Sexuality & Culture DOI 10.1007/s12119-016-9346-1 ORIGINAL PAPER
Sexual Fantasy, Masturbation and Pornography Among Egyptians Zeinab Kasemy1 • Dalia El-Sayed Desouky1,2 Gaafar Abdelrasoul1
•
Springer Science+Business Media New York 2016
Abstract Sexual behavior is subjected to varying degrees of social, cultural, religious and moral constraints. With the lack of Egyptian studies addressing the prevalence of sexual fantasy, masturbation and pornography consumption, the aim of this study was to assess the prevalence of these behaviors among Egyptians, and its relation to socio-demographic characteristics. A cross-sectional study was carried out on 1532 patients who attended four outpatient clinics of Menoufia University Hospital in the time from January to March 2015. A significant higher prevalence of sexual fantasy was found among female participants, whereas unmarried males showed a higher prevalence compared to married ones. The prevalence of masturbation and pornography was significantly higher among males and among participants with higher educational level. Higher masturbation and pornography prevalence was found among married males with a marriage duration of [10–20 years, where a higher prevalence was found among married females with a marriage duration of B10 years. The study showed a considerably high prevalence of sexual fantasy, masturbation and pornography among the participants. Future studies are needed to assess the risk factors that contribute to this high prevalence. This should be followed by a comprehensive and effective intervention program to ensure optimum reproductive and sexual health among Egyptians. Keywords
Sexual fantasy Masturbation Pornography Egyptians
& Dalia El-Sayed Desouky
[email protected];
[email protected] Gaafar Abdelrasoul
[email protected] 1
Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Shebeen Al Koom, Egypt
2
Departments of Public Health and Community Medicine, College of Medicine and Applied Medical Sciences, Taif University, Alsalama Street, Taif City, Saudi Arabia
123
Z. Kasemy et al.
Introduction Sexual fantasy is defined as any sexually arousing mental imagery a person can have while awake (Hicks and Leitenberg 2001). Previous studies have shown that men have more interest in sex compared to women (Baumeister et al. 2001), they report more frequent sex fantasies, think more about sex, and have more frequent feelings of sexual desire (Regan and Berscheid 1999). Pornography is any sexually explicit material with a primary intention of arousing the viewer sexually (Malamuth and Huppin 2005). It is a medium used to increase sexual arousal (Thornburg and Lin 2002). Around the world, there is a steady increase in the explicitness and frequency of sexual content in media (Straus 2004), particularly on the internet (Hald and Malamuth 2008). Pornographic materials are now easy available through the internet, magazines and blue films (Owens et al. 2012). Masturbation is now popularly lauded for its positive impact on sexual health and pleasure (Annual Western Pennsylvania Undergraduate Psychology Conference 2010). It is the simplest and the basic way to achieve orgasm (Regnerus and Gordon 2014). At the same time it is considered a safe alternative to higher risk practices as stated by clinicians, researchers and politicians (Pinkerton et al. 2002). Considering masturbation frequency, studies have found more prevalence among men (Herbenick et al. 2010a, b). A significant gender difference (male [ female) in prevalence of masturbation, sex fantasies, and pornography viewing was reported in previous studies (Regnerus and Gordon 2014; Chi et al. 2012; Kaestle and Allen 2011). A lot of studies were carried out in developed countries to assess the prevalence and factors contributing to porn viewing, masturbation and sexual fantasy. On the other hand, data from developing countries is lacking. In Egypt, few studies handled these sensitive topics. One of these studies was an old study carried out in 1999 on 163 wives with sexual dysfunction. The study found that 3.1 % of the wives had excessive masturbation (Owida and Amin 1999). Another study was done in 2000 and reported that 2.86 % of circumcised wives had excessive masturbation (Abdel Azim et al. 2000). A recent comparative study was done in 2013 to assess sexual knowledge, attitude and behavior among Egyptian and Jordanian married women. The study found that 11.6 % of Egyptian women watched pornographic films (Abdelaziz 2009). A recent study carried out in AlFayoum University on male patients who attended the dermatology, venereology and andrology department, found that 58.7 % of patients used pornography materials. Among pornography users, 32.6 % used pornography before marriage for masturbation and stopped after marriage, 17.7 % used it before marriage for masturbation and continue to use after marriage, and 8.4 % started using it after marriage or after development of the sexual dysfunction (Ali 2013). With lack of Egyptian studies addressing these sensitive topics, the aim of this study was to assess the prevalence of sexual fantasy, masturbation, and pornography consumption among a sample of the Egyptian population, and to assess the relation of this prevalence to the socio-demographic characteristics of the studied sample.
