Communication and sexual skills in marital functioning and satisfaction and reduced marital conflicts among Iranian couples: A systematic review

Abstract

This study aims to examine the effectiveness of communication and marital (sexual) skills in marital functioning and satisfaction and reduced marital conflicts among Iranian couples. The research literature has been collected from Magiran, SID, Noormags, ISC, and Civilica databases from 2006 to 2021. In the initial search, 104-related articles were extracted and after removing the duplicates, and screening the title and abstract, 34 articles were identified as relevant. After screening the full text of the articles, 20 studies were selected based on the inclusion criteria. According to the studies reviewed, the findings demonstrated that both interventions based on communication skills training and marital (sexual) skills training have improved marital satisfaction, sexual functioning and sexual satisfaction, and reduce marital conflicts. But the reviewed studies also had several blind spots and limitations were discussed in the article.

Introduction

A marital relationship means the exchange of verbal and nonverbal information between two life partners by pairing two people with different interests, wants and needs, which is formed according to specific social rules and regulations and significantly affects individuals’ growth and self-realization.[1,2] These relationships can have pathological aspects and lead to conflicts. Marital conflict is widely considered the leading indicator of family solidarity and the main element in determining the quality of family life.[3] Couples’ conflict in romantic relationships is inevitable; however, if it becomes chronic and repetitive and is not resolved, it will negatively affect the quality of emotional and marital relationships.[4] Marital conflicts result in disrespect, insult and psychological harassment between couples.[5] Marital conflicts are classified based on four dimensions frequency, content, intensity and clarity.[6] One of the most important causes of marital conflict includes the problems related to sexual dissatisfaction. Multiple findings have shown that sexual dissatisfaction is associated with a decrease in marital life satisfaction and an increase in marital conflicts.[7,8,9] In contrast, higher sexual satisfaction in the marriage relationship causes the continuity and more excellent stability of this relationship.[10] In other words, sexual satisfaction is the central dimension of studies on relationship quality and is classified as an indicator of relationship quality. Thus, understanding the meaning of sexual satisfaction in the context of the concept of two-member relationships in which members are committed to the opposite sex is very important.[11] For this reason, it is necessary to pay attention to effective therapeutic interventions in reducing these conflicts.

Various studies have evaluated the effectiveness of relationship training programs in bringing about changes in conflict actions and have found remarkable results with small to medium effect sizes.[4] In this regard, the effectiveness of two intervention methods has been investigated in several studies. One of these interventions is communication skills training. In this respect, Bulanda, Brown and Yamashita[12] stated that improving communication skills and conflict resolution in couples improves marital relations, reduces conflicts and improves mental health in them. These results have been confirmed in the studies of these researchers. Another intervention in this area is sexual skills training program. Sexual (marital) skills emphasize the importance of emotions (such as sexual arousal and pleasure) as natural functions of sexual behaviour. According to the model provided by Masters and Johnson, sex is a biological function. It is subject to physiological neural processes with which a person is born and which are not under the voluntary and immediate control by one, but can be controlled and guided by regular practice over time.[13] The findings of various studies have shown the effectiveness of this intervention in improving sexual performance and marital satisfaction of couples.[14,15,16,17] But the point that has not been considered in the research background, especially in domestic studies, is to conduct the review studies in this regard.

Given the importance of review studies in advancing more coherent perspectives on topics, this research, in a review study, seeks to answer the question as to whether communication skills and marital (sexual) skills affect marital functioning and satisfaction and reduce marital conflicts among Iranian couples.

Materials and Methods

This study was a descriptive study, and in terms of the implementation method, it was considered a systematic review.

Databases and keywords

Keywords were identified by reviewing related literature. Based on this, the keywords: ‘Couple Therapy’, ‘Communication Skills of Couples’, ‘Sexual Skills’, ‘Marital Conflicts’ and ‘Sexual Satisfaction’ were selected. The search was performed using these keywords or a combination of them in SID, Magiran, Civilica, ISC and Noormags databases.

Inclusion criteria

Inclusion criteria were: 1) Efficacy studies, 2) Studies that have at least one intervention of communication skills and marital sex skills, 3) Studies whose target group is couples, 4) Studies that include one of the variables of performance and marital satisfaction or reducing marital conflicts, 5) Studies published in Iran and 6) Studies that have been published in Iran between 2000 and 2021.

Selection process

In the initial search, 104 studies were retrieved. The retrieved sources were added to the EndNote software. After the elimination of duplicates, 65 studies remained. In the next stage, first, the title and abstract of the remaining studies were screened, and 31 studies were excluded. Then, two members of research team independently reviewed the full text of the remaining 34 studies based on inclusion criteria and selected 20 studies. The selection process is presented in Figure 1.

Figure 1.

Flow diagram of the selection process

Quality assessment

Two reviewers independently evaluated the quality of the included studies using the STROBE Statement. The third reviewer made the final decision in disagreement.

Data extraction

The data were extracted related to author, title, year of publication, sample size and study results, using an extraction form. Two members of the research team extracted the data independently and then compared their results. The third reviewer made the final decision in disagreement.

