Aofs 2014 brisbane_sexuality meaning among malay women_rosediani

SEXUALITY MEANING, EXPERIENCE
AND IMPACT AMONG MALAY WOMEN
WITH SEXUAL DYSFUNCTION
A.P (Dr.) Rosediani Muhamad1,2
Sup: Pranee Liamputtong1 , Paul O’ Halloran1 and Wah Yun Low3
1School of Public Health, Faculty of Health Sciences, La Trobe University, Victoria, Australia
2Department of Family Medicine, Universiti Sains Malaysia, Kelantan, Malaysia
3Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
.
Sexuality Meaning in Malay women_AOFS_2014_Brisbane

SEXUALITY
 Sexuality is a central aspect of human life.
 It is personal experiences of one’s sexual being,
and it is claimed to be a source of pain as much
as pleasure (Weeks, 1945).
 Some suggest that sexuality is natural (McCarthy &
McCarthy, 2012) but others argue that it is learned
(Weeks, 1945)
 It is also shaped by socio-cultural conditions,
gender roles, religious beliefs, and political
influences (World Health Organisation, 2006).
Sexuality Meaning in Malay
women_AOFS_2014_Brisbane

 Metasynthesis of sexuality meaning among
heterosexual women -32 qualitative papers
from 1990-2014:
 1. Penetrative and male-centric dominance
(70%)
 2. Resuming female centric and gratification
(45%)
 3. Realistic and quality hopes
 Equality in sex life (50%)
 More than physicality (44%)
 Quality in relationship

HOW ABOUT HEALTH CARE PROVIDERS?
 Clinicians tend to focus more on medical perspective.
 Health care providers are still ill-prepared to deal with
it (Dyer & Nair, 2013); have difficulties and uncomfortable in
talking and managing women with sexual problems,
while some still haven’t prioritised sexual health in
their practice (Abdolrasulnia et al., 2010; Auwad, 2012).
 “Normal” sexuality and sexual functioning in women
were conceptualised as similar to men’s (Masters & Johnson,
1966).
 However, treatment based on this view did not work,
since this approach ignores psychosocial aspects of
sexuality specific to women.
 This makes them conform more to circular model of
sexual functioning (Basson, 2000).

FEMALE SEXUAL DYSFUNCTION
 Highly prevalent :
Worldwide : 20% -67% ; Malaysia: up to 30%
(Hayes et al., 2006; Laumann et al., 1999;Sidi et al., 2007; Ishak et al.,
2010; Rawa et al., 2010)
 Affects women across cultures and age
groups as well as pre to postmenopausal
stages. ( Safarinejad, 2006; Sidi, 2007)
 It impacts significantly on women’s QoL
although not a life threatening condition
(Laumann, 1999; Bancroft et al., 2003)

SEXUALITY IN MALAYSIA
 Malays : professes the religion of Islam, habitually speaks the
Malay language and practice Malay customs” (Federal constitution,
2010)
 Malay Customs : Minangkabau matrilineality and Patriliny
Palembang
 The Islamization of the Malay states ( fifteenth century )
 The ideology and adat : men and women as similar rather than
dissimilar ways.
 Islamic ritualization & public policy generally enable men to
command more power.
 Women actually have other important roles to be fulfilled
according to adat (culture) and religion.
 The perfect partner is someone who can perform well sexually at
any time
 Ideal wife is one who can delivers as many children as they
afford to.
“Young men are the hope of people, but young women
the pillars of the state”
Karim, W-J.B. (1992).Women and culture: Between Malay Adat and Islam :Westview Pre

 Omar (1994) found that 46% women who did not feel sexual
pleasure, and they just ignored it
 Others: positive viewed on menstruation, sexuality as
sacred as they changed their attire when reached puberty.
Maintained their beauty, body image depended on
(generation)
 Ideal women was those helping in making happy marriage;
fulfil her duty to God ; loyalty to husband and well-groomed;
fertile and good at raising their children
Omar, R. (1994). The Malay woman in the body: between biology and culture. Kuala Lumpur : Penerbit Fajar Bakti S

