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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 3  |  Page : 1030-1036

Societal and cultural values toward female sexuality


1 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Menoufia University, Shebin Al Kawm, Menoufia, Egypt
2 Department of Dermatology, Venereology and Andrology, Berket Elsabae General Hospital, Menoufia, Egypt

Date of Submission17-Jan-2018
Date of Acceptance12-Mar-2018
Date of Web Publication17-Oct-2019

Correspondence Address:
Reham M. A. Rasoul
Department of Dermatology, Venereology and Andrology, Berket Elsabae, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_22_18

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  Abstract 


Objective
To evaluate the level of knowledge and perceptions of the Egyptian women regarding virginity, pain, and bleeding during hymen defloration; assess the forced virginity examination; evaluate the magnitude of sexual education of females; and assess its effect on female sexuality.
Background
Problems related to sexuality have consequences for men, women, and public health. Female virginity has had special significance for centuries, especially for traditional societies. Formal sexual education should be introduced in the curriculum of the schools within the context of our religion and culture.
Patients and methods
This a cross-sectional cohort study that included 100 married women and 100 virgin women, aged from 16 to 60 years, who attended the Dermatology and Andrology Outpatient Clinic of Menoufia University Hospitals. The self-filling questionnaire was written in English and translated into Arabic. The questionnaire was explained to the participants, and they were instructed on how to fill it out.
Results
A girl should remain virgin till marriage was the opinion of 100% in group A and 80% in group B. Moreover, 97.8% in group A and 65.9% in group B disagreed with premarital sex for men, because it is 'religiously haram'. Most of the participants in group A had a defect in knowledge concerning sexuality, and 45% in group A and 42% in group B acquired their knowledge from friend's activity.
Conclusion
The study showed a conservative opinion related to virginity and the hymen examination. Formal sexual education should be introduced in the curricula of the schools within the context of our religion and culture.

Keywords: female sexuality, forced virginity tests, premarital sex, sex education, virginity


How to cite this article:
Gaber MA, Rasoul RM. Societal and cultural values toward female sexuality. Menoufia Med J 2019;32:1030-6

How to cite this URL:
Gaber MA, Rasoul RM. Societal and cultural values toward female sexuality. Menoufia Med J [serial online] 2019 [cited 2019 Nov 16];32:1030-6. Available from: http://www.mmj.eg.net/text.asp?2019/32/3/1030/268816




  Introduction Top


Sexuality is an important and complex issue for quality of life and general well-being [1]. Problems such as cultural and religious values, inadequate sex education, restricted discussion with health professionals about sexual problems, and feelings of embarrassment may complicate women's chances of receiving help and consultation from health care institutes [2].

Female virginity has had special significance for centuries, especially for traditional societies. Unmarried women were expected to stay pure and untouched until their wedding night [3]. Premarital sexual relations are forbidden so that sexuality is restricted to marital life in traditional terms. The maintenance of female virginity has traditionally been equated with 'family honor' [4].

The expected bleeding on the first penile penetration of the hymen is considered to be a sign of virginity. In many countries, the testing of virginity is common, but it is prohibited by law [5]. Nurses, midwives, and gynecologists in Egypt are requested to perform 'virginity examinations' to prove to the family that a young woman has not had premarital relations [6].

Formal sexual education should be introduced in the curriculum of the schools within the context of our religion and culture. Parents and teachers should be more open to discuss sexual issues with their children and students [7]. Premarital educational programs are a relatively new approach to avoid dissatisfaction and failure in conjugal life, which is based on the idea that couples can learn how to have a successful and stable life [8].

This study aimed to evaluate the level of knowledge and perceptions of the Egyptian women regarding virginity, pain, and bleeding during hymen defloration, to assess the forced virginity examination, to evaluate the magnitude of sexual education of females, and to assess its effect on female sexuality.


