Relationship between the frequency and duration of masturbation and the sexual health literacy and sexual function of women in western Turkey: a cross-sectional study

Abstract

Background

Although sexual life and its knowledge are still taboo in many cultures, especially for women, it can negatively affect women’s sexual health.

Aim

The aim of this study was to examine the relationship between the frequency and duration of masturbation and the sexual health literacy among young Muslim women of reproductive age between 18 and 25 years living in western Turkey.

Methods

The cross-sectional descriptive study was conducted with 921 young women in western Turkey between March and December 2023. Participants were included in the study per the snowball method. The data consisted of attitudes, beliefs, and behaviors regarding masturbation, sexual life, and sexual health literacy. Data were obtained on an online platform and analyzed with SPSS (version 24; IBM). Difference, correlation, and regression analyses were performed. The significance level for statistical analyses was accepted as P < .05.

Outcomes

The outcomes of the study are the attitudes, beliefs, and behaviors regarding masturbation, orgasm, sexual health literacy, and sexual function in women.

Results

The participants were young Muslim women aged 21.00 ± 1.89 years (mean ± SD). The frequency of masturbation was 5.06 ± 2.03 times per month, and the duration was 3.47 ± 1.77 minutes per day. Masturbation frequency and duration were significantly associated with sexual health literacy and sexual function (P < .001). According to regression analysis, sexual function increased and sexual health literacy increased as masturbation frequency and duration increased (P < .001).

Clinical Implications

This study presents results on the current situation regarding the sexual health literacy and sexual lives in women from different geographies and cultures, and it serves as a source for future studies on areas that need to be improved.

Strengths and Limitations

The limitation of the study is that it was conducted only with Muslim and Turkish women who use smartphones and are sexually active, so it cannot be generalized to all women. The strengths of the study are that it was conducted with a sample of 921 women, it was based on self-report and addressed many dimensions related to masturbation and female sexuality, and the results were reached through exploratory analysis.

Conclusion

The study found that the higher the duration and frequency of masturbation in young women, the better their sexual function and higher their sexual literacy.

Introduction

Sexuality is a concept that is based on gender, sexual orientation, pleasure, and love of the human race; it is a concept that starts before birth and continues throughout life, shaped according to people’s^1–3 values, beliefs, emotions, personalities, attitudes, behaviors, physical appearance, and the society in which they live, involving not only the genitals but the whole body and mind. In the formation of individuals’ attitudes and behaviors related to sexuality, certain factors are effective, such as the structure of the family in which they grow up, their circle of friends and peers, their level of education, and the culture in which they live.^1,4

Sexual health is a global issue of vital importance for overall well-being. Orgasm is a multidetermined psychophysiologic process involving biological, physiologic, anatomic, emotional, and interpersonal aspects. The female orgasm is complex: women need to know their bodies and the anatomy and physiology of the female orgasm. Female sexuality, including orgasm, is much more complex than a formula involving hormones, psychological aspects, culture, religion, anatomy, and previous experiences.⁵ Physiologically, orgasm in women occurs between the clitoris and the brain with the collection of vaginal and clitoral stimuli; it is felt in the whole body starting from the sexual regions. Adequate stimulation, foreplay, and duration of sexual activity are important for a woman to reach orgasm.^1,6 Anorgasmia—the inability to orgasm at all, difficulty reaching orgasm, or rarely achieving orgasm—is a sexual function problem and the second-most common sexual dysfunction in women. It is estimated to affect 5% to 30% of women according to population-based studies.^3,7 In a meta-analysis study, it was 40.16%.⁸ Another study reported orgasm absence or delay, as well as infrequent or markedly diminished orgasm, in at least 75% of women in the last 6 months, affecting 28% of women in the United States and up to 46% in countries in Asia.⁹

