Journal of Health Literacy

Journal of Health Literacy

The Paradox of Silence: Universal Inadequacy of Sexual Health Literacy and Its Lifespan Impact on Quality of Life among Iranian Women

Articles in Press

Document Type : Original Article

Authors
Samaneh Torkian 1
Fatemeh Torkian 2
Vahid Khosravi 3
Azimeh Chaboki 1
Sahebjan Torkian 4
Zeinab Heidari 5
1 Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran.
2 Department of Midwifery, Falavarjan Branch, Islamic Azad University, Isfahan, Iran.
3 PhD, Department of Public Health, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran.
4 Department of Health Education and Promotion, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
5 Associate Professor, Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
10.22038/jhl.2026.93799.1917
Abstract
Background and Objectives: Sexual health literacy enables individuals to access, understand, and apply sexual health information, while low literacy is associated with unsafe behaviors and negative outcomes. Quality of life is a key aspect of women’s overall well-being. This study examines the association between sexual health literacy and sexual quality of life among women in Isfahan.

Material and Methods: This cross-sectional study was conducted in 2022 among women in Isfahan, Iran. A total of 212 women aged over 18 years were recruited through two-stage cluster sampling from health centers. Data were collected using the Sexual Health Literacy for Adults (SHELA) questionnaire, which assesses four indicators (access, understanding, analysis, and application of sexual health information), and the Sexual Quality of Life Questionnaire (SQOL-F), which assesses indicators such as sexual satisfaction and emotional well-being. Statistical analyses were performed in SPSS 27 using generalized linear regression models (GLM).

Results: The majority of participants exhibited limited (inadequate or problematic) sexual health literacy. The mean quality of life score among participants was 75.35 ± 10.39 (in 18-108 score range). In this study, sexual health literacy was directly associated with sexual quality of life (β= 0.11, 95%CI: 0.04, 0.19, P=0.004). Longer duration of marriage (β= -0.16, 95%CI: -0.30, -0.02, P=0.022) and lower education (β= -11.69, 95%CI: -22.35, -1.03, P=0.031) were significantly associated with lower quality of life scores.

Conclusion: This study revealed that women had limited sexual health literacy in most domains, which was positively associated with quality of life. Longer marital duration and lower education were related to lower quality of life scores. These findings highlight the need for interventions aimed at improving sexual health literacy, which may enhance women’s overall well-being.
Keywords
Health literacy
Quality of life
Sexual health
Women

Acknowledgements: The authors would like to express their sincere appreciation to all participants who generously took part in this study. This research was conducted with ethical approval obtained from Isfahan University of Medical Sciences (Ethical Code: IR.ARI.MUI.REC.1400.018). The authors are grateful to all individuals and institutions whose cooperation contributed to the successful completion of this study.


Availability of data and material: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.


Conflicts of Interest: The authors declare that they have no conflicts of interest.


Consent for Publication: Not applicable.


Ethics approval and consent to participate: This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki–Tokyo for research involving human subjects. Ethical approval was obtained from the Institutional Ethics Committee of Isfahan University of Medical Sciences (Approval Code: IR.ARI.MUI.REC.1400.018). All participants were fully informed about the objectives and procedures of the study, and written informed consent was obtained from each participant prior to data collection. Participation was voluntary, confidentiality was ensured, and all data were handled anonymously.


Funding: This study was supported by Isfahan University of Medical Sciences, Isfahan, Iran.


Authors’ Contributions: ST and FT conceived and designed the study. VK contributed to the methodology and data interpretation. AC participated in data collection and preliminary analyses. SaT was involved in data management and technical support. ZH supervised the study and critically reviewed the manuscript. All authors contributed to drafting and revising the manuscript and approved the final version.


AI Declaration: The authors acknowledge the use of ChatGPT and DeepSeek for improving the English language, grammar, and readability of the manuscript. All scientific content, analyses, and interpretations were developed by the authors. The final version of the manuscript was thoroughly reviewed and approved by all authors, who take full responsibility for the content.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1. Maasoumi R, Tavousi M, Zarei F. Development and psychometric properties of sexual health literacy for adults (SHELA) questionnaire. Journal of Hayat. 2019;25(1):56-69.
2. Organization WH. Health in 2015: from MDGs, millennium development goals to SDGs, sustainable development goals 2015 [Available from: https://www.paho.org/en/node/63065.
3. Organization WH. Consolidated Guideline on Sexual and Reproductive Health and Rights of Women Living with HIV 2017 [Available from: https://www.ncbi.nlm.nih.gov/books/NBK442189/.
4. Jamali B, Maasoumi R, Tavousi M, Haeri Mehrizi AA. Women's Sexual Health Literacy and Related Factors: A Population-Based Study from Iran. International Journal of Sexual Health. 2020;32(4):433-42. https://doi.org/10.1080/19317611.2020.1841056
5. Martin SP, editor Young people's sexual health literacy: seeking, understanding, and evaluating online sexual health information2017.
6. Organization WH. Sexual and reproductive health literacy and the SDGs Geneva2016 2016 [Available from: http://www.who. int/healthpromotion/conferences/9gchp/health-literacysdgs/en/
7. Khandehroo M, Peyman N, Gholian-Aval M, Tehrani H. Self-efficacy intervention on health literacy and quality of life in menopausal women of suburban areas. Scientific Reports. 2025;15(1). https://doi.org/10.1038/s41598-025-09347-7 PMid:40610658 PMCid:PMC12229341
8. Wagner Cv, Knight K, Steptoe A, Wardle J. Functional health literacy and health-promoting behaviour in a national sample of British adults. Journal of Epidemiology and Community Health. 2007;61(12):1086-90. https://doi.org/10.1136/jech.2006.053967 PMid:18000132 PMCid:PMC2465677
 