  Patients and Methods Top


This a cross-sectional cohort study that included 100 married women and 100 virgin women; their ages ranged from 16 to 60 years, and they were randomly selected from those attending the Dermatology and Andrology Outpatient Clinic of Menoufia University Hospitals during the period from January 2017 to June 2017. Patients free from psychological diseases and able to read and write so as to fill the questionnaire by themselves were included in this study, whereas patients with any of the following characteristics were excluded: girls younger than 16 years, women older than 60 years, women who refused to provide study consent, women with incomplete data, women with psychiatric problems as this may affect their judgment, illiterate women, and women refusing to cooperate. All patients gave their formal consent. The protocol was approved by the Ethical Committee of the Faculty of Medicine, Menoufia University.

The self-filling questionnaire was written in English and then translated into Arabic. The questionnaire was explained to the participants, who were instructed on how to fill it out, with the investigator remaining accessible if they needed clarification. Face-to-face questionnaire was not used to avoid any embarrassment and to give the participants a wide range of privacy and freedom to express themselves without any disturbance or fear. Each questionnaire was handed in an open envelope, and each participant had to fill her copy of the questionnaire, leave it anonymous as instructed, put it in the envelope, sealed the envelope, and put it in a basket containing other sealed envelopes. The items of the questionnaire were taken mainly from Nurse Education Today [6]. Some items were selected from the female sexual function index [9].

Other questions were added to serve the purpose of the study and included epidemiological data: age; marriage status (age of marriage, duration of marriage, and contraception method); whether had female genital cutting; educational level; occupation and place of residence; opinion on sexual intercourse, female virginity, premarital sex for male, and virginity examination before marriage; knowledge about emotional effects after forced virginity examination, amount of blood following hymen defloration, and defloration pain; assessment degree of religiosity of participants; sexual knowledge about anatomy of genital organs, phases of sex response cycle, female genital cutting, menstrual cycle phases, and disorders; premarital examination; information concerning coitus; contraception methods and its problems; sexually transmitted diseases; problems of first intercourse; sexual contact during pregnancy; resuming the intercourse after labor; masturbation and coital positions; sources of sexual knowledge; benefits in the marital life; preferable educational level; and best method to learn. A copy of the English and Arabic versions of the questionnaire is given in appendix I and III.

Results were collected, tabulated, and analyzed statistically using the computer program statistical package for social science (SPSS), version 16 (IBM Company, New York City, United State of America). Descriptive data were calculated for the statistical analysis in the form of frequency and distribution for qualitative data. Intergroup comparison of categorical data was performed by either χ2-test or Fisher exact test when one of cells of a table was up to 5. A P value up to 0.05 was considered statistically significant, more than 0.05 was considered statistically insignificant, and P value up to 0.001 was considered highly significant in all analyses.


  Results Top


The study was performed on 200 participants: 100 in group A and 100 in group B. In all, questionnaires were handed over to 220 married and unmarried females, but 20 of them refused to cooperate and were excluded from the study.

Penovaginal penetration was what most participants considered as complete coitus (95% in group A and 97% in group B). A woman should remain virgin till marriage was the opinion of 100% in group A and 80% in group B. Regarding the opinion of premarital sex for men, 97.8% in group A and 65.9% in group B disagreed because it is 'religiously haram' [Table 1].
Table 1: Comparison between the studied groups regarding their knowledge about premarital sex

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Regarding the amount of defloration bleeding, most participants of group A (75%) and group B (58%) expected it to be a few drops. Defloration pain was expected to be moderately painful as suggested by 58% of participants in group A. Mild defloration pain was expected by 48% of participants in group B. In group B, 49% of participants stated their partner's expectation to be few drops of blood in defloration bleeding [Table 2].
Table 2: Comparison between the studied groups regarding their knowledge about defloration and its amount of blood and pain

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Overall, 82% in group A and 95% in group B refused premarital virginity tests. Moreover, 65% in group A and 82% in group B did not know that the law prohibits forced virginity tests without the woman's consent. Regarding emotional consequences of the forced examination, self-blaming was the answer chosen by most women in group A (57%) and in group B (73%) [Table 3].
Table 3: Comparison between the studied groups regarding their knowledge about virginity examination

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In this study, most of participants in group A (virgin) had sexual knowledge concerning anatomy of female genitalia (55%), female genital cutting (75%), and menstrual cycle phases and disorders (58%). However, in group B (married), most of them had knowledge concerning anatomy of female genitalia (90%), female genital cutting (88%), menstrual cycle phases and disorders (92%), phases of sex response cycle (74%), marital examination (63%), sexual behavior during coitus (74%), and coital positions (60%) [Table 4].
Table 4: Comparison between the studied groups regarding their knowledge about sexual information

