Perception of Contributory Factors to Marital Sexual Satisfaction among Married Persons in Ebonyi State University, Abakaliki, Nigeria: Implications for Family Health.

Objective: The study aimed at determining the perception of contributory factors to marital sexual satisfaction among married persons in Ebonyi State University, Nigeria as influenced by socio- demographic variables of gender, age and length of marriage. Method: The study was a cross sectional survey which involved a sample of 144 randomly selected married persons. The instrument for data collection was the Perception of Marital Sexual Satisfaction Questionnaire (PMSSQ), a 15 item, 4-level scaled self-constructed questionnaire. Mean was used to answer the research questions with the criterion mean set at 2.5 and the hypotheses were tested using t-test and ANOVA. Results : Result showed that intimacy, amount of physical affection, pre-coital caressing, and frequency of coitus, frequency of orgasm by spouse and attitude of spouse to sex were perceived to positively contribute to marital sexual satisfaction. The result also indicated that age, gender and length of marriage influenced the perception of respondent and were significant on some of the identified factors. Conclusion: These findings have implications for family health and overall marital satisfaction which may manifest in both physical and emotional health problems for the couples and had devastating effect on the psych of the children. Based on the findings and discussion recommendations were made which included among others, the inclusion of family education in school’s curriculum in both the secondary and tertiary institutions and that natural family planning methods should be embraced to reduce the distance created by the use of contraceptives and improve marital sexual satisfaction.


Introduction
Marital Satisfaction is one of the expectations of most people who go into marriage contracts. Marital satisfaction is understood to be an individual's weighing of attractions and alternatives in marriage and these are conceived to be aspects of perception, not action [1]. Marital sexual relationship has been identified as one of the most important components of marital relationships that increase stability in marriage. In his study, Levinger [2] outline the following aspects of the marital relationship that will be rewarding to include sexual fulfillment, emotional security and social status. Sexual satisfaction has been conceptualized as absence of sexual dissatisfaction. Sexual satisfaction has been defined as the affective response arising from one's evaluation of his or her sexual relationship, including the perception that one's sexual needs are being met, fulfilling one's own and one's partners expectations, and a positive evaluation of the overall sexual relationship [3]. Lawrence and Byer [4] also identified in their interpersonal theory of sexual satisfaction that sexual satisfaction is based on the principle of reward and cost. Reward according to them include the pleasurable and gratifying sexual exchanges between couples while cost include sexual exchanges that require effort, produce pain, embarrassment and anxiety.
There are evidence from studies to the fact that sexuality within marriage is an important component of marital quality, satisfaction and stability. Most of the studies are positive in the relationship between higher sexual satisfaction and frequency to marital stability [5][6][7][8][9][10]. Studies have reported ratings of marital sexual satisfaction as an important component of marital satisfaction; it was observed that sexual relationship was ranked as the second most problematic issue among sample of young married couples [11]. It was also identified that Chinese men rate sexual satisfaction as the third and fourth most important factor in marital satisfaction [12]. Barrientos and Paez [13] have suggested that sexual and non-sexual constructs can play a significant role in an individual's sexual satisfaction. Some of these constructs are advanced as parameters to measure sexual satisfaction among married couples. The following has been identified as some factors which may or may not contribute to marital sexual satisfaction, level of intimacy among couples, amount of physical attraction, frequency of coitus, lack of cooperation of spouse, interference with contraceptives, precoital caressing, effect of premarital sexual experience, frequency/consistency of orgasm, fear of pregnancy, emotional distance, not feeling loved, unresolved marital conflicts, attitude of partner to sex, suspected infidelity of spouse and dominance by spouse [4,11,14]. This study recognises that these factors are not exhaustive but limited its scope to these factors in the study and is designed to measure the perception of married persons in Ebonyi State University (EBSU) Abakaliki, Nigeria, as it relates to these factors and how they contribute to marital sexual satisfaction.
It is the opinion of some researchers [12,15,16] that gender may significantly influence the perception of factors related to marital sexual satisfaction. This will refer most especially in cultures such as Nigeria where more emphasis are placed on the sexual pleasure of men than that of women. Zhou [14] emphasizes these facts by his finding that husband are more likely than their wives to initiate coitus and most often than not the men experience ejaculation while lower percentage of the women sometimes experience orgasm.
It is obvious that lack of sexual satisfaction may lead to marital problem which may affect the health of the couples and the family. This may come in the form of marital instability and distress which may lead to infidelity to seek satisfaction outside the confines of the matrimonial home [6]. The negative consequences of this may compromise the physical, emotional, and social wellbeing of spouses and the family.

