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The relationship between coping strategies with sexual satisfaction and sexual intimacy in women with multiple sclerosis

Annals of General Psychiatry volume 22, Article number: 22 (2023) Cite this article

Abstract

Background

Multiple sclerosis profoundly affects the sexual aspects of patients’ life, especially in women. Various coping strategies are used by women with multiple sclerosis to overcome, tolerate, or minimize these sexual effects. The present study aimed to assess the relationship between sexual satisfaction, sexual intimacy, and coping strategies in women with multiple sclerosis.

Methods

This cross-sectional study was performed on a sample of 122 married women who were members of Iran’s MS society in Tehran, Iran. The study was conducted from December 2018 to September 2019. Data were collected using the Index of Sexual Satisfaction (ISS), the Sexual Intimacy Questionnaire (SIQ), and the Folkman and Lazarus Coping Strategies Questionnaire. Frequency, percentage, mean and standard deviation were used to explore the observations. Independent t-test and logistic regression were applied to analyze the data using the SPSS-23.

Results

The majority (n = 71, 58.2%) used an emotion-focused coping strategy with the highest score for the escape-avoidance subscale [mean (SD): 13.29 (5.40)]. However, 41.8% of the patients (n = 51) used a problem-focused coping strategy with the highest score for the positive reappraisal strategy subscale [mean (SD): 10.50 (4.96)]. The sexual satisfaction in women with problem-focused coping strategies was significantly higher than women who used emotion-focused coping strategies (95.6 vs. 84.71, P-value = 0.001). There was a negative association between sexual intimacy and higher emotion-focused coping strategy (OR = 0.919, 95% CI 0.872–0.968, P = 0.001).

Conclusions

Problem-focused coping strategy in women with multiple sclerosis increases sexual satisfaction, while the emotion-focused coping strategy has a significant negative relationship with sexual intimacy.

Introduction

Multiple sclerosis (MS) is a central nervous system disease that is common in women of reproductive age. The disease leads to progressive demyelination and destruction of nerves and neurons [1] and significantly affects physical, sexual, and mental health [2]. The incidence rate of MS is increasing. It is estimated that 2.8 million people are living with MS worldwide [3], and its latest prevalence in Iran and Tehran (the capital) is 148.06 and 162.38 per 100,000, respectively [4, 5]. The prevalence of MS in women is three times higher than in men [6].

Sexual disorders have been reported in 34–85% of women with MS [6, 7]. Neurological and psychological factors, depression, side effects of medications, and physical problems such as fatigue, muscle weakness, changes in menstruation, pain, and concerns about urinary and bowel incontinence are some of the factors affecting sexual disorders [8]. Sexual disorders affect patients’ sexual health [9]. Since sexual health plays an important role in improving women’s quality of life, it is necessary to pay particular attention to this issue [1].

Sexual satisfaction and sexual intimacy are considered the main components of sexual health [10]. Sexual satisfaction is a physical and emotional response to a person’s assessment of sex that emphasizes the positive or negative feelings after intercourse and the fulfillment of sexual needs of the person and his/her partner [11]. Numerous studies have reported the effect of sexual satisfaction on marital satisfaction, quality of life, and women’s self-esteem [12, 13]. Studies have shown that MS reduces sexual satisfaction in women through physical changes, sexual disorders (decreased genital nerve conduction, orgasm disorders), and psychological effects (fatigue, depression, and anxiety) [10, 14]. This can cause many unfortunate consequences such as coldness between couples, feelings of inferiority, lack of self-confidence, and depression in women with MS [7].

Sexual intimacy is another factor that can be affected by MS [1]. It refers to sharing romantic experiences, the need for body contact and sexual intercourse which is planned for sexual arousal and satisfaction. Studies have shown that neurological disorders such as MS can directly or indirectly affect women’s the sexual health and sexual function [8]. It is argued that following physical and psychological disorders caused by MS, sexual dysfunction [8] decreased sexual arousal, and decreased sexual desire [14] is inevitable. In turn, these could lead to a decrease in sexual intimacy in women, which is one of the most important concerns in women with MS [6].

There are various coping strategies in different age groups, at different stages of life, or among different patient populations. In general, coping strategies include the mental, emotional and behavioral efforts of individuals that are used to overcome or minimize the effects of stress when faced with mental pressure. The purpose of these strategies is to manage and change the source of stress (problem-focused strategies) or to regulate stressful emotions (emotion-focused strategies) [15].

