Document Type : Original Article


Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran


BACKGROUND: Infertility is one of the main concerns in women’s lives that may lead to psychological
imbalance and disrupt their sexual relationship. The study was conducted with the aim of evaluating
role of mental health in prediction of sexual function in infertile women.
MATERIALS AND METHODS: This analytic‑descriptive study was conducted in 2015–2016 in
424 infertile women referring to Fatemeh Zahraa Infertility and Reproductive Health Center, Babol,
Iran. The participants filled out the Female Sexual Function Index (α = 0.72–0.90), General Health
Questionnaire (GHQ‑28, α = 0.86), and demographics questionnaires. Linear regression used to
analyze the data.
RESULTS: The mean of total GHQ was 23.57 ± 12.06. The highest mean of GHQ subscales was
social dysfunction (8.68 ± 3.69). There was a negative association between GHQ with the overall
sexual function of infertile women (r = −0.397, P < 0.0001). The higher mental health disorder was
associated with lower sexual function. Furthermore, there was an inverse significant association
between all the subscales of mental health and sexual function. Based on the multiple linear regression
analysis, the variables of anxiety and sleep disorder (β = −0.143, P < 0.035), social dysfunction
(β= −0.139, P < 0.003), depression symptoms (β = −0.121, P < 0.046), sexual intercourse frequency
(β = 0.272, P < 0.0001), and educational level (β = −0.110, P < 0.016) were the significant predictors
of perceived sexual dysfunction after adjusting for other variables. The strongest predictor of the
GHQ subscale was anxiety and sleep disorder.
CONCLUSIONS: Undesirable conditions of mental health and its adverse effects on sexual function
and also other predictors emphasize the need to develop more effective screening and supportive
strategies with the help of the psychologists.


  1. Galderisi S, Heinz A, Kastrup M, Beezhold J. Norman sartorius
    toward a new definition of mental health. World Psychiatry
    2. World Health Organization. Mental Health: Strengthening
    our Response. World Health Organization; 2018. Available
    from: https://www.‑room/fact‑sheets/detail/
    3. Lamers SM, Westerhof GJ, Bohlmeijer ET, ten Klooster PM,
    Keyes CL. Evaluating the psychometric properties of the Mental
    Health Continuum‑Short Form (MHC‑SF). J Clin Psychol
    4. Pakpour AH, Yekaninejad MS, Zeidi IM, Burri A. Prevalence
    and risk factors of the female sexual dysfunction in a sample of
    infertile Iranian women. Arch Gynecol Obstet 2012;286:1589‑96.
    5. Zarepour M, Asoodeh M. Mental health of couple: The role of
    marital intimacy and communication patterns. In: 2th National
    Conference on Psychlogy (Family Psychology). 2012 7‑9 March
    2012; Islamic Azad University: Marvdasht Branch Iran; 2012.
    p. 1‑5.
    6. NIH. National Institute of Mental Health. Mental Health
    Information; 2018.
    7. Doyle M, Carballedo A. Infertility and mental health. Adv
    Psychiatric Treatment 2014;20:297‑303.
    8. Faramarzi M, Kheirkhah F, Esmaelzadeh S, Alipour A,
    Hjiahmadi M, Rahnama J. Is psychotherapy a reliable alternative
    to pharmacotherapy to promote the mental health of infertile
    women? A randomized clinical trial. Eur J Obstet Gynecol Reprod
    Biol 2008;141:49‑53.
    9. Cunha MD, Carvalho JA, Albuquerque RM, Ludermir AB,
    Novaes M. Infertility: Association with common mental
    disorders and the role of social support. Rev Psiquiatr Rio Gd
    Sul 2008;30:201‑10.
    10. Mohammadi M, Khalajabadi Farahani F. Emotional and
    psychological problems of infertility and strategies to overcome
    them. J Reproduct Infertility 2001;4:33‑9.
    11. Pasha H. Evaluation of depression in infertile women using beck
    and Hamilton. IJFS 2011;5:22.
    12. Faramarzi M, Alipor A, Esmaelzadeh S, Kheirkhah F, Poladi K,
    Pash H. Treatment of depression and anxiety in infertile women:
    Cognitive behavioral therapy versus fluoxetine. J Affect Disord
    13. Pasha H, Basirat Z, Faramarzi M, Kheirkhah F. Pharmacological
    and Non‑pharmacological therapeutic strategies for improvement
    of state‑trait anxiety: A randomized controlled trial among Iranian
    infertile women with sexual dysfunctions. Crescent J Med and
    Biol Sci 2017;4:47‑53.