In a European study, 41% to 65% of men and 27% to 40% of women in middle age reported masturbation in the previous month.¹⁰ As a woman gets to know her own body, the likelihood of orgasm increases. While 50% of women orgasm after vaginal intercourse alone, this rate increases to 73% when clitoral stimulation is added. As a result, external stimulation or masturbation is the fastest way to reach orgasm in women.^1,2,11 Masturbation was considered a mental health problem in the 18th and 19th centuries.¹² Today, it is still one of the sexual myths purporting that female orgasm and masturbation are dirty and harmful. For men, masturbation is still an intimate but tolerable concept, a biological need, whereas for women, masturbation ends up being something that is private and shameful and should be kept secret. In many cultures, female masturbation, orgasm, and sexuality are taboo.^6,13,14 In the literature, a multiparameter and broad perspective study was not found that included masturbation frequency, duration, attitude, and orgasm, as well as sexual function and sexual health literacy. The aim of this study was to evaluate the relationship between the frequency and duration of masturbation and the sexual function and sexual health literacy of young women of reproductive age (18-25 years) living in western Turkey.

Methods

Study design

This cross-sectional study was conducted on 921 women from Turkey between March 1 and December 1, 2023. Participants were included in the study via the snowball method from the nonprobability sampling method. The population of the study consisted of all Muslim single women between the ages of 18 and 25 years who were university students. The sample size was calculated as 325 women according to the sample calculation method (r = 0.18) from the study of Barikani et al¹⁵:

Inclusion criteria were Turkish citizenship; being heterosexual, sexually active, and Muslim; and having a female biological identity. Exclusion criteria were being married, having a disease or taking medication that affects libido (hypothyroidism, antidepressants, obesity, major depression, etc), and being diagnosed with sexual dysfunction (vaginismus, dyspareunia, arousal disorders, sexual aversion, etc).

Data collection tools and method

An internet-based survey technique, one of the electronic survey types, was used for data collection. Data collection tools were created by one of the researchers (A.Y.K.) through Google Forms. The first page of the forms included items containing sample selection criteria. Participants who were not eligible for sample selection could not proceed to the next page. The information was based on the statements of the participants. The prepared forms were digitally transmitted to the university students through the links created by the researchers. At the beginning of the study, women who met the inclusion criteria were informed about the content and purpose of the study in a short text before the online survey. A voluntary consent form was administered online from those who volunteered to participate in the study. After consent was obtained, participants could see the questions. Participants completed a 3-part questionnaire, including demographic and masturbation information (age, place of residence, family status, masturbation), the Sexual Health Literacy Scale (SHLS), and the Arizona Sexual Experiences Scale (ASEX).

Measurement

Data were acquired by use of a data collection form, SHLS, and ASEX.

Data collection form

The form, created by scanning the literature, consisted of 15 questions regarding the participants’ demographic and masturbation information (age, place of residence, family status, masturbation).

Sexual Health Literacy Scale

The only instrument specific to Turkey was the SHLS developed by Üstgörül.¹⁶ The SHLS designers believe that one of the most important advantages of this tool is its generalizability; that is, it does not belong to a class, profession, education, age group, or any specific range and can be used for different population groups. As a result of the scale development research, the SHLS was introduced to the literature, and it consists of 17 items and 2 factors: sexual knowledge and sexual attitude. The scale is based on Likert-type scoring ranging from 1 (strongly disagree) to 5 (strongly agree). The last 5 questions are reverse scored. The scale has a 2-dimensional structure for sexual knowledge and sexual attitude. There are 12 items in the sexual knowledge subdimension, for which the lowest score is 12 and the highest is 60. The sexual attitude subdimension consists of 5 items and is reverse coded. The lowest score from this section is 5 and the highest is 25; high scores are considered to reflect a negative attitude toward sexual health knowledge. The fact that the SHLS yielded adequate fit indices in confirmatory factor analysis reveals that a total score related to digital literacy can be obtained from the scale, as well as the scores from the subdimensions of the scale. The increase in the scores from the SHLS subdimensions and the overall scale indicates high sexual health literacy. Application of the scale is based on individuals’ self-report. While Cronbach’s alpha was 0.88 in the validity and reliability study of the scale, it was 0.91 in this study.