Women with MS usually use coping strategies such as problem-solving, emotional release, and avoidance strategies; to adapt and meet their own impaired needs [16]. Several studies investigated the relationship between using different coping strategies by multiple sclerosis patients and a variety of issues such as mood profile [17], psychological outcomes [18], employment [19], and burden of disease [20].

It is believed that women with MS who benefit from medication, psychological counseling, and using active and positive coping strategies have a faster treatment process and achieve the desired state of physical, psychological, and social health in a short time [16, 21]. Conversely, a study on coping strategies used by patients with relapsing multiple sclerosis found that maladaptive coping strategies used by MS patients were associated with relevant clinical aspects of the disease and with worse health-related quality of life [22]. As pointed out by some investigators, using less avoidant and cognitively demanding adaptive coping strategies may improve the quality of life in MS patients [23]. Also, a recent study indicated that the use of coping strategies in multiple sclerosis is associated with demographic and clinical characteristics [24]. However, although various factors of quality of marital life and sexual disorders caused by MS have been investigated in these patient populations [25,26,27], to the best of our knowledge, the relationship between coping strategies and important factors related to the quality of marital life, including sexual satisfaction and sexual intimacy has not been studied yet. Thus, considering the importance of identifying coping strategies used by MS patients, the present study was conducted to determine the relationship between sexual satisfaction and sexual intimacy with the type of coping strategies in women with MS. More specifically, we were interested to know which type of coping strategy could be helpful to improve sexual satisfaction and sexual intimacy in women who are suffering from MS to be able to provide evidence for appropriate interventions.

Methods

Study design

The present cross-sectional study was performed on a sample of women with MS in Tehran, Iran. A convenience sampling method was used. The study was conducted from December 2018 to September 2019.

Participants and setting

Participants were married women who suffered from MS and were members of Iran’s MS society. To recruit patients, we contacted the society and introduced the project. They provided a list of married female members living in Tehran, Iran. The first investigator contacted women and explained the study and those who fulfilled the inclusion criteria and were interested in participating were entered into the study. The continuous sampling method was used to obtain the calculated sample size. The inclusion criteria were being literate, married for at least six months, having sexual activity, and no physical disability. The exclusion criteria were partial completion of questionnaires and having a spouse with sexual dysfunction (according to the woman’s statement).

Sample size calculation

Considering the least correlation between coping strategies with sexual satisfaction and sexual intimacy (r = 0.3) the following formula was used to calculate sample size:

$$n \ge \left[ {\frac{{\left( {z_{1 - \alpha /2} + z_{1 - \beta } } \right)}}{{0.5 \times \ln \left[ {\left( {1 + r} \right)/\left( {1 - r} \right)} \right]}}} \right]^{2} + 3$$

where α = 0.05, β = 0.10 (power 90%) a sample size of 112 women was achieved. However with a 10% drop out a sample of 122 women was thought [28].

Data collection

The following questionnaires were used to collect the data:

  1. 1.

    Index of sexual satisfaction (ISS): this was developed by Hudson et al. in 1981 [29]. The ISS consists of 25 questions, and the response categories are rated on a 5-point Likert scale ranging from 1 to 5 (never, rarely, sometimes, most of the time, and always). The questionnaire includes both positive aspects (12 items such as ‘I feel that my partner enjoys our sex life’) and negative aspects (13 items such as ‘My partner does not satisfy me sexually’). The score for the questionnaire ranges from 125 (maximum) to 25 (minimum). The score on the questionnaire could be categorized as follows: a score below 60 as poor sexual satisfaction, a score between 60 and 90 as moderate sexual satisfaction, and a score above 90 as high sexual satisfaction. The validity of this questionnaire has been confirmed in various studies [10, 22, 30]. We used a validated Persian version of the questionnaire [30]. The reliability of the questionnaire for the current study was 0.89, as estimated by Cronbach’s alpha coefficient.

  2. 2.

    The Sexual Intimacy Questionnaire (SIQ): it was developed by Shahsiah et al. in Iran (2010) based on the Bagarozi sexual intimacy questionnaire [31] and consists of 30 items such as ‘We talk to each other about the quality of our sexual relationship’ and ‘I could not express my sexual feeling to my partner’. Each item is rated on a 4-point Likert scale from ‘always’ to ‘never’ giving maximum and minimum scores of 120 and 30, respectively. A score less than 60 indicates poor, between 60 and 90 moderate, and above 90 as high sexual intimacies [11]. The validity of the questionnaire has been confirmed by various studies [11]. The internal consistency of the questionnaire for the current study was 0.90 as calculated by the Cronbach’s alpha coefficient.