    14. RamezanzadehF, NoorbalaAA, AbediniaN, Rahimi ForooshaniA,
    Naghizadeh MM. Psychiatric intervention improved pregnancy
    rates in infertile couples. Malays J Med Sci 2011;18:16‑24.
    15. Faramarzi M, Pasha H, Esmailzadeh S, Kheirkhah F, Heidary S,
    Afshar Z. The effect of the cognitive behavioral therapy and
    pharmacotherapy on infertility stress: A randomized controlled
    trial. Int J Fertil Steril 2013;7:199‑206.
    16. Zemishlany Z, Weizman A. The impact of mental illness on sexual
    dysfunction. Adv Psychosom Med 2008;29:89‑106.
    17. Peyvandi S, Hosseini S, Daneshpour M, Mohammadpour R,
    Qolami N. The prevalence of depression, anxiety and marital
    satisfaction and related factors in infertile women referred to
    infertility clinics of sari city in 2008. J Mazand Univ Med Sci
    18. Correti G, Baldi I. The relationship between anxiety disorders
    and sexual dysfunction. Psychiatric Times J 2007;24:58‑9.
    19. ShoaaKazemi M, Javid Momeni M. The relationship between
    mental health and bad sexual function in women with breast
    cancer in Tehran. Iranian J Br Dis 2011;4:48‑56.
    20. Pasha H, Basirat Z, Esmailzadeh S, Faramarzi M, Adibrad H.
    Marital intimacy and predictive factors among infertile women
    in Northern Iran. J Clin Diagn Res 2017;11:QC13‑17.
    21. Pasha H, Faramarzi M, BasiratZ, Kheirkha F, Shafee H. Evaluation
    of sexual dysfunction and its associated risk factors in the male
    partners of the infertile couples using International Index of
    Erectile Function. Turk J Obstet Gynecol 2020;17:1‑8.
  2. 22. LewisRW, Fugl‑MeyerKS, BoschR, Fugl‑MeyerAR, LaumannEO,
    Lizza E, et al. Epidemiology/risk factors of sexual dysfunction.
    J Sex Med 2004;1:35‑9.
    23. Faubion SS, Rullo JE. Sexual dysfunction in women: A practical
    approach. Am Fam Physician 2015;92:281‑8.
    24. Samadaee‑Gelehkolaee K, McCarthy BW, Khalilian A,
    Hamzehgardeshi Z, Peyvandi S, Elyasi F, et al. Factors associated
    with marital satisfaction in infertile couple: A comprehensive
    literature review. Glob J Health Sci 2015;8:96‑109.
    25. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R,
    et al. The female sexual function index (FSFI): A multidimensional
    self‑report instrument for the assessment of female sexual
    function. J Sex Marital Ther 2000;26:191‑208.
    26. Basirat Z, Pasha H, Esmailzadeh S, Faramarzi M. Evaluation of
    the female sexual dysfunction in a sample of Iranian infertile
    women. Br J Med Res 2014;4:5825‑38.
    27. Fakhri A, Pakpour AH, Burri A, Morshedi H, ZeidiIM. The female
    sexual function index: Translation and validation of an Iranian
    version. J Sex Med 2012;9:514‑23.
    28. Goldberg DP, Hillier VF. A scaled version of the General Health
    Questionnaire. Psychol Med 1979;9:139‑45.
    29. Aderibigbe YA, Riley W, Lewin T, Gureje O. Factor structure of
    the 28‑item general health questionnaire in a sample of antenatal
    women. Int J Psychiatry Med 1996;26:263‑9.
    30. HasanpourS, BaniS, MirghafourvandM, Yahyavi KochaksarayieF.
    Mental health and its personal and social predictors in infertile
    women. J Caring Sci 2014;3:37‑45.
    31. Shayan A, Kaviani M, Azima S, Masoumi SZ, Haghpanah S,
    Gholamzadeh S, et al. Relationship between general health indices
    and sexual dysfunction in women experiencing spousal abuse.
    Glob J Health Sci 2016;8:275‑81.
    32. Noorbala A, Bagheri Yazdi S, Mohammad K. The validation of
    general health questionnaire‑ 28 as a psychiatric screening tool.
    Hakim Res J 2009;1:47‑53.
    33. Hasanpoor‑Azghdy SB, Simbar M, Vedadhir A. The
    emotional‑psychological consequences of infertility among
    infertile women seeking treatment: Results of a qualitative study.
    Iran J Reprod Med 2014;12:131‑8.
    34. Podolska MZ, Bidzan M. Infertility as a psychological problem.
    Ginekol Pol 2011;82:44‑9.
