Prediction of Sexual Function in Married Women Based on Sexual Attitudes: The Mediating Role of Sexual Self-Esteem
Keywords:
sexual function, sexual attitudes, sexual self, esteem, married womenAbstract
The present study aimed to develop a structural model of sexual function in married women based on sexual attitudes, with sexual self-esteem as a mediating variable. This study employed a descriptive-correlational design. The statistical population consisted of all married women residing in Kermanshah, Iran. Of this population, 251 women were selected through convenience sampling, with the required sample size determined using G*Power software. Data were collected using the Female Sexual Function Index (FSFI; Rosen et al.), the Sexual Attitudes Questionnaire (Ozgoli et al.), and the Sexual Self-Esteem Questionnaire (Farrokhi et al.). Data were analyzed using partial least squares structural equation modeling (PLS-SEM) with SmartPLS software. The findings indicated that the direct effects of sexual attitudes (β = −0.516, p < .01) and sexual self-esteem (β = 0.327, p < .01) on sexual function were statistically significant. Examination of the indirect effects also indicated a significant mediating effect in the relationship between sexual attitudes and sexual function (β = 0.182, p < .01). Sexual self-esteem mediated the relationship between sexual attitudes and sexual function (β = −0.086, p < .01); however, its mediating role in relation to sexual function was not statistically significant. The results further suggest that sexual function among married women is more strongly associated with sexual attitudes and sexual self-esteem than with individual factors directly. Accordingly, the development of intervention packages and programs focusing on the cognitive restructuring of sexual attitudes and the enhancement of emotional bonds between couples is recommended.
Downloads
References
Abdi, F., & Sadeghi, F. (2024). The relationship of cognitive emotion regulation and marital intimacy or quality of life in women with breast cancer. Applied Psychology, 18(9), 152-172.
Ahmadi, H., Taghvaei, D., & Jahangiri, M. M. (2026). Developing a structural model of body image concern based on cognitive reappraisal and cognitive fusion with the mediating role of experiential avoidance. Psychology of Motivation, Behavior and Health, 4(2), 1-13.
Ahmadi, K., & Saadati, N. (2025). Female sexual dysfunction and associated factors among women of reproductive age: A cross-sectional study. BMC Women's Health, 25(1), 178-190. https://bmcwomenshealth.biomedcentral.com
Alikhani, Z. (2024). Predicting sexual interest/arousal disorder based on body image concern, sexual guilt, and marital satisfaction with the mediating role of self-esteem among women attending sexual disorder treatment centers in Tehran Payame Noor University, Tehran Province, South Tehran Center].
Arab Khazaei, F. (2020). Examining the mediating role of sexual desire in the relationship of sexual schemas and gender role with sexual assertiveness among married female students at universities and higher education institutions in Mashhad Basir Higher Education Institute, Abyek, Department of Humanities].
Aslami, E., & Malekzadeh, A. (2025). Modeling women's sexual function based on sexual desire and body image satisfaction with the mediating role of sexual self-esteem. Woman and Society, 16(61), 19-38.
Behravan, S., & Behrad, M. (2024). Predicting sexual self-efficacy based on sexual attitudes with the mediating role of sexual schemas among married women in Yazd. Journal of Psychology and Educational Sciences Studies, 10(3), 139-157.
Chesli, S. R., Bostani Khalesi, Z., & Chenari, S. S. (2024). The role of sexual self-esteem, sexual desire, and sexual assertiveness in the female sexual function. Psicologia: Reflexão e Crítica, 37, 21. https://doi.org/10.1186/s41155-024-00303-4
Chesli, S. R., Bostani Khalesi, Z., & Shirzad Chenari, S. (2024). The role of sexual self-esteem, sexual desire, and sexual assertiveness in the female sexual function. Psicologia: Reflexão e Crítica, 37, 21. https://doi.org/10.1186/s41155-024-00303-4
Fakhar, M., Sohrabi Shekofti, N., Samani, S., & Rezaei, A. (2024). Investigating young couples' low motivation for childbearing in Shiraz through developing a conceptual model using a qualitative approach. medical journal of mashhad university of medical sciences, 67(3), 1111-1123.
Fischer, N., Kozák, M., Graham, C. A., Clifton, S., Mercer, C. H., & Mitchell, K. R. (2025). Trends in masturbation prevalence and associated factors: Findings from the British Surveys of Sexual Attitudes and Lifestyles. The Journal of Sex Research, 1-12. https://doi.org/10.1080/00224499.2025.2555053
Fischer, V. J., Andersson, G., Billieux, J., & Vögele, C. (2022). The relationship between emotion regulation and sexual function and satisfaction: A scoping review. Sexual Medicine Reviews, 10(2), 195-208. https://doi.org/10.1016/j.sxmr.2021.11.004
Ganjian, A., Mardani, Z., & Zakeri Nasrabadi, Z. (2025). A structural model of marital intimacy based on distress tolerance and differentiation: The mediating role of relationship quality with the spouse's family among married women attending counseling centers. Social Psychology Research, 15(58), 101-124.