  3. 3.

    Folkman and Lazarus Coping Strategies Questionnaire: this questionnaire was developed by Folkman and Lazarus in 1986 [15] and consists of eight subscales tapping into two coping strategies: problem-focused strategies (seeking social support, accepting responsibility, planful problem-solving, and positive reappraisal) and emotion-focused strategies (confrontive coping, distancing, escape-avoidance, self-controlling). The questionnaire contains 66 items where each item is rated on a Likert scale ranging from zero ‘I have not used at all’ to 3 ‘I have used a lot’. We used a validated Persian version of the questionnaire [32]. As estimated by Cronbach's alpha coefficient, the internal consistency of the questionnaire in the current study was 0.92 for problem-focused coping strategies and 0.88 for emotion-focused coping strategies.

Data analysis

The data obtained from the questionnaires were analyzed using SPSS version 23. Statistical data were described by calculating indices of central tendency and dispersion. To assess the relationship between coping strategies and outcome variables (that are, sexual satisfaction and sexual intimacy), binary logistic regression analyses were performed. As such proportional to the mean score of sexual satisfaction and sexual intimacy, respondents were categorized into two groups: those who scored equal or higher than mean and those who scored less than mean. Age, education, duration of marriage, number of children, frequency of sexual intercourse per week before and after the disease, and coping strategies were entered into the logistic model as independent variables. Odds ratio (and 95% confidence intervals) for likelihood of higher sexual satisfaction and sexual intimacy were reported. The significant level was set at P < 0.05.

Ethics approval and consent to participate

The ethics committee of Shahid Beheshti University of Medical Sciences approved the study (IR.SBMU.PHARMACY.REC.1399.268). All participants signed written informed consent form after explaining the objectives of the study and ensuring the confidentiality of data for them.

Results

In all 122 women with multiple scholars were entered onto the study. The mean age of women was 36.3 ± 7.40 years, and the majority (52%) had a university degree. The mean disease duration was 7.95 ± 6.22 years. Some characteristics of the participants are shown in Table 1.

Table 1 The characteristics of participants (n = 122)
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The detailed descriptive statistics for sexual satisfaction and sexual intimacy scores are presented in Table 2. Overall the mean score of sexual satisfaction was 89.3 ± 18.6, and the mean score of sexual intimacy was 80.5 ± 17.2.

Table 2 Sexual satisfaction and sexual intimacy in participants (n = 122)
Full size table

The majority of women with MS (n = 71, 58.2%) used emotion-focused coping strategies in dealing with their disease, and the highest mean score was for scape-avoidance strategy (Mean = 13.29, SD = 5.40). The remaining 41.8% (n = 51) of the patients used problem-focused coping strategies, and the highest mean score was for positive reappraisal strategy (Mean = 10.50, SD = 4.96). The patients’ coping strategies scores are presented in Table 3.

Table 3 Coping strategies in participants (n = 122)
Full size table

As shown in Table 4, the results obtained from two independent samples t-test showed that sexual satisfaction was significantly higher in women with problem-focused coping strategy than women using emotion-focused coping strategy (P = 0.001). In terms of sexual intimacy, the difference between the two groups was not statistically significant (P = 0.570).

Table 4 Relationship between total score of sexual satisfaction and sexual intimacy with coping strategies in participants
Full size table

Table 5 shows the results obtained from the multivariable logistic regression analysis indicating a significant negative association between likelihood of higher sexual satisfaction and marriage duration (OR = 0.891, 95% CI 0.808–983, P = 0.021), a significant positive association with frequency of sexual intercourse after MS (OR = 1.827, 95% CI 1.115–2.992, P = 0.017), and problem-focused coping strategy (OR = 1.114, 95% CI 1.049–1.182, P < 0.0001)). Similar analysis showed that there was a significant positive association between higher sexual intimacy and frequency of sexual intercourse after MS (OR = 1.755, 95% CI 1.090–2.828, P = 0.021), and a significant negative association with higher emotion-focused coping strategy score (OR = 0.919, 95% CI 0.872–0.968, P = 0.001). The results are shown in Table 6.

