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ORIGINAL ARTICLE
Year : 2021  |  Volume : 24  |  Issue : 11  |  Page : 1728-1736

Evaluation of the marital adjustment and sexual functions in individuals with visual disability


1 Department of Midwifery, Faculty of Health Sciences, Cukurova University, Adana, Turkey
2 Department of Nursing, Faculty of Health Sciences, Osmaniye Korkut Ata University, Osmaniye, Turkey

Date of Submission17-Dec-2019
Date of Acceptance29-Apr-2021
Date of Web Publication15-Nov-2021

Correspondence Address:
Dr. E Gozuyesil
Department of Midwifery, Cukurova University, Faculty of Health Sciences, Adana; Postal address: Cukurova Universitesi, Sağlik Bilimleri Fakültesi, Balcali Kampusu 01330 Saricam – Adana
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_679_19

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   Abstract 


Background: Sexuality is an important component of marriage. Individuals with visual disability tend to experience more sexual problems, which could deteriorate their marriage relationships and cause difficulties in establishing and maintaining sexual relationships. Aims: This study aims to evaluate marital adjustment and sexual functions in individuals with visual disability. Subjects and Methods: The sample of this descriptive study consisted of 95 individuals with visual disability who were members of a relevant private association in Turkey and met the inclusion criteria. The sample size was calculated using the sample with a known population approach. Data were collected using the Sociodemographic Form, the Marital Adjustment Scale (MAS), and the Golombok–Rust Inventory of Sexual Satisfaction (GRISS). The data were analyzed using the Mann–Whitney U test, Kruskal–Wallis test, Dunn's test, and the Spearman's Rho Correlation Analysis.Results: The mean scores for the MAS and the GRISS were 48.0 (23–60) and 51.5 (17–72), respectively. There was a statistically significant difference between the mean scores of individuals with visual disability and their spouses in the MAS by their age (P < 0.05). The subscales of the GRISS (except for frequency and communication) indicated that men with visual disability had problems regarding impotence, premature ejaculation, sensuality, avoidance, and satisfaction subscales. There was a statistically significant and negative relationship between the marital adjustment total scores of the males with visual disability and their scores in the avoidance, satisfaction, frequency, and communication subscales (P < 0.05; P < 0.01). Conclusion: The participants were found to have good marital adjustment. However, males with visual disability had a low level of sexual problems.

Keywords: Individuals with visual disability, marital adjustment, sexual satisfaction, Turkey


How to cite this article:
Gozuyesil E, U Aslan K S, Atik D, Tar E. Evaluation of the marital adjustment and sexual functions in individuals with visual disability. Niger J Clin Pract 2021;24:1728-36

How to cite this URL:
Gozuyesil E, U Aslan K S, Atik D, Tar E. Evaluation of the marital adjustment and sexual functions in individuals with visual disability. Niger J Clin Pract [serial online] 2021 [cited 2021 Nov 28];24:1728-36. Available from: https://www.njcponline.com/text.asp?2021/24/11/1728/330475




   Introduction Top


Visual disability refers to a condition that affects the functional life in areas such as learning, living, and working among individuals with visual impairment.[1] The World Health Organization estimates that 2.2 billion people around the world have visual.[2]

The National Disability Database[3] reports that there are 2, 16, 077 individuals with visual disability in Turkey. Like individuals with other disabilities, individuals with visual disability face many challenges in their lives. The issue of disability has financial, social, and psychological effects not only on people who experience it but also on their families and immediate network of friends and acquaintances.[4]

Marital adjustment is the adaptation of spouses to each other and the changing circumstances in their daily lives within a certain period and refers to the continuation of marriage in a healthy and happy manner. Maintaining a harmonious marriage depends on spouses' meeting each other's psychological and biological needs.[5]

