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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 40  |  Issue : 2  |  Page : 112-117

Is there a difference in female sexuality in urban and rural areas: an Egyptian experience


Department of Dermatology and Andrology, Faculty of Medicine, Benha University, Benha, Egypt

Date of Submission19-Dec-2019
Date of Acceptance06-May-2020
Date of Web Publication09-Jun-2020

Correspondence Address:
Ihab Younis
6 Syria Street, Mohandeseen, 12411
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejdv.ejdv_56_19

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  Abstract 


Background There are known variations in social, cultural, demographic, and health characteristics across urban and rural residence areas that affect the sexual behavior and degree of sexual knowledge and beliefs between urban and rural couples.
Objective The aim of our work was to compare female sexuality among urban and rural married women in a sample of Egyptian women.
Patients and methods The study included 404 women, who were equally distributed regarding residence between rural and urban areas. All the women answered a self-report questionnaire including 25 questions, and other questions were added to suit the purpose of the study. Privacy was guaranteed for all the participants.
Results No significant differences were observed in sexual activity between women living in urban areas and those living in rural areas. However, four statistically significant differences were observed. Urban women reported more initiation of coitus, preferred more man on top as a sexual position, more of them reported not having enough time for foreplay as a cause of inability to have orgasms, and more of them stated that the purpose of intercourse was having pleasure for them and their husbands.
Conclusion Rural and urban communities in Egypt differ from each other in a few sexual aspects. A significantly high percentages of Egyptian women are still exposed to female genital cutting.

Keywords: female, rural, sexuality, urban


How to cite this article:
Younis I, Ibrahim A, El-Helaly RA. Is there a difference in female sexuality in urban and rural areas: an Egyptian experience. Egypt J Dermatol Venerol 2020;40:112-7

How to cite this URL:
Younis I, Ibrahim A, El-Helaly RA. Is there a difference in female sexuality in urban and rural areas: an Egyptian experience. Egypt J Dermatol Venerol [serial online] 2020 [cited 2020 Oct 22];40:112-7. Available from: http://www.ejdv.eg.net/text.asp?2020/40/2/112/286292




  Introduction Top


Sex is a motive force bringing a male and a female into an intimate contact. Satisfying sexual experience is an essential part of a healthy and enjoyable life for most people. Although essentially sex is meant for procreation, it has also been a source of joy and pleasure, a natural relaxant, it confirms one’s gender, enhances one’s self-esteem and sense of attractiveness for mutually satisfying relationship [1].

There are known variations in social, cultural, demographic, and health characteristics across urban and rural residence. These variations may affect the sexual behavior and degree of sexual knowledge and beliefs between urban and rural couples, affecting the sexual life, sexual satisfaction, and sexual well-being. For women, many factors can affect sexual functioning including age, fertility status, hormonal levels, socioeconomic factors, quality of life, educational level, relationship with spouse, sexual knowledge and behaviors, family planning methods, and physical and mental health [2]. Viswanathan et al. [3] documented a variety of personal, social, and cultural factors associated with sexual function. Increasing age, menopause, marital discord, a history of physical abuse, the lack of privacy at home, and medical illness were risk factors that must be considered in dealing with female sexuality.

Literature in the field of differences in sexuality between women living in rural areas versus those living in urban areas is scarce. The present work aimed to bridge this knowledge gap in a sample of Egyptian women.


  Patients and methods Top


This is a cross-sectional, population-based study that was carried out in different urban areas in Egypt, including Zagazig and Benha cities, and different rural areas, including Dondeit, Menya Alkamh, and Elasayed-El-Sharquia governorates. The study extended for 6 months, starting from May 2018 to October 2018.

The study was approved by the Dermatology and Andrology Department and the Medical Ethics Committee, Faculty of Medicine, Benha University. An informed consent was obtained from each participant in the study.