Table 5 The results obtained from logistic regression analysis for association between independent variables and likelihood of higher sexual satisfaction
Full size table
Table 6 The results obtained from logistic regression analysis for association between independent variables and likelihood of higher sexual intimacy
Full size table

Discussion

The findings from this study indicated that there was a significant positive relationship between problem-focused coping strategies and sexual satisfaction, while sexual intimacy did show a significant negative association with emotion-focused coping strategy.

We found that the majority of participants had moderate sexual satisfaction (54.9%). In a study by Zamani et al., sexual dissatisfaction due to sexual dysfunction in women with MS was relatively low [14]. This difference can be attributed to the fact that we used a specific measure of sexual satisfaction while they used the female sexual functioning index. One of the main complications of MS is sexual disorders such as reluctance to intercourse and impaired orgasm in many affected women [6, 14]. The disorders usually occur due to muscle weakness [33], urinary incontinence [24], fatigue, anxiety, and depression [1]. These all can decrease self-confidence and distortion of the appropriate feminine image of their sexual abilities compared to women without MS. With the mentality of inability to sexually satisfy the spouse, inability to play an effective role in sexual intercourse, and creating a mental-psychological barrier, these disorders prevent sexual intercourse and significantly reduce the sexual satisfaction [34].

The majority of participants had moderate sexual intimacy (59.0%). It seems that sexual disorders caused by MS could intensify a feeling of guilt [1], and such feeling might reduce a woman’s sense of security and create an anxious environment, and ultimately lead to not sharing the feelings, needs, and sexual perceptions with their sexual partner, which in turn leads to more separation between couples and diminishes sexual relations between them [31]. Indeed, living in a safe and stress-free environment helps to improve sexual relationships and intimacy [16, 33].

In the present study, less than half of the participants used problem-focused coping strategies, and the most frequent strategy was positive reappraisal which refers to the acceptance and positive interpretation of the disease. Coping by positive reappraisal is shown to be correlated positively with psychological well-being [35,36,37]. Implementing this strategy assists patients to redefine their condition more positively and adapt to stressful situations [38]. Some studies have shown that using this strategy brings out more flexibility confronting the disease or stressful conditions [39,40,41]. Patients who use problem-focused coping strategies in dealing with their disease achieved a relative acceptance of the existing conditions over time, considering all the limitations and complications of MS [23] and it has strengthened their use of problem-focused strategies. Interpreting stressful events is more important than the events themselves, which helps patients, respond to disease as a source of stress [33].

According to the results, more than half of the participants (58.2%) used emotion-focused coping strategies, especially the escape-avoidance strategy. Emotion-focused coping is always associated with weaker levels of compromise and higher levels of distress. In such situations, to change the source of stress and negative feelings and emotions caused by the disease, the patient tries to deny the disease or overcome it through daydreaming, conscious self-occupation, and participating in an alternative activity [16]. Acceptance of the disease, psychological complications, physical disabilities and mobility limitations are difficult for patients [42]. As such, the easiest and most accessible coping style is to resort to coping strategies based on expressing emotions, avoiding the source of the problem and accepting reality [22]. Hence, patients move away from rational thinking and conscious behavior [16]. Many previous studies have pointed to the regulating and modulating roles of coping strategies on the level of anxiety, stress and depression in patients, and it has been found that if these strategies are based on awareness and cognition, the patient will have higher peace of mind, efficiency and overall mental health [33].

The study results showed that sexual satisfaction was higher in women with problem-focused strategies. Perhaps applying a problem-focused coping strategy might lead patients to deal with issues more rationally and respond better to stressors or the disease [23, 24]. Therefore, she can accept the disease easier and adapt to the situation and does not have excessive expectations of herself, and ultimately with better mental health, she will have higher health with better sexual health [22]. In such a situation, the person will be at a healthier level of social relationships and consequently in a better situation of marital and sexual relationships because mental health and sexual health are strongly related to each other [33]. Marital and sexual relationships are considered as protective factors against psychological and physiological problems [14]. A woman using strategies to deal with her disease will have a lower stress level, be more successful in establishing relationships, and experience a higher sense of satisfaction, peace of mind and mental health. This manifests itself in all aspects of her personal and social life and its most important consequences are a successful sexual relationship, a good level of sexual health, and sexual satisfaction [33]. Therefore, as an individual strengthens the use of problem-focused coping strategies, it indirectly helps to increase sexual satisfaction [22, 23].