Purpose of the Study
The main purpose of this study is to assess the perception of married person in Ebonyi State University Abakaliki, Nigeria of the contributory factors to marital sexual satisfaction, and it will specifically do this by answering the following research questions: 1. What is the influence of gender on perception of married persons in EBSU of the contributory factors to marital sexual satisfaction? 2. What is the influence of age on the perception of married persons in EBSU of the contributory factors to marital sexual satisfaction? 3. What is the influence of length of marriage on the perception of married persons in EBSU of the contributory factors to marital sexual satisfaction? 4. Three hypotheses of no significant influence of gender, age and length of marriage on the perception of contributory factors to marital sexual satisfaction was also tested at 0.05 level of significance.

Methods
The study is a cross-sectional survey of the married persons in EBSU Abakaliki to assess their perception of contributory factors to marital sexual satisfaction. A sample of 150 married persons of EBSU Abakaliki, Nigeria was drawn from the population through purposive sampling.

Instrument
The instrument for data collection was the Perception of Marital Sexual Satisfaction Questionnaire (PMSSQ), a 15 item, 5-level scaled self-constructed questionnaire based on the research questions which sought to elicit responses on levels of perception of some identified factors and their contributions to marital sexual satisfaction among married persons in EBSU, Abakaliki. The instrument was validated by three specialists in health education and measurement and evaluation.
The instrument was pre-tested for reliability on a small sample of married persons in a similar institution, Enugu State University of Technology (ESUT), Enugu, Nigeria using test-retest method which yielded a .81 reliability coefficient. The reliability coefficient was high enough considering Ogbazi and Okpala's [17] criteria of .60 acceptable for good instruments.
The researcher posted research assistant at the entrance of the three major annexes of the University who administered the questionnaire to eligible respondents who were willing and disposed to respond to the questionnaire. The completed copies of the PMSSQ were examined for completeness of responses and copies that had incomplete responses were discarded. Out of 150 copies administered; 147 representing about 98% return rate, were used for analysis. Mean was used to answer the research questions with the decision rule that any mean value of less than 2.5 is an indication that the item was perceived as having a negative influence on marital sexual satisfaction, mean scores of 2.5 and above was perceived as having positive influence on marital sexual satisfaction. The hypothesis was tested using the t-test and Analysis of Variance (ANOVA) statistics on an item by item basis at 0.05 level of significance. All data analyses were done with SPSS version 17.0 for windows [

Results
Data in Tables 1-3 indicate that married persons perceive level of intimacy, amount of physical affection, pre-coital caressing, frequency of coitus, frequency of orgasm by spouse and attitude of spouse to sex (items 1, 2, 3, 6, 8, and 13) as contributing positively to marital sexual relationships; interference with contraception, fear of pregnancy, emotional distance and dominance by spouse (items 5, 9, 10 and 15) where perceived to have neutral effect on marital sexual satisfaction; while lack of cooperation of partner, not feeling loved, unresolved marital conflicts, and suspected infidelity by spouse (items 4, 11, 12, and 14) are perceived as having a negative influence on marital sexual relationships. Table 1 further indicated that gender influenced the perception of married persons in varying degrees. T-test result indicates that the influence of gender of respondents was significant on these contributory factors: frequency of coitus, lack of cooperation of spouse, interference with contraceptives, emotional distance and dominance by spouse. Table 2 indicates that age of respondents influenced the perception of contributory factor to marital sexual satisfaction among married persons in varying degrees. The ANOVA test indicated that the following contributory factors to marital sexual satisfaction were influenced significantly by age of respondents: level of intimacy among couples, pre-coital caressing, fear of pregnancy, emotional distance and not feeling loved.  Length of marriage was found to have influence on the perception of contributory factors to marital sexual satisfaction as indicated in Table 3. The table also indicated that the influence of length of marriage were significant on the following contributory factors: amount of physical affection, frequency of coitus, lack of cooperation by the spouse, fear of pregnancy, emotional distance, attitude of partner towards sex, unresolved marital conflict and suspected infidelity of spouse.