FSD IN MALAYSIAN CONTEXT
• Apart from high prevalence, it was significantly
affect Malay women and those with decline in
sexual activity. (Sidi et al.,2007)
• Malaysian women - lowest frequency of performing
sexual intercourse in a year as compared women in
other Asian Countries.(Nicolasi, 2004)
• Sexual dissatisfaction among Malaysian women in
urban areas was higher (52.2%) than in rural
Malaysia, particularly in Kelantan (8%). (Sidi, 2007 ;Rawa,
2010)

ISLAMIC VIEWS ON SEXUALITY
 Islam is the way of life. Everything must follows the God’s
will
 Sexuality is broad in meaning. Focus: marriage , sex and
family
 Marriage aims to cast down the gaze and walls up the
genitals from illegal conduct (premarital/ extramarital sex)
since man finds his fulfilment only in woman (but not really
in woman)
 In terms of gender status :
 Same in God’s view
 Man(Husband) status higher than women (wife)
 Men are the managers of the affairs of women for that, God had preferred in bounty
one of them over another, and for that they have expended of their property.
Righteous women are therefore obedient, guarding a secret for God’s guarding. ..
 Mother has a higher status than her children

SEX IS OBEDIENT TO GOD
O people! be careful of (your duty to) your
Lord, Who created you from a single being and
created its mate of the same (kind) and spread
from these two, many men and women; and be
careful of (your duty to) Allah, by Whom you
demand one of another (your rights), and (to)
the ties of relationship; surely Allah ever
watches over you

SEXUAL RELATIONSHIP IS A CONGENIAL
PARTNERSHIP FOR MUTUAL SATISFACTION,
LOVE, AFFECTION AND TRANQUILLITY IN LIFE
And of His signs is that He created for you
from yourselves mates that you may find
tranquillity in them; and He placed between
you affection and mercy. Indeed in that are
signs for a people who give thought.

SEXUAL RELATIONSHIP IS A COMPLEMENTARITY
AND SECRET WORK
They (wives) are
clothing for you
and you (husband)
are clothing for
them
“And they (women) have rights (over their husbands as regards living
expenses) similar (to those of their husbands) over them (as regards
obedience and respect) to what is reasonable” [al-Baqarah 2:228]

RIGHT’S OF THE HUSBAND
Gain love and affection :
"Allah is pleased with those women who love and have affection for
their husbands and protect themselves from other men."
Wife’s obedience
"After fear of Allah a believer gains nothing better for himself than a
good wife who obeys him if he gives her a command, pleases him if
he looks at her, is true to him if he adjures her to do something, and
is sincere towards him regarding her person and his property if he is
absent.” Hadith narrated by Tarmizi
To discipline wife :
“As to those women on whose part you see ill-conduct, admonish
them (first), (next) refuse to share their beds, (and last) beat them
(lightly, if it is useful)” [al-Nisaa’ 4:34]

RIGHT’S OF THE WIVES
Gain Protection From Maltreatment
"0 People! fear Allah with regard to your wives. You have taken them
into your possession with the permission of Allah.” “Men are the
protectors and maintainers of women, because Allah has made one
of them to excel the other, and because they spend from their means.
Kindness and Fair Treatment with co-wives
Amongst the most perfect of mu’mins in Iman is he who is best
character & amongst the best of them is he who kindest towards his
wife”
Sexual satisfaction:
The Prophet warned against rushing to gratify one's pleasure,
forgetting that of one's wife, quickly withdraw without wife agreement,
refused SI
Financial right (dowry, spending and accomodation)
And give to the women (wife) their Mahr (obligatory bridal-money
given by the husband to his wife at the time of marriage) with a good
heart” [al-Nisa’ 4:4]
Making available for the husband except
–menses , having bleeding (nifas) during confinement, obligatory
fasting and sickness

AIM OF STUDY
 To gain an in-depth understanding of
sexuality meaning and experience among
Malay women with sexual dysfunction
 As well as further understanding on how
sexual dysfunction affects Malay women’s
overall well-being