Arizona Sexual Experiences Scale

The ASEX is a self-report scale developed to assess changes and disorders in sexual functions. It has 2 separate forms for men and women and consists of 5 questions each. Each question in the scale examines sexual desire, psychological arousal, physiologic arousal, the capacity to reach orgasm, and the feeling of satisfaction as a result of orgasm. Each question is scored from 1 to 6, and the total score ranges from 5 to 30. Individuals with a total score ≤10 are considered to have a very low likelihood of being diagnosed with sexual dysfunction by psychiatric examination. A total score ≥19, a score of 5 or 6 on any item, or a score of 4 on ≥3 items indicates sexual dysfunction and is highly associated with clinician-defined sexual dysfunctions. The questionnaire has been used in many studies abroad and has shown high internal consistency and reliability as well as validity. The validity and reliability study of the Turkish version of the scale was conducted by Soykan.¹⁷ While Cronbach’s alpha was 0.89 in the validity and reliability study of the scale, it was 0.89 in this study.

Statistical analysis

SPSS version 24.0 for Windows (IBM) was used for all statistical analyses. Data were obtained from descriptive statistics; the conformity of the number, percentage, mean, and SD of numerical variables to normal distribution was evaluated with the Kolmogorov-Smirnov test. In addition to descriptive statistical methods (number, frequency, mean, SD, minimum-maximum), an independent samples t-test was used for paired group comparisons, and an analysis of variance test was used for comparisons of >2 groups. Spearman’s correlation analysis was used to define the strength and direction of the linear relationship between the variables. Regression analysis was used to predict sexual health literacy and sexual function with masturbation variables. A statistical significance level of P < .05 was accepted.

Ethical approval

Ethical approval was obtained from the ethics committee within the scope of the research (March 28, 2023; Ethics Committee No. 61). Permission was secured from the authors responsible for the scale. During the data collection process through the online questionnaire, the necessary information about the study was given on the first page, and if women agreed to participate in the study, they were asked to check the statement “I agree to participate in the study.” It stated that the women’s participation was voluntary. Women who filled out the form online were considered to have agreed to participate in the study. It also stated that women would not be charged and/or paid any fee for research purposes.

Results

The age range of the participants was 21.00 ± 1.89 years (mean ± SD); the majority (60.58%) lived in the city and had families (61.56%); and their income was equivalent to their expenses (50.70%; Table 1).

The frequency of masturbation was 5.06 ± 2.03 per month, and the duration was 3.47 ± 1.77 minutes per month. The majority of the participants watched pornographic content (45.71%), did not use a vibrator (62.44%), masturbated in bed (52.98%), masturbated between 00:01 and 06:01 (58.84%), did not feel regret after masturbation (76.98%), and reached satisfaction after masturbation (74.37%). Furthermore, for most participants, masturbation positively affected sleep quality (73.61%); they thought that masturbation was for pleasure (66.99%); they had an orgasm during masturbation (66.34%); masturbation made them feel good (75.24%); and they did not masturbate before and after sexual intercourse (68.90%). The results showed that masturbation characteristics and sexual health literacy scores were significantly associated with sexual dysfunction (P < .001). A statistically significant difference was found between the sexual health literacy and sexual functions of women who used nude photos and vibrators while masturbating in the early morning hours and while masturbating on a chair (P < .05; Table 2).

There was a strong and positive relationship between masturbation duration and sexual health literacy (P < .001) and a positive relationship between sexual function and masturbation frequency (P < .001). A significant relationship was found between women’s masturbation frequency and sexual function (P < .001), as well as a positive and strong relationship between the frequency of masturbation and sexual health literacy (P < .001). A significant and negative relationship occurred between total sexual health literacy and sexual function (Table 3).

According to the regression analysis results, sexual health literacy and sexual function have a statistically significant effect on masturbation frequency (t = 8.537, P < .001; t = –5.120, P < .001, respectively). As sexual health literacy (β = 0.87) increases and sexual function decreases (β = –0.59), masturbation frequency causes an increase of 0.87 and a decrease of 0.59, respectively (Table 4).

According to the regression analysis results, sexual health literacy and sexual function have a statistically significant effect on masturbation duration (t = 10.392, P < .001; t = –5.828, P < .001, respectively). As sexual health literacy increases (β = 0.78) and sexual function decreases (β = –0.69) masturbation duration causes an increase of 0.78 and 0.69, respectively (Table 5).