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Most of participants in group A had a defect in knowledge concerning sexual activity such as factors affecting coitus (93%), sexual contact during pregnancy (90%), problems of first intercourse (92%), time of resuming intercourse after labor (80%), and STDs (88%) [Table 5].
Table 5: Sexual activity knowledge among the studied groups

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  Discussion Top


In this study, most participants in group A and B were 20–29 years old (95 and 35%, respectively), so most of them were in the age of the highest sexual activity [10]. Most of them lived in the city (62%), 62.5% of them had a job, 32.5% of them had finished their secondary school, and 67.5% had a university degree. To ensure the accuracy of the results, illiterate women were excluded from the study to let participants fill the questionnaire by themselves to provide privacy. However, this exclusion makes the results of the current study not representative of a large portion of Egyptian women, as illiteracy among them reaches 65.8% [11].

A girl should remain virgin till marriage was the opinion of 100% of group A and 80% of group B. These results are in agreement with Zeyneloǧlu et al. [6], and it this view is attributed to the religious and cultural background of participants.

In group A (virgins), 100% of participants agreed that women must remain virgin till marriage because of societal values, and this was in agreement with Zeyneloǧlu et al. [6], who stated 'women must be virgin till marriage due to religious values'. Our study showed that 97.8% in group A and 65.9% of group B disagreed with premarital sex for men, because 'it is haram', and this agrees with the finding of Zeyneloǧlu et al. [6], but premarital sexual activity for boys can be accepted by society [12].

Regarding virginity tests, 82 and 95% of the participants in groups A and B respectively, refused premarital virginity tests and 65% of group A and 82% of group B did not know if the law prohibits forced virginity tests. Zeyneloǧlu et al. [6], reported that 58.4% of women did not know that forced virginity test is prohibited by law. The most reported emotional effect of forced virginity tests was self-blaming (57% in group A and 73% in group B), but according to Zeyneloǧlu et al. [6], it was reduction of self-esteem. Most participants of group A (75%) and group B (58%) expecting bleeding during defloration to be a few drops. These results agree with Weststeijn [13]. In group B, women viewed their husbands' expectation of defloration bleeding to be few drops (49%). Approximately 76.7% of rural residents who were virgins had a true expectation about defloration bleeding. This in contrast to Yount [14], who stated that 'residence has an effect on defloration knowledge.' This finding is surprising but may be a result of limited number of participants in our study.

Women in group A expected defloration pain to be moderate (58%), whereas in group B, women found it to be mild (48%). According to Miller [15], it varies according to age and psychology. Virgins thought that defloration pain was severe pain based on their friend's stories about severity of defloration pain.

In this study, most of the participants in group A (virgin) had sexual knowledge concerning anatomy of female genitalia (55%), female genital cutting (75%), menstrual cycle phases and disorders (58%), and masturbation (77%), whereas in group B (married), most of them had knowledge concerning anatomy of female genitalia (90%), female genital cutting (88%), menstrual cycle phases and disorders (92%), contraception methods and problems (95%), phases of sex response cycle (74%), marital examination (63%), sexual behavior during coitus (74%), coital positions (60%), sexual contact during pregnancy (96%), and time of resuming intercourse after labor (90%).

However, there was deficiency in knowledge in group A concerning marital examination, phases of sex response cycle, sexual behavior during coitus, coital positions, contraception methods and its problems, sexual contact during pregnancy, time of resuming intercourse after labor and STDs. This defect may be because of religious restrictions in Egypt compared with other countries that are more open regarding sexuality.

In this study, most of the participants in group A (virgin) and group B (married) who had sexual knowledge got their information from friends (43.5%), media (22%), and family (18%). According to Balsamo [16], sexual socialization is the process by which adolescents acquire sexual knowledge and values. Although parents and friends are identified by adolescents as the most common source of sexual information, the mass media is also recognized as an important contributor to sexual knowledge.