Data synthesis

The synthesis of data in this study was narrative. Based on this, the data obtained from the study were classified, and reported in a narrative form. Also, the data were presented in the form of a table.

Results

From the number of 104 retrieved studies, after removing duplicates, title/abstract screening, full-text screening and quality assessment, 20 studies were selected to enter the review [Figure 1].

In general, the results revealed that both interventions of communication skills and marital (sexual) skills were effective in improving components such as marital satisfaction, mental health, quality of life, marital intimacy, sexual satisfaction, sexual functioning and finally, reduced marital conflicts. But the intervention based on marital (sexual) skills has been more effective in improving sexual satisfaction, and communication skills have been more effective in improving the overall components of marital life satisfaction. Additionally, only one of the studies (28) indicated that the effects of therapeutic intervention based on marital (sexual) skills and increased sexual knowledge are established only in the post-test stage, and this effect is not stable in the follow-up stage [Table 1].

Table 1.

Summary of the studies on the effectiveness of communication skills and marital (sexual) skills in marital functioning and satisfaction and reduced marital conflicts among Iranian couples

Authors	Year	Sample size	Result
Akbari, et al.[18]	2020	60	The results revealed that communication skills training and cognitive-behavioural therapy significantly increased the happiness and marital satisfaction of couples there was no difference between the two methods in terms of the effectiveness in enhancing happiness and marital satisfaction.
Tayarani, et al.[19]	2019	10	Training in communication skills of listening, negotiation, assertiveness, explicit communication and expression of feelings and needs has made significant changes in the marital satisfaction of couples in the experimental group.
Sanei et al.[20]	2019	40	The results of this study indicated that sexual skills training is effectively improves the sexual self-schemas and marital satisfaction of married women.
Ebrahimipour et al.[21]	2013	80	After the educational intervention, the mean scores of knowledge, attitude, perceived behavioural control, sexual functioning and intent increased in the experimental group, and this increase was statistically significant.
Gerafar et al.[11]	2017	30	The results of repeated measures analysis of variance suggested that sexual satisfaction in women increased in the intervention group, and this increase was stable over time.
Hasannezhad, et al.[22]	2017	30	After the intervention, the scores of patients who received communication skills training indicated that this intervention has been effective in marital satisfaction scales, including marital satisfaction, communication, conflict resolution, ideal distortion and full marital satisfaction scale of infertile women.
Mousavi Bazaz, et al.[23]	2017	50	The results of mean satisfaction before and after the intervention showed a significant difference. In the subscales of personality issues, marital relationships, conflict resolution, financial management and sexual relationships, improvement of indicators was observed, still the subscales of children, family and friends, no difference was statistically observed.
Akbari Samani and Arefi[24]	2016	60	The analysis of covariance demonstrated that sex therapy training has led to improved marital satisfaction and conflict resolution.
Moeini et al.[25]	2016	100	The mean scores of communication skills, marital satisfaction and social support of the experimental group increased significantly in the post-test stage compared to the control group.
Keshavarz Safiei et al.[26]	2015	4	Evaluations showed that women’s sexual desire and marital satisfaction have increased. The recovery slope for both sexual desire and sexual satisfaction was from the ninth session, in which the participants’ spouses attended the session. In addition to teaching communication and couple skills, the sensate focus technique was also used. This study revealed that the couple and sexual skills training package has increased the marital satisfaction of the participants and also improved women’s sexual desire.
Khamse et al.[27]	2015	22	The analysis of covariance demonstrated that the educational intervention of the practical application of intimate relationship skills improved sexual satisfaction by 44% and increased marital happiness by 37% in the experimental group in the post-test. The results of the three-month follow-up suggested a 42% effect of this intervention on sexual satisfaction and a 36% effect on marital happiness.
Moein Afshar et al.[28]	2014	60	The results of analysis of covariance indicated that in the post-test, the sexual satisfaction score of the subjects in the experimental group increased significantly compared to the control group subjects, and the marital conflict score of the experimental group subjects decreased significantly compared to the control group subjects.
Rastgo et al.[29]	2014	30	The study suggested increased sexual knowledge increased women’s marital satisfaction, but this increase did not continue until the follow-up session.
Sasan-Nezhad et al.[30]	2014	57	According to the obtained results, the couples in the experimental group showed a significant change in all three variables of marital satisfaction, sexual satisfaction, and intimacy compared to the control group and all three variables increased.
Amani and Letafati Beriss[31]	2013	28	The findings indicated that group communication skills training had a significant effect on reducing marital conflict and its components in couples.
Khanjani Veshki et al.[32]	2012	60	The results of data analysis showed that this treatment method has improved the quality of marital life and increased marital satisfaction and the quality and quantity of sexual relationships between couples in the experimental group.
Fathi Aqdam et al.[33]	2011	32	The results of this study indicated that communication skills training reduces marital conflicts and has a positive effect on the quality of life.
Rezaei and Sedaqat-Nezhad[34]	2011	60	The communication skills training significantly reduced marital conflict and its dimensions (decreased cooperation, increased emotional reactions, increased child support, increased personal relationship, reduced family relationship and reduced effective communication and marital conflicts). But in the dimensions of reducing sex and separating financial affairs, the results have not been significant. Further, communication skills training has a significant effect on marital satisfaction and the dimensions of contractual responses, marital satisfaction, marital relationship, conflict resolution, financial supervision, sex, relatives and friends, male and female roles, ideological orientation and marital satisfaction. But in the dimensions of personality issues, leisure activities and marriage and children, the results have not been significant.
Bahari et al.[35]	2011	60	The findings showed a significant difference between the couples of the intervention and control groups in the mean post-test scores. Further, a significant difference was observed in the rate of general conflict, marital conflict and areas of emotional reactions, attracting child support and relationship with relatives and friends. This program has to effectively reducing emotional reactions, the attraction of child support, relationships with relatives and friends and the overall rate of marital conflict in divorce-seeking couples.
Mahmoudi et al.[36]	2008	92	The results demonstrated that sex education is effective in health behaviour, healthy sexual behaviour, mental health and prevention of disorders as well as family health.