Sexuality is an important component of marriage, and its main functions in marriage include reinforcement of intimacy, pleasure sharing, and reduction of tension in dealing with the difficulties that arise in marriage. On the other hand, sexual dysfunction deteriorates intimacy in marriage and has many negative effects on the marital relationship.[6] Sexual adjustment constitutes part of the general harmony in an individual's life and involves many complex mental events. Therefore, for a harmonious sexual life, spouses must adjust to one another and be compatible with each other. Severe mental disorders, physical defects, and personality disorders could be causes of sexual incompatibility and dissatisfaction.[7] People with disability suffer from poor health, education, and economic conditions more than people who do not have any disabilities.[8],[9] Like all people, those with visual disability also have natural human needs such as having sex, loving and being loved, touching and being touched, getting married, and having children.[6],[7],[8] People with disability who need special care and support due to various problems they experience in society are recognized as a special group whose sexual lives should be considered important. In addition to the difficulties of being disabled, they usually tend to experience more sexual problems than individuals without disability. This condition results in disabled people experiencing more psychosocial problems, which could deteriorate their marriage relationship and cause difficulties in establishing and maintaining sexual relationships[8],[9] Disabled individuals should be provided with more support than non-disabled individuals about sexual life and having children to improve their quality of life. Moreover, health professionals should be equipped with adequate knowledge of this issue, provide the necessary support for disabled individuals, and work toward solving their sexual problems.[8],[9]

A number of studies in the literature were found to have been conducted on this issue 10-20. Lee et al.[10] and Abed et al.[11] investigated marital adjustment of individuals with disability other than visual disability. Two other studies have investigated only the sexuality of individuals with visual disability.[12],[13] These studies mostly involved individuals with visual disability or individuals with other disabilities.[14],[15],[16],[17],[18] The negative effects of visual disability on sexual life have been reported in these studies. In Turkey, studies on marital adjustment and sexual functions have been conducted with various sample groups.[19],[20],[21] However, no studies were found to have investigated these issues in individuals with visual disability.

Marriage, one of the basic institutions of society, involves sexuality in all stages. Marriage and sexual functions could be affected by biological, psychological, and even sociocultural factors.[6],[7],[8] It is important to improve the level of sexual functioning of individuals with visual disability by securing a happy and peaceful marriage relationship to improve their quality of life. The present study is the first study that aims to determine the marital adjustment and sexual functions in individuals with visual disability in Turkey. In addition, it is original and valuable as it provides guidance to health professionals. The study results are believed to make an important contribution to the literature by helping professionals in nursing and other fields of health.

This study aims to evaluate the marital adjustment and sexual functions in individuals with visual disability.


   Materials and Methods Top


Study design

The present study is descriptive in nature.

Study focus

This study involved individuals with visual disability who were members of a private visual disability association in Turkey.

The private visual disability association, established in Turkey in 1950 with branches in 33 provinces, is a non-governmental organization. All of its members are individuals with visual disability. The Osmaniye branch, which currently has 150 members, was established in 1997. The association organizes useful activities such as vocational training courses, daily life skills training, seminars, panels, and workshops in cooperation with public education centers in the all provinces that have branches.

Target population and the sample

The target population consisted of 150 individuals with visual disability who were registered in the Osmaniye branch of the relevant private association. The researchers contacted 133 members of the association.

The sample size was calculated for the finite population using the formula presented below.



N: Size of the population

n: Sample size

P: Probability for the event in the population

d: Sampling error

Zα: α = 0.05 (Z0.05 table value is 1.96)

According to the formula, the minimum sample to be reached with N = 133, P = 0.70 probability (marriage rate), and dd = 0.05 sampling error was calculated as 94 people.[22]

The study sample consisted of 95 individuals who had visual disability, met the study inclusion criteria, and agreed to participate in the study.

Inclusion and exclusion criteria

This study involved individuals with visual disability who were aged between 18 and 70, who agreed to participate in the study, who were married, and who had a sexual partner. The study excluded individuals who had a mental disability or difficulty in communicating, who were diagnosed with a psychiatric disorder, or who used psychotropic medication. Collecting data from individuals with communication difficulties and mental disabilities would be problematic, and the sexual activities of individuals diagnosed with psychiatric disorders and using psychotropic drugs would be negatively affected by their disorders and drugs. Hence, individuals with these characteristics were not included in this study.

Data collection tools

The research data were collected using the Sociodemographic Form, the Marital Adjustment Scale (MAS), and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS).

The sociodemographic form

The Sociodemographic Form was prepared by the researchers based on the relevant literature. The form included 17 questions about the sociodemographic characteristics.

