In this study 19 interviews were conducted with 19 adult males, aged 18 -59 (mean age 37.4 years). The participants were representative of a local population with good diversity of various demographic characteristics. Table 1 shows the demographic characteristics of study participants.
Three main concepts and 9 categories emerged from the conventional content analysis: 1) Needs including “access to sexual and reproductive health services”, “awareness”, and “high-quality and safe sex”; 2) Responsibilities including “health - seeking behaviors”, “sexual skills”, “childbearing responsibilities” and “ethical commitment”; and 3) Social norms including “gender role attitudes”, and “changing marriage rules” (Table 2)
1 - Needs
The concept of needs has three categories including access to sexual and reproductive health services, awareness, and high-quality and safe sex.
1-1 - Access to sexual and reproductive health services
Most men did not know where to refer if they needed specialized services on sexual and reproductive health issues. Access to sexual and reproductive health services has two sub-categories including sexual and reproductive health service delivery centers and supportive environments.
1-1-1 - Centers for sexual and reproductive health service delivery
Most men expressed their personal experiences to highlight their difficulties for access to their services required in the fields of prevention and treatment of infections, sexual problems, and infertility. Even educated participants in medical fields believed that they needed to learn more about sexual and reproductive health issues.
“I think that sexuality is a real need. Men have often inadequate information on sexual health services. Even, although I am a Master of Sciences in Health, I do not have enough information about sexual issues. Therefore, special centers should be considered to provide health services for men”. (36 years old, single, MSc)
1-1-2 - Supportive environment
Some participants suggested that creating a safe and supportive environment to meet men’s sexual needs is vital to prevent sexual chaos in society, mainly due to the current conditions of society, in which marriage requirements are not met and the age of marriage has increased.
“I think that it's very good to limit sex, e.g. it can be limited to a permanent specified location, a place which can be used to meet sexual needs; having such a place will ensure safety for men and women”. (50 years old, single, diploma)
1-2 - Awareness
Study participants believed that the awareness about male genital tract symptoms, timely diagnosis methods, prevention of diseases, cancers, and sexually transmitted infections and HIV, infertility and sexual issues are important factors for adopting sexual and reproductive health behaviors. Sub-categories of awareness include sexually transmitted infection (STIs)/ HIV/ acquired immunodeficiency syndrome (AIDS), cancers, infertility, sexual.
1-2-1 - Sexual issues
Men believed that if they have higher awareness, their sexual health would also improve.
“If I had enough sex awareness, I would prefer my wife to be prepared for enjoyable experiences during sex. I wish I had more knowledge sexual issues”. (31 years old, married, bachelor’s degree)
There were major misconceptions about the signs of diseases and the sexual and reproductive disorders in men. An interviewee considered occasional and spontaneous ejaculation at bedtime as a disorder; he thought that masturbating is a factor in inducing weakness of the body, and even a source of unemployment and dismissal from a job.
“I think that erection during sleep and masturbation cause my weakness, frailty, anger, and even the loss of my job”. (25 years old, single, guidance school)
1-2-2 - STIs/ HIV/AIDS
“As far as I know, AIDS is transmitted through dirty work. I think that I do not get AIDS by once sex; but I'm not sure. I wish I knew what to do”. (25 years old, single, guidance school)
1-2-3 - Male genital cancers and infertility
Male information on male genital cancers and infertility was inadequate; this can influence their exploratory behaviors.
“I do not really have any information about male genital disorders. I just know that the testis is a fertility organ in men. Nobody gives us comprehensive information about the genital system and its diseases”. (50 years old, single, diploma)
1-3 - High-quality and safe sex
Majority of men considered high-quality and safe sex very important issues and a positive sign of sexual health.
1-3-1 - Sexual pleasure
Among sexual health issues, sexual pleasure was the main topic of discussions which most men had in terms of sexual health. Most men considered positive satisfactory feelings of both partners as the criterion for sexual health.
