ABSTRACT
BACKGROUND/AIMS:
The feelings and thoughts on sexuality and sexual activity of expectant fathers, similar to mothers during pregnancy, are influenced by many factors. Therefore, this qualitative study was conducted to investigate Turkish expectant fathers’ experiences regarding their sexual life during pregnancy.
MATERIALS AND METHODS:
The sample of the study consisted of 29 expectant fathers. The data of this study were collected using a semistructured individual in-depth interview form and a personal information form. Researchers prepared the forms based on the relevant literature. The data were analyzed using content analysis.
RESULTS:
Two main themes were developed as a result of this study. The first theme, “Feelings and thoughts on sexuality”, revealed that sexuality/sexual activity was very important for expectant fathers, however, this was not communicated between the spouses, and expectant fathers did not want to talk about sexuality. The other theme, “Sexual life during pregnancy”, showed that pregnancy affected sexual life, and it strengthened the marriage and the bonds between spouses. The themes also revealed that the expectant mothers were disturbed by their changing body images and feared their husbands engaging in extramarital relationships, and that sexual intercourse might become a dull duty during pregnancy.
CONCLUSION:
In accordance with these results, researchers recommend creating a service model which includes expectant fathers in order to provide couples with an information service through an integrative approach.
INTRODUCTION
According to the World Health Organization, sexuality is defined as the combination of physical, emotional, intellectual and social aspects of personality, communication, and love-enhancing effects.1 The expression of sexuality, which starts in intrauterine life and continues until death, differs in every period of life. Human sexuality is a multidimensional phenomenon developing throughout life, and it is influenced by psychological, physiological and socio-cultural factors.2
Pregnancy is an important life experience which affects sexuality. Pregnancy, having an important place in women’s lives, is a transition from one psychological state to another: from being a couple to becoming a family.2 It is a process during which many changes and feelings occur, which are affected by biological, psychological and social factors. Accordingly, it significantly affects the sexual behaviors of the couple.3-5
Although in normal conditions pregnancy occurs because of sexual intercourse, sexual life is still a taboo subject in certain societies. Thus, couples do not get enough counseling from health professionals during pregnancy and the sexuality of the couple is interrupted.6 In the literature, the usual reasons for the interruption of sexual activity during pregnancy are seen to be worries about the risks of damaging the fetus, miscarriage, infection, early delivery and preterm membrane rupture development.7-10
The minimum follow-up is carried out four times in the prenatal period in Turkey.11 During these follow-ups, the main focus is on the physical health of pregnant women but not on their sexual lives. In addition, expectant fathers are not provided with any service during this period and their informational needs are not met.12 Therefore, couples have a misconception about their sexual life. Culture and religion are also particularly influential on such an issue in Turkey as sexual intercourse during pregnancy may be perceived as shameful, prohibited and sinful in Turkish culture.13 In addition, emotional changes such as ambivalence, refraining from having sexual intercourse with one’s spouse, fear of damaging the fetus, anxiety, and depression may occur in expectant fathers during pregnancy. All these factors negatively affect the sexual lives of couples during pregnancy.2 Therefore, couples should try to maintain their relationship in a healthy way in order to develop their mutual emotional bond and close physical attraction, to achieve their sexual satisfaction, and to satisfy the sexual needs of each other.14
During pregnancy, couples often interrupt sexual activity for various reasons and are reluctant to ask questions about their sexual life. Thus, pregnant women and their spouses who experience problems in maintaining their sex life during pregnancy may need professional support. Especially, since nurse are close to the pregnant women and their spouses, they should try to consult with the couple in order to help them adapt to this new situation. Furthermore, they should try to eliminate the concerns, worries, and misconceptions of the expectant couple regarding sex during pregnancy.2
Despite, the existence of many studies on pregnant women’s sex lives in the literature,3-10 there are not enough scientific studies on the sex lives of expectant fathers. This situation was one of the most important reasons which prompted the researchers to conduct this study.15-17
The present paper is an attempt to provide answers to the following questions:
1.Does pregnancy affect the sexual experiences of expectant fathers?
2.Do expectant fathers experience sexual problems and changes during pregnancy?
3. How do the expectant fathers perceive sexuality?
MATERIALS AND METHODS
Study Design
This qualitative study was conducted to investigate Turkish expectant fathers’ experiences of their sexual life during pregnancy.
Selection and Description of Participants
Expectant fathers attending a university hospital’s obstetrics outpatient clinic between August 25th and October 18th, 2017, with their wives, participated in this study. A purpose-oriented sample selection method was used in this study. The sample selection approach utilized in our study required the data collection process to continue until the concepts and processes that are able to answer the research questions begin to repeat themselves (saturation point).18 The researchers concluded that the saturation point was attained when the sample reached 29 individuals who agreed to participate in this study.