METHODOLOGY
Interpretative phenomenology
Participants: 20 married middle-aged(27-51 years; M= 38.6
years) Malay women from Kelantan dan Klang Valley.
Most women had tertiary education and had been married for
13(mean) years; almost all Malay women self-reported sexual
dysfunction, lasting for about 10 years (M=9.75 years)
Most of the disorders affecting them were a combination of
desire, arousal and orgasmic problems, at 30%
Procedures: Face-to-face in- depth interviews
Data Analysis: Thematic Data Analysis

RESULTS :THEMES FOR SEXUALITY MEANING
AND EXPERIENCES:
 Sexual intimacy is key
 Sexual gratification is religious
mission
 Sexual display is culturally
unacceptable
 Sex as natural or learned
experience

3 THEMES FOR SEQUENCE OF SEXUAL FUNCTIONING
IMPAIRMENT:
1. It just for you, leave me alone
2. It’s a matter of sex work
performance
 Dissatisfied with self-performance on
sex
 Dissatisfied with spouse
performance
3. Expectation unmet, relationship
threatened
 Husband’s emotion and sexual
function also affected
 Relational conflict

SEXUAL INTIMACY IS KEY
• Sexual intercourse
Wani: Hubungan kelamin (Sexual relationship). I think stimulation before we
start ‘jimak’(penile-vaginal intercourse) also included, anything that at the
end will leads to penile-vaginal intercourse like hugging , kissing
• Intimate activities
Linda :Sex is sexual intercourse in which not necessarily ends with climax.
Meaning, if we sit together, just want to berseronok-seronok (please one
another), not necessarily ends with climax, just sit closer, err...not
necessarily leads to intimate relationship. Meaning no intercourse occurs.
Sometimes what I only need is belaian (caresses).

• Pleasure & masturbation only in the
framework of marriage
Yana: I think sexuality was something so pleasurable and something I can’t
wait to experience after marriage (SI), and I had no problem whatsoever..,
to be aroused, either in real meeting or through a movie short scene [..].
Masturbation, it used to be done before I got married, before I become
more committed to the Deen. It was just for the sake of it, fun…pleasure
only, not really because it needed to be done. I think it is feeling one
achieve after masturbation – 30 y/o, ex-lawyer, cultivated from western
culture, sexual pain.
• Oral sex is legal but disgusting (evil/socially)
Mona: He really wants me to do it; I do it because he wants it. In my heart I
feel like I’m his servant. Satan may be. One method that he likes most but
for me, hate. most 30 y/o, housewife with sexual desire loss
• Anal sex is prohibited
Asiah : How to do that (SI)? I mean ( I should) follow what has been told in
Islam, not doing at the back. I mean, not through anus. 38 y/o, psychologist,
sexual desire impairment

• Religious obligation & right
Alya : The relationship of husband and wife is an obligation. In Islam, sex
with husband is a responsible that we must obey the husband’s request. If
the husband wants it and at the same time we want to pray, we should
obey him since sex itself is calculated as worship to God too. However, sex
is not only for the husband.– 36 y/o, teacher, sexual desire and orgasmic
problems
• Complimentarity and clear vision in couple brought
harmony to life
There must be a vision. First and foremost thing we should do when we get
married is to determine its purposes. The husband and wife have to know
their roles, rights and need mutually understanding. Not just for intimate
relationships. Intimate relationship is just to strengthen the relationship, and
have children. But more important than that is to understand each other
and perform our roles as husband and wife. Must have understanding, and
able to compromise.
SEXUAL GRATIFICATION IS RELIGIOUS MISSION

