Sexual functions and marital adjustment among persons with alcohol use disorder

Navneet Kaur; Manoj Kumar Bajaj; Ajeet Sidana

doi:10.4103/jmhhb.jmhhb_29_18

ORIGINAL ARTICLE

Year : 2018 | Volume : 23 | Issue : 2 | Page : 120-124

Sexual functions and marital adjustment among persons with alcohol use disorder

Navneet Kaur, Manoj Kumar Bajaj, Ajeet Sidana
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India

Date of Web Publication

14-Nov-2019

Correspondence Address:
Manoj Kumar Bajaj
Assistant Professor of Clinical Psychology, Department of Psychiatry, Room No. 4210, Level 4, B Block, GMCH-32, Chandigarh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jmhhb.jmhhb_29_18

Abstract

Background: Relationship between sexual functioning and marital adjustment has been widely studied; further, the alcohol use has been found to be an important factor in the marital adjustment, but these variables are not much researched together. Aim: The aim of the study is to examine the sexual functions and marital adjustment among persons with alcohol use disorder. Setting and Design: The current study was carried out at the department of psychiatry in a tertiary care hospital of North India, which followed the cross-sectional, single-assessment exploratory study design. Materials and Methods: A total number of 50 male patients with alcohol use disorder and their spouses from the de-addiction clinic of the outpatient services of the department of psychiatry were recruited. Patients who were in the age range of 25–50 years, married for at least 1 year, and came in contact for the first time for treatment for alcohol use disorder were included. Patients having diagnosable comorbid major psychiatric disorder which requires immediate pharmacological treatment, having any medical or neurological comorbid illness that can lead to sexual dysfunction, and/or on any medication which is known for affecting sexual functioning and severe withdrawal or intoxicated at the time of assessment were excluded from the study. Patients were assessed using Diagnostic and Statistical Manual of Mental Disorders-5 Diagnostic Criteria for sexual dysfunctions and severity of alcohol dependence questionnaire for assessing the severity of alcohol dependence, while participants and their spouses were assessed on marital adjustment questionnaire for measuring marital adjustment among them. Results and Conclusion: Fifty-four percent of the patients with alcohol use disorder had sexual dysfunctions. The prevalence of premature ejaculation was the most, followed by decline in sexual desire or hypoactive sexual disorder and then erectile dysfunction; majority of them had more than one sexual dysfunction. No significant difference was found in the marital adjustment between the couples with and without sexual dysfunctions. There was no correlation between marital adjustment and alcohol dependence severity found in the present study.

Keywords: Alcohol dependence, marital adjustment, sexual dysfunctions

How to cite this article:
Kaur N, Bajaj MK, Sidana A. Sexual functions and marital adjustment among persons with alcohol use disorder. J Mental Health Hum Behav 2018;23:120-4

How to cite this URL:
Kaur N, Bajaj MK, Sidana A. Sexual functions and marital adjustment among persons with alcohol use disorder. J Mental Health Hum Behav [serial online] 2018 [cited 2023 Mar 31];23:120-4. Available from: https://www.jmhhb.org/text.asp?2018/23/2/120/270986

Introduction

Alcohol use disorder can be a leading cause for sexual dysfunctions and leads to difficulty in marital adjustment.^[1] Sexual dysfunctions are clinical conditions characterized by abnormalities of sexual desire and psychophysiological modifications of the sexual response cycle, which can lead to distress and interpersonal difficulties.^[2] Marital adjustment is an important component in a marriage. Alcohol abuse and marital adjustment are also coexisting variables. Research suggests that alcohol abuse can lead to a lot of problems in marital adjustment. Alcoholism is believed to cause severe social consequences on a person's life.^[3] Domestic violence, marital conflict, legal problems, and isolation from friends and family are also common results of alcohol abuse, impacting the marital adjustment and disrupting interpersonal relationship.^[4] There are quite a number of research articles and textbooks that have accounted for alcohol dependence as one of the leading factors for causing sexual dysfunction.^[5] A study conducted at NIMHANS, Bengaluru, found that 72% of the subjects with alcohol dependence syndrome had sexual dysfunctions and the most evident was premature ejaculation, then low desire for sex, and erectile dysfunctions. It was also noted that the amount of alcohol consumed plays an important role in developing sexual dysfunctions. Another study in 2017 reported that about 60% of patients with alcohol dependence syndrome had sexual dysfunctions.^[6] In another study which suggested that in patients who had a history of long-standing use of alcohol, the results adumbrate that the prevalence of lack of sexual desire varies from 51% to 58%, of erectile dysfunction ranges from 16% to 59%, and of premature ejaculation ranges from 4% to 15.9%.^[7] A number of factors leading to increased marital conflict and issues in marital adjustment have been accounted for. Another prospective study which consisted of 634 couples found that increased and large amount of alcohol consumption led to increased marital dissatisfaction, leading to problems in marital adjustment.^[8] The relationship between sexual functioning and marital adjustment is very important as studies suggest that these two variables are codependent on each other. In a recent Indian study, it reported that the correlation between sexual functioning and marital adjustment in the couples was positive, suggesting that good sexual functioning does impact positively on marital adjustment.^[9]