Data Collection Procedures
The data collection form included two sections. The first section consisted of questions regarding the socio-demographic characteristics of the expectant fathers, which are age, profession, education, longest-lived place of residence, age disparity between the husband and his wife, their number of children and the gestational week of the wife. The second section included the “semi-structured individual in-depth interview form”, which was prepared in order to determine the feelings, thoughts, and experiences of the expectant fathers in relation to their sexual lives during pregnancy.3-5,15-17
The following four questions were included in the individual in-depth interview form:
1. How was your relationship with your wife before; and how is it now during pregnancy?
2. Could you explain your feelings and thoughts about your sexual life before and during pregnancy?
3. Do you think that pregnancy has affected your sexual life? (Positively/negatively).
4. Could you explain yours and your wife’s opinions and experiences about receiving information/counseling regarding sexuality during pregnancy?
After receiving the opinions of two qualitative research experts, the semi-structured individual in-depth interview questionnaire was put into its final form. Following this, a pilot application of the questionnaire was carried out with five expectant fathers to assess the usability of the semi-structured individual in-depth interview questionnaire. No modifications were made to the questionnaire after the pilot application.
Expectant fathers who came to the outpatient clinic with their wives were invited to individual in-depth interviews. When the pregnant women came to the outpatient clinic alone, they were informed about the participation of their husbands in the research, and their phone numbers were obtained. The purpose of this study was explained to those expectant fathers who accepted to participate in the study before starting. In addition, if there were any hesitations about the researchers or the study on the part of the expectant fathers, they were reminded of their opportunity to disclose their hesitations. They were requested to read and sign the “informed consent” and to fill in “Personal Information forms”. Prior to the interview, the expectant fathers were assured of the confidentiality of all the information given by them. Face-to-face interviews were conducted with expectant fathers at a determined date and time in the investigator’s office by a researcher. Interviews were recorded with an audio recorder after obtaining permission from the expectant fathers. The investigator also took notes about the body language of the expectant fathers during the interviews, paying special attention to their gestures and mimics. Each interview lasted for approximately 60 minutes.
All procedures were approved by Mersin University Social Sciences Institutional Ethics Review Board (approval number: 2017/53) and Mersin University Health Research and Application Center (approval number: 41993462-774.001.0600000443843). In addition, all the participants signed informed consent forms.
Statistical Analysis
Within the analysis process of the data obtained through the semi-structured individual in-depth interviews, at first, the recordings of the interviews were transcribed and classified. The content analysis was carried out by the researchers by taking into consideration the prevalence of the comments in the answers given, the number of participants who made the same comment or used the same words. As for the qualitative analysis of the data transferred to the computer, researchers paid heed to what was meant to be said and the originality of the responses. The raw data were coded after being carefully read by the researchers. Themes were created by combining the coded data. The themes obtained were sent to the two above-mentioned experts who are experienced in the field of qualitative research. The content analysis was completed after receiving expert opinions. The data concerning the socio-demographic characteristics of the expectant fathers, as well as the gestational weeks of the spouses and probable problems during pregnancy were assessed through the SPSS, 20.0 (Chicago, Illinois, USA) package software in terms of mean, standard deviation, minimum and maximum values.
RESULTS
As presented in Table 1, the average age of expectant fathers was determined to be 33.5±5.1 years. The number of expectant fathers working as government employees was 18; 22 had at least a bachelor’s degree, 16 lived in the province, the average age difference between them and their spouses was 4±3.4 years, 17 did not have a previous child. The average gestational week of their spouses was 26.3±10, and 25 had not had any problems during pregnancy.
The content was analyzed to determine the characteristics of the sexual life of expectant fathers during pregnancy. Two main themes and eight sub-themes were obtained (Table 2).
Theme 1. Feelings and Thoughts on Sexuality
1.1. The Significance of Sexuality for Expectant Fathers
All expectant fathers explained sexual activity as a vital need such as eating and drinking, a function that is necessary for reproduction, happiness, pleasure, satisfaction, and joy. The expectant fathers stated that sexual activity is an important and vital need in daily life and marriage, especially for men. The statement of one of the expectant fathers regarding the significance of sexual activity is quoted below:
“It is a necessity, a desire of the body, there is somehow a production in the body, especially in the male’s, of course, you do not know what happens after that poison spreads to the body, though... I can say it is primarily a necessity.” (#18, 30 years old, master’s degree, expecting his first child).