• Congenial partnership & tranquillity
Linda :Marriage of two humans who has different backgrounds. We have
never known him before this. [..]. Meaning, marriage is a union between
two people to complement each other. That thing (intercourse) is legal,
when we get married. That’s our way to channel our nafsu (desire), we
become tenang (calm), more secure because this is the aim of marriage
itself. – 41 y/o, educationist, sexual desire impairment and orgasmic
problem.,
• Faithful : Confidential, love, obedience, affection &
sacrifice
Alya: Sexuality is a confidential relationship between husband and wife,
intimate relationships and interactions. It involves the connection between
two hearts, from touching, hugging, kissing, and conversation.... Even
words can bind these hearts and develop love. Not necessarily just sex,
intercourse alone, all at once, from eyes go to heart, from heart goes down
there. All practices that can lead to feelings of obedience, love and
affection and all, which could result in the sacrifice of everything, I mean
faithful, sehidup semati (life and death together).– 36 y/o, teacher, sexual
desire and orgasmic problems

SEXUAL DISPLAY IS CULTURALLY
UNACCEPTABLE
• Secret , shameful and dirty things
Malay people do not talk about sex matters. Mom and dad would angry
because that thing is a secret of married couple. If we talk about it, it is like
talking an obscene thing.
Sex was not being told in family because of shameful thing.
• Romantic is something weird
Linda: If kissing, not really. Malay people. Last time, when my husband
started working in Department K, we stayed with my mother. Every time my
husband went out for work, we shake hands and he kissed my brow. Then
many people started asking, how about today, already kissed his hands?
He kisses your brow? Meaning ...that things so weird. 41 y.o, educationist
with sexual desire and orgasmic problem

SEX AS NATURAL OR LEARNED EXPERIENCE
• Learned experience
Aisya: I did not know when the exact time it (desire and orgasmic
problems) started to occur because I did not know what sex was all about.
So when I did not know, either I met the normal sex or not ..I was not sure.
But when chatting occurred among friends with multiple categories.. Got
friend who more senior, when discussed, “Oh is it like that?”.- 42 y/o
medical scientist.
• Natural (Societal view)
Linda: Because lack of exposure to sex. By right...because ever heard,
when in Malaysia.. would like to implement sex education, so the elderly
people, relatives of mine in the village said like this, “ Ah! Blind people even
can..Meaning, that thing no need to be learn. Like eat rice. He said, “when
hunger, this hand moves, this mouth automatically open widely. He gave
analogy liked that. No need to be learn, they still got 4-5 children, even up
to 10. – 41 y/o, educationist, sexual desire impairment and orgasmic
problem.,

IT JUST FOR YOU, LEAVE ME ALONE
• No pleasure, adopted male dominance culture
Yana : I’m fulfilling my obligation as a wife. It is a one-side gain.– 30 y/o, ex-
lawyer, sexual pain
Sofia: What he knew, he only wanted his desire to be fulfilled.- 30 y.o
housewife, sexual desire loss
•Not interested in performing SI and happier with asexual
Yusnita: Only in my heart, not interested, if not do it I feel much happier.- 41
years old with lack of desire..
• Sex boredom with no pleasure and frequent entry
Asiah: I like, aahh. Till when I have to serve him but I don’t have desire, so
bored. -38 years old, psychologist with desire loss
Mona: Do you not feel bored? Eight years already, everyday without miss.
He said, “It (sex) is like eating rice, (so he) wants to eat it everyday.-29 y.o
with lack of desire

• Emotional reaction :depressing with severe form of dislike which was
disgusting and even resisted sex. (Loss of desire or sexual pain)
Huda : But now I feel “menyampah” (disgust) to do it...How much he tried to
arouse me, I became more dislike, ‘meluat’ (more disgusting). – 30 y.o hw
SDL
Eni: I don’t even feel want it (SI), I don’t even feel ‘ngaa’ (arouse), feeling
‘disgust only. [..], if (sex intercourse) prolonged, husband will be kicked out.
- 29 y/o teacher with vaginismus.
•Body reaction
Roza: I want to be served with love. My sex desire also fall down, dismiss to
nowhere. (I) Become like banana tree, stiff like that. Perform it because of...
(I) have to. I’m already his wife. -42 y.o, lecturer, desire and orgasmic
problem
• Love also affected (sexual pain)
Yana : I don’t think I feel anything. I love my husband at other times. His
sacrifice, his good responsibility towards family…but during SI, I think there
was no feeling of love. There was really no feeling, because, it feels like it’s
just a routine, a painful one. -30 y.o ex-lawyer with sexual pain
• Satan as a culprit
Mona: I don’t know why (I) feel like don’t want, don’t like, and hate of that
thing (SI). May be I follow Satan’s whisper. Satan really wants to destroy our
marriage when everything is ‘halal’ (legal). -30 y.o housewife with desire
loss