The MAS

The MAS, developed by Locke and Wallace (1959), consists of 15 items.[23] The scores to be obtained from the scale range from 1 to 60. The scores over 43 points indicate marital satisfaction whereas the scores below 43 points indicate marital dissatisfaction. The validity and reliability of the scale for Turkish was conducted by Kışlak–Tutarel (1999). The scale items include both Likert-type and multiple-choice questions with two options. Each item is scored between 0 and 6 depending on the number of options. Accordingly, the items are scored as follows: Item 1 = 0–6 points, Item 2 to 9 = 0–5 points, Items 10, 12, and 14 = 0–2 points, Items 11 and 13 = 0–3 points, and Item 15 = 0–2 points. No items in the scale are scored reversely; the scale is one-dimensional and gives a total score. Higher scores in the scale indicate better marital adjustment while lower scores indicate higher marital maladjustment. Cronbach's alpha internal consistency coefficient and two-half reliability coefficient of the MAS were found to be. 80 and. 67, respectively.[24]

The GRISS

The GRISS was developed by Rust and Golombok in 1986 to assess features of sexual intercourse and sexual dysfunctions.[25] The scale addresses both men and women and is divided into two forms, each consisting of 28 items. The versions of the scale for males and females include seven subscales five of which are common. These common subscales include avoidance, satisfaction, communication, sensuality, and frequency. In addition to these subscales, the version for females includes the subscales of vaginismus and anorgasmia while the version for males includes the subscales of premature ejaculation and impotence. The scores obtained from both the whole scale and the subscales could be used in evaluating the individuals' sexual satisfaction levels. The total score gives a general idea about the sexual relationship while the subscale scores provide more detailed information about various aspects of the relationship. Higher scores indicate greater deterioration in sexual functions and sexual relationships. Scores of five or above in any subscales indicate the presence of a problem in the related area.[26] The scale is responded on a 5-point Likert scale. The validity and reliability study of the scale for Turkish was conducted by Tuğrul et al. (1993).[26]

Data collection

The data were collected by the researcher between March 1 and April 1, 2018. The individuals selected were invited to the association and administered the questionnaire in separate rooms. The data were collected by the researchers through face-to-face interviews. Phone interviews were administered to the female participants and the participants who were not able to come to the association. It took approximately 15 minutes to complete each questionnaire.

Data analysis

The data were analyzed in the IBM SPSS Statistics 22 software (SPSS IBM, Turkey) using descriptive statistical methods (mean, standard deviation, frequency). The Mann–Whitney U test was used for the two-group analysis of the quantitative data. The Kruskal-Wallis test was employed to analyze the data of three or more groups. Besides, Dunn's test was used for pairwise comparisons to determine the significant differences between the groups. The Spearman's Rho Correlation Analysis was performed to assess the correlation between the test scores. The results were assessed with a 95% confidence interval and at the P < 0.05 significance level.

Ethical considerations

Before the study was conducted, the ethics committee's approval was obtained from the Osmaniye Korkut Ata University Ethics Committee (2018/3-1 dated 20.02.2018). The institutional permission was also received. In addition, the participants were informed about the study, and their written and signed consent was obtained using the Informed Consent Form.


   Results Top


[Table 1] shows the general descriptive characteristics of the participants.
Table 1: Descriptive characteristics of individuals with visual disability (n=95)

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The MAS mean score was found to be 48 (23–60). There was a statistically significant difference between the MAS total mean scores of the individuals with disability by their age (P < 0.05). The results of the further analysis showed that the difference was caused by the individuals who were aged 30 or below (P < 0.01) [Table 2]. The difference between the MAS scores of the individuals with disability was also significant by the ages of their spouses (P < 0.01). Further analysis showed that the difference was caused by the individuals who were aged 30 or below (P < 0.01) [Table 2].
Table 2: Evaluation of MAS scores of individuals with visual disability by general features (n=95)

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The MAS total mean scores of the individuals with visual disability who got married at the age of 25 or below were found to be significantly higher than those who got married at the age of 25 and above (P < 0.05) [Table 2].

The MAS total mean scores of the individuals with visual disability who had been married for 10 years or less were found to be significantly higher than the MAS total scores of those who had been married for more than 10 years (P < 0.05) [Table 2]. MAS Cronbach's alpha internal consistency coefficient was calculated as 0.77 for this study.

The GRISS mean score of the males with disability was 51.5 (17–72) [Table 3]. Since in this study there were only five females with disability, their GRISS mean score could not be calculated. GRISS Cronbach's alpha internal consistency coefficient was determined as 0.819 for this study. [Table 3] presents the mean GRISS subscale scores of male participants with visual disability.
Table 3: Distribution of MAS scores of individuals with visual disability and GRISS scores of males with visual disability

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There was a statistically significant and negative correlation between the marital adjustment total scores of the males with visual disability and their scores in the avoidance, satisfaction, frequency, and communication subscales (P < 0.05; P < 0.01).