“In my opinion, the quality of the relationship between the two sex partners is very important. I think that if both sex partners adequately enjoy sex, it means they have been successful in their sexual relationships”. (27 years old, married, bachelor degree)
1-3-2 - Sexual satisfaction
The majority of men, while expressing the importance of sexual satisfaction in couples' health, referred to strategies that increased satisfaction, while others believed that a lack of sexual satisfaction can lead to being unfaithful in their relationships.
“I think that because sexual issues are so important for people, sexual dissatisfaction leads to being unfaithful in their relationships”. (24 years old, single, associate degree)
1-3-3 - Safety of sex
The concept of safety in the quality of sexual relationships was repeatedly discussed in the participants' conversations of the study. From the point of view of participants, safety includes the need to have a suitable companion for good sex, elimination of stress and tensions to be able to have good mutual relationship without thinking about others, and feeling empowered.
“In terms of health, if these are marital relationships, we are more relaxed and not worried about future problems”. (28 years old, married, bachelor degree)
1-3-4 - Sexual function
Most participants emphasized the need to maintain an appropriate sexual relations for the survival of married life and quality of sex; they also had different perspectives on premature ejaculation, which was one of the most commonly considered issues among participants in the study.
2 - Responsibilities
This concept includes health-seeking behaviors, sexual skills, childbearing responsibilities, and ethical commitment.
2-1 - Health- seeking behaviors
Participants believed that men had checkups for their health status only when they or their friends/ their relatives had a specific disease. Some men were afraid to talk about their fertility and sexual problems and tried to hide it.
2-1-1 - Regular check up
Almost no participant had ever referred to a health care provider for issues related to his reproductive and sexual system before the problem occurred.
“I do not have enough information on essential checkups related to fertility and sexual health. For example, the only information I have on the prostate is because my uncle died due to prostate cancer; I went for a checkup, but they told me to have tests after the age of 40 years.” (32 years old, single, diploma)
2-1-2 - Fear and hiding the problems
Most participants had a fear of problems with the reproductive and sexual system, and other participants believed that these problems or infertility caused serious concern.
“I would like to see a doctor and be tested for evaluating my fertility, but I’m afraid the results show that I’m infertile. For this reason, I do not refer to the doctor to check my fertility status.” (24 years old, single, associate degree)
2-2 - Sexual skills
Participants believed that for sexual success, which is a prerequisite for the continuation of marital life, and is the cornerstone of a good marital relationship; sexual skills should be associated with mutual satisfaction.
2-2-1 - Sexual negotiation
From the perspective of men, negotiation skills about sexual needs were necessary for self-confidence in sexual issues; they believed that these skills can manage sexual problems.
“I think that negotiation is one of the most important skills among couples. For example, when two people talk, they can discuss their own issues, and problems are much easier to solve. Negotiation can help to discover solutions and couples also learn to understand what their partner enjoys.” (31 years old, married, MSc)
2-2-2 - Interactive and respectable sex practice
This subcategory includes women's psychological readiness and satisfaction of virgins for a sexual relationship; this readiness is very important, and is considered as an ethical issue.
“I think sexual issues must be respected during sexual relationships, e.g., it is important that whether my behavior in this position is acceptable to my partner; did I consider all ethical issues during sexual relationships?” (27 years old, married, bachelor degree)
2-2-3 - Sexually protective behavior
Although all men were familiar with the condom, they sometimes were reluctant to use it even in high-risk conditions, or they did not have the skill of convincing their partner to agree to its use. We asked participants the following question:
If the sex worker wants you to have a relationship without using a condom, what is your reaction? One of the participants hesitantly answered I use a condom.
“I think that if I tell my sexual partner that I want to use a condom, my partner will be upset by my demand. One of my friends suggested that in such cases, I tell my partner, that I am ill. But, in my opinion, this way is ineffective and my partner will get annoyed.”(26 years old, single, Associate Degree)
2-3 - Childbearing responsibilities
Study participants believed that a responsible man should consider some issues such as financing, parental maturity, parenting skills, and family planning before childbearing.
2-3-1 - Financing and providing children's welfare
Participants of the study had different perspectives on the relationship between childbearing and financial and social welfare; however, the majority of men believed that they should have appropriate conditions for childbearing.