“It is one of the basic elements such as food and water. It’s quite a principal criterion for a man to feel manly. The impulse or the psychology behind reproduction, which is caused by hormones, is intended to make you feel normal. The word ‘pleasure’ simply means the joy of life.” (#6, 36 years old, Master’s degree, expecting his first child).
1.2. Feelings About Sexuality are not Communicated Between the Spouses
In the study, 17 expectant fathers reported that they did not talk with their spouses about their emotions since they thought that there was no problem concerning their sexual life during pregnancy. Below is the statement of an expectant father.
“We do not talk excessively about those subjects, but we do not worry about it. No, we did not talk on it at all, but this is a normal process, so we did not feel a need to talk.” (#26, 27 years old, Bachelor’s degree, expecting his second child).
1.3. Expectant Fathers do not Want to Talk About Sexuality
In the study, 9 expectant fathers said that they did not want to have any discussions regarding sexuality or their sexual life. Four expectant fathers stated that sexuality was considered forbidden and a “sinful matter” in society. The statements of two expectant fathers regarding this topic are as follows:
“I do not think that it (talking about sex/sexuality) is necessary. I mean, it is a private issue, we talk about (the health condition of) my (pregnant) wife.” (#10, 37 years old, secondary school graduate, expecting his third child).
“In our society, religion is very important; we do not talk about the sexual and private lives of others. We also do not find it right in the religious sense to talk about sex/sexuality, because it is a sin to talk about sex/sexuality in our religion.” (#1, 27 years old, Bachelor’s degree, expecting his first child).
1.4. Expectant Fathers are not Willing to Receive Counseling on Sex/Sexuality
Approximately 50% of the expectant fathers who participated in this study stated that they did not want to receive counseling from healthcare professionals when they had problems regarding sex/sexuality; they believed that they were able to solve these problems by themselves, and they were ashamed of talking about sex and their sexual lives. The statement of an expectant father on the subject is as follows:
“Actually, I wanted to beat the doctor when he first asked me (questions about sexual life); I thought “how dare you ask me something like this?”. I mean, I did not want to beat him up, but I just got angry since he questioned me about my privacy, but later I thought (on the subject) and I got used to it.” (#29, 29 years old, Bachelor’s degree, expecting his first child).
Theme 2. Sexual Life During Pregnancy
2.1. Pregnancy may Affect Sexual Life
All expectant fathers stated that their sexual life was negatively affected during pregnancy. They used to have sexual intercourse 3-4 times per week before pregnancy, and this frequency decreased, or their sexual life completely disappeared during pregnancy. Expectant fathers indicated that their sexual life was negatively affected because of reasons such as the fear of harming the baby, the belly growth, and the limitation of the mother’s movements. The statements of two expectant fathers are as follows:
“When you know that your wife is pregnant, you still want to have sexual intercourse, but you have a fear of harming the baby inside her. I mean, if your normal routine is to do it every day before pregnancy, it decreases to once or twice a week during pregnancy; you become worried or afraid, the doctor does not say anything, but you become psychologically disturbed.” (#8, 39 years old, Bachelor’s degree, expecting his first child).
“There is no situation in which you can hang in any position you want, so as a result of our thinking of the baby every time, we wonder if something is happening to it or we touch it or I am pressing down on it, so such things as that can be negative.” (#18, 30 years old, master’s degree, expecting his first child).
2.2. Pregnancy may Strengthen the Marriage and Increase the Bond Between Spouses
In this study, 13 expectant fathers stated that pregnancy strengthened their marriage, and pregnancy enhanced the bonds between spouses. The statement of an expectant father on this subject is as follows:
“It seems like we have become attached to each other more. Because we’re happy that we’ll become a complete family” (#24, 30 years old, Primary school graduate, expecting his first child).
2.3. The Effect of the Changes of the Body Image on Pregnant Women and the Fear of an Extramarital Affair
Six expectant fathers who participated in this study reported that their spouses might be uncomfortable with their physical appearance because of the weight they had gained, and might not feel as attractive as they used to feel since their belly had grown. As a result, they might have a sense of not being sexually desirable. In addition to this, four expectant fathers expressed that their spouses had a fear of being cheated on during pregnancy. The statements of two expectant fathers on this subject are as follows respectively:
“For example, she is so afraid of her body being deformed; she says “I have stretch marks on my body, get me a stretch mark cream,” her feeling of not being desirable increases.” (#6, 36 years old, Master’s degree, expecting his first child).