   Discussion Top


A compatible marriage relationship accompanied by a compatible sexual life are factors that complement each other. Research has documented that individuals with visual disability experience problems in their sexual life.[12],[14],[16],[17],[18] The present study is believed to contribute to the literature because no studies in the literature were found to have investigated marital adjustment and sexual functions in individuals with visual disability.

In this study, the male participants with visual disability accounted for 94.7% of the sample. This finding indicates that there are either a few women with visual disability in Osmaniye province, or there are not many female members in the association. A reason for this may be that Osmaniye, an underdeveloped and rural province of Turkey, has a higher level of gender inequality and a lower level of female participation in social life than other developed provinces of Turkey as generally people's awareness and education level in rural areas are low. In societies with gender inequality, women are less educated, usually, they are not engaged in professional life, and they are paid less.[27] For this reason, having fewer female participants in this study may be attributed to gender inequality and women's low rate of association membership.

The MAS mean score of the participants was 48 (23–60). The cut-off value in the MAS was determined as 43.5.[24] This value suggests that the majority of the study sample had good marital adjustment.

A review of the literature showed no studies on the marital adjustment of individuals with visual disability and few studies on the marital adjustment in individuals with other disabilities.[10],[11] Lee and Oh found that men with disability were more satisfied with their marriage than women. In addition, they reported that the foremost determinants of marital satisfaction for women with disability included income level, amount of housework, quality of family relationships, and marriage at a young age. For men, these determinants were income level, health, and quality of life. Abed et al.[11] reported that there were no significant differences between healthy couples and couples with disabilities in the scale of adjustment and marital satisfaction. Bal et al.[28] reported a better marital adjustment in males than in females. The present study also found better marital adjustment in men, which is consistent with the results above.

Women are considered to demonstrate more self-sacrificing and tolerating attitudes and have more social and familial responsibilities than men because of the traditional gender roles that are imposed by social norms in the Turkish society. Women reporting more problems than men about marriage relationships could be associated with this characteristic of the Turkish society.

There was a statistically significant difference between the MAS total mean scores of the individuals by their ages and the ages of their spouses. Binary post hoc comparisons were performed to determine the group that caused the difference. These comparisons revealed that the MAS mean scores of the individuals who were aged 30 or below were significantly higher than those of the others. Since there were no studies that examined the relationship between sociodemographic variables of individuals with disability and their marital adjustment, the researchers revealed only the studies involving individuals without disability. Özbucak Tıraşoğlu, and İpek reported that there was a statistically significant and negative relationship between marital adjustment and age. Accordingly, marital adjustment partially decreased with the increase in age.[29] Madanian and Mansor found a higher level of marital satisfaction in individuals aged between 29 and 32 than those aged between 33 and 42.[30] The participants' mean age of marriage was 26. The present study found a higher marital adjustment in individuals aged 30 or below, which could be attributed to the probability that their marriage relationships had not yet been completely developed. The literature also includes some other study results that are not parallel to the ones in the present study.[20],[31]

The MAS total mean scores of the individuals who got married at the age of 25 or below were significantly higher than the scores of those who got married after 25. This result suggests that individuals aged 25 or below would probably be newly married, indicating that they could be more understanding and tolerant toward each other in marital life.

This study found that marital adjustment varied by the amount of time spent as a married individual. The MAS total mean scores of individuals who had been married for 10 years or less were significantly higher than those of the individuals who had been married for over 10 years. These results are consistent with the results of some studies that were conducted with individuals that had no disabilities.[5],[28],[32] Kublay and Oktan found that marital adjustment became worse as marriage duration became longer.[5] Bal et al.[28] found that the level of marital adjustment of individuals who had been married for 11 years and less were higher than the individuals who had been married for over 12 years. Özbucak, Tıraşoğlu, and İpek reported that couples tended to show less affection toward each other as their marriage duration increased.[29] However, other studies indicated that marriage adjustment did not change depending on the duration of the marriage.[32],[33]

Considering the pathology threshold (5 points) in the GRISS subscales, there was no sign of pathology in men with visual disability regarding their scores in the subscales of frequency and communication. However, pathology was found in their scores in the subscales of impotence, premature ejaculation, sensuality, avoidance, and satisfaction. The total mean score in the GRISS was 51.5 (17–72). Considering that the maximum score of the scale is 112, the GRISS total mean scores of the men with visual disability suggest that they had a low level of sexual problems.

