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ORIGINAL ARTICLE
J Edu Health Promot 2019,  8:52

A study on association of premarital attitude toward intact hymen in new grooms: A cross-sectional study


1 Departments of Midwifery, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
2 Department of Statistics and Epidemiology, Medical Faculty, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

Date of Submission18-Jun-2018
Date of Acceptance26-Sep-2018
Date of Web Publication14-Mar-2019

Correspondence Address:
Dr. Zohreh Ghorashi
Department of Midwifery, School of Nursing and Midwifery, Parastar Street, Rafsanjan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jehp.jehp_161_18

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  Abstract 

BACKGROUND: Young people's attitudes toward marriage have been undergone changes in recent years and it seems to be contradicting in the struggle between conservative and modern liberal attitudes. The purpose of this study was to evaluate the attitude of new grooms toward intact hymen in Kerman.
MATERIALS AND METHODS: This cross-sectional study has been conducted on 790 new grooms in Kerman, Iran. In this study, we examined the attitudes in two aspects of sexual norm and personal attitude toward premarital relationships in new grooms. The sampling method was purposive sampling and the data were analyzed using t-test and analysis of variance.
RESULTS: The results of this study have showed a more conservative sexual attitude toward the sexual norms of premarital sex. The average score of the participants in the sexual norm and personal attitude was, respectively 15.86 and 48.15, indicating that their conservative views have been overcome. Most of the samples (90%) have believed in required preserving virginity before marriage, and 82% believed in virginity as the most valuable asset of the girls. In this study, the conservative attitudes of men were inversely related with their age and were directly related with perceived sexual norm and the level of affinity to religious affairs.
CONCLUSION: According to the results of this study, conservative attitudes toward premarital relationships are predominating in new grooms, but this is not generalized. The conservative attitude of new grooms may have harmful effects on their interpersonal behaviors after marriage, which requires purposeful training.

Keywords: Attitude, intact hymen, Kerman, men


How to cite this article:
Nikirashidi F, Ghorashi Z, Esmaeilzadeh S, Asadollahi Z. A study on association of premarital attitude toward intact hymen in new grooms: A cross-sectional study. J Edu Health Promot 2019;8:52

How to cite this URL:
Nikirashidi F, Ghorashi Z, Esmaeilzadeh S, Asadollahi Z. A study on association of premarital attitude toward intact hymen in new grooms: A cross-sectional study. J Edu Health Promot [serial online] 2019 [cited 2019 May 22];8:52. Available from: http://www.jehp.net/text.asp?2019/8/1/52/254044


  Introduction Top


Based on ancient traditions in many religious communities and especially in the Middle East, sexual relationships have been permitted only in the context of marriage and any heterosexual relationship between single women and men has been prohibited and considered guilty and taboo.[1],[2] Of course, this ban was generally reserved for young girl and as a cultural expectation of girls, they are obliged to refrain from premarital sex in accordance with the community's tradition, and they have been supported by honor men, family and community.[2],[3],[4] It is imperative that they preserve their virginity until marriage with sexual abstinence, and bring this value to the husband's house.[5],[6]

Human societies have revolved as a general principle over time, and existing norms have been changed and modernity has been replaced traditional values and old concepts.[7] Over the last few decades, the sexual culture of Iranian society was no exception and has been transformed rapidly.[8] Under the influence of economic issues, increasing unemployment, cultural tendency to high education, especially in women, access to various media and information technologies, immigration and cultural influence, the marriage age of the youth has been risen and the gap between maturity and marriage has been increased.[1],[4] This issue has led to an increase in the premarital relationship among Iranian youth and adolescents.[2],[9]

In this cultural transition, following the wave of changes in attitudes and sexual behaviors and the attitude to premarital relationships has undergone tremendous mutation among young people, and many of them are allowed themselves to have premarital relationships and follow the modern culture of modernity until marriage.[4],[8],[10],[11]