IT’S A MATTER OF SEX WORK PERFORMANCE
1. Dissatisfied with Self-performance
• Ever felt the pleasure
Liza : Feelings not satisfied exist because we used to enjoy it so much.
That’s why I feel not satisfied, I mean, if we work, our work performance
have markedly reduced. I become like that. [..]. Sometimes it disturbs my
mind because think too much, but not really make me stressful. 44 y.o
teacher, sexual desire prob
•Afraid of Sin
Zety: Fear of sin, even if I'm not satisfied I will serve him. I'm going to do
until he is satisfied. 42 y.o designer, sexual pain
• Panic of polygamy, fear of divorce
Yana: This (polygamy) is the inside joke since a few months ago, or maybe
since a year ago. So..it does send me a panic attack each time. No woman
likes it when the husband makes joke about that. 30 y.o with sexual pain
Sofia: There are four friends of mine who took the injection like me. All of
them faced the same problem (desire loss) and one of them is already
divorced because of this problem. Her ex-husband is a hot-tempered. He
is type of person who cannot stand if his desire is not fulfilled. [...]. I prefer
separated by death than being divorced. 30 years old with total desire loss

2. Dissatisfied with husband performance
• Felt frustration because husband not fulfil his role yet
Sofia: I want to feel sexual satisfaction. He has to make an effort. I want to
feel pleasure..- 30 y.o housewife, sexual desire loss
•It caused more devastating emotional disturbance
Linda: I also feel stress when I do my works. I keep on thinking; sometimes
think where our right is; things that we can have fun, always busy (with
office work). So when I don’t feel climax, my life also disturb. He had
complained about my emotional unstable. He said, I easily get stress
especially now with increasing work load at work. But I think I can handle it,
but sometimes it still slip through. When stress I become moody, also with
him.
• And negative reactions and affected relationship.
Alya : If I feel painful or not satisfy after doing it, I will go berserk. [..]. I will
rumble like..”I’m hurt, I’m tired while doing house chores.” My mood for that
day will ruin. [..]. If I can’t release it (orgasm), I feel everything I do is not
right, that person not right, this person also not right. My emotions become
not stable for whole day

• Good to irritable mother
Alya : My children also get less tenderness. I would
like to show my love but cannot because my husband
not shows it either, perhaps my heart has already
broken. [..]. I cannot be like other mothers who are full
with ‘kasih sayang’ (tender-hearted), because their
husband also compassionate with them, so do they
with their children. If the husband treat their wife
harshly, the wife will feels annoy and subsequently
behaves roughly towards their children. Some sort like
reciprocate. I have tried to become soft-hearted with
my children, but still cannot. Feel annoyed.- 36 y.o teacher
with desire and orgasmic problems.

EXPECTATION UNMET, RELATIONSHIP
THREATENED
 Husband’s circumstances altered
• Husbands’ emotion affected.
Wani :(Husband said) As a normal person, when others chatting [about
that], “if I can’t get at least 3 times per week”, and he started to think, “Me,
to get it from my wife once a month even cannot”. When I asked him, how
about marrying another woman? His feeling at that time was, felt like to
knock his head against the wall. Sometimes he cried alone. I realised it. His
feeling liked got stuck. – 33 y.o, teacher with vaginismus
• Husband’s sexual function also disturbed
Suzy: At present, his member (penis) is not that healthy. Like when we play,
it can’t last more than ten minutes. It went totally down. Sometimes it
doesn’t even get up, making me feeling undesirable anymore to play on.
When I asked him to go to the hospital, he refused. I did mention to him
that this problem can lead to divorce. With my age of only 29 and he is only
35, I don’t think it is illogical that he is impotent.- welfare worker, sexual desire
and orgasmic problems.