9. Graf AS, Patrick JH. Foundations of life-long sexual health literacy. Health Education. 2015;115(1):56-70.https://doi.org/10.1108/HE-12-2013-0073
10. Roshan Chesli R, Soleimani Z, Erfan T, Mantashlou S, Hashemi A. Evaluate the psychometric properties of sexual quality of life questionnaire (SQOL-F). Clinical Psychology and Personality. 2020;17(1):213-24.
11. Mirzaei H, Aghayari T, Katebi M. A Study on Life Quality among Married Women in Family Institution. Sociology of Social Institutions. 2014;1(3):71-93.
12. Forbes MK, Baillie AJ, Schniering CA. Critical flaws in the Female Sexual Function Index and the international index of Erectile Function. J Sex Res. 2014;51(5):485-91. https://doi.org/10.1080/00224499.2013.876607 PMid:24826876  
13. Evaluation of Sexual Quality of Life and its Relationship with Marital Satisfaction and Emotional Divorce in Hemodialysis Patients in Birjand, 2017. Journal of Jiroft University of Medical Sciences. 2019;5(2):35-45.
14. Panahi R KM, Abolhasani Daronkolaei Z, et al. The effect of sexual health literacy on the sexual life quality of women referring to healthcare centers in Qazvin, Iran. J Educ Health Promot. 2021;10:1-8. https://doi.org/10.4103/jehp.jehp_1484_20 PMid:34912927 PMCid:PMC8641725
15. Bahrampour B SS, Lamyian M, Rasekhi A. Sexual health literacy among rural women in Southern Iran. Scientific Reports. 2024 Jul 29;14(1):17377. https://doi.org/10.1038/s41598-024-68444-1 PMid:39075136 PMCid:PMC11286827
16. Shirpak KR, Ardebili HE, Mohammad K, Maticka‐Tyndale E, Chinichian M, Ramenzankhani A, et al. Developing and testing a sex education program for the female clients of health centers in Iran. Sex Education. 2007;7(4):333-49. https://doi.org/10.1080/14681810701636044
17. Lamyian M, Zarei F, Montazeri A, Hajizadeh E, Maasoumi R. Exploring the factors affecting Iranian women's quality of sexual life. Journal of Hayat. 2016;22(2):185-200.
18. Samimi K, Mokarami H, Tontab Haghighi S, Taban E, Yazdani Aval M, Maasoumi R. Assessment of affecting factors on women's sexual quality of life among hospital employees. Journal of Gorgan University of Medical Sciences. 2016;18(3):128-34.
19. Sheykholeslami A, Azarniyoor S, Mohammadi N. Prediction of Quality of Life Based on Sexual Attitude and Knowledge, and Personality Traits in Married Women. Journal of Health and Care. 2015;17(3):260-9.
20. Bagherinia M, Dolatian M, Mahmoodi Z, Ozgoli G, Alavi Majd H. Predictors of social intermediate factors associated with sexual quality of life of women: systematic review and meta-analysis. BMC women's health. 2024;24(1):64. https://doi.org/10.1186/s12905-024-02899-2 PMid:38267989 PMCid:PMC10809577
21. Organization WH. HRP annual report 2023: World Health Organization; 2024.
22. Panahi R, Kheiri M, Daronkolaei ZA, Arjeini Z, Taherpour M, Dehghankar L, et al. The effect of sexual health literacy on the sexual life quality of women referring to healthcare centers in Qazvin, Iran. Journal of Education and Health Promotion. 2021;10:391. https://doi.org/10.4103/jehp.jehp_1484_20 PMid:34912927 PMCid:PMC8641725
23. Organization WH. Working for a brighter, healthier future: how WHO improves health and promotes well-being for the world's adolescents: World Health Organization; 2024.
24. D N. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health promotion international. 2000 Sep 1;15(3):259-67. https://doi.org/10.1093/heapro/15.3.259
25. Fisher JD FW. Changing AIDS-risk behavior. Psychological bulletin. 1992;111(3):455. https://doi.org/10.1037/0033-2909.111.3.455 PMid:1594721  
26. Panahi R, Kheiri M, Daronkolaei ZA, Arjeini Z, Taherpour M, Dehghankar L, et al. The effect of sexual health literacy on the sexual life quality of women referring to healthcare centers in Qazvin, Iran. J Educ Health Promot. 2021;10:391. https://doi.org/10.4103/jehp.jehp_1484_20 PMid:34912927 PMCid:PMC8641725
