psychiatry 1993;4:83-8. |
|18.||Molarius A, Seidell JC, Sans S, Tuomilehto J, Kuulasmaa K. Varying sensitivity of waist action levels to identify subjects with overweight or obesity in 19 populations of the WHO MONICA Project. J Clin Epidemiol 1999;52:1213-24. |
|19.||Baðrıaçık N, Onat H, Ýlhan B, Tarakci T, Oºar Z, Özyazar M, et al. Obesity profile in Turkey. Int J Diabetes Metab 2009;17:5-8. |
|20.||T.C. Ministry of Health. General Directorate of Primary Health Care. Turkish Obesity Control Programme 2010-2014. Ankara: Kuban Publishing; 2010. |
|21.||Esposito K, Ciotola M, Giugliano F, Bisogni C, Schisano B, Autorino R, et al. Association of body weight with sexual function in women. Int J Impot Res 2007;19:353-7. |
|22.||Kadioglu P, Yetkin DO, Sanli O, Yalin AS, Onem K, Kadioglu A. Obesity might not be a risk factor for female sexual dysfunction. BJU Int 2010;106:1357-61. |
|23.||Hisli ªahin N, Durak Batıgün A, Alkan Pazvantoðlu E. The role of interpersonal style, self perception and anger in sexual dysfunction. Turk Psikiyatri Derg 2012;23:18-25. |
|24.||Tuðrul C, Kabakçı E. Vaginismus and its correlates. J Sex Marital Ther 1997;12:23-34. |
|25.||Doðan S, Saraçoðlu VG. The assessment of sexual knowledge, marital characteristics, sexual function and satisfaction in women with lifelong vaginismus. J Med Fac Trakya Univ 2009;26:151-8. |
|26.||Kolotkin RL, Binks M, Crosby RD, Østbye T, Gress RE, Adams TD. Obesity and sexual quality of life. Obesity (Silver Spring) 2006;14:472-9. |
|27.||Adolfsson B, Elofsson S, Rössner S, Undén AL. Are sexual dissatisfaction and sexual abuse associated with obesity? A population-based study. Obes Res 2004;12:1702-9. |
[Table 1], [Table 2], [Table 3]