“In our society, economic issues are major problems that force people to have only one child, or not have any children.” (36 years old, single, MSc)
2-3-2 - Parents’ emotional maturity and skill
Some participants believed that men should accept the responsibility for childbearing, only when they reach achieve emotional maturity for adapting to difficulties of admitting a third child in their lives.
“In today’s society, economic and psychological problems are highly prevalent, whereas many people cannot even manage their own personal lives. In my opinion, egocentrism and selfishness make people unable to reach parental maturity, and make them think negatively about bringing up children and child-rearing.” (33 years old, married, MSc)
2-3-3 - Family planning
From the perspective of all participants, family planning was a shared responsibility for women and men. In this respect, some participants believed that men sometimes have the major responsibility.
“In my opinion, although both men and women are responsible for unwanted pregnancy prevention, more responsibility is with men.” (27 years old, married, bachelor degree)
2-4 - Ethical commitment
All men in this study believed that ethical commitment and adherence to morality are essential to maintain marital relationships and child-rearing; they also said that the lack of maintaining marital relationships was common in the community.
2-4-1 - Marital and Extramarital relationships
“When a man marries, he is committed to his family (wife and child). In my opinion, the concept of commitment applies for different issues. In other words, we should be committed to all issues of life. I know a lot of people who, despite being married, are not committed to their marital relationship and they have sex with others.” (24 years old, single, associate degree)
2-4-2 - Child upbringing
One participant described his efforts to avoid having an extramarital relationship and also providing a suitable behavioral pattern for his or her child as follows:
“In many cases, I have been denied by my relatives; for example, if someone drinks alcohol, I will not associated with him at all, even if the person is my father. Someone who does an unpleasant act, I’ll cut off all contact with him/her”(49 years old, married, bachelor degree)
3 - Social norms
This concept includes gender role attitudes and changing marriage rules.
3-1 - Gender role attitudes
This category describes gender role attitudes in the fields of fertility and infertility and sexual relationships. Study results show a change in attitudes of men from traditional attitudes to modern.
3-1-1 - Fertility and infertility
Despite many men explicitly stating the importance of having a child in their life, some believed that having a good life in a situation where fertility was not possible for couples is important. From the perspective of men of the study, both parents should be involved in making decisions about having children.
3-1-2 - Sexual relationships
Participants focused on the rights and needs of women/spouses in sexual intercourse; they believed that both, the woman and the man should enjoy sex, otherwise it would be selfish and could cause infidelity.
“I believed that not only should I be satisfied; both the man and the women have the right to enjoy sex and reach orgasm. I think that having sex without enjoying a sexual partner is like doing business. In the past years, there was absolute manhood, but today, each partner expects everything to be good in sex. If sex is not performed in accordance with the partner's wishes, she may be unfaithful him.” (26 years old, single, bachelor degree)
Some men said that having sex before marriage in the woman can lead to lack of trust toward her.
“I think that if a woman/ man tells her/his spouse about having a history of sex before marriage with another, the spouse thinks she may still have sex with other people.” (50 years old, single, guidance school)
Some men tried to think like women; these individuals did not accept the plurality of sexual partners in relationships.
3-2 - Changing marriage rules
This category includes white marriage and suspicion towards non-virgin girls.
3-2-1 - White marriage
Today, many Iranians cohabit before marriage as white marriage. From the perspective of younger and more educated participants, white marriage is inevitable and growing among young couples. Some men believed that white marriage was a prerequisite for marriage. They wanted to marry after ensuring that they were sexually compatible.
“My wife and I lived together in a house before getting married. Many people do this, and in my opinion, it is okay.” (28 years old, married, Ph.D.)
3-2-2 - Suspicion towards non-virgin girls
Most men did not trust the girls who have had sexual relationships with other men before marriage and believed that such girls are unsuitable for marriage. For some men, the virginity issue is an important criterion for choosing a spouse.
“In my opinion, a girl who has sex with me, has probably been in a relationship with other men and is not trustworthy for a marital relationship. Although some men who know that a girl previously had sex with others, they marry her; I believe that their relationships are often temporary.” (33 years old, married, diploma)