“My wife generally questions this issue; she asks me ‘if there is a problem for me (about not having sexual intercourse]’ because of the rumors she has heard from people around for years like ‘men cheat on their wives most during pregnancy.” (#18, 30 years old, master’s degree, expecting his first child).
2.4. Sexual Intercourse may Become Just a Duty During Pregnancy
In the study, 4 expectant fathers stated that sex might become just a duty during pregnancy and their sexual intercourse took place without the desire of their spouses. Only 2 of the expectant fathers emphasized that the sexual desire of their wives had increased during this period. The statements of two expectant fathers on this subject were as follows:
“Sexual activity turns into something else after a certain point. I mean, like a duty, rather than (taking place) out of a desire” (#11, 37 years old, Bachelor’s degree, expecting his second child).
“But after I heard that she was pregnant, I continued for a while for another month or two at request of my wife” (#15, 37 years old, Bachelor’s degree, expecting his second child).
DISCUSSION
Sex is one of the main daily activities of individuals. Among the physiological needs, Abraham Maslow emphasized the importance of sex in his basic human need theory by ranking it on top.6 In this study, the expectant fathers stated that they defined sex as an indispensable need that brings happiness, pleasure, and satisfaction to men. The study conducted by Rust et al.19 emphasized that sexual activity was very important in marriage for men. Their findings are parallel to the findings of the present study. That result may arise from the fact that men view sex as an action aimed at ensuring their sexual satisfaction as well as the continuity of their lineage.
The fact that couples do not discuss their sexual life negatively affects their sexual relations. It also causes many conflicts among spouses.20 Expectant fathers stated that they could not talk about their feelings regarding their sexual lives with their spouses. In the study conducted by Cakir Kocak21, almost all of the expectant fathers (90%) stated that they could comfortably talk about subjects related to their sexual lives with their spouses during pregnancy. In a study conducted with pregnant women, they emphasized that they talked about sex with their husbands and got information from them.8 Turkish men have difficulties in talking about sex with women, and still view this matter as a taboo topic.
In the present study, it appeared that expectant fathers are reluctant to make discussions regarding their sex lives. In addition, expectant fathers reported that sex is seen as a sin in their religion. As far as the literature is concerned, there are no studies reporting that the expectant fathers are not willing to talk about their sex lives. However, in a study conducted by Torun et al.22 which aimed at investigating the beliefs about sexual myths and the factors affecting belief in these myths among Turkish men, while the majority of men responded to all of the questions, more than a quarter of men did not want to answer questions about relevant sexual experiences. The results of our study can be explained by the fact that sex and sexuality are seen as taboo topics in our country, just as in other developing countries.
Additionally, expectant fathers do not seem to be willing to receive counseling regarding sex. In the study conducted by Bilen Sadi and Aksu16, 63.8% of expectant fathers were determined not to get information, which is in parallel with the results of our study. In the study conducted by Seturk Erenel et al.9, 64.3% of pregnant women were found to not have received counseling on their sexual life during pregnancy from health professionals. The results of our study can be explained by the fact that sexuality and sexual life are still considered as a subject which must be kept secret in our society, as well as by the fear of men of being perceived as weak by others if they disclose such matters.
The sex life of expectant fathers is negatively affected during pregnancy due to reasons such as the fear of harming the baby, avoidance of risking the life of the baby, and the restriction of the mother’s movements due to the growth of her belly. In the studies conducted by Radoš et al.15 and Onah et al.17, researchers concluded that the sexual desire, the frequency of sexual intercourse and the sexual satisfaction of expectant fathers decreased during pregnancy due to reasons such as fear of harming the baby and fear of miscarriage; while erection problems could also be frequent. Studies on pregnant women and their spouses emphasize that the fear of harming the fetus, stress, fatigue, and weakness are followed by a decrease in sexual desire and discomfort during sexual intercourse, which negatively affect the couple’s sexual life during pregnancy.3-5,7 These findings are in parallel with the findings of the present study. However, it was emphasized that overall sexual satisfaction and function were not problematic for couples during pregnancy based on the Golombok-Rust Inventory of Sexual Satisfaction scale in the another study by Dwarica et al.23. In other reviews in the literature, it is stated that sex is normal in pregnancy and there are very few proven contraindications and risks to intercourse in low-risk pregnancies.24 In addition, it was emphasized that recommendations for or against restricting sexual activity should follow evidence-based guidelines.25
Pregnancy may increase the love between spouses and may strengthen the bond of marriage.2 In some studies, it was determined that expectant fathers paid more attention and were closer to their wives, and also expressed love to them more during pregnancy.26,27 In our study, expectant fathers stated that pregnancy increased the intimacy between them and their spouses. This result might have arisen from the peculiarities of the individual characteristics of the expectant fathers and the dynamics of their marriage. In addition, it can be explained by the fact that positive emotions related to the future new member of the family make the attachment between spouses stronger since the concept of family is given much importance and value in Turkish society.