    35. Baghiani Moghadam MH, Aminian AH, Abdoli AM, Seighal N,
    Falahzadeh H, Ghasemi N. Evaluation of the general health of
    the infertile couples. Iran J Reprod Med 2011;9:309‑14.
    36. Araoye MO. Epidemiology of infertility: Social problems of the
    infertile couples. West Afr J Med 2003;22:190‑6.
    37. Pasha H, Faramarzi1 M, Esmailzadeh S, Kheirkhah F, Salmalian H.
    Comparison of pharmacological and nonpharmacological
    treatment strategies in promotion of infertility self‑efficacy scale
    in infertile women: A randomized controlled trial. Iran J Reprod
    Med 2013;1:495‑502.
    38. Faramarzi M, Pasha H, Esmailzadeh S, Kheirkhah F,
    Hajian‑Tilaki K, Salmalian1 H. A survey of correlation infertility
    self‑efficacy with behavioral health scales in infertile women.
    Health 2014;6;943‑49.
    39. Abbey A, Andrews F, Halman LJ. Gender’s role in responses to
    infertility. Psychol Women Quarterly 1991;15:295‑316.
    40. Fanni E, Castellini G, Corona G, Boddi V, Ricca V, Rastrelli G, et al.
    The role of somatic symptoms in sexual medicine: Somatization
    as important contextual factor in male sexual dysfunction. J Sex
    Med 2016;13:1395‑407.
    41. Montesi J, Conner B, Gordon E, Fauber R, Kim K, Heimberg R.
    Relationship among social anxiety, intimacy, sexual
    communication, and sexual satisfaction in young couples. Arch
    Sexual Behav 2013;42:81‑91.
    42. Sadock B, Sadock VA. Kaplan and Sadock’s Synopsis of
    Psychiatry: Behavioral Sciences/Clinical Psychiatry. New York:
    Lippincott Williams & Wilkins 2011.
    43. Christensen B, Grønbaek M, Osler M, Pedersen B, Graugaard C,
    Frisch M. Associations between physical and mental health
    problems and sexual dysfunctions in sexually active Danes. J Sex
    Med 2011;8:1890‑902.
    44. Kennedy SH, Rizvi S. Sexual dysfunction, depression, and the
    impact of antidepressants. J Clin Psychopharmacol 2009;29:157‑64.
    45. Pasha H, BasiratZ, Faramarzi M, Kheirkhah F, Khafri S. Predictive
    factors of antidepressant response and remission to bupropion
    extended‑release or psychosexual therapy among infertile women
    with sexual dysfunction. Int J Women’s Health Reproduc Sci
    46. Pasha H, Basirat Z, Faramarzi M, Kheirkhah F. Comparative
    effectiveness of antidepressant medication versus psychological
    intervention on depression symptoms in women with infertility
    and sexual dysfunction. Int J Fertil Steril 2018;12:6‑12.
    47. Lin CF, JuangYY, Wen JK, Liu CY, Hung CI. Correlations between
    sexual dysfunction, depression, anxiety, and somatic symptoms
    among patients with major depressive disorder. Chang Gung
    Med J 2012;35:323‑31.
    48. Kalmbach DA, Arnedt JT, Pillai V, Ciesla JA. The impact of sleep
    on female sexual response and behavior: A pilot study. J Sex Med
    49. Amasyali AS, Taştaban E, Amasyali S, Turan Y, Kazan E, Sari E,
    et al. Effects of low sleep quality on sexual function, in women
    with fibromyalgia. Int J Impot Res 2015;19:1‑4.
    50. Reddy RM, Saravanan RA, Praharaj SK, Thirunavukarasu M.
    Sexual dysfunction in women with depression: A hospital‑based
    cross‑sectional comparative study. Indian J Psychol Med
    51. Bakhshayesh A, Mortazavi M. The relationship between sexual
    satisfaction, general health and marital satisfaction in couples.
    J Applied Psychology 2010;3:73‑85.
    52. Amirkhani Z, Jangholi E, Ramezi P, Shafiei M, Saberi M,
    Sadreddini N, et al. Prevalence survey of sexual dysfunction
    among women in the reproductive age group referred to the
    Islamic Azad University Hospital During 2011‑2012. GMJ
    53. Swihart PJ, Wooten W. Frequency of Marital Intercourse. Illinois,
    USA: Tyndale House Publishers; 2006.
    54. Varcarolis E. Foundations of Psychiatric Mental Health Nursing.
    New York: W.B. Saunders Company; 1990.
    55. Dosch A, Rochat L, Ghisletta P, Favez N, van der Linden M.
    Psychological factors involved in sexual desire, sexual activity,
    and sexual satisfaction: A multi‑factorial perspective. Arch Sex
    Behav 2016;45:2029‑45.