In the study, it was noted that although the Iranian youth accept the participation of women in marriage before the marriage, but about the traditional way of preserving virginity, they have agreed to improve the chances of marriage of girls which expresses a contradictory liberal attitude.[1],[12] Despite the claim of modernity in society, traditions are also of particular importance in certain aspects of life, including the necessity to have virginity as a condition of marriage and the necessity of proving it after marriage as a social value is rooted.[4]

The dichotomy between the traditional cultural values and the modern Western values has led to bewilder of young people, especially young girls and in some cases, they have generated many problems for young couples.[13],[14] The domain of these problems has been widespread from marital discord and divorce to the occurrence of honor killings.[6],[15],[16]

It seems that the wave of cultural transition from traditional values to modern perspectives has occasion that many young boys who consider themselves modern and new-fashioned, divulge the tradition of pressure on themselves and their spouse occasionally during the marriage. The purpose of this study was to evaluate the attitude of new grooms toward the intact hymen (as an indicator of virginity) and its relation with some of the demographic factors in Kerman.


  Materials and Methods Top


This research is a cross-sectional descriptive study that has been conducted from August to December 2012 in a sample of new grooms in Kerman, Iran. The research population has been included all new grooms who referred to the only premarriage counseling center in the city of Kerman to receive the services of the center. Inclusion criteria included being Iranians, having reading and writing skills, lack of history of known psychic illness and first wife marriage. Participate was in a fully voluntary study and the participants had the right to withdraw from research if they did not have the willingness to participate in this study.

Five hundred and twenty-five people were calculated in sample size using statistical formula and based on similar studies, which is estimated at 682 people due to the chance of falling (30% drop). In the early stages of sampling due to the nature of the study and the concern of the lack of cooperation and accountability of the participants who agree with the opinion, the statistical consultant has been increased the sample size to 790 people (50% drop). The sampling was done using purposive sampling. The researcher has collected the information with written permission after approval of the project in the research council of Rafsanjan University of Medical Sciences and getting a letter of introduction and administrative coordination with the Research adjutancy of Kerman University of Medical Sciences.

Considering the mandatory referral of all volunteers to the premarriage counseling center in order to obtain a permit from the center for spouse and centralization of all Kerman's premarriage services, including testing, counseling and training in a center and presenting them in 1 day, clients have been attended in the laboratory for 7 morning then they came to assist at didactic classes at 9 o'clock to the educational hall of the counseling center located elsewhere.

Sampling this study was done at a limited time of 1 h since the time of the affairs related to the tests and the relevant administrative hierarchy, before the start of the training classes in order to control the effect of educational content of these classes. The researcher, while introducing herself, by using the checklists of inclusion and exclusion criteria, had invited from the new grooms referred to participate in the study and after expressing the research goals and assurances regarding anonymity of the questionnaire and the principle of secrecy and confidentiality of information and using its results only for research purposes; received written consent then the questionnaire gave to samples. In order to respect the privacy of individuals and increase the credibility of data, the samples were able to take with oneself the questionnaire and completed if they wish or at the specified location in the center, they can calmly respond to the questionnaire questions and put up the completed questionnaire in the folder for which was considered. Folders were collected before the beginning of the training classes and questionnaires that were delivered after this time were excluded from the study. At the time of sampling, the researcher has been attended the site and has been monitored the privacy and completeness of the questionnaires and he has been answered the questions of the research samples, to resolve the ambiguity and enlightenment.

Among 790 volunteers who have been received the questionnaire; 723 people have placed the questionnaires in the sightly folders and 11 of the delivered forms were omitted due to failure to answer key questions and finally, 712 questionnaires have been entered into the statistical survey.

A self-completed anonymous questionnaire with a structured tested has been used in this survey. This tool consisted of two parts: demographic information and premarital relationship attitudes questionnaire. The attitude questionnaire has been consisted of 16 phrases in two domain sexual norm and personal attitude with a 5-degree Likert scale and earning a higher score reflects a more conservative attitude. This questionnaire is part of a questionnaire that has been validated in Iran by Khalajabadi Farahani and Cleland, and its reliability was determined by measuring the internal correlation with Cronbach's alpha of 0.86.[8] The Cronbach's alpha coefficient in the current questionnaire is 0.878, which shows that the questionnaire has an acceptable reliability. Internal consistency of the two dimensions of sexual norm and personal attitude were evaluated to be 0.802 and 0.885. Furthermore, the convergent validity of the questionnaire was by 100% in both aspects of sexual norm and sexual attitude. The variable of adherence to religious affairs is also one of the variables of the questionnaire who were asked to give themselves 0 points (totally unconditional) to 10 (highly religiously affiliated) according to their adherence to religious affairs.