Need for the study

Sexual functions, marital adjustment, and alcohol use disorder are invariably dependent on each other. The prevalence of sexual dysfunctions among persons with alcohol use disorder is widespread. Most of the studies conducted have had the limitations of using simple and subjective tools for measuring sexual dysfunctions such as Arizona Sexual Experiences scale^[10] which has only five items on 1–6 Likert scale, sexual dysfunction checklist, etc., heterogeneity in sampling and inability to control extraneous variables such as side effect of medicines on sexual dysfunctions. Further, alcohol dependence, marital satisfaction, and sexual functioning have been extensively researched individually, but not in relation to each other. Therefore, the current study was planned in overcoming the above limitations using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 Criteria for sexual dysfunction and with the aim to study the relationship between the severity of different types of sexual dysfunctions and severity of alcohol use disorder, impacting marital adjustment.

Materials and Methods

An exploratory, single-assessment, cross-sectional design was employed to achieve the aim of the study. The current study has approval from the research and ethics committee of the institute. A total number of 50 male patients from the age range of 25–50 years, diagnosis of alcohol use disorder as per the DSM-5 confirmed by the consultant psychiatrist were recruited after screening as per se lection criteria out of 99 consecutive patients who visited outpatient services of the department of psychiatry. Selected patients gave their consent and fulfilled the selection criteria as they have to be accompanied by their spouse, married for at least 1 year and staying with spouse, and seeking treatment for the first time in the department, between the age range of 25 and 50 years. Of 99 patients, 49 did not include as they did not fulfill the selection criteria. Patients (n = 28) were already on follow-up and not accompanied with spouses (n = 5); detailed general physical examination and psychiatric evaluation by the expert psychiatrist was conducted, and patients having comorbid psychotic illness, patients having medical or neurological comorbid illness, patients on any medications which can cause sexual dysfunctions, dependence on other substance, except nicotine and caffeine, and patients in severe withdrawal state or intoxicated at the time of assessment and requiring pharmacological intervention were (n = 12); and (n = 4) patients did not match the age criteria were excluded from the study. Enrolled patient's consent was obtained. Sociodemographic and clinical details were collected on semi-structured pro forma prepared for the study. Patients were administered measures for severity of alcohol dependence, sexual dysfunctions, and marital adjustment on specified tests by an M. Phil Clinical Psychology trainee who received training from expert clinical psychologist. After the data collection, all the patients were referred back to a treating consultant.

Tools

Severity of alcohol dependence questionnaire

Severity of alcohol dependence questionnaire (SADQ)^[10] is a 20-item questionnaire designed to measure the severity of dependence on alcohol. It is divided into five subscales: physical withdrawal symptoms, affective withdrawal symptoms, craving and withdrawal relief drinking, consumption, and reinstatement. Answers to each question are rated on a four-point scale: almost never – 0, sometimes – 1, often – 2, and nearly always – 3. A score of 31 or higher indicates “severe alcohol dependence.” A score of 16–30 indicates “moderate dependence.” A score below 16 usually indicates only mild physical dependency. A detoxification regimen is usually indicated for someone who scores 16 or over. It has been found to have particularly good reliability and validity compared to a number of major self-report questionnaires.