The findings indicated a significant negative relationship between emotion-focused coping strategy and sexual intimacy. In addition, marital relationships, regardless of sexual interactions, can affect sexual intimacy because sexual intimacy is dynamic and can change over time [43]. It is argued that a better understanding of sexual intimacy might need to incorporate interpersonal dynamics into current models of sexual activities between partners [44, 45]. In fact, it can be said that attachment and empathy between couples and deep emotional connections play a greater role in creating sexual intimacy than the type of coping strategy. Other studies on Iranian women with MS showed the role of demographic factors (education and employment status) and implementing support strategies by the husband for improving sexual function [27, 46]. The desire for intimacy has biological roots and for most people lasts from birth to death. Intimacy in marital relationships has strong emotional and social aspects and is based on acceptance, satisfaction and love [16]. For instance, physical intimacy or emotional intimacy that could reflect the ‘innermost’ feelings are necessary components of a healthy relationship and evidently higher levels of intimacy are associated with more sexual desire [44]. Other studies have also emphasized the relationship between sexual intimacy, and quality of marital life [42, 47].

Strengths and limitations

One of the strengths of the present study was the investigation of the relationship between important factors of sexual health, namely sexual satisfaction and intimacy with coping strategies in women with MS, which rarely was considered in previous studies. Among the study limitations is the fact that we recruited the study samples from one setting, and there was no comparison group. Thus the generalization of the results should be avoided. In addition, since we only included sexually active patients, a selection bias might be occurred, as the study does not include women who ceased having sex due to MS. Finally, since we did not collect the data for those who might be used both coping strategies; the results should be interpreted with caution. Perhaps future investigations should assess the outcome of different interventions that are seeking to improve different coping strategies among this population.

Conclusion

The results suggest that using problem-focused coping strategy in women with MS significantly increases sexual satisfaction, and using emotion-focused strategy significantly decreases sexual intimacy. Indeed, to promote sexual satisfaction and intimacy in women with multiple sclerosis health providers might focus on improving women’s skills on using problem-focused coping strategy.

Availability of data and materials

The data sets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Abbreviations

MS:

Multiple sclerosis

References

  1. Valvano AK, Rollock MJ, Hudson WH, Goodworth MCR, Lopez E, Stepleman L. Sexual communication, sexual satisfaction, and relationship quality in people with multiple sclerosis. Rehabil Psychol. 2018;63:267. https://doi.org/10.1037/rep0000203.

    Article  PubMed  Google Scholar 

  2. Mikula P, Nagyova I, Vitkova M, Szilasiova J. Management of multiple sclerosis: the role of coping self-efficacy and self-esteem. Psychol Health Med. 2018;23(8):964–9. https://doi.org/10.1080/13548506.

    Article  PubMed  Google Scholar 

  3. Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, Robertson N, La Rocca N, Uitdehaag B, van der Mei I, Wallin M, Helme A, Angood Napier C, Rijke N, Baneke P. Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS. Mult Scler. 2020;26(14):1816–21.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Almasi-Hashiani A, Sahraian MA, Eskandarieh S. Evidence of an increased prevalence of multiple sclerosis: a population-based study of Tehran registry during 1999–2018. BMC Neurol. 2020;20:1–7.

    Article  Google Scholar 

  5. Eskandarieh S, Ayoubi S, Sahraian MA. The prevalence of multiple sclerosis in Tehran, Iran, in 2020. Curr J Neurol. 2023;22(1):63–4.

    Google Scholar 

  6. Miletta M, Bogliatto F, Bacchio L. Multidisciplinary management of sexual dysfunction, perineal pain, and elimination dysfunction in a woman with multiple sclerosis. Int J MS Care. 2017;19:25–8. https://doi.org/10.7224/1537-2073.2015-082.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ghasemi V, Simbar M, Ozgoli G, Nabavi SM, Majd HA. Prevalence, dimensions, and predictor factors of sexual dysfunction in women of Iran multiple sclerosis society: a cross-sectional study. Neurol Sci. 2020;1:9. https://doi.org/10.1007/s10072-019-04222-6.

    Article  Google Scholar 

  8. Konstantinidis C, Tzitzika M, Bantis A, Nikolia A, Samarinas M, Kratiras Z, Thomas C, Skriapas K. Female sexual dysfunction among Greek women with multiple sclerosis: correlations with organic and psychological factors. Sex Med. 2019;7(1):19–25. https://doi.org/10.1016/j.esxm.2018.11.003.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Petersen M, Kristensen E, Giraldi L, Giraldi A. Sexual dysfunction and mental health in patients with multiple sclerosis and epilepsy. BMC Neurol. 2020;20:41. https://doi.org/10.1186/s12883-020-1625-7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Smith RL, Gallicchio L, Flaws JA. Factors affecting sexual activity in midlife women: results from the midlife health study. J Womens Health. 2017;26:103–8. https://doi.org/10.1089/jwh.2016.6135.