Collected data by the researcher have been recorded for statistical analysis in SPSS statistical software (version 18, Chicago, IL, USA). Quantitative data were reported as mean ± standard deviation and qualitative data were reported as number (%). One-way analysis of variance has been used to investigate the relationship between quantitative variables based on qualitative variables. Pearson correlation coefficient was used to examine the relationship between quantitative variables. The significance level was considered 0.05 in all tests.


  Results Top


Among 790 volunteers who received the questionnaire; 723 people have placed the questionnaires in the sightly folders and 11 of the delivered forms were excluded due to failure to answer key questions and finally, 712 questionnaires (The respond ratio was 90%) have been entered into the statistical survey. In general, the mean and standard deviation of men's age was 26.83 ± 29.4 years (min 19 and max 46 years), and their wives were 37.34 ± 4.80 years (min 15 and max 43 years). In general, the mean and standard deviation of adherence to religious affairs and male household size in the present study were obtained 7.70 ± 2.14 (min 0 and max 10) and 5.70 ± 1.61 (min 2 and max 12).

In this study, 410 (57.6%) of couples were began to live together immediately after marriage independently, 239 (33.6%) were espoused and each of the couples were lived with their parents and 63 (8.8%) were started their common life with one of their families or their spouse. 8 (1.1%) of the volunteers were weak in their relationship with the family, 61 (8.6%) were moderate and 643 (90.3%) have been reported good.

Frequency distributions of volunteers have been listed in [Table 1] based on the variables of the spouse's education level, type of religion, place of residence, husband's employment status, and male income per month.
Table 1: Demographic characteristics of the participants

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In general, the mean and standard deviation of men were 15.86 ± 3. 8 (min 4 and max 20) in the sexual norm's dimension and 48.15 ± 7.46 (min 17 and max 60) in the personal attitude's dimension. [Table 2] shows the comparison of the mean of two dimensions of sexual norm and personal attitudes based on the male level of education, male employment status and the type of spouse's choice. In the dimension of sexual norm based on the level of education, the men with the least education, based on the variable of male employment status, students also, based on the type of spouse's choice, the men who chose their spouse by choosing their own and their consent family were the most likely to score in this dimension, that it means they were more conservative in this dimension. However, this difference was significant only on the basis of the male employment status variable (P = 0.047). In the dimension of personal attitudes based on the variables of the level of education, the men with the least education, based on the variable employment status of the man, the unemployed people and also, based on the type of spouse's choice, the men whose wife was chosen by their families and themselves have been opposed this choice; they got the highest score in this dimension, which means they had a more conservative attitude in this dimension. In this section, the differences were statistically significant based on two variables: male level of education (P = 0.10) and spouse's choice (P = 0.016) [Table 2].
Table 2: Comparison of mean scores of two dimensions of sexual norms and personal attitudes based on demographic variables

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The results of [Table 3] have been shown that there is a positive and significant correlation between sexual norm and adherence to religious affairs (r = 0.326) (P < 0001). This correlation coefficient shows that with increasing adherence of men to religious affairs, their sexuality norms score also increase, that is, they have more conservative sexual norms and vice versa. There is a positive and significant correlation between two dimensions of sexual norms and personal attitude (r = 0.548) (P < 0.0001) [Table 3].
Table 3: Relationship between sexual norms and personal attitudes with age and adherence to religious affairs

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Furthermore, the results of [Table 3] have been indicated that there is a reverse and significant correlation between personal attitude and men's age (r = 0.270) (P = 0.001). This correlation coefficient indicates that with the increase in age, the score of the dimension of personal attitude decreases and vice versa or, by increasing age, men's conservative attitudes decreases. In addition, there is a positive and significant correlation between personal attitude and adherence to religious affairs (r = 0.554) (P < 0.0001). This correlation coefficient has been shown that with increasing adherence of men to religious affairs, their personal attitude scores also increase, meaning they have a more conservative personal attitude and vice versa [Table 3].