Marital adjustment questionnaire

Marital adjustment questionnaire (MAQ) was developed by Dr. Pramod Kumar and Dr. Kanchana.^[11] The MAQ has totally 25 “Yes–No”-type items divided into three areas such as sexual, social, and emotional. It is a frequently used tool in Indian studies. According to this questionnaire, the higher the score, better is the adjustment. This scale has a reliability of 0.71 and a validity of 0.84.

Diagnosis and Statistical Manual for Mental Disorders-5 Criteria for diagnosing sexual dysfunctions and severity^[12]

Premature (early) ejaculation (302.75[F52.4])
Male hypoactive sexual desire disorder (302.71 [F52.0])
Erectile disorder (302.72 [F52.21]).

Statistical analysis

The obtained findings were analyzed using Statistical Package for the Social Sciences) version 20.0 (IBM Corp, Armonk, New York, USA). Descriptive statistics were used to study the frequency data of various sociodemographic characteristics of the sample selected and to find out the prevalence of sexual dysfunctions and other variables used in the study. Independent t-test was used to compare marital adjustment in male patients and their spouse with or without sexual dysfunctions. Pearson correlation was used to ascertain the correlation between severity of alcohol dependence with marital adjustment in the male patients and their spouse. Results obtained are presented in the following tables.

Results

Majority, 54% of the participants, are of 41–50 years of age followed by 36% in the 31–40 years of age. Considering the education status of the participants, 44% were uneducated followed by 24% 10^th pass and 20% 10+2 pass, and 12% graduate. Maximum persons, i.e., 82%, were from high socioeconomic status. Sixty-two percent were from urban background and the rest were from rural background. Fifty-two percent of the participants were shop owners or farmers or clerks followed by 32% semi-professionals, 10% professionals, and 6% unemployed. 30%, 28%, 22%, 18%, and 2% of the participants regularly take alcohol quantity as full bottle, half bottle, quarter bottle, 1.5 bottle, and two full bottles, respectively. Sexual dysfunctions were found in the 54% (n = 27) of the participants of which premature ejaculation was in nine participants, hypoactive sexual dysfunction in five participants, and erectile dysfunction in one participant. Twelve out of 27 participants had more than one sexual dysfunction. On measures of alcohol dependence severity, participants who have mild severity had 23% sexual dysfunction, moderate severity had 50% sexual dysfunctions, and severe severity had 26.93% sexual dysfunctions [Table 1].

Table 1: The sociodemographic and clinical variables with frequency and percentage (n=50)

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From [Table 2], correlation between SADQ and MAQ of male participants was found to be −0.091 and of females was −0.87, which was insignificant. Further, difference between the two groups such as participants with sexual dysfunctions and participants without sexual dysfunctions on MAQ assessed by the male and female was found to be insignificant.

Table 2: The difference between marital adjustment of patients and their spouses with and without sexual dysfunctions (n=50)

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Discussion

The prevalence of sexual dysfunctions in alcohol use disorder individuals in the study was found to be 54%, which is in accordance to the studies carried out in the past that suggests the prevalence of sexual dysfunctions in alcohol use disorder ranges from 40% to 95.2%. Similar results of 58% prevalence of sexual dysfunction in alcohol dependence syndrome were found in a study conducted in North India.^[13] These findings are indicative of low prevalence of sexual dysfunction in alcohol dependence syndrome in studies conducted in Northern India^[14] as compared to Southern India.^[15],[16]

High prevalence of sexual dysfunctions in alcohol dependence in South Indian subjects may be because these patients were assessed during inpatients treatment and might be having severe level of dependence, having medical/surgical/psychiatric comorbidity, and on treatment, whereas the current study has controlled the above factors.

There are several studies^{[14],[15],[16]} that have reported the prevalence of sexual dysfunctions in alcohol dependence syndrome; however, not many have reported the severity and types of sexual dysfunctions in terms of mild, moderate, or severe sexual dysfunction and have also mentioned this as a variable for further researchers. To examine this, a DSM-5 Criterion was used to be able to find out the severity of the sexual dysfunctions in this study. Findings indicate that majority of patients with alcohol dependence had mild level of sexual dysfunction of all types [Table 1]. The prevalence of premature ejaculation was the most prevalent, followed by decline in sexual desire or hypoactive sexual disorder and then erectile dysfunction. Majority of them had more than one sexual dysfunction of varying severity. The level of severity of sexual dysfunctions is important to assess the level of distress which plays an important role in the treatment.