123
Sexual Fantasy, Masturbation and Pornography among…
Subjects and Methods Study Design and Settings A cross-sectional study was carried out on patients who attended the four most frequently attended outpatient clinics at the Menoufia University Hospital (medical, surgical, obstetrics/gynecology, and pediatrics), in the time from January to March 2015. The selection of these four clinics was purposive based on the high patient turn out in those clinics according to the hospital records. Sample Size The total number of the participants was estimated using the following equation: n = (z29 p 9 q)/D2. Since the actual prevalence of pornography was unknown, the probability of its occurrence was estimated to be equal to that of its nonoccurrence (p = q = 0.5) and a value of 0.025 was chose as the acceptable limit of precision (D). Based on these assumptions, the sample size was estimated to be 1536 persons. Sampling Methodology Proportional allocation method was done to allocate samples into the four clinics, which was done taking into consideration the average number of patient flow to the four clinics in the same months of the preceding year (2014) according to the hospital records. Therefore, the proportionate sample size for every clinic was as follows: 401 patients for the medical outpatient clinic, 398 patients for the surgical outpatient clinic, 355 patients for the obstetrics/gynecology clinic w and 382 patients for the pediatrics clinic. The inclusion criteria were patients who attended the four outpatient clinics in Menoufiya university hospital during the study period. The exclusion criteria were hospital staff, medical personnel, medical students, patients who: refused sharing in the study, did not give consent, could not speak or listen or who had mental health problems. The researchers also excluded all emergencies and critically ill patients to avoid delay in providing treatments. On every day of the study in every clinic, a register was made for patients’ attendance and used as the sampling frame from which patients were selected. A systematic random sampling methodology was carried out to select the participants. At first, a simple random sampling methodology was carried out to select the first patient from the sampling frame, where a randomly selected number between one, two or three was used. For example: if the number one was picked, the first patient became the first participant, and then a sample interval of 3 was used to systematically select patients who will participate in the study. When the selected patient did not meet the inclusion criteria, the next patient was selected until the desired sample size was reached.
123
Z. Kasemy et al.
Study Instrument the study tool was a pre-designed questionnaire including data about: (1) sociodemographic characteristics of the participant (age, sex, education, residence, occupation and marital status), and (2) Sexual behaviour (coital frequency, sexual fantasies, masturbation and pornography). A question about the duration of marriage was added, and participants were classified according to their educational level into a low educated group who were illiterate or were primary, preparatory or secondary school graduates, and highly educated who had a higher level of education. After exclusion of patients who did not meet the inclusion criteria, a total of 1560 questionnaires were distributed. The response rate was 98.7 %, and after exclusion of the incomplete questionnaires, 1532 questionnaires were left for final analysis. Statistical Analysis It was carried out using SPSS statistical software (SPSS, version 20; IBM Corp., Armonk, New York, USA). Results were expressed as number and percentage, and Chi square test was used for comparisons between groups. A p value less than 0.05 was considered significant.
Results About 10 % of the participants (11.5 %) had an age \20 years, 45.7 % had an age ranging from 20 to 40 years, and 42.8 % were more than 40 years. According to their residence, 45.4 % were urban residents, and 54.6 % were of rural residency. Table 1 Gender difference among the participants regarding prevalence of the sexual fantasy, masturbation and pornography Parameter
Gender
Total
Test
p value
Males (780) No (%)
Females (752) No (%)
724 (92.8)
748 (99.5)
1472 (96.1)
56 (7.2)
4 (0.5)
60 (3.9)
Yes
640 (82.1)
142 (18.9)
782 (51.0)
24.69
\0.001
No
140 (17.9)
462 (61.4)
602 (39.2)
17.38
\0.001
Don’t know what is it
0 (0.0)
142 (18.9)
142 (9.3)
12.66
\0.001
No answer
0 (0.0)
6 (0.8)
v2
Sexual fantasy Yes Never Masturbation
44.96
\0.001
Z
6 (0.4)
Pornography
2.09
0.036
Z \0.001
Yes
576 (73.8)
148 (19.7)
724 (47.3)
21.15
Never
196 (25.1)
600 (79.8)
796 (51.9)
21.37
0.049
8 (1.0)
4 (0.5)
0.84
0.403
No answer
123
0.8
Sexual Fantasy, Masturbation and Pornography among…