Ghaffari, M., Mohammadzadeh, A., & Eftekhari, E. (2023). Developing a structural model of makeup addiction among married women based on body dysmorphic disorder, sexual self-esteem, and bodily intelligence. Woman and Society, 14(55), 65-78.
Izadi, M. (2023). Developing and designing a sexual health training package and its effectiveness on sexual quality of life, sexual function, and sexual knowledge and attitudes among employed engaged and newlywed couples at Kermanshah University of Medical Sciences Islamic Azad University, Sanandaj Branch].
Khani, S., Firouzi, A., Mousavizadeh, M., Hosseini Karnami, H., Karimian, Z., & Siri, F. (2025). The effect of a multidimensional sexual education and counseling program on sexual knowledge and attitudes among couples preparing for marriage. Journal of Mazandaran University of Medical Sciences, 35(247), 74-87.
Khanmohammadi Otaghsara, A. (2022). The effectiveness of cognitive behavioral therapy in developing sexual self-concept among married women. Journal of Psychological Science, 117(21), 2056-2065.
Ledermann, K., Zuccarella-Hackl, C., Altwegg, R., Dörner, M., Attanasio, V., Guth, L., Zirngast, L., Pazhenkottil, A. P., Menzi, A., Känel, R., & Princip, M. (2024). Relationship between erectile dysfunction and alexithymia in male patients with implantable cardioverter defibrillators: A cross-sectional study. Frontiers in Psychiatry, 15, 1327796. https://doi.org/10.3389/fpsyt.2024.1327796
Merino, M., Tornero-Aguilera, J. F., Rubio-Zarapuz, A., Villanueva-Tobaldo, C. V., Martín-Rodríguez, A., & Clemente-Suárez, V. J. (2024). Body perceptions and psychological well-being: A review of the impact of social media and physical measurements on self-esteem and mental health with a focus on body image satisfaction and its relationship with cultural and gender factors. Healthcare, 12, 1396. https://doi.org/10.3390/healthcare12141396
Mirzaei Jahed, A., & Saberi, H. (2019). Predicting women's marital burnout based on their sexual attitudes and their spouses' dark personality tendencies. Applied Psychology, 13(3), 371-389.
Mohammadbeigi, M., & Ganji, H. (2024). Predicting female sexual dysfunction based on alexithymia and aggression. medical journal of mashhad university of medical sciences, 67(4), 1310-1322.
Nguyen, T. N. D., Tran, H. Y., Nguyen, G. H. M., Nguyen, Y. K., & Dinh, H. T. M. (2025). Narcissism, social media addiction, self-esteem, and haxeco traits: Exploring influences on life satisfaction among Generation Z. Psychology research and behavior management, 26, 419-434. https://doi.org/10.2147/PRBM.S447067
Nisani Samani, L., Arjmand, S., Seyed Fatemi, N., & Haghani, S. (2024). The effect of virtual stress management training on sexual function in perimenopausal women. Iran Journal of Nursing, 37(148), 163-177.
Özbay, S. (2025). Body image, self-esteem and attitudes toward sexuality in older adults with chronic diseases. https://doi.org/10.1007/s10508-025-03146-x
Rabiei, E. (2025). Examining the mediating role of sexual self-esteem in the relationship between sexual mindfulness and marital adjustment Alzahra University, Faculty of Educational Sciences and Psychology].
Rahbar-Zeraati, A., Fathnezhad-Kazemi, A., & Velayati, A. (2026). Determinants of childbearing intention among Iranian women: Integrating psychological, demographic, and socioeconomic factors. Journal of Public Health Research, 15(1), 22799036251410258. https://doi.org/10.1177/22799036251410258
Rezaei, N., Taheri, S., Tavalaee, Z., Rezaie, S., & Azadi, A. (2021). The effect of sexual health education program on sexual function and attitude in women at reproductive age in Iran. Journal of education and health promotion, 10, 45. https://doi.org/10.4103/jehp.jehp_556_20
Rezaeian Bilondi, H., Rahmati, A., & Rezvani Divkolai, S. Z. (2023). Women's psychological well-being based on religious orientation and self-esteem: A path analysis study. Women and Family Studies, 10(18), 257-284.
Saberi, H., Salehian, A., & Amiri, M. (2022). A model for predicting women's sexual function based on childhood trauma with the mediating role of sexual self-image. Psychology of Woman, 4(2), 43-53.
Silva, G., Lima, S., Reis, B., Macruz, C., & Postigo, S. (2020). Prevalence of hypoactive sexual desire disorder among sexually active postmenopausal women with metabolic syndrome at a public hospital clinic in Brazil: A cross-sectional study. Sexual Medicine, 8(3), 545-553. https://doi.org/10.1016/j.esxm.2020.05.008
Wu, Y., & Zheng, Y. (2021). Effect of sexual esteem and sexual communication on the relationship between body image and sexual function in Chinese heterosexual women. Sexual Medicine, 9(4), 100403. https://doi.org/10.1016/j.esxm.2021.100403
Downloads
Additional Files
Publication Timeline
- Submitted
- Revised
- Accepted