[Table 4] shows the frequency distributions of response male volunteers who referring to the premarriage counseling center for questions about personal attitudes toward relationships with the opposite sex.
Table 4: Distribution of the frequency of personal attitude toward relationship with the opposite sex in male volunteers referring to the premarriage counseling center in Kerman

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  Discussion Top


In the present study, the overall mean score of participants in two aspects of sexual norm and personal attitude indicates their conservative views. While the mean scores of attitudes toward premarital sexual relations in the study of Motamedi et al. has indicated a more liberal attitude in Tehran.[12] The difference in the statistical population in two studies is due to this discrepancy.

In the present study, the average age of marriage in men and women has respectively been 26.83 and 23.37 years, which is consistent with the average age that reported by the Statistical Center of Iran in 2011.[17],[18] Proving the age of marriage in recent years in Kerman has been shown the relative success of demographic policies. Providing education and providing the necessary infrastructure seems mandatory to reduce the age of marriage as one of the goals of these policies.

According to the findings of this study, about three-quarters of the samples have been reported their religiosity to be moderate and higher. Which are consistent with the results reported in the study of Honarvar et al.[2]

In the recent study, more than half of the couples immediately began their common life. Due to the lack of information and studies that examine the amount of espouse and wedding in Iran; it seems that this high percentage in Kerman is due to its traditional context. Perhaps this is a solution that families have adopted to reduce the social problems of the period of the agreement despite economic problems. In addition, according to the results, about two-thirds of men had the main role in choosing a spouse, and the family has only accompanied them. This also refers to changing the cultural trend of society and reducing traditional marriages.

In the findings of this study, people with the least education and unemployed and those who choose their wife by the family and opposed to their views (families with a very traditional structure) have shown a more conservative attitude with the highest score. In line with this study, in Tehran (2011), people with higher economic and educational status had a more liberal view of opposing sexes.[9]

In the study of Farahani et al., good family relationships will lead to a more conservative attitude and will reduce the likelihood of having sex before marriage. However, in the recent study, this finding was not confirmed, which could be due to the sample size and statistical population differences.[9] In this study, compatible with other studies, higher scores of religious affairs have led to an increase in self-efficacy of individuals and a more positive view toward the abstinence of premarital sexual relationship. In other words, in most studies, there has been an inverse relationship between religiosity and the liberal sexual attitude.[2],[19],[20] Of course, proving the causal relationship is not possible due to the nature of cross-sectional studies. Because religious people may be involved in such relationships, they will consider themselves nonreligious due to their revaluation.

The findings have shown that, like the study done in Turkey (2011), the use of religious beliefs and values has been seen as a tool to disapprove of premarital sex in the majority of men.[21] In this study, about three-quarters of contributors have announced that premarital sex is sinful and prohibited based on their religious beliefs. Which it can be due to the fear of individuals being subjected to religious rules in the event of conflict in premarital sexual relationships.

Participating men by emphasizing virginity as a precondition for marriage have tended to support patriarchal traditions and have exerted social restrictions on women. According to the obtained results, approximately 90% of the samples are required virginity for girls until marriage, and about 82% of them were introduced as the most valuable asset of a girl. In this regard, in Lebanon, approximately 77%,[19] in Turkey 76%,[21] in Tehran 43%[12] of the men have been considered the virginity of the spouse necessary for the decision making to marriage. The existence of such a conservative view in new grooms in Kerman refers to the roots of sexual taboos and its focus on the physical state of virginity. In societies like Iran, sexual education is very scarce, and sex issues are taboo. Fear and worries about premarital sexual relations have been shaped not only among single people, especially girls, but also these fears and concerns have been continued and fromed generations to permanent generations. Even they are origins of problems in marital couples' relationships include vaginismus and dyspareunia; which requires a review and adoption of the necessary measures in this regard.