The male participants accounted for 50.9 % of the sample, and 52.9 % of the participants were married. Only 0.1 % of the participants were illiterates, 9.9 % were of basic education (primary and preparatory), 29.6 % were of secondary education and 60.4 % were of higher education. The working participants accounted for 72.8 %, leaving 27.2 % as non-working males and housewives. In Table 1, a significant higher prevalence of sexual fantasy was found among females compared to males (99.5 vs 92.8 %). While a significant higher prevalence of masturbation and pornographic viewing was found among males (p B 0.001). According to marital status for males, unmarried ones reported a significant higher prevalence of sexual fantasy compared to married (97.5 vs 84.9 %) (p B 0.001). In contrast, married males reported a significant higher prevalence of pornography (p = 0.001). As regards masturbation prevalence, a non-significant difference was found between married and unmarried (p = 0.143) (Table 2). For female participants, married females reported a significant higher prevalence of sexual fantasy compared to unmarried ones (100 vs 98.3 %) (p = 0.003). And according to the prevalence of masturbation and pornographic viewing, a nonsignificant difference was found between married and unmarried (p = 0.051 and 0.064) (Table 2). Table 3 shows a significant higher prevalence of masturbation and pornography among highly educated participants compared to the low educated (p B 0.001),
Table 2 Relationship between marital status of the participants and their sexual behavior (sexual fantasy, masturbation and pornography) Parameter
Males Married (292) No (%)
Test Unmarried (488) No (%)
Yes
Females
Test
Married (518)
Unmarried (234)
No (%)
No (%)
v2
Sexual fantasy 248 (84.9)
476 (97.5)
44 (15.1)
12 (2.5)
Yes
232 (79.5)
408 (83.6)
No
60 (20.5)
80 (16.4)
Never
p value
v2
43.59 \0.001
518 (100.0)
230 (98.3)
0 (0.0)
4 (1.7)
108 (20.8)
34 (14.5)
296 (57.1)
166 (70.9)
108 (20.8)
34 (14.5)
6 (1.2)
0 (0.0)
Masturbation
Don’t know what is it
p value
8.9
0.003
Z
–
v2 2.14
0.143
–
No answer Pornography
Z
1.94
0.051
3.52 \0.001 1.94
0.051
1.25
0.212
Z
Yes
188 (64.4)
388 (52.5)
3.17
0.001
92 (17.8)
56 (23.9)
1.85
0.064
Never
104 (35.6)
92 (18.9)
5.12
\0.001
422 (81.5)
178 (76.1)
1.61
0.107
0 (0.0)
8 (1.6)
1.8
0.071
4 (0.8)
0 (0.0)
0.84
0.400
No answer
123
Z. Kasemy et al.
while a non-significant difference was found between the two groups according to sexual fantasy. Table 4 shows a significant higher coital frequency among participants who reported a marriage duration of (B10 years), compared to those with a longer duration of marriage (p \ 0.001). For male participants, those with a marriage duration of ([10–20 years) showed a significant higher pornography consumption and more masturbation practice (73.3 and 86.7 % respectively), compared to those with a marriage duration of (B10 years and [20 years). For female participants, a significant higher masturbation and pornography prevalence was found among married females with a marriage duration of (B10 years) (31.4 and 25.7 % respectively).
Discussion Results from studies done in western countries showed a higher prevalence of sexual fantasy among men compared to women (Regnerus and Gordon 2014; Chi et al. 2012; Kaestle and Allen 2011; Owida and Amin 1999; Binter et al. 2012). This was explained by the higher sex drive of males and their higher interest in sex (Baumeister et al. 2001). In contrast to those results are the finding revealed from the present study, where a significant higher prevalence of sexual fantasy was demonstrated among female participants (Table 1). This contrast could be attributed to the religious and the culture nature of our society that prevent women from expressing their sexual feelings or even to enjoy sex in many contexts (Baumeister and Twenge 2002). Added to this is the effect of mass media, socioeconomic Table 3 Relationship between the educational level of the participants and their sexual behavior (sexual fantasy, masturbation and pornography) Educational level Low (606) No (%)
Test of significance High (926) No (%) v2
Sexual fantasy Yes
578(95.4)
894(96.5)
28(4.6)
32(3.5)
Yes
236(38.9)
546(59.0)
7.64
No
250(41.3)
352(38.0)
1.24
Don’t know what is it
116(19.1)
26(2.8)
10.68
4(0.7)
2(0.2)
Never Masturbation
No answer
p value
1.32
0.251
Z
Pornography
1.11
\0.001 0.215 \0.001 0.269
Z
Yes
224(36.9)
500(54.0)
6.5
\0.001
Never
378(62.4)
600(45.1)
6.57
\0.001
4(0.7)
4(0.9)
0.13
0.892
No answer
123
Sexual Fantasy, Masturbation and Pornography among… Table 4 Relationship between the marital duration of the participants their coital frequency, sexual fantasy, masturbation and pornography Parameter
Marital duration v2
Married males B10 [10–20 (200) (60) % %
p value
[20 (32) %
v2 test
Married females B10 (84) %
[10–20 (172) %
p value
[20 (36) %
Coital frequency 125.03 \0.001
Daily
84.0
66.7
37.5
70.7
68.9
17.2
Weekly
16.0
20.0
12.5
10.0
16.4
44.8
Monthly
0.0
6.7
50.0
15.0
4.9
37.9
No answer
0.0
6.7
0.0
4.3
9.8
0.0
Yes
86.0
86.7
75.0
84.3
93.4
96.6
Never
14.0
13.3
25.0
15.7
6.6
3.4
Yes
80.0
86.7
62.5
31.4
16.4
0.0
Never
20.0
13.3
37.5
61.4
60.7
43.1
Don’t know what is this?
