create the summary of the findings "3. Methods
The study was conducted in Family and Sexual Health
Division in BASIR, Neurosciences Institute affiliated to
Tehran University of Medical Sciences from July 2017 to
June 2018. Convenience sampling method was employed
and 28 couples with one SCI-affected partner referring
to BASIR Center in Imam Khomeini Hospital Complex of
Tehran were recruited.
Couples were eligible to participate in the study if: they
were > 18 years old, had incomplete or complete SCI for
more than a year; had no history of chronic psychological
and physical illnesses other than SCI; not referred to psychiatric clinics over the past six months; had no history of
substance abuse, disorders, or physical aggression; had interest in attending medical sessions; were married at least
one year before the occurrence of SCI, and did not attend
the couples’ educational programs before the study.
3.1. Larson Sexual Satisfaction Questionnaire
The Larson sexual satisfaction (SS) questionnaire includes 25 items, which are scored based on a five-point Likert scale and measures sexual satisfaction in general. Its
internal consistency (IC) based on Cronbach’s alpha coefficient was 0.93 (14).
3.2. Sexual Knowledge and Attitude Questionnaire
Sexual knowledge and attitude (SKA) questionnaire
has 30 items on sexual knowledge and attitude scored
based on a five-point Likert scale. Its IC based on Cronbach’s alpha was 0.72 (15).
3.3. Sexual Expression
Sexual expression (SE) is a five-item questionnaire
scored based on a five-point Likert scale from 1 to 5 and
measures sexual expression of the couples with each other.
Its IC was 0.77 based on Cronbach’s alpha coefficient (16).
3.4. Bagarozzi Intimacy Questionnaire
The Bagarozzi intimacy (BI) questionnaire assesses the
intimate emotional, psychological, rational, sexual, physical, spiritual, aesthetic, and sociopsychological aspects. It
has 41 items, which are scored based on a 10-point Likert
scale from 1 (there is no need at all) to 10 (there is a huge
need). The reliability of the questionnaire was 0.94 based
on Cronbach’s alpha (17, 18).
3.5. ENRICH Marital Satisfaction Questionnaire
ENRICH marital satisfaction (EMS) questionnaire with
47 items evaluates marital relationship issues including
marital satisfaction, personality issues, communication,
conflict resolution, financial management, leisure activities, sexual relationship, children and parenting, family
and friends, egalitarian roles, and religious orientation.
Each item is scored based on a five-point Likert scale from 1
to 5. The Cronbach’s alpha coefficient of the questionnaire
was 0.68, 0.78, 0.62, and 0.77, respectively (19).
3.6. Marital Adjustment Questionnaire
Marital adjustment (MA) questionnaire contains 32
items and addresses the quality of marital relationship.
The total reliability of the scale was 96%, reported by
Cronbach’s alpha, which had a significant IC. In a study
conducted in Iran, researchers achieved a high IC (95%)
throughout the questionnaire (20).
3.7. Female Sexual Function Index
Female sexual function index (FSFI) has six domains of
desire, arousal, lubrication, orgasm, satisfaction, and pain
in a total of 19 items that are scored based on a six-point
Likert scale from 0 to 5. The Cronbach’s alpha value of the
FSFI was 0.82 and even higher (21).
3.8. International Index Erectile Function
International index erectile function (IIEF) has five areas of erectile function, orgasm, sexual desire, satisfaction
with intercourse, and overall satisfaction in a total of 15
items scored based on a six-point Likert scale from 0 to 5.
The total Cronbach’s alpha for the IIEF was 0.91 and higher
(22).
Since, to the authors’ best knowledge, there was no
similar study on couples with SCI, and based on studies
conducted on healthy couples and measuring similar variables (23), and using the proper formula, the minimum
number of samples required in each group was 13. With the
probability of a 10% dropouts in response rate, confidence
interval (CI) of 95%, and power of 90%, the sample size was
determined 28 couples.
3.9. Statistical Analysis
Chi-square test, the Pearson and Spearman correlation
coefficients, and the Student t-test were employed to analyze the data with SPSS version 21.