    Article  Google Scholar 

  11. Shahsiah M. Effect of attachment-based couple therapy on sexual satisfaction and intimacy. J Fundam Ment health (JFMH). 2010;12(46):496–505.

    Google Scholar 

  12. Flynn KE, Lin L, Bruner DW, Cyranowski JM, Hahn EA, Jeffery DD, Reese JB, Reeve BB, Shelby RA, Weinfurt KP. Sexual satisfaction and the importance of sexual health to quality of life throughout the life course of US adults. J Sex Med. 2016;13(11):1642–50.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Schoenfeld EA, Loving TJ, Pope MT, Huston TL, Štulhofer A. Does sex really matter? Examining the connections between spouses’ nonsexual behaviors, sexual frequency, sexual satisfaction, and marital satisfaction. Arch Sex Behav. 2017;46(2):489–501.

    Article  PubMed  Google Scholar 

  14. Zamani M, Tavoli A, Khasti BY, Sedighimornani N, Zafar M. Sexual therapy for women with multiple sclerosis and its impact on quality of life. Iran J Psychiatry. 2017;12(1):58–65.

    PubMed  PubMed Central  Google Scholar 

  15. Folkman S, Lazarus RS, Dunkel-Schetter C, Delongis A, Gruen RJ. Dynamics of a stressful encounter: cognitive appraisal, coping, and encounter outcomes. J Pers Soc Psychol. 1986;50(5):992. https://doi.org/10.1037//0022-3514.50.5.992.

    Article  CAS  PubMed  Google Scholar 

  16. Calandri E, Graziano F, Borghi M, Bonino S. Coping strategies and adjustment to multiple sclerosis among recently diagnosed patients: the mediating role of sense of coherence. Clin Rehabil. 2017;31:1386–95. https://doi.org/10.1177/2F0269215517695374.

    Article  PubMed  Google Scholar 

  17. Milanlioglu A, Özdemir PG, Cilingir V, Gülec TÇ, Aydin MN, Tombul T. Coping strategies and mood profiles in patients with multiple sclerosis. Arq Neuropsiquiatr. 2014;72:490–5.

    Article  PubMed  Google Scholar 

  18. Tan-Kristanto S, Kiropoulos LA. Resilience, self-efficacy, coping styles and depressive and anxiety symptoms in those newly diagnosed with multiple sclerosis. Psychol Health Med. 2015;20(6):635–45.

    Article  PubMed  Google Scholar 

  19. Grytten N, Skår AB, Aarseth JH, Assmus J, Farbu E, Lode K, Nyland HI, Smedal T, Myhr KM. The influence of coping styles on long-term employment in multiple sclerosis: a prospective study. Mult Scler. 2017;23(7):1008–17.

    Article  PubMed  Google Scholar 

  20. Lorefice L, Fenu G, Frau J, Coghe G, Marrosu MG, Cocco E. The burden of multiple sclerosis and patients’ coping strategies. BMJ Support Palliat Care. 2018;8(1):38–40.

    Article  PubMed  Google Scholar 

  21. Corallo F, Bonanno L, Di CaraI M, Rifici C, Sessa E, D’aleo G, Buono VL, Venuti G, Bramanti P, Marino S. Therapeutic adherence and coping strategies in patients with multiple sclerosis: an observational study. Medicine. 2019;98(29): e16532. https://doi.org/10.1097/md.0000000000016532.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Carnero Contentti E, López PA, Alonso R, Eizaguirre B, Pettinicchi JP, Tizio S, Tkachuk V, Caride A. Coping strategies used by patients with relapsing multiple sclerosis from Argentina: correlation with quality of life and clinical features. Neurol Res. 2021;43(2):126–32.

    Article  PubMed  Google Scholar 

  23. Grech LB, Kiropoulos LA, Kirby KM, Butler E, Paine M, Hester R. Importance of coping in the relationship between executive function and quality of life in people with multiple sclerosis. Int J MS Care. 2019;21(5):201–6. https://doi.org/10.7224/1537-2073.2018-029.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Holland DP, Schlüter DK, Young CA, Mills RJ, Rog DJ, Ford HL, Orchard K, TONiC study group. Use of coping strategies in multiple sclerosis: association with demographic and disease-related characteristics. Mult Scler Relat Disord. 2019;27:214–22. https://doi.org/10.1016/j.msard.2018.10.016.