0.0
0.0
0.0
7.1
19.7
55.2
No answer
0.0
0.0
0.0
0.0
3.3
1.7
Yes
68.0
73.3
25
25.7
16.4
0.0
Never
32.0
26.7
75
74.3
80.3
100.0
0
0
0
0
3.3
0
147.18 \0.001
Sexual fantasy 2.79
0.248
15.79 \0.001
Masturbation 7.58
0.023
144.70 \0.001
Pornography
No answer
24.88 \0.001
13.08
0.001
development and modernization that lead to observed changes in sexual attitudes in developing (Gao et al. 2012; Trent 2008), and Muslim countries (Hanassaba and Tidwella 1993). In the present study, the observed higher significant prevalence of masturbation among men (Table 1), was also found in previous studies (Regnerus and Gordon 2014; Herbenick et al. 2010a, b; Abdel Azim et al. 2000; Peplau 2003; Awaluddin et al. 2015; Herbenick et al 2010a, b). This gender difference was attributed to the repressive societal sexual scripts that constrain women’s pursuit of physical pleasure, or explained by social stigmas that lead to underreporting of women actual rates of masturbation. Others explained this by the higher sex drive among males (Baumeister et al. 2001; Petersen and Hyde 2010). Another explanation was the tendency of men to report becoming aroused by their fantasies (Ellis and Symons 1990), and to fantasize during masturbation (Leitenberg and Henning 1995). The
123
Z. Kasemy et al.
same explanation was observed in a meta-analysis which showed that men were more sexually active and more sexually permissive than women (Petersen and Hyde 2010). The association between higher educational level and masturbation observed in the present study was reported in other studies (Das 2007; Gerressu et al. 2007, 2008). This relationship was explained by the greater access of the highly educated persons to public debate, information, and sex education, which decreases their fears and guilt, and increased their willingness to report masturbation (Kontula and Haavio-Mannila 2002). Another study explained the this relationship by the internalization of less inhibiting ‘‘cultural scenarios’’ of sexual appropriateness, whether through the educational process itself or by leading to embeddedness in more sexually permissive peer networks (Ellingson et al. 2004). The present study shows that higher educational level was also associated with higher prevalence of pornography (Table 3). This finding is in consistence with results revealed from previous studies (Regnerus and Gordon 2014; Gerressu et al. 2008). This observed relationship was explained by the tendency of high educated persons to have more access to information and sex education (Gerressu et al. 2008). As regards marital status, the present study showed a higher prevalence of sexual fantasy among unmarried males (Table 2), which could be attributed to the religious nature of our community that prevent sex outside marriage making sexual fantasy a way to overcome the sexual desire, as men are known to have more interest in sex (Baumeister et al. 2001), think more about sex, and have more frequent feelings of sexual desire (Regan and Berscheid 1999). The present study showed a non-significant difference between married and unmarried males and females according to masturbation prevalence. This is in contrast to another study where masturbation prevalence was significantly higher among single and previously married men and women (Gerressu et al. 2007). This different result from the previously mentioned study was explained by the ‘‘replacement’’ behavior for men, as those who don’t have sex regularly are more likely to masturbate compared to women (Regnerus and Gordon 2014). The disagreement between the results of the present study and the previously mentioned one, could be explained by the suppression of female’s sexual impulse before marriage which is considered a great social ill that is highly shameful and blameworthy in Muslim societies, in addition to the sex separation in the Islamic societies(Hammad et al. 1999). The exposure to modern media and the internet is claimed for changing the conservative values in Muslim and Arab communities (Massad et al. 2014). The significant higher prevalence of pornographic viewing among males in the present study was revealed from other studies which demonstrated that men are more interested in visual sexual stimuli (Regnerus and Gordon 2014; Chi et al. 2012; Kaestle and Allen 2011; Owida and Amin 1999; Abdel Azim et al. 2000; Peplau 2003; Awaluddin et al. 2015). This gender difference was also explained by the higher sex drive among men who are aroused by pornography than women (Wang et al. 2007), in addition to the stigma associated with female autoerotic behaviors that result in underreporting rates of pornography viewing (Kaljee et al. 2007).