The tool used in this study was a self-report questionnaire designed by Younis et al. [4], including 25 questions, and other questions were added to suit the purpose of study. It is written in English and translated into Arabic. To ensure that all gathered information is confidential and the patients are anonymous, each questionnaire was handed in an open envelope, and after filling it, the participant sealed the envelope and put it in a basket containing other sealed envelopes.

Included participants in the current study were married women of all age groups who have active sexual life and stable marriage. Unmarried women and women with diseases that prevent sexual contacts, for example, psychiatric, renal, or hepatic failure, were excluded from the study. Illiterate women were also excluded to provide participants with enough privacy to respond to the questionnaire through self-administration.

Statistical analysis

The clinical data were recorded on a report form. These data were tabulated and analyzed using the computer program SPSS (statistical package for the social science) (IBM Corp., Armonk, NY, USA), version 20 to obtain. Descriptive statistics were calculated for the data in the form of frequency and distribution for qualitative data.

In the statistical comparison between the different groups, the significance of difference was tested. Intergroup comparison of categorical data was performed by using χ2 test (χ2 value) and Fisher exact test. A P value less than 0.05 was considered statistically significant, P value more than 0.05 was considered statistically insignificant, and P value less than 0.01 was considered highly significant in all analyses.


  Results Top


Demographic data

The number of the studied participants was 404, who were equally distributed regarding residence between rural and urban areas. The most common age of participants was 20–29 (62.4%) years, and the most common age of marriage was 20–29 (84.9%) years. University degree was the most common educational level (84.9%), with almost half of the participants (48.8%) exposed to female genital cutting (FGC) ([Table 1]).
Table 1 Demographic data

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Sexual activity

A statistically highly significant difference was found between women residing in rural areas and women residing in urban areas regarding the frequency to initiate coitus in more than 50% of sexual encounters (49.0 vs. 65.8%, P>0.003). Moreover, a statistically highly significant difference (P>0.002) was found regarding the purpose of intercourse, as 68.8% of the rural group and 84.2% of the urban group reported that the purpose of intercourse is for their and their husband’s pleasure.

Residence did not affect other aspects of sexual activity in both groups, for example, coital frequency and its suitability (P<0.02), lubrication (P<076), orgasm (P<0.06), and oral sex (P<0.09).

Moreover, a statistically highly significant difference (P<0.038) was found regarding the preferred position of intercourse, as 50.3% of the rural group and 36.5% of the urban group preferred the man-on-top position. Among the urban group, 34.6% preferred the rear entry position, as compared with only 24.5% of the rural group ([Table 2]).
Table 2 Relation between residence and sexual activity

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Sexual difficulties

Compared with women in urban areas, women in rural areas reported more difficulty in obtaining lubrication and more incidence of faking orgasm, especially for fear of being insulted by their husbands. All these differences were not statistically significant.

The only statistically significant differences were in explaining cause of difficulty to obtain orgasm. In this respect, 19.3% of the rural group and 31.7% of the urban group reported that the cause of not reaching orgasm is that the husband did not give enough time for foreplay, whereas 29.2% of the rural group and 41.6% of the urban group reported that the cause is not focusing ([Table 3]).
Table 3 Relation between residence and sexual difficulties

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  Discussion Top


There are known variations in social, cultural, demographic, and health characteristics across urban and rural residence. These variations affect sexual behavior and degree of sexual knowledge and beliefs between urban and rural couples, affecting sexual life, sexual satisfaction, and sexual well-being. For women, many factors can affect sexual functioning, including age, fertility status, hormonal levels, socioeconomic factors, quality of life, educational level, relationship with spouse, sexual knowledge and behaviors, family planning methods, and physical and mental health [2].

It is not surprising that 67.3% of our rural participants were exposed to FGC, whereas only 30.2% of urban participants were genitally cut. As reported by El-Gibaly et al. [5], urban women are less likely to be exposed to FGC than rural women (86 and 95%, respectively, in their study). These authors reported that women in the urban areas in Egypt were most likely to say the practice of FGC should be stopped and least likely to think that their husbands want the practice to continue.