Discussion
This study sought to determine the level of perception of identified contributory factors to marital sexual satisfaction among married person in Ebonyi State University Abakaliki (EBSU), Nigeria. The study showed that these married persons who took part in the study were male and female s aged 21-50 and have been married for not more than 30 yrs.
The findings on level of perception of identified contributory factors to marital sexual satisfaction in Tables 1-3 are interesting. That intimacy amongst couples was perceived highly as a contributory factor to marital sexual satisfaction was expected because naturally, the closer couples are to each other the more passion they will feel for one another. According to The Society for Scientific Study of Sexuality [19] intimacy is one of the most important elements in sexual satisfying relationships.
Unresolved marital conflict was perceived as a very low contributory factor to marital sexual satisfaction, in fact it contributed negatively. The finding is not unexpected as these disruption or difficult periods in relationships take their toll on emotions that affect sexuality negatively. It has been posited that conflicts may have serious implications on the overall relationship satisfaction which can be averted through improved communication which will enhance the quality of their intimate relationship by bringing couples closer together [19]. Table 1 also indicated the influence of gender on the level of perception of the identified contributory factors to marital sexual satisfaction. It is interesting to note that there are significant difference in the perception of these identified factors among male and female respondents on item 3, 4, 5, 10 and 15. For instance, interference with contraception was perceived as contributing negatively to marital sexual satisfaction by males while females perceive it as a positive contributor. This difference may have been accounted for by the fact women see a greater good in the use of contraception which supposedly prevents unwanted pregnancy. The negative perception males may have been accounted for by the interference they observe in the use of male condom. According to the findings of Randolph, Pinkerton, Bogart, Cecil and Abramson [20] men believe that condoms reduce sexual pleasure more than the females because it reduces tactile sensation.
Data in Table 2 indicated that age of the respondent influenced their perception on the identified contributory factors to marital sexual satisfaction. ANOVA analysis indicated that age had a significant influence items 6, 9, 10, 11 and 13 the fact that those aged 31-40 had the lowest perception of intimacy as a factor in sexual satisfaction is surprising since those couples are adjudged to be young and have more sexual drive. It is believed that couples at this age are supposed to report more sexual pleasure than those older than them [19]. The table also indicated that age 41-50 had the highest perception of fore play as a factor in marital sexual satisfaction. This was expected because of the effect of aging on sexual drive. For instance in premenopausal and menopausal women it has be noted that physiological changes and hormonal fluctuation have made them to report less sexual pleasure than younger women [21]. Also men over 40 have more difficulties with erectile dysfunction and prostrate problem become more common with age. The finding that couples aged 21-30 perceived the fear of pregnancy as contributing negatively to sexual satisfaction is rather surprising especially since married persons in this age group are at the stage of child bearing. The table also indicated that those aged 41-50 had the highest perception of emotional distance and not feeling loved as contributing negatively to marital sexual satisfaction. This is an interesting finding which might have been accounted for by the fear of for instance of women in this age range who culturally are categorized as less sexually desirable and desirous and the possibility of the women absorbing and acting on this categorization [19]. Table 3 indicated levels of influence of length of marriage on the perception of contributory factors to marital sexual satisfaction. ANOVA analysis indicated that length marriage had a significant influence on items 2, 3, 4, 9, 10, 12, 13 and 14. One of the surprising findings in Table 2 is the finding that those in marriages 10 years and below perceived pregnancy as a negative factor in sexual satisfaction. This might be because of interference of the changing features of their pregnant wives or the inconveniences experienced by pregnant mother during intercourse. It was also found that those have been married for 11-20 perceived negatively more than any other group lack of cooperation of spouse as a factor in sexual satisfaction. This might be accounted for by the observed decline in sexual satisfaction experienced by couples some years after marriage. This decline is more rapid in women may affect the overall sexual satisfaction among concerned couples [22]. It was also observed that there is a progressive loss of sexual satisfaction among couples as relationships age [23].
In conclusion, the results of the study indicated that while some of the identified factors (level of intimacy, amount of physical affection, frequency of coitus, pre-coital caressing, frequency of orgasm of spouse and attitude of partner towards sex) were perceived to contribute positively to marital sexual satisfaction, the others had neutral of even negative effect on marital sexual satisfaction. The levels of perception observed in the study were influence in varying levels by gender, age of respondents and length of marriage. These findings may have implications for family health and overall marital satisfaction. These implications include marital instability, searching for sexual satisfaction outside the matrimonial bed, divorce, sexual transmitted infections and others. These problems may manifest in both physical and emotional health problems for the couples and had devastating effect on the psych of the children especially in case of divorce and separation of spouses.

Recommendations
From the findings and discussions the following recommendations are made: The ministries of education should include family education in school's curriculum in both the secondary and tertiary institutions to properly equip youths who may eventually get into marriage on the rudiments of marital satisfaction including sexuality in marriage.
Since age has been found to influence perception of marital sexual satisfaction, parents and guardian, therefore should educate and ensure that their ward only get into marriage an acceptable age and maturity.
Religious organizations and NGOs working with families and propagating family values should intensify efforts in propagating those factors which improve marital satisfaction especially in spousal sexual relationship to preclude the development of marital and family instability occasioned by poor sexual relationships among couples. They should also encourage in couples other non-sexual activities which help to improve relationship.
Since married men perceived interference with contraceptive as contributing negatively to sexual satisfaction, married couples should be encouraged to embrace the natural family planning methods which reduces the distance created by the use of contraceptives and improve marital sexual satisfaction.
Health educators and family counselors should provide information for married couples on how to prevent and manage health and psychological issues (erectile dysfunction, menopausal crisis, decrease in sexual drive, prostrate and others) that may present themselves and destabilize rhythm in marital sexual relationship.