123
Sexual Fantasy, Masturbation and Pornography among…
A significant difference was found between married and unmarried males according to pornographic viewing with married males reporting a higher prevalence (64.4 vs 52.5 %). This result is in contrast with previous reports and studies. One of those reports is that issued by the ‘‘Covenant Eyes’’, which is internet accountability and filtering software for computers, tablets and mobile devices which showed a higher pornographic viewing among married males (Pornography Statistics 2015). Another report was that issued by the Institute for the Study of Labor which revealed that married men presumably have fewer opportunities to look at pornography (Institute for the Study of Labor 2014). Our result is also in contrast with a study done in USA which demonstrated a high prevalence of pornographic viewing among unmarried young adults (Maddox et al. 2011). It is also in contrast with another study which showed that those who are not married are more likely than those married to use online pornography (Doring 2009). This contrast could be explained by the effect of marital relation as those who are happily married are 61 % less likely to look at porn (Stack et al. 2004). Old news from Egypt showed that early divorces; even before the fifth anniversary, have been common occurrences since the 1930s (Hopkins 2003). Recently, about 40 % of marriages in Egypt end in divorce, which is the highest rate of divorce in the Arab world (CNN breaking news 2009). There is about one divorce in Egypt every 3 min, which mean 16 divorce cases every hour (Leila 2011). These figures were proved by The Central Agency for Public Mobilization and Statistics (CAPMAS), which stated that there is an increase of 4.7 % in divorce cases from 2012 to 2013 (Egypt independent 2013). One leading sexologist in Cairo attributed 80 %t of divorce in Egypt to sexual problems. This sexologist stated that in most cases, couples simply don’t know how to deal sexually with their partner which is often attributed to miscommunication, as the psychology of men is not understood by women and vice versa (CNN breaking news 2009). In the present study 64.4 % of married males and 52.5 % of the unmarried reported pornographic viewing which was a shocking result for the researchers. This finding could have lots of explanations that still have to be investigated by further researches. One of the explanations could be the greater risk for Egyptian males for sexual dysfunction as a result of common bad habits, such as heavy smoking (Inhorn 2002). Another explanation could be that 72.8 % of the participants in this study were working. Previous studies showed that the increase in the number of working hours results in long contact between men and women and may contribute to establishments of extramarital relationships and marriage distress (Ahmed and Bhugra 2004). A third explanation could be the reported decrease in the sexual satisfaction for couples over years of marriage (Schmitt 2003). In the present work, although a non-significant difference was found between married and unmarried females according to pornographic viewing, 17.8 % of married females reported pornographic viewing. This prevalence could be explained by data from studies carried out in Egypt which claimed sexual dissatisfaction among females to female genital circumcision. This habit results in expressing difficulties during sexual intercourse. It leads to overall less satisfaction due to vaginal dryness, lack of sexual desire, less sexual initiation and orgasm problems
123
Z. Kasemy et al.
(Ahmed and Bhugra 2004). Added to this, is the lack of sexual education (Ahmed and Bhugra 2004). This is going with other studies which stated that in Arab countries, sexual dissatisfaction is usually experienced by women (Yasan and Gurgen 2009; Onsy 2013), which could be a trigger that forces women to pornographic viewing. As an initial exploration study on the Egyptian society, all these findings need in depth investigation of the risk factors that contribute to this prevalence among the studies sample. A higher masturbation and pornography prevalence was found among married males with a marriage duration of [10–20 years. This observed higher prevalence could be explained by the significant higher prevalence of masturbation among males in the present study, and the previously reported relationship between high rates of masturbation and decreased satisfaction with sexual life (La˚ngstro¨m and Hanson 2006). The higher masturbation and pornography prevalence among married females with a marriage duration B10 years, could be attributed to the tendency of women who had not experienced orgasm before marriage to be less likely to be orgasmic with their partners in marriage (Hurlburt and Whittaker 1991). A cause of this finding among married males and females in the present study could be the decrease in sexual desire and the related constructs of sexual satisfaction and sexual frequency with increasing the length of the intimate relationship (Klusmann 2002). Another cause could be the decrease in frequency of intercourse over the course of relationships (Klusmann 2002; Levine 2003; Liu 2000). This study is one of the few studies done in Egypt to address such sensitive topics in the Egyptian community which is a conservative and religious one. Future studies are needed for such an important topic that should be studied more meticulously and with attention to detail.
