Marriage, a union between men and women is intended as a source of happiness, pleasure, compassion, love, a powerful form of communication and it typically provides a reliable means for satisfaction of sexual desires [¹]. The success of a marriage largely depends on the sexual relationship between the couple. Ignorance of the sexual need of each other has led to many broken homes as well as extra-marital affairs [¹]. Inability to perform up to the partner's expectation in a sexual relationship is usually considered as a weakness. Marthol and Hilz, [²] defined sexual dysfunction as the disturbances in sexual desire and the psycho-physiological changes that characterize the sexual response and cause marked distress and interpersonal difficulty. SD is a mixture of problems that has both biologic and psychosocial components and is multi-factorial in terms of aetiology. SD is an important public health problem that is more prevalent in women [³] than in men [⁴].

How a man would react to his wife's SD may depend on his psychological and sexual susceptibility. Inability to penetrate his wife due to her SD might lead to frustration or feeling of rejection [⁵]. A normal sexually functional man may develop secondary impotence in response to their wives' disorder [⁵].

Factors such as stress, negative emotional response, anxiety, sexual dissatisfaction and infrequency of intercourse are associated with happiness in marriage [⁶]. Frank et al., [⁷], Schenk et al., [⁸] and Lawrance et al., [⁹] also indicated that the level of sexual dissatisfaction had a negative impact on the quality of the relationship between the couples. It has been suggested that satisfaction with the sexual relationship plays a vital role in creating and maintaining a happy marriage [⁶,^10-14]. However, this relation between marital sexual satisfaction and SD has been reported to be stronger in men than in women [¹⁵]. Rust et al., [¹⁵] indicated that premature ejaculation and erectile dysfunction had a stronger relation with marital unhappiness than vaginismus and orgasm disorders in women. Whereas SD is usually perceived to be an indication of disturbed relations between spouses by family and marital therapists, sex therapists are more likely to focus on the SD in the therapeutic context. The level of non-communication and affection between marriage couples, expression of feelings and thoughts which are extremely important to a couple's marital satisfaction are usually ignored.

Generally, there is paucity of data among Africans concerning sexual dysfunction probably because of the conservative nature of most African cultures. Previous reports among Ghanaians indicated the prevalence of sexual dysfunction to be 66% among males [⁴], 73% among females [³] and 60% among men presenting with various medical conditions [¹⁶]. However, very little research if at all has examined the prevalence of SD and its subscales among African married couples as dyadic units. To date, no study has examined how such central elements of marital functioning might influence each other when predicting marital sexual satisfaction and as such the sole purpose of this study is to address such gaps.

Sexual dysfunction is defined as disturbances in sexual desire and the psycho-physiological changes that characterize sexual response and cause marked distress as well as interpersonal difficulty [²]. Several social and demographic variables have been identified to influence sexual behaviour and these include gender, race, age, education, marital status and religion. Laumann et al., [²²] reported that these variables organize the individuals' pattern of social relations and shape their understanding of the social world thus influencing their sexual behaviour. Therefore, among couples, the occurrence of sexual dysfunction in an interpersonal context will have implications for both partners in the relationship.

The relationship between the quality of sexual function in marriage and the quality of marriage and how the major social and demographic variables (e.g., gender, age, race, education etc) affect marital sex satisfaction have been extensively studied [^22-24]. The observed differences in the duration of marriage as a risk factor for sexual dysfunction in husbands and wives in this study could be attributed to the differences in sexual preference or taste and the different ways in which men and women express themselves sexually as related in the study of Laumann et al., [²²]. Other researchers have also reported that declines in frequency of marital sex with marital duration is due to the loss of novelty which is often referred to as the "honeymoon effect", meaning that the frequency of marital sex decreases because satisfaction with marital sex declines with marital duration [²⁵,²⁶]. Liu, [²⁷] explained that marital sexual actions between a husband and a wife initially bring about a relatively high level of satisfaction; therefore one can expect sexual activity to be more frequent. As marital sex increases, the level of satisfaction lowers; thus, fewer resources will be allocated to it and consequently the frequency of marital sex declines.