Further, the prevalence of sexual dysfunctions in accordance with severity of alcohol dependence in the present study was found to be 23.07% in persons with mild alcohol dependence, 50% in persons with moderate alcohol dependence, and around 26.9% in persons with severe alcohol dependence. Majority of the participants with sexual dysfunctions had moderate level of alcohol dependence. Similar results were found in a study conducted in South India,^[17] where the impact of severity of alcohol use in sexual dysfunctions was studied. The results found in the study in South India were similar to the present study; the prevalence of sexual dysfunctions in moderate alcohol-dependent subjects was more than in the severe alcohol-dependent subjects.^[6] The correlation between the severity of alcohol dependence and sexual dysfunctions is said to be significant in many studies which imply that the amount of alcohol is invariability associated with developing sexual dysfunctions. Impotence both erectile and ejaculatory, desire problems, and unpleasant ejaculation are said to be reported due to large amount of alcohol consumption.

The correlations between severity of alcohol consumption and marital adjustment reported by male participants (r = −0.09) and reported by their wives (r = −0.08) were insignificant. Hence, severity of alcohol consumption and perception of marital adjustment by both the partners did not have any significant association in the present study. It can be further interpreted that severity of alcohol dependence did not have any impact on marital adjustment scores which was even reported by the spouses. Furthermore, it is interesting to find that participants with alcohol dependence and their spouses have significant higher correlation in the marital adjustment domain, which shows higher consistency with their counterparts on marital adjustment. These findings do not match with the finding in the other studies.^[14] This may be because of the higher the age range of the patients and their spouses as majority of them from 41 to 50 years of age [Table 1] and also severity of sexual dysfunction was mild in majority of the patients which may have affected the perception of marital adjustment similar to their counterparts. Similarly, no significant difference [Table 2] was found in marital adjustment in the participants with sexual dysfunctions or without sexual dysfunctions which means that the marital adjustment in the couple was not affected even if the male alcohol-dependent patients had sexual dysfunctions. In other words, their presence, absence, and their severity of sexual dysfunctions did not have any significant impact on the marital adjustment was reported by the individual with alcohol dependence and their spouses. This also suggests no contribution of sexual dysfunction affected their marital adjustment. The results of this present study are not in accordance with other studies that have suggested good sexual functioning played an important role in marital adjustment. It could also be possible that the main concern of spouses was to get treatment of alcohol dependence and which overshadow the concern of sexual dysfunction. In a recent Indian study in 2009, the correlation between sexual functioning and marital adjustment in the women and in their male spouses was studied. The results of the study suggested that the correlation between sexual functioning and marital adjustment in the couples was positive, also suggesting that good sexual functioning does impact positively on marital adjustment.^[18] Tools such as MAQ, quality of life questionnaire, and family interaction scale have been used to get better analysis and findings, while in this present study, only one tool of MAQ was used which might explain the difference in the results.

This may also be because of the higher the age range of the patients and their spouses as majority of them from 41 to 50 years of age [Table 1], and also, severity of sexual dysfunction was mild in majority of the patients which may have resulted into no significant differences in the perception of marital adjustment. Increasing the number of subjects and of early age will help to study the exact impact of sexual dysfunctions on marital adjustment.

Apart from the following limitations of small sample size, assessment of wives sexual functioning, lack of control group, and inadequate sexual history, the current study has some strengths as participants were enrolled only first visit patients with alcohol dependence with the purpose to rule out any effect of the medication on the sexual performance of the patients; also, marital adjustment in the male participants was measured which has not been done in the previous studies. DSM-5 Criteria were used to diagnose and assess the severity of sexual dysfunctions and severity of sexual dysfunction and the severity of alcohol dependence assessed which can be helpful in planning treatment.

Conclusion

It can be concluded that more than half of the patients of alcohol use disorder had sexual dysfunctions. The most prevalent sexual dysfunctions were premature ejaculation followed by hypoactive sexual dysfunction and then finally erectile dysfunction and also the more than one sexual dysfunction present. Mild level of sexual dysfunction of all types can be present in alcohol use disorder. The prevalence of sexual dysfunction is most in participants with moderate level of alcohol dependence. Marital adjustment is an important factor which is related to the sexual dysfunctions among patients with alcohol use disorder although present study did not find any significant association, therefore further studies are required to comment on this.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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