Limitations A limitation of this study was the recruitment of patients attending a tertiary hospital to be the sample of the study to ensure a large sample size. That is why this sample may not represent the whole Egyptian population. Another limitation was the usage of a self-reported questionnaire to collect data about sexual behaviour, which was prone to recall bias.
Conclusion The present study showed a considerable high prevalence of sexual fantasy, masturbation and pornography among the studied sample. It is an initial exploration of these sensitive topics among Egyptians. Future studies are needed to address factors contributing to these high figures in a religious and conservative community like Egypt. These studies should be carried out in a larger sample representing all
123
Sexual Fantasy, Masturbation and Pornography among…
Egyptians. This should be followed by a comprehensive and effective intervention program to ensure optimum reproductive and sexual health among Egyptians. Acknowledgments The authors gratefully acknowledge the support provided by the administrative office and staff members of Menoufia University Hospital Compliance with Ethical Standards Conflicts of interest The authors declare that there are no conflicts of interest related to that work. Research Involving Human Participants Official approvals were obtained from the Ethics Committee of Faculty of Medicine of Menoufia University, from the director of Menoufia university hospital, and from the heads of the four related departments. Informed Consent All participants were informed about the purpose of the study and the way of answering the questionnaire, and written and informed verbal consents were taken from all patients before sharing in the study.
References Abdel Azim, E., Shalanda, A. A., Abdellatef, R. R., Basiouny, M., Khashaba, A. M., Sweelem, S. H., & Askar, A. (2000). Some psychosexual aspects of female circumcision: A pilot study in Sharkia. Current Psychiatry, 7(2), 155–166. Abdelaziz, A. (2009). Sexual knowledge, attitude and behavior among Egyptian and Jordanian married women. Transcultural Study. Current Psychiatry, 16(4), 335–341. Ahmed, K., & Bhugra, D. (2004). The role of culture in sexual dysfunction. Sexual Disorders and Psychosexual Therapy, 3(2), 23–25. Ali, H.E. (2013). Study of the prevalence and the possible interaction between porn addiction and male sexual function. Thesis Submitted for partial fulfillment of the master degree in Dermatology, venerology and Andrology. Faculty of Medicine, Fayoum University. Annual Western Pennsylvania Undergraduate Psychology Conference. (2010). Poster presented at the April 38th. Slippery Rock, PA. An investigation of masturbation and coping style1. Awaluddin, S. M., Ahmad, N. A., Saleh, N. M., Aris, T., Kasim, N. M., & Sapri, N. A. M. (2015). Rashid NRN. Prevalence of sexual activity in older Malaysian adolescents and associated factors. Journal of Public Health Aspects, 2, 1–7. Baumeister, R. F., Catanese, K. R., & Vohs, K. D. (2001). Is there a gender difference in strength of sex drive? Personality and Social Psychology Review, 5, 242–273. Baumeister, R. F., & Twenge, J. M. (2002). Cultural suppression of female sexuality. Review of General Psychology, 6(2), 166–203. Binter, J., Leongomez, J. D., Moyano, N., Valenttova, J. V., Jouza, L., & Klapilova, K. (2012). Sex differences in the incidence of sexual fantasies focused on evolutionary relevant objects. Anthropologie, 50(1), 83–93. Chi, X., Yu, L., & Winter, S. (2012). Prevalence and correlates of sexual behaviors among university students: A study in Hefei, China. BMC Public Health, 12, 972–982. CNN breaking news. (2009). Let’s talk about sex, divorce’ in Egypt. http://edition.cnn.com/2009/ WORLD/meast/11/11/egypt.divorce/. Das, A. (2007). Masturbation in the United States. Journal of Sex and Marital Therapy, 33(4), 301–317. Doring, N. M. (2009). The internet’s impact on sexuality: A critical review of 15 years of research. Computers in Human Behavior, 25(5), 1089–1101. Egypt independent. (2013). CAPMAS: Divorce rates up, marriages down in 2013. http://www. egyptindependent.com/news/capmas-divorce-rates-marriages-down-2013. Ellingson, S., Laumann, E. O., Paik, A., & Mahay, J. (2004). The theory of sex market. In E. O. Laumann, S. Ellingson, J. Mahay, A. Paik, & Y. Youm (Eds.), The sexual organization of the city (pp. 3–38). Chicago: University of Chicago Press.