In the present study, 6.5% of men have been agreed with sexual intercourse in the presence of romantic relationships. While in Tehran (2016), 42% of men had such an attitude.[12] The difference can be due to the difference in the research community. Considering that Tehran is the capital of Iran and pioneers in accepting social change and modern views. This difference was natural and represented a wave of attitudinal evolutions which results in more changes in the sexual norms of the studied community and reduces the existing gap in the future.[22] Due to the close relationship between attitudes and behaviors and the impact of education on attitudes formation, these results should be considered in examining the premarital sexual behavior of young people.

Comparing the attitudes of new grooms toward virginity with perceived sexual norms, express a greater conservatism in the sexual attitude toward the perception of social norms of premarital sexual relations, contrary to similar studies.[12],[18],[23],[24] The reason for this contradiction and the difference is in the statistical society of this study and the above studies and its sociocultural differences. Of course, due to the gradual adaptation of society, especially the younger generation, to the dominant atmosphere and their willingness to adhere to the modern values of the big cities, it is not unlikely that expecting for the emergence of more liberal attitudes in this cultural transition.

The findings of the recent study have been revealed a more liberal personal attitude with increasing age. However, in other studies, younger people showed a more liberal attitude.[12],[25],[26],[27] This inconsistency is also due to the difference in statistical populations. Given that new grooms, who are generally more responsible and are on the verge of forming a family, specific conditions in the statistical society of this study were being created which may be different from general society. On the other hand, older people in this group may have more experience in marriage and even premarital relationships, in which case their liberal attitude can be justified.

The ability of participants to understand questionnaire questions and their willingness and motivation to provide honest answers is very important in the value of this study. Though probability of occurrence problems in understanding the content from them unlikely. In the used tool in this research, by designing intermittent questions and in the opposite direction, the response bias has been minimized by choosing similar options. By applying the described methods in the methodology; accuracy of answers to maximum and fear express opinion participants reached the minimum.

This cross-sectional descriptive study, due to its intrinsic nature, includes only new grooms in Kerman, and cannot be generalized to the general population. The first marriage of a woman as inclusion criteria restricts the attitude to virginity in this study for a particular group of men. Despite the paid attention, due to the use of self-report questionnaire to collect data and the relationship between the topic of research and the field of sexuality, the probability of bias is the answer. There is also the probability of bias in acceptability due to the refusal of some of the participants to cooperate in the study due to the very sensitive nature of the subject and prejudice toward that (14.3%), which may affect the outcome of the study.


  Conclusion Top


Although there is seen a change in the attitude toward the importance of virginity before girls' marriage. However, virginity is still a powerful and rooted stimulus for conservative attitudes toward premarital sexual relations in the cultural structure of our society. Although virginity is an undeniable value, the misconceptions and conservative attitudes which are associated with it, are a serious threat to the success of marital life and the strength of the family system. These attitudes represent the limitations of women and unbalanced structure power between the sexes and are in conflict with the concept of sexual health of societies, and they are needed to be reviewed and educated.

According to the evidence, despite the negative attitude toward sexual education in many societies, especially Muslims, these trainings do not lead to increase sexual activity. As the training coincides with cultural values and popular beliefs in the society, in accordance with the gender and age of the audiences, they are effective in promoting the sexual health of the community.[28] In this regard, using the results of this study seems effective for premarital education.

So in order coping with wrong beliefs and academic education and evidence-based all cultural, social, and religious capacities in different societies should be used so that sexual abstinence, that the main meaning is virginity, becomes a step toward promoting sexual health.

Acknowledgments

Thanks and appreciation of all new grooms who have trusted us and completed the questionnaires. This project was conducted with the approval number IR.RUMS.REC.1396.81 and supported by Rafsanjan University of Medical Sciences.

Financial support and sponsorship

Rafsanjan University of Medical Sciences.

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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