The expectant fathers stated that their spouses were affected by the changes in their body image and accordingly afraid of the possibility of an extramarital affair by them. Similarly, Olsson et al.28 found that the sexual life of pregnant women whose body image was distorted, who felt overweight and who believed that their husbands considered them ugly, were adversely affected. In the study conducted by Bilen Sadi and Aksu16, 37.1% of expectant fathers stated that their wives were sexually attractive, even though they had gained weight. In the study carried out by Bello et al.29 to determine Nigerian women’s experiences and opinions about their postpartum sexual experiences, 26% of women reported that they accepted sexual intercourse in order to prevent their husbands’ infidelity. In another study conducted in Nigeria, women were indicated to have sexual intercourse with their partners during pregnancy since they were afraid of their partners’ infidelity.30 As we have seen in studies conducted before, there are usually fears of unfaithfulness in pregnant women who live in Middle Eastern countries. When the population of Mersin is examined, it can be seen that there is a lot of migration from the Southeast region of Turkey. Apart from this, hormonal changes in estrogen and progesterone may also influence mood and body image in pregnant women, in addition to their increasing body weight. Therefore, women are expected to experience such fears caused by increasing body weight and changing body image during pregnancy.
In conclusion, sex is generally viewed by expectant fathers to be a duty, which is fulfilled mostly due to the sexual desire of the husband. Nevertheless, some studies support the fact that the sexual desire of pregnant women increases during pregnancy.7,31 The result of the present study might have arisen from the fact that expectant fathers did not want to have sexual intercourse due to a fear of harming the fetus and/or the mother.
Study Limitations
Being a qualitative research, the results of this study are not representative and should be carefully interpreted. In addition, other limitations of this study are its small sample size and the fact that it was derived from a specific area of Turkey with certain cultural characteristics.
CONCLUSION
This study is the first qualitative study which investigates the sexual life of expectant fathers during pregnancy in Turkey, addressing possible problems which may emerge during this period. According to the content analysis, two main themes were developed as a result of this study. The first theme “Feelings and thoughts on sexuality”, revealed that sex was very important for expectant fathers, but this was not communicated between the spouses, and expectant fathers did not want to talk about their sex lives. The other theme, “Sexual life during pregnancy”, showed that pregnancy affected their sexual life, and it strengthened the marriage and the bonds between spouses. The themes also revealed that the wives of expectant fathers were disturbed by their changing body images and feared that their husbands might engage in extramarital relationships, and sexual intercourse might become only a dull duty during pregnancy. Therefore, these findings may guide physicians and nurses in planning counseling and training services which could be provided to expectant fathers since healthcare professionals play a critical role in helping people maintain a healthy sexual life.
In accordance with the results obtained from the present study, the researchers recommend forming an integrated service model in which expectant fathers are also included in the prenatal preparation classes which provide services for pregnant women in order to address the topics that expectant fathers are curious about and need to know about the during pregnancy. In addition, more research is needed, including both qualitative and quantitative studies, in order to look into this interesting aspect of sexuality and sexual activity more thoroughly and investigate possible intercultural differences.
MAIN POINTS
- These results give data on the feelings and thoughts regarding the sexual lives of expectant fathers during pregnancy.
- These results give data on the sexual lives of expectant fathers during pregnancy.
- The most striking result of this study is that all expectant fathers stated that their sexual life was negatively affected during pregnancy.
- According to these results, nurses should plan training and counseling which will cover both partners in the prenatal period.
ETHICS
Ethics Committee Approval: All procedures were approved by Mersin University Social Sciences Institutional Ethics Review Board (approval number: 2017/53) and Mersin University Health Research and Application Center (approval number: 41993462-774.001.0600000443843).
Informed Consent: In addition, all the participants signed informed consent forms.
Peer-review: Externally peer-reviewed.
Authorship Contributions
Concept: A.A.C., D.Y.V., M.Y., Design: A.A.C., D.Y.V., M.Y., Supervision: D.Y.V., M.Y., Materials: A.A., M.Y., Data Collection and/or Processing: A.A.C., D.Y.V., M.Y., Analysis and/or Interpretation: A.A.C., D.Y.V., M.Y., Literature Search: A.A.C., Writing: A.A.C., Critical Review: A.A.C., D.Y.V., M.Y.
DISCLOSURES
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The author declared that this study had received no financial support.