Alquaiz et al. [7] found that studies conducted in Egypt, Morocco, and Turkey have identified friends as the most important source for adolescents in building their knowledge on sexual health.

Villa-Torres and Svanemyr [17] found that the most monitored and evaluated youth-related SRH intervention type is peer education. Alquaiz et al. [7] found that parent's education is an important contributing factor to adolescent's sexual knowledge and behavior.

It is not surprising that 73% of our participants in group B (married) got benefits from sexual knowledge in their marital life. This indicates that women may benefit from SRH education and should not be deprived of it.

Moreover, Keshavarz et al. [8] found that premarital educational programs are a relatively new approach to avoid dissatisfaction and failure in conjugal life, which is based on the idea that couples can learn how to have a successful and stable life. Therefore, premarriage education is therapeutic and precautionary.

In this study (69%) of participants in group A and (68%) in group B preferred 2ry school stage as the best educational stage for acquiring sexual knowledge, because this is the age at which occurs most of the physiological changes in females, curiosity about these changes and early age of marriage in Egypt.

Ogden and Harden [18], in their study in London, found that the median age at which adolescents reported starting sexual education was 11 years; although the majority of those who were surveyed felt that this was an appropriate age, approximately one-third felt that this was too late.

In the present study, most of participants in group A (virgins) (75%) and in group B (married) (78%) preferred attaining their sexual knowledge through medical sources such as doctors; this trust may be owing to high educational status and the correct and scientific information among doctors. These results agree with the study of Wendt et al. [19], who showed that most women trusted clinicians and midwives as professionals.

We found that most of the participants viewed books and magazines (40%) as the best method to acquire sexual knowledge; they preferred this indirect method owing to sensitivity of the topic and shyness of obtaining such knowledge directly.

Da Silva [20] showed that primary school education is not just an extension of family education and the teacher is neither an aunt nor a second mom. The learning experience and social norms in school are defined by the social inclusion.

We found insignificant difference between unmarried participants living in different areas regarding sexual knowledge and knowledge concerning sexual activity; this may be owing to widespread of sexual knowledge through mass media and internet. These results are supported by the study of Eustace [21], who found that developing countries are now confronting what industrialized countries have faced over the last century: the emergence of 'adolescence' and the social changes about sexuality that came with it. Although there was a significant difference between participants living in different areas regarding sex education source and learning, most of urban participants obtained their knowledge through media compared with rural participants.

El-Gelany and Moussa [22] identified a high level of information at the university, exposure to the media, and living in modernized cities were the main contributing factors to a high awareness of reproductive health issues.

Comparing the effect of age groups on sexual knowledge, the current study showed that the participants aged 20–29 years usually had more sexual information in relation to other age groups; this may be owing to the fact that education in recent years had become more developed and prevalent.

These results agree with the study of Garrett and Tomlin [23], who found that, as people progress in age, physiologic or psychosocial misconceptions enhance decreased sexual knowledge.

These results also agree with the study done by Vanwesenbeeck et al. [24], who found that young people today have more opportunities and challenges.

Comparing the effect of age groups on knowledge about sexual activity, the current study showed that most of the participants aged 20–29 years usually had more information concerning sexual activity in relation to other age groups. The finding is consistent with previous study of Barlow et al. [25], who found that knowledge about sexual activities and sexual function decline with age.

The same results were obtained by Moree et al.,[26] who found that FSD (Female sexual Dysfunction) was associated with aging and inability to comprehend sexual activity knowledge compared to younger adolescents.


  Conclusion Top


Sexual knowledge had a beneficial role in the success of sexual life and had a strong effect on marital relationships. The study showed a conservative opinion related to virginity and the hymen examination. A girl must be virgin till marriage and has the right to refuse the premarital forced virginity tests. In terms of the virginity examination, the participants did not know their rights in this respect. Premarital sex for men is not approved owing to religious background of the participants.

Most of virgin, married women, and married women's husbands expect few drops in bleeding defloration. In group A, women expected defloration pain to be moderately painful, but in group B, they stated it to be mildly painful. Formal sexual education should be introduced in the curricula of the schools within the context of our religion and culture. Parents and teachers should be more open to discuss sexual issues with their children and students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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