123
Z. Kasemy et al. Ellis, B. J., & Symons, D. (1990). Sex differences in sexual fantasy: An evolutionary psychological approach. Journal of Sex Research, 27, 527–556. Gao, E., Zuo, X., Wang, L., Lou, C., Cheng, Y., & Zabin, L. S. (2012). How does traditional confucian culture influence adolescents’ sexual behavior in three Asian cities? Journal of Adolescent Health, 50(3), S12–S17. Gerressu, M., Mercer, C. H., Graham, C. A., Wellings, K., & Johnson, A. M. (2007). Who reports masturbation? British National probability data on prevalence and associated factors. http://bura. brunel.ac.uk/bitstream/2438/4767/1/Fulltext.pdf. Gerressu, M., Mercer, C., Graham, C., Wellings, K., & Johnson, A. M. (2008). Prevalence of masturbation and associated factors in a British national probability survey. Archives of Sexual Behavior, 37, 266–278. Hald, G. M., & Malamuth, N. M. (2008). Self- perceived effects of porn consumption. Archives of Sexual Behavior, 37, 614–625. Hammad, A., Kysia, R., Rabah, R., Hassoun, R., & Connelly, M. (1999). ACCESS Arab Community Center for Economic and Social Services, Community Health Center Public Health Education and Research Department ACCESS Guide to Arab Culture: Health Care Delivery to the Arab American Community, 1999. http://www.naama.com/pdf/arab-american-culture-health-care.pdf. Hanassaba, S., & Tidwella, R. (1993). Change in the premarital behavior and sexual attitudes of young Iranian women: From Tehran to Los Angeles. Counselling Psychology Quarterly, 6(4), 281–289. Herbenick, D., Reece, M., Schick, V., Sanders, S. A., Dodge, B., & Fortenberry, J. D. (2010a). Sexual behavior in the United States: Results from a national probability sample of men and women ages 14–94. The Journal of Sexual Medicine, 7(5), 255–265. Herbenick, D., Reece, M., Schick, V., Sanders, S. A., Dodge, B., & Fortenberry, J. D. (2010b). Sexual behaviors, relationships, and perceived health status among adult women in the United States: Results from a National Probability Sample. The Journal of Sexual Medicine, 7(5), 277–290. Hicks, T. V., & Leitenberg, H. (2001). Sexual fantasies about one’s partner versus someone else: Gender differences in incidence and frequency. Journal of Sex Research, 38, 43–51. Hopkins, N. S. (2003). The new Arab family. Cairo, New York: The American University in Cairo Press. http://www.fayoum.edu.eg/English/Medicine/Dermatologyv/pdf/DrHazem.pdf. Hurlburt, D., & Whittaker, K. (1991). The role of masturbation in marital and sexual satisfaction: A comparative study of female masturbators and non-masturbators. Journal of Sex Education and Therapy, 7(4), 272–282. Inhorn, M. C. (2002). Sexuality, masculinity, and infertility in Egypt: Potent troubles in the marital and medical encounters. The Journal of Men’s Studies, 10(3), 343–359. Institute for the Study of Labor (2014). Are pornography and marriage substitutes for young men?. Forschungs institute zur Zukunft der Arbeit, IZA DP No. 8679, 2014. http://pornharmsresearch.com/ wp-content/uploads/Are-Pornography-and-Marriage-Substitutes-for-Young-Men.pdf. Kaestle, C., & Allen, K. (2011). The role of masturbation in healthy sexual development: Perceptions of young adults. Archives of Sexual Behavior, 40(5), 983–994. Kaljee, L. M., Green, M., Riel, R., Lerdboon, P., Thole, H., Thoale, T. K., & Minh, T. T. (2007). Sexual stigma, sexual behaviors, and abstinence among Vietnamese adolescents: Implications for risk and protective behaviors for HIV, sexually transmitted infections, and unwanted pregnancy. Journal of the Association of Nurses in AIDS Care, 18(2), 48–59. Klusmann, D. (2002). Sexual motivation and the duration of partnership. Archives of Sexual Behavior, 31, 275–287. Kontula, O., & Haavio-Mannila, E. (2002). Masturbation in a generational perspective. Journal of Psychology and Human Sex, 14, 49–83. La˚ngstro¨m, N., & Hanson, R. K. (2006). High rates of sexual behavior in the general population: Correlates and predictors. Archives of Sexual Behavior, 35(1), 37–52. Leila, R. (2011). The national split. Al-Ahram weekly. Retrieved from http://weekly.ahram.org.eg/2011/ 1031/eg12.htm. Leitenberg, H., & Henning, K. (1995). Sexual fantasy. Psychological Bulletin, 117, 469–496. Levine, S. B. (2003). The nature of sexual desire: A clinician’s perspective. Archives of Sexual Behavior, 32, 279–285. Liu, C. (2000). A theory of marital sexual life. Journal of Marriage and Family, 62, 363–374. Maddox, A. M., Rhoades, G. K., & Markman, H. J. (2011). Viewing sexually-explicit materials alone or together: Associations with relationship quality. Archives of Sexual Behavior, 40(2), 441–448.