Discussion

This systematic review research showed that both interventions communication skills and marital (sexual) skills are effective in improving marital functioning and satisfaction and reducing marital conflicts of Iranian women.

These findings are consistent with the results obtained by Williamson[37] in emphasizing the essential role of communication skills in reducing marital conflicts and improving the quality of relationships over time.

These findings are also consistent with the findings of Akbari et al.,[18] Tayrani et al.[19]

Sanei et al.[20] and Hasannezhad et al.[22] According to Alipour et al.,[38] improving communication skills can increase marital satisfaction and improve the mental health of couples. This issue becomes more critical in that young couples usually seek to transfer their communication styles and family interaction patterns to their marital relationship while entering into this relationship requires newer and more efficient communication skills based on which couples can act independently of their family and have a clear understanding of their spouse’s needs,[31] if such conditions are established, satisfaction with marital life will also occur. The relationship between communication skills and marital life satisfaction is not one-sided and linear. Instead, it can be said more precisely that when couples are more satisfied with their life; they participate in more positive work in the couple relationship, are less involved in antagonistic interactions, and will have effective communication.[39] As a result, it can be stated that a positive and constructive cycle of communication and life satisfaction can be formed in people, each of which strengthens and stabilizes the other.

The findings of the present study are also consistent with the results of the studies by Bokaie M et al.,[40]Salehi Moghaddam et al.,[41] Luk and Loke[42] and Allen et al.[43] in terms of the effectiveness of marital (sexual) skills training in improving sexual satisfaction and functioning.

In explaining these findings, in line with Sanei et al.,[20] it can be mentioned that many people, especially in Iran, enter into a marital relationship with incomplete and even incorrect information, which results in a relationship of low quality. As a result, providing accurate information about the sexual response cycle and differences between men and women in this regard and the expression of love increases the likelihood of improving practical marital skills and marital satisfaction. It corrects couples’ misconceptions, which is especially important in women because the mechanism of triggering sexual desire in women is greatly influenced by the thoughts and beliefs, they have about marital relationships; unlike men, who are easily and very quickly aroused by the sense of sight or smell. Therefore, it can be said that when a couple’s sexual satisfaction increases with the acquisition of sexual skills in a marital relationship, marital satisfaction and sexual functioning eventually improve because dysfunctional beliefs are often challenged. A more satisfying interaction is formed between the couples and the amount of affection and understanding felt between them increases. Since the intervention based on sex education provides such information in a categorized and codified form, it has been able to play a role in improving these skills.

The reviewed background has some neglected points and limitations that need to be addressed because one of the essential goals of a systematic review is to identify blind spots so that researchers know what aspects of the subject should be discussed further in the future. In this regard, it should be stated that since most studies have not been concerned with the theoretical framework, they could not provide a general view, and some of them could not determine their position among the rest of the studies conducted in this field have only repeated themselves. The problem of the lack of connection between Iranian studies and the lack of scientific accumulation can be observed. Simply put, these studies do not enter into dialogue with each other, and in an isolated way, they have sometimes only repeated the effectiveness of these interventions in a number of identical components, and broader layers of these components have not been studied, and only a few and limited studies have done this. Moreover, almost all the studies were short-term, and none of them were conducted in the long-term and multi-year periods, and no longitudinal study is seen among them. Specific interventions based on indigenous culture and subcultures have been less studied. Accordingly, these neglected points should be further considered in future studies in this field.

Conclusion

The findings of this study generally indicated that both communication skills training and marital (sexual) skills training have been effective in improving the components related to mental health and couples’ relationships, such as marital satisfaction, quality of life, sexual functioning and satisfaction and reducing marital conflicts.

Author contributions

M.A., A.R. and M.H. contributed to the design of the study, conceptualization and wrote original draft. M.A., and M.S.M. acquired the data. M.A. and A.R. devised the method, interpretation of data. M.H. and M.S.M. revised. J.M. supervised on the study, critically reviewed and approved the final submitted draft of the article.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.