Tag-Eldin et al. [6] reported that in rural secondary schools, the prevalence rate of FGC is 61.7% compared with 46.2% in urban schools. Of note, in private urban schools, the prevalence rate was very low (9.2%). Their study concluded that the difference in the prevalence rates of FGC is mainly owing to educational status in both rural and urban areas.

In our study, 68.8% of the rural participants and 84.2% of the urban ones stated that the purpose of intercourse was obtaining pleasure for both husband and wife. Only 15.3% of the rural participants and 5.4% of the urban ones reported that the main purpose of intercourse is their husbands’ pleasure, and also 12.4% of the rural participants and 8.9% of the urban ones reported that the main purpose is fear of God. This means that 27.7% of our rural participants have intercourse for causes other than their own sexual pleasure, whereas this percentage is lower in the urban group, reaching only 14.3%. A higher percentage was reported by Younis et al. [4], where 89.87% of their participants reported that they would engage in sex because of husband’s desire. This indicates that they consider that sexual intercourse is a duty rather than a pleasure for themselves. This percentage was greatly higher than the percentage reported in our study, which may be related to the larger portion of genitally cut participants (80.7%) contributing in their study, whereas only 48.8% of our participants were genitally cut.

In the current study, 50.3% of the rural group and 36.5% of the urban group stated that they preferred the man-on-top position. Among the urban group, 34.6% preferred the rear entry position, as compared with only 24.5% of the rural group. These results agree with the results of Younis et al. [4], where 73.8% of their participants stated that coital position affects orgasms during sexual intercourse, and 69.7% preferred the man-on-top position. A dissertation in Benha university [7] reported that the commonest coital position used by participating women was man on top (72.73%) followed by woman on top (12.27%) followed by rear entry (7.27%), but 54.55% of participants can use more than one position in the same intercourse.

Among the rural group in our study, 63.3 and 73.3% of the urban group reported that they gave oral sex. Moreover, 57.5% of the rural group and 77.3% of the urban group reported that they receive oral sex. These percentages indicate that most of the participants have been engaged in an act of oral sex, with a higher percentage in the urban community, but also a significant percentage in the rural community. This suggests a high level of sexual knowledge in both communities. Moreover, to be noted, a higher percentage of participants in the rural community give oral sex, whereas a higher percentage in the urban community receive oral sex. Based on this information, it may be stated that women may be giving oral sex to their husbands as a duty part of the sexual relationship, especially in the rural community, where most of the men may focus on their own sexual pleasure and most of the women target their husbands’ pleasure, not their own pleasure.

Receiving oral sex may be a sign of sexual intimacy and an exchangeable fair sexual relationship. Among young men and women in the United Kingdom, for instance, 43% agreed that men expect to be given oral sex (i.e. oral-penis contact), whereas 20% agreed that women expect to receive it (i.e. oral-vulva contact) [8]. In the United States and Canada, studies record more young men and women reported the experience of oral-penis than oral-vulva contact with a different-sex partner, both across their lifetime [9]. Other studies indicate that men may receive more frequent oral sex than young women; for example, an online survey with US college students (n=1928, 62% female) [10] found that women were more likely than men to report giving oral sex more often than they received it, and men were more likely than women to report receiving oral sex more often than giving it. In a study conducted by D’Souza et al. [11] differences in oral sexual behavior were observed by sex, age, and race. Most men (85.4%) and women (83.2%) had ever performed oral sex. Their study also reported that 60–69-year-old patients were less likely than 45–59 or 30–44-year-old ones to have performed oral sex (72.7, 84.8, and 90.3%, respectively).