123
Sexual Fantasy, Masturbation and Pornography among… Malamuth, N., & Huppin, M. (2005). Pornography and teenagers: The importance of individual differences. Adolescent medicine clinics, 16(2), 315–326. Massad, S. G., Karam, R., Brown, R., Glick, P., Shaheen, M., Linnemayr, S., & Khammash, U. (2014). Perceptions of sexual risk behavior among Palestinian youth in the West Bank: A qualitative investigation. BMC Public Health, 4, 1213–1220. Onsy, E. (2013). Attitudes toward seeking couples counseling among Egyptian couples: Towards a deeper understanding of common marital conflicts and marital satisfaction. The American University in Cairo School of humanities and social sciences. A Thesis submitted to Department of Sociology, Anthropology, Psychology and Egyptology In partial fulfillment of the requirements for the degree of Master of Arts in Counseling Psychology. http://dar.aucegypt.edu/bitstream/handle/ 10526/3562/Eman%20Onsy_Couples%20Counseling%20Thesis.pdf?sequence=3. Owens, E. W., Behun, R. J., Manning, J. C., & Reid, R. C. (2012). The impact of internet pornography on adolescents: A review of the research. Sexual Addiction and Compulsivity, 19, 99. Owida, M. A., & Amin, A. E. (1999). Descriptive study of some Egyptian females having sexual dysfunction. Egyptian Journal of Psychiatry, 22, 257–265. Peplau, L. A. (2003). Human sexuality: How do men and women differ? Psychological Bulletin, 114, 29–51. Petersen, J. L., & Hyde, J. S. (2010). A meta-analytic review of research on gender differences in sexuality: 1993 to 2007. Psychological Bulletin, 136, 21–23. Pinkerton, S. D., Bogart, L. M., Cecil, H., & Abramson, P. R. (2002). Factors associated with masturbation in a collegiate sample. Journal of Psychology and Human Sex, 14, 103–121. Pornography Statistics. (2015). Pornography staatistics: 250? facts, quotes, and statistics about pornography use (2015 edition). Covenant Eyes, Inc. Internet accountability and filtering. file:///C:/ Users/M.salah/Downloads/2015-porn-stats-covenant-eyes%20(6).pdf. Regan, P. C., & Berscheid, E. (1999). Lust: What we know about human sexual desire. Thousand Oaks: Sage Publications, Inc. Regnerus, M., & Gordon, D. (2014). Social, emotional, and relational distinctions in patterns of recent masturbation among young adults. Austin institute for the study of family and culture. http://www. austin-institute.org/wp-content/uploads/2014/02/Masturbation-Patterns-among-Young-Adults.pdf. Schmitt, D. (2003). Universal sex differences in the desire for sexual variety: Tests from 52 nations, 6 continents, and 13 islands. Journal of Personality and Social Psychology, 85(1), 85–104. Stack, S., Wasserman, I., & Kern, R. (2004). Adult social bonds and use of Internet pornography. Social Science Quarterly, 85(1), 75–88. Straus, M. A. (2004). Prevalence of violence against partners by male and female university students worldwide. Violence Against Women, 10, 790–811. Thornburg, D., & Lin, S. (2002). Youth, pornography and the internet. United States of America: National Academy of Science. Trent, K. (1990). Teenage childbearing: Structural determinants in developing countries. Journal of biosocial science, 22(03), 281–292. Wang, B., Li, X., Stanton, B., Kamali, V., Naar-King, S., Shah, I., & Thomas, R. (2007). Sexual attitudes, pattern of communication, and sexual behavior among unmarried out-of-school youth in China. BMC Public Health, 7, 189–199. Yasan, A., & Gurgen, F. (2009). Marital satisfaction, sexual problems, and the possible difficulties on sex therapy in traditional Islamic culture. Journal of Sex and Marital Therapy, 35(1), 68–75.
123