 Relational conflict
• No effective communication and mutual understanding
Huda : Common to have ‘gaduh-gaduh’ (frequent quarrelling). Not knowing
what are the (real) causes, but at the some point in the fighting he did say
like, “on top of no desire, (you are ...)”, sometimes I feel very sad but do not
know how to overcome it. Really hurts (crying). Sometimes if he wants (to
have sex), but then I do not serve him, meaning quarrel will happen.
• Continuously serve and respect reduce the risk
Mona: At the beginning, he always angry, sulk as well. Upper limit of his
anger, he remained quiet. He did not say something bad. If he starts
talking, I’m the one who will silent. Like that. I understand, he didn’t get it
last night, or I didn’t properly serve him. Perhaps it let him down already.
Although I don’t want, he constantly gets it when he wants it, so at last he
some sort likes not really thinking [about it]. [He] Looks fine now. But (I)
feel pity him. If other men, perhaps eating outside already -welfare worker,
sexual desire and orgasmic problems.

• Naive about sex risk for polygamy or divorce
Alya: He said to me, “You just like angel”. Because why? Because during
that time, we did it, I had known nothing what I supposed to do, ‘keras
kengkong’ (lying straight doing nothing), not even arouse. Because... In the
beginning of the marriage I felt so weird. I, before this never knew about
sexual [activities]”. He said, “I can’t be like this; I have to marry more than
one. My sexual desire is strong, I feel not enough.- 36 y.o teacher with sexual
desire and orgasmic problem
• Insensitive about sexual satisfaction leads to sexual affair
Suzy: Our sexual relationship was not good from the beginning since he
wasn’t good at identifying where I was sensitive. He was not good. So I
myself have no desire, no mood to do it. That was the problem. At that
time, I did not open my mind to sex that much. In fact, I did not really care.
But now (after her husband committed adultery and she involved in love
triangle with other man who admired her since she wants to feel what love
was) that I heard others talking obscenely about sex then only I went ‘Ahhh’
that is how it felt, that’s it.-welfare worker, sexual desire and orgasmic problems.

Zety : I suffer lots that time. It really hurts [painful SI], and infertility
problem, and had psychological impact too. When go back to hometown,
they asked, “When do you want have a baby?”. Don’t you understand?
What? It’s a gift from god”[..]. At that time, I feel down. Like wanting to
suicide myself, like jumping into the pool, sitting at the lakeside of
Metropolitan. Then I tell my husband to try adopting a child first, who knows
after that we can get our own and if we still don’t have it at least we already
have the adopted one.
• Plays a crucial role in maintaining the problem and worsen the
sufferers emotional pain , causing some degree of depressive
symptom.
Eni : Anybody who sits in my shoes will feel sad with what they had said,
“Marry other (woman)”, “Wife like that”, “Daughter of so and so, cannot be
used”, “Leave wife like this”. [..] Last time if staying [alone] at home [before
starting to working] ,when he came back, I will go berserk to him, wanted
to release my [anger] feeling. When we adopted [a child] I felt slightly calm.
[..] But when I got [my own] children, it is able to close so many doors of
problem…shut down the people mouth. Meaning, after I got children, no
more stories about I could or couldn’t perform (SI).What they knew, I
already did it.
 Insensitive society

Refine and
educate
positive
sexuality
Correct socio-
cultural-
religious
misbelieve
Close the gap
between
couple, focus
on emotion &
needs
Propose good
sex and
better
relationship
Encourage
positive
problem
solving and
support from
spouse
IMPLICATION FOR SEXUAL HEALTH

CONCLUSION
 This research will provide additional and
valuable knowledge to help promote better
sexual health education, as well as cultural
and religiously acceptable therapy from the
perspective of women who experience
sexual difficulties.

THANK YOU FOR YOUR ATTENTION

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