Considerable literature abounds on the relationship between sexual and marital dysfunction [^28-32]. The question as to the sort of sexual problems that arise when marriages are disturbed and how sexual problems affect marriages is yet to be answered. Sexual infrequency in husbands was positively linked with vaginismus and non-sensuality in the wives whilst infrequency in the wives' correlated positively with impotence, premature ejaculation and dissatisfaction. Therefore, where sex takes place less often, there could be sexual function problems in either partner which might affect the quality of marriage. Husbands in this study were not only more dissatisfied about their sexual life but also responded more to their spouse's dissatisfaction of sexual acts compared to the wives response to their spouse's dissatisfaction. This implies a reduced level of sexual satisfaction in married couples which is expressed more in the husbands than their wives. This finding agrees well with that of Derogatis et al., [³³] who stated that males were more psychologically reactive than women to their partner's sexual dysfunction and attributed it to society's definition of the man's role as the responsible partner regarding satisfaction in sexual relationships. LoPiccolo and Steger, [³⁴] found that males acceptance of their wives sexual pleasure was more important to couples overall satisfaction with the sexual relationship than females acceptance of their husbands sexual pleasure. Frank et al., [³⁵] found males sexual satisfaction to be predicted most strongly by their partner's sexual pleasure and Nowinski et al., [³⁶] reported that for males, the best predictor of sexual behaviour was their estimate of their partner's level of pleasure; for women it was self-reported pleasure.

With the note that sexual and marital dissatisfaction are generally highly related [¹⁵], correlational analyses showed that reduced sexual satisfaction in husbands was positively linked with anorgasmia, non-sensuality and infrequency in the wives. Dissatisfaction in the wives' had little impact on the subscales of the husband and this finding agrees well with that of Rust et al., [¹⁵] which stated that a woman's dissatisfaction with sexual relationship has little impact on the man's perception of marriage. Donnelly, [¹¹] further demonstrated that lower marital satisfaction is linked with a greater probability of sexual inactivity and separation demonstrating a strong link between marital and sexual satisfaction. This interpretation is further supported by the fact that the sexual dissatisfaction subscales of the GRISS are the only ones in which respondents are asked specifically about their partners rather than about themselves.

The prevalence of sexual dysfunction in husbands (as subjects) (59.2%) and wives (as subjects) (61.5%) are lower than the sexual dysfunction prevalence rates of 65.9% and 72.8% reported in Ghanaian males and females respectively [³,⁴] in our earlier studies. However, the sexual dysfunction prevalence rates in wives whose husbands have sexual dysfunction (69.8%) and husbands whose wives had sexual dysfunction (67.3%) compares well with the prevalence rates quoted for males [⁴] and females [³], depicting a greater burden of sexual dysfunction in one spouse when the other is affected and vice versa. The high prevalence rate of sexual dysfunction observed in the wives is however in agreement with the findings of Frank et al., [³⁵] and Spector et al., [³⁷] who have equally reported a high prevalence of sexual dysfunction in females. Most studies have also suggested that sexual dysfunction is more prevalent in women than in men [³⁸,³⁹].

Problems in communication have been noted as a common complaint presented by couples seeking marital therapy [^40-42]. Communication has long been considered important to sexual satisfaction and adjustment [^43-45]. Non-communication in the wives correlated positively with impotence, premature ejaculation and non-sensuality in the husbands whilst its presence in the husbands had no effect on the subscales of the wives. It could be interpreted that communication deficits, lack of confidence in communicating existing disorders and inhibitions to communication are related to this observation. This could therefore play a central role in the development and maintenance of sexual dysfunction disorders in the various subscales of the GRISS.

Is the sexual problem in each partner due to their own inherent problem or the problem is in response to the problem in their partner? Though the overall results indicated that either direction is plausible as is common causality, further study might be needed to clarify this. It seems likely that sexual dysfunction and a disorder in any of the subscales in one partner might elicit a reduction in sexual function in the other partner which could lead to marital problems.

Some of the limitations of this study include the fact that the study was based on volunteers and self-reported data on socio-demographic information. The GRISS questionnaire has also not been validated in Ghanaians and as such further studies are required to pre-validate the questionnaire among cohorts of Ghanaians.

The prevalence of sexual dysfunction in married couples is comparable to prevalence rates in the general male and female population and is further worsened by duration of marriage. This could impact significantly on a couple's self-esteem and quality of life thereby causing emotional distress leading to relationship problems. Also spouses' sexual dysfunction is related and as such in married couples, relationship with the spouse should be taken into consideration in treatment processes. It is clear that sexual education does not take place in the family. The national education system should be used more effectively for sexual education. There is a need for more comprehensive surveys, including larger population groups, to be made in order to assess the prevalence of sexual disorders and related factors.

The authors declare that they have no competing interests.

NA and WKBAO developed the concept and designed the study. NA, WKBAO, EW, LQ and CKG-S administered the questionnaire, analysed and interpreted the data. NA, LQ and CKG-S drafted the manuscript. NA, WKBAO, EWLQ and CKG-S revised the manuscript for intellectual content. All authors read and approved the final manuscript.

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2490/11/3/prepub