The present study revealed that 49% of the rural participants and 65.8% of urban participants initiate coitus in more than 50% of times; 19.8% of the rural participants and 11.9% of urban participants initiate coitus in less than 50% of times. This means that, collectively, 68.8% of the rural participants and 77.7% of urban participants initiate coitus with their male partners. The study conducted by Younis et al. [4] reported that 53.7% of the participants would initiate coitus with their husbands. Both studies suggest that the female partner usually is the initiator of the sexual relationship. These high percentages may be attributed to the cultural nature of our community, as each woman tries to sexually satisfy her husband in an attempt to preserve their relationship and to prevent her husband from searching for another wife. This may have a financial aspect, where many women are nonworkers and depend financially on their husbands. Moreover, the tough working conditions in our community may affect man’s sexual desire and sexual arousal, making their wives more demanding for sex.

Limitations

Some of the questions for assessment of sexual life were annoying to some participants, and some participants avoided answering some sensitive questions, owing to the nature of our culture. It is recommended that future pilot studies containing a larger number of participants should be conducted to adjust the wording of the questions.

Some women tended to exaggerate in the answer of some questions, especially questions about the frequency they initiate coitus.

All women were literate and the majority were within 20–29 years of age and highly educated; these factors may limit the diversity of participants and the generalization of results. This limitation can be met with multicenter studies on broad geographic distribution.


  Conclusion Top


Rural and urban communities differ from each other in a few sexual aspects; however, great similarities have been found regarding Egyptian women sexual life. The significant differences were in the domains of alluding to coitus, preferred coital positions, cause of inability to reach orgasm and aim of intercourse.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bancroft J, Loftus J, Long JS. Distress about sex: a national survey of women in heterosexual relationships. Arch Sex Behav 2003; 32:193–208.  Back to cited text no. 1
    
2.
Oniz A, Keskinoglu P, Bezircioglu I. The prevalence and causes of sexual problems among premenopausal Turkish women. J Sex Med 2007; 4:1575–1581.  Back to cited text no. 2
    
3.
Viswanathan S, Prasad J, Jacob KS, Kuruvilla A. Sexual function in women in rural Tamil Nadu: disease, dysfunction, distress and norms. Natl Med J India 2014; 27:4–8.  Back to cited text no. 3
    
4.
Younis I, El-Esawy F, Abdel-Mohsen R. Is female orgasm an earth-moving experience: an Egyptian experience. Hum Androl 2015; 5:37–44.  Back to cited text no. 4
    
5.
El-Gibaly O, Ibrahim B, Mensch BS, Clark WH. The decline of female circumcision in Egypt: evidence and Interpretation. Soc Sci Med 2002; 54:205–220.  Back to cited text no. 5
    
6.
Tag-Eldin MA, Gadallah MA, Al-Tayeb MN, Abdel-Aty M, Mansour E, Sallem M. Prevalence of female genital cutting among Egyptian girls. Bull World Health Organ 2008; 86:269–274.  Back to cited text no. 6
    
7.
Diab D. A study of positions used in marital life and their relations to some health problems [MSc dissertation]. Benha, Egypt: Faculty of Medicine, Benha University, 2018.  Back to cited text no. 7
    
8.
Stone N, Hatherall B, Ingham R, McEachran J. Oral sex and condom use among young people in the United Kingdom. Perspect Sex Reprod Health 2006; 38:6–12.  Back to cited text no. 8
    
9.
Fortenberry JD, Schick V, Herbenick D, Sanders SA, Dodge B, Reece M. Sexual behaviors and condom use at last vaginal intercourse.A national sample of adolescents ages 14-17 years. J Sex Med 2010; 7:305–314.  Back to cited text no. 9
    
10.
Chambers WC. Oral sex.Varied behaviors and perceptions in a college population. J Sex Res 2007; 44:28–42.  Back to cited text no. 10
    
11.
D’Souza G, Cullen K, Bowie J, Thorpe R, Fakhry C. Differences in oral sexual behaviors by gender, age, and race explain observed differences in prevalence of oral human papillomavirus infection. PLoS ONE 2014; 9:e86023.  Back to cited text no. 11
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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