27. Bahrampour B, Lamyian M, shahali s. The relationship between sexual health literacy and sexual assertiveness in married women: A quantitative study in southern Iran. Payesh (Health Monitor) Journal. 2022;21(1):59-67. https://doi.org/10.52547/payesh.21.1.59
28. Dülger H, Ada G, Dilcen HY, Bilişli Y. Social media's effect on sexual literacy and healthy life skills in young adults. BMC Public Health. 2025 https://doi.org/10.1186/s12889-025-25651-3 PMid:41327098 PMCid:PMC12777471
29. Tehranian A, Vahid Dastjerdi M, Hatamian S, Ghahghaei-Nezamabadi A. Sexual Function and Quality of Life in Iranian Women With Human Papillomavirus Infection. J Family Reprod Health. 2024;18(3):154-9. https://doi.org/10.18502/jfrh.v18i3.16656 PMid:39439738 PMCid:PMC11491696
30. Yilmaz FA, Avci D, Tahta T. Relationship Between Marriage Satisfaction and Sexual Functions in Couples Undergoing Infertility Treatment. International Journal of Sexual Health. 2020;32(4):421-32. https://doi.org/10.1080/19317611.2020.1834046
31. Rakhshani T, Amirsafavi M, Motazedian N, Harsini PA, Kamyab A, Jeihooni AK. Association of quality of life with marital satisfaction, stress, and anxiety in middle-aged women. Front Psychol. 2024;15:1357320. https://doi.org/10.3389/fpsyg.2024.1357320 PMid:39291177 PMCid:PMC11405199
32. Asali Z, Takarli F, Khazaei S, Jenabi E. Predictors of sexual quality of life among women in reproductive age in the west of Iran: A cross-sectional study. Heliyon. 2025;11(13). https://doi.org/10.1016/j.heliyon.2025.e43676
33. Pious AA, Amaresha AC, Shankar RG. A Cross-sectional Study on Factors Associated with Sexual Satisfaction Among Non-working Married Women in Bengaluru. Journal of Psychosexual Health. 2025;7(3):278-84. https://doi.org/10.1177/26318318251338988
34. Gutacker N, Kinge JM, Olsen JA. Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study. BMC Public Health. 2023;23(1):805. https://doi.org/10.1186/s12889-023-15663-2 PMid:37138293 PMCid:PMC10155341
35. Higgins JA, Lands M, Ufot M, McClelland SI. Socioeconomics and Erotic Inequity: A Theoretical Overview and Narrative Review of Associations Between Poverty, Socioeconomic Conditions, and Sexual Wellbeing. J Sex Res. 2022;59(8):940-56. https://doi.org/10.1080/00224499.2022.2044990 PMid:35302915  
36. Dehghankar L, Panahi R, Khatooni M, Fallah S, Moafi F, Anbari M, et al. The association between sexual health literacy and sexual function of women in Iran. J Educ Health Promot. 2022;11:11. https://doi.org/10.4103/jehp.jehp_414_21 PMid:35281379 PMCid:PMC8893068
37. Xing Z, Alman AC, Chen H, Cain MA, Kirby RS. Parity, Age at Childbirth, and Later-Life Health-Related Quality of Life in Postmenopausal Women. Journal of Women's Health. 2025. https://doi.org/10.1097/og9.0000000000000063 PMid:41000565 PMCid:PMC12456564
38. Workneh WM, Handebo S, Geleta T, Wotango BY, Bekele BT. Health related quality of life and associated factors among postpartum women after normal vaginal delivery and caesarean section: A comparative cross-sectional study. medRxiv. 2024:2024.03.14.24304310. https://doi.org/10.1101/2024.03.14.24304310
39. Keles E, Kaya L, Yakşi N, Kaya Z. Effect of mode of delivery on postpartum health-related quality of life. Revista da Associação Médica Brasileira. 2024;70(4):e20231003.https://doi.org/10.1590/1806-9282.20231003PMid:38537006 PMCid:PMC10962265
40. Arief A, Ahmed S, Ahmed A, Rashad S. Postpartum quality of life among women after vaginal birth and Cesarean section. Evidence-Based Nursing Research. 2019;1(1):63-74.https://doi.org/10.47104/ebnrojs3.v1i1.34
41. Rezaei S, Salimi Y, Zahirian Moghadam T, Mirzarahimi T, Mehrtak M, Zandian H. Quality of life after vaginal and cesarean deliveries: a systematic review and meta-analysis. International Journal of Human Rights in Healthcare. 2018;11(3):165-75. https://doi.org/10.1108/IJHRH-01-2018-0001
Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 06 July 2026