3.10. Ethical Considerations
All participants were informed about the research objectives by a trained research assistant. The participants
were assured about the confidentiality of their information, and verbal and written informed consent was obtained from them. The current study protocol was approved by the Ethics Committee of Tehran University of
Medical Sciences (ethical code: IR.TUMS.REC.1394.1963).
4. Results
The couples with one SCI-affected partner (20 males,
eight females) were enrolled into the study. Table 1 shows
the demographic characteristics of the subjects in SCI and
non-SCI groups. The participants were in theirmiddle ages.
Length of marriage (LOM) was not long. Living with SCI in
the SCI group was not longer than 4 - 5 years.
Table 2 separately compares the mean scores of male
and female subjects with and without SCI. There was no statistically significant difference between male and female
2 Arch Neurosci. 2019; 6(2):e83940.
Salmani Z et al.
Table 1. The Baseline Characteristics of Male and Female Subjects with and Without SCIa
Characteristics Male (N = 28) Female (N = 28)
SCI = 20 Non-SCI = 8 SCI = 8 Non-SCI = 20
Age, y 39.65 ± 9.483 37 ± 9.067 34.88 ± 10.412 41.38 ± 10.155
LOM, y 13.50 ± 9.703 8.25 ± 6.519
Duration of living with SCI, y 5.15 ± 3.815 4.63 ± 3.249
Mean number of children 1.75 ± 1.33 0.87 ± .991
Sample education level
Uncompleted diploma 7 (100) 0 (0.00) 0 (0.00) 5 (100)
Diploma 8 (80) 6 (37.5) 2 (20) 10 (62.5)
Bachelors’ degree 5 (45.5) 2 (28.6) 6 (54.5) 5 (71.4)
Occupational status
Employed 6 (54.5) 4 (33.3) 5 (45.5) 8 (66.7)
Unemployed 14 (82.4) 4 (33.3) 3 (17.6) 12 (75)
Abbreviations: LOM, length of marriage; SCI, spinal cord injury.
a
Values are expressed as Mean ± SD or No. (%).
subjects with SCI regarding the mean scores of SS (P =
0.684), EMS (P = 0.779), BI (P = 0.246), SKA (P = 0.540), SE
(P = 0.474), and MA (P = 0.378). There was no significant
difference between male and female subjects without SCI
in the mean scores of SS (P = 0.270), EMS (P = 0.772), BI
(P = 0.829), SE (P = 0.242), and MA (P = 0.084), but significant in SKA (P = 0.033). FSFI in female subjects with and
without SCI was 17.92 and 17.63, respectively compared with
FSFI cutoff point (26.5), and showed that female subjects in
both groups had sexual dysfunction. IIEF score of male subjects with SCI was 42.25 that indicated sexual dysfunction
in comparison with IIEF cutoff point (40). IIEF in male subjects without SCI was 71.62 that showed no sexual dysfunction in comparison with IIEF cutoff point (40).
Comparison of the mean scores of questionnaires in
the groups SCI and non-SCI by chi-square test showed no
significant difference in SS (P = 0.936), SKA (P = 0.405), SE (P
= 0.695), and FSFI (P = 0.927). There was a significant difference in EMS (P = 0.012), BI (P = 0.035), MA (P = 0.000), and
IIEF (P = 0.001) (Table 3).
Results of the Pearson correlation coefficient indicated
no significant correlation between the mean scores of FSFI
and IIEF and the sociodemographic characteristics including sample age, partner age, LOM, duration of living with
SCI, education level of the sample, education level of the
partner, mean number of children, and occupational status (P > 0.05). The current study findings based on Spearman correlation coefficients showed a significant negative
correlation between SS score and sample age (P < 0.009, r
= -0.486), partner age (P < 0.002, r =-0.549), and LOM (P =
0.05, r = -0.374). There was an obvious negative correlation
between the scores of SKA and LOM (P = 0.02, r = -0.374). Results of Spearman correlation coefficients showed no significant correlation between sociodemographic characteristics and scores obtained from other questionnaires (P >
0.05) (Table 4)."