Peer-reviewed article

Social Determinants of Health and Quality of Sexual Life Among Married Women in Behshahr, Iran, in 2023: A Cross-Sectional Study.

Farangis Habibi, Soghra Khani, Hoseinnataj Abolfazl, Razieh Afra · 11 May 2026

Abstract

Sexual health is a multidimensional aspect of women's well-being, yet its intersection with social determinants of health (SDH) remains critically underexplored in culturally conservative settings. In such contexts, sociocultural norms often obscure open discourse and research on sexual quality of life (QoSL), despite its central role in marital satisfaction and overall health. This study addresses this gap by examining the relationship between SDH and QoSL among married women in Behshahr, Iran. This study aimed to examine the associations between key social determinants of health and sexual quality of life, marital satisfaction, and perceived social support among married women of reproductive age in Behshahr, Iran. A descriptive cross-sectional study was conducted in 2023 among 380 married women aged 16 to 52 years, recruited through stratified random sampling from 6 healthcare centers in Behshahr, Iran. Data collection instruments included: Sociodemographic Form (SDF), Sexual Quality of Life-Female (SQOL-F) questionnaire, ENRICH Marital Satisfaction (EMS) scale, Multidimensional Scale of Perceived Social Support (MSPSS), Statistical analyses were performed using SPSS v26 and AMOS v26. Descriptive statistics (mean, SD, frequency) summarized the data. Inferential analyses included Pearson correlation, multiple linear regression (MLR), and confirmatory factor analysis (CFA). A significance level of P ≤ .05 was applied. The mean age of participants was 33.08 ± 5.31 years. The average scores were: QoSL = 90.92 ± 13.08, marital satisfaction = 162.16 ± 25.05, and perceived social support = 48.63 ± 11.62. A statistically significant but weak positive correlation was found between QoSL and marital satisfaction (r = .15, P = .004). Husband's education, socioeconomic status, and place of residence emerged as significant predictors of QoSL. Marital satisfaction was modestly associated with women's employment status and vehicle ownership. Perceived social support was positively influenced by socioeconomic status and number of children. Confirmatory factor analysis supported the structural relationships among the 3 constructs. Sexual quality of life and marital satisfaction are significantly shaped by social determinants such as education, occupation, socioeconomic status, and living conditions. These findings highlight the need for public health strategies and social policies that address structural inequalities to promote sexual and relational well-being among women.