Discussion

Sexual health, which is an important dimension of health, is “emotional, mental and social well-being related to sexuality and is also an important element of quality of life”.¹⁸ Sexual health literacy is very important for maintaining sexual health and preventing sexually transmitted diseases. Individuals need information to maintain their sexual quality of life, to recognize sexual health problems, and for early diagnosis and treatment of sexual health problems.¹⁹ In the study findings, sexual function and sexual health literacy were higher in Muslim Turkish young women as the duration and frequency of masturbation increased.

Women use pornography to feel sexually empowered, improve sexual arousal, and masturbate.²⁰ In this study, women who used nude photos and vibrators while masturbating and masturbated on a chair and early in the morning had higher sexual health literacy and better sexual function. A thematic synthesis of qualitative studies reported that pornography use has positive and negative consequences for women’s sexual and relationship lives. Pornography use may help some women feel sexually empowered, relaxed, and better able to enjoy their sex lives.²⁰ The findings of the study are in line with the literature. In this study, women who enjoyed masturbation, reached satisfaction, thought that masturbation positively affected sleep quality, and had orgasm by masturbation had higher health literacy and better sexual function. In a study conducted in Spain, masturbation had a positive effect and increased satisfaction in women with orgasm difficulties.²¹ In a systematic review, there was a relationship between sexual function, sexual satisfaction, and sleep quality and masturbation, but there was no relationship between sexual frequency and sleep.²² The findings of the study are in parallel with the literature. This situation shows that sexuality is an integral part and a biological need in women’s lives, just as in men.⁸

Sexuality, masturbation, and orgasm are taboo for many women.¹⁴ In this study, health literacy was high in those who felt regret after masturbation. In a study conducted in Black women, women who responded negatively to masturbation were influenced by religion and that Black churches limited their desire to explore their sexuality, gain sexual self-awareness and body awareness, and experience sexual pleasure.¹⁴ In studies conducted in Turkey, young people have a moderate level of knowledge about sexuality.^4,23–25 In other studies, the frequency of masturbation of young people living apart from their families increases and masturbation frequency and sexual knowledge are related.^4,25 In this study, although women’s sexual health literacy was high, the fact that women felt regret after masturbation suggests that masturbation is affected by cultural structures and that female masturbation is still a myth in Turkish society.

Since masturbation is a self-determined and available way to obtain physical pleasure, sexual satisfaction is expected to be higher; however, the study reports that the opposite is true.^10,26,27 According to the results of the regression analysis conducted in this study, as the duration and frequency of masturbation increased in young women, sexual function was better and sexual literacy was higher. In a systematic review of 11 qualitative studies examining masturbation experience in women, women believe that they should change or stop their masturbation habits when they have a partner.²⁸ In a study conducted in Spain, the frequency of masturbation in men was higher than in women.²¹ In one study, women who masturbated more frequently had a higher frequency of orgasm because they knew how they liked to be stimulated and were less sexually inhibited.² Masturbation and sexual function outcomes are conflicting in the literature. This situation suggests that the studies were conducted in different age groups and in different cultures. The results on the relationship between sexual health literacy and masturbation are parallel to the literature but are quite limited.

Limitations and strengths

The limitation of the study is that it was conducted only with Muslim and Turkish women who use smartphones and are sexually active, so it cannot be generalized to all women. Another limitation of the research is that it carries a risk of bias since the data were obtained by the snowball sampling method. The strengths of the study are that it was conducted with a sample of 921 women, that it was based on self-report and addressed many dimensions related to masturbation and female sexuality, and that the results were reached through exploratory analysis.

Conclusion

The study found that the higher the duration and frequency of masturbation in young women, the better their sexual function and higher their sexual literacy. Appropriate touch and knowledge of the female body and regular masturbation may affect sexual health and orgasm in women. Programs can be designed, implemented, and evaluated to promote women’s sexual health literacy. Sexual health literacy education should be one of the goals of health centers. A recommendation is to design and use simple and educational materials for women with average health literacy. There is also a need for more descriptive studies examining female sexuality in different cultures.

Author contributions

A.Y.K.: conceptualization-equal, data curation-equal, formal analysis-equal, investigation-equal, methodology-equal, project administration-equal, writing–original draft-equal, writing–review and editing-equal. F.S.B.: conceptualization-equal, data curation-equal, investigation-equal, methodology-equal, writing–original draft-equal, writing–review and editing-equal.

Funding

None declared.

Conflicts of interest

None declared.

References