    Article  CAS  PubMed  Google Scholar 

  25. Mohammadi K, Rahnama P, Mohseni SM, Sahraian MA, Montazeri A. Determinants of sexual dysfunction in women with multiple sclerosis. BMC Neurol. 2013;12(13):83. https://doi.org/10.1186/1471-2377-13-83.

    Article  Google Scholar 

  26. Dehghan-Nayeri N, Khakbazan Z, Ghafoori F, Nabavi SM. Sexual dysfunction levels in Iranian women suffering from multiple sclerosis. Mult Scler Relat Dis. 2017;12:49–53. https://doi.org/10.1016/j.msard.2017.01.005.

    Article  Google Scholar 

  27. Mohammadi K, Rahnama P, Rafei Z, Ebrahimi-Aveh SM, Montazeri A. Factors associated with intimacy and sexuality among young women with multiple sclerosis. Reprod Health. 2020;17(1):110. https://doi.org/10.1186/s12978-020-00960-5.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kołtuniuk A, Przestrzelska M, Karnas A, Rosińczuk J. The association between sexual disorders and the quality of life of woman patients with multiple sclerosis: findings of a prospective, observational, and cross-sectional survey. Sex Med. 2020;8(2):297–306. https://doi.org/10.1016/j.esxm.2020.02.009.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hudson WW, Harrison DF, Crosscup PC. A short-form scale to measure sexual discord in dyadic relationships. J Sex Res. 1981;17:157–74. https://doi.org/10.1080/00224498109551110.

    Article  Google Scholar 

  30. Shams MZ, Shahsiah M, Mohebi S, Tabaraee Y. The effect of marital counseling on sexual satisfaction of couples in Shiraz city. HSR. 2011; 6(3).

  31. Bagarozzi DA. Marital intimacy needs questionnaire: preliminary report. Am J Fam Ther. 1997;25(3):285–90.

    Article  Google Scholar 

  32. Alipour A, Hashemi T, Babapour J, Tousi F. Relationship between coping strategies and happiness among university students. J Psychol (Tabriz Univ). 2010;5(18):71–86.

    Google Scholar 

  33. Bassak Nejad S, Ebadeh Avazi P, Mehrabizadeh Honamand M. Comparison of sexual intimacy, life satisfaction and coping strategies with postmenopausal and non-menopausal women referring to health centers. Avicenna J Nurs Midwifery Care. 2019;26:389–96. https://doi.org/10.30699/sjhnmf.26.6.389.

    Article  Google Scholar 

  34. Marck CH, Jelinek PL, Weiland TJ, Hocking JS, Delivera AM, Taylork KL, Neate SL, Pereira NG, Jelinek GA. Sexual function in multiple sclerosis and associations with demographic, disease and lifestyle characteristics: an international cross-sectional study. BMC Neurol. 2016;16:210. https://doi.org/10.1186/s12883-016-0735-8.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Guszkowska M, Dąbrowska-Zimakowska A. Coping with stress during the second wave of the COVID-19 pandemic by Polish university students: strategies, structure, and relation to psychological well-being. Psychol Res Behav Manag. 2022;17(15):339–52. https://doi.org/10.2147/PRBM.S345648.

    Article  Google Scholar 

  36. Bailey S, Bailey C, Boivin J, Cheong Y, Reading I, Macklon N. A feasibility study for a randomised controlled trial of the positive reappraisal coping intervention, a novel supportive technique for recurrent miscarriage. BMJ Open. 2015;5:7322–30.

    Article  Google Scholar 

  37. Ockhuijsen H, van den Hoogen A, Eijkemans M, Macklon N, Boivin J. Clarifying the benefits of the positive reappraisal coping intervention for women waiting for the outcome of IVF. Hum Reprod. 2014;29:2712–8. https://doi.org/10.1093/humrep/deu253.

    Article  PubMed  Google Scholar 

  38. Ockhuijsen HD, van den Hoogen A, Macklon NS, Boivin J. The PRCI study: design of a randomized clinical trial to evaluate a coping intervention for medical waiting periods used by women undergoing a fertility treatment. BMC Womens Health. 2013;3(13):35. https://doi.org/10.1186/1472-6874-13-35.

