Reduced sex drive can have a profound effect on the individual’s quality of life and other aspects of self-functioning [1]. Women’s lack of confidence or negative body images may affect their sexual life [1]. WHO (2013) defines infertility as a disease of the reproductive system and results in the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (and there is no other reason, such as breast-feeding or postpartum amenorrhea) [2]. Primary infertility is infertility in a couple who have never had a child. Secondary infertility is the failure to conceive following a previous pregnancy. Infertility leads to negative consequences in most marital lives [3], especially the wife’s self-esteem and the concept of her body image [4]. Infertility can also badly affect the couple’s sexual life [5]. Most wives show a marked decrease in frequency, quality, and satisfaction of their sexual life including performance and practice after being diagnosed with infertility [6]. On the other hand, husbands showed less effect than their wives. Other studies found that erectile dysfunction and premature ejaculation are more prevalent in husbands with infertility than men with children [7]. A recent meta-analysis of 14 studies concluded that husbands have an increased rate of erectile dysfunction, while wives with primary infertility complain of decreased libido [8]. In general, many studies found that overall sexual relation and couple’s life could be badly affected by infertility [9].
Women who discover that they are infertile usually appear normal but they experience distress. They find it difficult to express their feelings and they have to suppress feelings of grief, depression, anxiety, anger, frustration, as well as the loss of self-esteem, self-confidence, and a sense of control over their destiny.
The hypothesis of this study was that women with primary infertility have low general and sexual self-esteem. They also have a high prevalence of depression and anxiety. Self-esteem is one of the important aspects of personality and determinants of human behavioral characteristics and development. Self-esteem is a set of attitudes and beliefs expressed by persons in their relationships with the outside world. Self-esteem indicates the degree to which a person perceives him/herself as able, valuable, and important [10]. General self-esteem used to describe a person’s overall sense of self-worth or personal value. In other words, how much you appreciate and like yourself. Sexual self-esteem defined as how you view your sense of self as a sexual being [11]. Low self-esteem can lead to many physical and mental disorders such as anxiety, depression, behavioral, and communication problems [10]. Sexuality is among the important needs of life. To be a sexually satisfied person should have good sexual self-esteem. Sexual disorder is difficulty experienced by an individual or a couple during any stage of normal sexual activity (physical pleasure, desire, preference, arousal or orgasm) [12]. Sexual dysfunction disorders classified into 4 categories: sexual desire disorders, arousal disorders, orgasm disorders, and pain disorders [13]. Infertility can affect a person’s sexual esteem and also can lead to sexual dysfunction. The prevalence of sexual disorders in infertile couples remains unclear [14]. The aim of this study was to assess self-esteem (sexual and general), anxiety, and depression in women with primary infertility.
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Patients and methods
This cross-sectional comparative study was carried out in the outpatient clinic of Obstetrics and Gynecology Department, Mansoura University, during the period from 1st of September 2016 to 31st of August 2017. It was carried out at the obstetrics and gynecology outpatient clinic. In the study, a total of 201 women who attended the clinic for treatment from primary infertility were diagnosed with infertility as they were unable to conceive after regular unprotected sex in a marital relationship for 1 year [2]. All women were examined by a gynecologist and were invited to take part in this study. Sixty-four patients were excluded as they or their husbands refused to give consent to share in this study. The remaining patients were referred to a psychiatrist. Three patients dropped out at the time of the referral or the psychiatric assessment. The rest of the patients were interviewed using the Mini-International Neuropsychiatric Interview (MINI) version 5. The scale had been previously translated and validated into Arabic [15]. All patients were diagnosed using DSM-5 criteria for any psychiatric disorders [16].
The control group is composed of 150 volunteers who attended the gynecology outpatient clinic for contraception and reported that they were married and have a number of children. They were healthy with no medical or psychiatric disorders.
One hundred thirty-four women were diagnosed with infertility on grounds of failure to conceive after 1 year of unprotected sex in a marital relationship [2]. A specially designed sheet was used to collect the needed information. It includes age, education, residence, socioeconomic standard, religious background, marriage, and sex information.
All patients underwent a full clinical examination including general, abdominal, and local gynecologic examinations. Other investigations are semen analysis, hysterosalpingogram, mid-luteal progesterone, and other tests according to each case were done.
Patients were divided into four social classes according to the Egyptian social class classification [17]. Intelligent quotient (IQ) was assessed using Wechsler Adult Intelligence Scale-Revised (WAIS-R) [18], anxiety by Arabic version Hamilton Anxiety Scale [19, 20], depression using the Arabic Form of Hamilton Depression scales [21], self-esteem using the Arabic translation of Rosenberg Self Esteem Scale [22, 23],and Arabic version of Self-esteem and Relationship Questionnaire (SEAR).
The exclusion criteria included the following: learning disability, IQ below 70 using the Arabic version of Wechsler Adult Intelligence Scale-Revised (WAIS-R), any psychiatric disorder proceeding marriage, organic or medical illness that could lead to psychiatric disorders, chronic illness, thyroid disorders, congenital disfigurement, and pituitary disorders that could affect patient self-esteem. Clinically language or hearing disability would interfere with the patient’s ability to understand or complete the instruments used in the study.
This study was approved by the Mansoura Faculty of medicine, ethical committee, and Institutional Research Board (IRB) (R.18.10.313) and then it has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Written informed consent was obtained from all participants before inclusion in the study.
Statistical analysis
Parametric data were summarized as means and standard deviations. Chi-square and t test were used to measure associations found in different non-parametric data and parametric data respectively. The results were computed using the SPSS version 20 program.