There is only a limited number of studies on the sexuality of individuals with visual disability.[12],[13] Relevant studies largely involved adolescents/older adults with visual disability or individuals with other disabilities.[14],[15],[16],[17],[18] Lahane et al.[14] reported high levels of sexual inactivity, which were associated with a decrease in one of the partner's sexual desire and sexual satisfaction.

Smith et al.[18] reported that visual disability is associated with a lower prevalence of any sexual activity in older men and a lower frequency of sexual intercourse in older women.

Kef and Bos reported that the age of the first sexual intercourse was 16.7 for adolescents without disability, and 18.5 for adolescents with visual disability. They also reported that adolescents with visual disability may experience more difficulties in communicating with their peers and in experiencing and initiating sexual behavior.[12] Studies report that adolescents with visual disability establish their social network much later and improve it less commonly than their peers. They also experience their first sexual intercourse later than adolescents without disability.[12],[15] The results of the other studies indicating negative effects of visual impairment on sex life are consistent with the present study results.

Contrary to these results, Chappell showed that disability did not cause problems in establishing sexual identity and having sexual partners.[16] Pinquart and Pfeiffer examined the sexual relationships of adolescents with and without visual disability and reported similar times and conditions for the first sexual intercourse; first time falling in love, flirting, romantic involvement, and intimate relationships.[17]

Visual disability may have fewer negative consequences compared to other disabilities. Retznik et al.[15] reported that all of the participants with disability in their study had experienced partnership and sexuality. They also reported that male participants experienced sexual intercourse earlier than female participants. In the same study, the participants with visual disability were reported to have more partners than the participants with other disabilities, which may be related to the fact that they had less fear in starting a relationship than those with other disabilities and had different methods of communication with individuals without visual disability.

Abramson et al.,[13] reported that gender differences in sexual motivation were evident in these individuals. The male participants had advantages in that they focused on sexuality and dreamed about sex and sexual fantasies, and individuals with visual disability placed greater emphasis on sexuality. These results support the present study indicating that males with visual disability had no pathology according to their scores in the GRISS subscales of frequency and communication.

A statistically significant and negative relationship was found between the MAS mean score and mean scores in the subscales of avoidance, satisfaction, frequency, and communication obtained from the males with visual disability. In other words, they had fewer problems related to avoidance, satisfaction, frequency, and communication when they had an adjustment in their marriage.

Yalaz reported that the sexual satisfaction levels of individuals who had been married for 5 years or more increased as their marital adjustment increased.[19] Similar studies also reported a significant relationship between marital adjustment and sexual satisfaction.[28],[31],[32],[33],[34]

Limitations of the study

This study was conducted in a rural province of Turkey where there were social gender inequality and dominant cultural beliefs and traditions, which meant that an insufficient number of women were included in the study. These factors might have had effects on the results.

This study provides data about a small sample of individuals with visual disability since it was conducted only with individuals with visual disability who were the registered members of the Osmaniye branch of a private association, which is one of the many active associations across Turkey. Hence, the study results cannot be generalized to the whole society. For this reason, further studies with larger samples should be conducted at the national level to achieve the generalizability of the results.


   Conclusion Top


In this study, the men with visual disability had problems regarding all subscales of the GRISS except for frequency and communication, and they had a low level of sexual problems. In addition, the participants were found to have good marital adjustment.

As per the relevant regulations in place in Turkey, sexual health education is considered to be an independent function of nurses.[35] Therefore, within a holistic nursing approach, nurses are responsible for creating an environment where individuals with visual disability can express their sexual problems, evaluating sexual functions, and providing appropriate training and consultancy services to patients.

The sexual functioning of individuals with visual disability should be improved by securing a happy and peaceful marriage to improve their quality of life. Nurses could play a role in helping individuals with visual disability to solve their sexual problems through sexual health training.

The importance of marital adjustment and sexuality problems in individuals with visual disability has not been adequately investigated in Turkey. Therefore, more comprehensive studies should be conducted on this issue by taking gender and sociocultural differences into account.

Acknowledgments

We would like to thank all the individuals with visual disability who agreed to participate in the study. This study received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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