    Article  Google Scholar 

  39. Riepenhausen A, Wackerhagen C, Reppmann ZC, Deter H-C, Kalisch R, Veer IM, Walter H. Positive cognitive reappraisal in stress resilience, mental health, and well-being: a comprehensive systematic review. Emot Rev J. 2022;14(4):310–31.

    Article  Google Scholar 

  40. Everaert J, Joormann J. Emotion regulation difficulties related to depression and anxiety: a network approach to model relations among symptoms, positive reappraisal, and repetitive negative thinking. Clin Psychol Sci. 2019;7(6):1304–18. https://doi.org/10.1177/2167702619859342.

    Article  Google Scholar 

  41. Varela JP, Guerrero JG, Rodríguez KE, Kawas O. Positive reappraisal as a stress coping strategy during the COVID-19 pandemic. Salud Mental. 2021;44(4):177–84.

    Article  Google Scholar 

  42. Young CA, Tennant A. Sexual functioning in multiple sclerosis: relationships with depression, fatigue and physical function. Mult Scler J. 2017;23(9):1268–75. https://doi.org/10.1177/1352458516675749.

    Article  Google Scholar 

  43. Rezapour Mirsaleh Y, Esmaeelbeigi M, Delikhon H, Chehrehazad F. The efficacy of sexual intimacy and commitment based intervention on the women’s marital adjustment and sexual satisfaction. J Psychiatr Nurs. 2019;7(1):41–9. https://doi.org/10.21859/ijpn-07016.

    Article  Google Scholar 

  44. Dewitte M, Mayer A. Exploring the link between daily relationship quality, sexual desire, and sexual activity in couples. Arch Sex Behav. 2018;47(6):1675–86. https://doi.org/10.1007/s10508-018-1175-x.

    Article  PubMed  Google Scholar 

  45. Van Lankveld J, Jacobs N, Thewissen V, Dewitte M, Verboon P. The associations of intimacy and sexuality in daily life: temporal dynamics and gender effects within romantic relationships. J Soc Pers Relat. 2018;35(4):557–76. https://doi.org/10.1177/0265407517743076.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Azari-Barzandig R, Sattarzadeh-Jahdi N, Mehrabi E, Nourizadeh R, Najmi L. Sexual dysfunction in Iranian Azeri women with multiple sclerosis: levels and correlates. Crescent J Med Biol Sci. 2019;6(3):381–7.

    Google Scholar 

  47. Moghaddam FS, Zahrani ST, Moslemi A, Azin SA, Ozgoli G, Rad NJ. Effectiveness of sexual skills training program on promoting sexual intimacy and satisfaction in women in Tehran (Iran): a randomized clinical trial study. Urol J. 2020;281:288. https://doi.org/10.22037/uj.v0i0.4690.

    Article  Google Scholar 

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Acknowledgements

The authors would like to extend their gratitude to Shahid Beheshti University of Medical Sciences, MS society and all the participants who provided us with their sex life information.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Students Research Office, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Samaneh Imanpour Barough

  2. Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Hedyeh Riazi & Zohreh Keshavarz

  3. Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Maliheh Nasiri

  4. Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran

    Ali Montazeri

  5. Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran

    Ali Montazeri

Authors
  1. Samaneh Imanpour Barough
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  2. Hedyeh Riazi
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  3. Zohreh Keshavarz
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  4. Maliheh Nasiri
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  5. Ali Montazeri
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Contributions

SIB collected the data. HR designed the study and supervised it. ZK involved in data interpretation. MN participated in data analysis. AM contributed to analysis and provided the final draft. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Hedyeh Riazi or Ali Montazeri.

Ethics declarations

Ethics approval and consent to participate

The ethics committee of Shahid Beheshti University of Medical Sciences approved the study (IR.SBMU.PHARMACY.REC.1399.268). All participants signed written informed consent form after explaining the objectives of the study and ensuring the confidentiality of data for them. The study has been performed in accordance with the declaration of Helsinki.

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Imanpour Barough, S., Riazi, H., Keshavarz, Z. et al. The relationship between coping strategies with sexual satisfaction and sexual intimacy in women with multiple sclerosis. Ann Gen Psychiatry 22, 22 (2023). https://doi.org/10.1186/s12991-023-00451-4

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Keywords

Annals of General Psychiatry

ISSN: 1744-859X