Participants' socio-demographic characteristics are summarized in Table 1.
A total of 773 codes, 22 subcategories, 8 categories, and 3 themes were extracted from the interviews (Table 2).
The first theme was labeled “mental-spiritual lack”; the following topics were the basis of the first theme: lack of emotional support, uncertain future, mental rumination, and sexual concerns:
- Lack of emotional support
This category was formed by combining three sub-categories, 1. need for a companion, 2. need to love and be loved, and 3. striving to be a mother:
One of the unmet needs that the never-married women suffered from was not having a companion. One participant said, "... "When an older person gets married, she actually wants a companion" (64 years old).
The participants also needed someone to love and to be loved by him. "I have everything now ..., I just want someone to love me" (38 years old).
From the participants' point of view, the desire to become a mother is an innate need for women. One participant said, "Everyone gathers around me calling me 'Madam or Professor', but I wish someone would call me Mom instead!” (41 years old).
This category had three subcategories: 1. fear of permanent celibacy, 2. fear of unsuccessful marriage in the future, and 3. fear of being an imposition on family members.
One participant said, "I'm always afraid that I'll grow old and stay single ...” (40 years old).
At the same time, participants were worried about an unsuccessful marriage in the future. "I'm worried that I can't be able to cope with married life, and he may not be the person who can comfort me ...." (36 years old).
Being an imposition on others was another concern of the participants. "When I see everyone going somewhere with their family, but I have to go with my brother family, I feel I'm a burden on their lives” (38 years old).
This was composed of sub-categories: 1. psychological insecurity 2. incessant never-ending despair, 3. feeling guilty, 4. incessant continuous regret formed this category.
One participant, talking about psychological insecurity, said, "As you grow older, you need mental security; you want to have peace of mind with your husband ...” (39 years old).
Despair was another psychological concern of the participants. "How can I know whether someone will marry me in the future ...” (43 years old).
Some participants also felt guilty. "We wronged ourselves by not getting married and hurt ourselves mentally and physically" (37 years old).
At the same time, the women also had a desire for married life. "It's very difficult to see girls younger than you got married, but you got nothing ...” (42 years old).
This category consisted of two sub-categories: 1. concerns if meeting sexual needs 2. forced to ignore sexual needs.
Concerns about consequences of meeting sexual needs were seen in the interviews. "Well, a never-married women who wants to satisfy her sexual needs in any way will not have a good result and will cause harm ...” (36 years old).
Some participants had to ignore their sexual needs. "We do not have a husband to meet this need ... So, this feeling is lost in us" (37 years old).
The second theme in the study (the reform of culture and society) consisted of two categories: 1 adverse effect of culture, and 2. being overlooked in society.
- Adverse effect of culture
This category had three sub-categories as 1. stigma of being single, 2. stereotypical thinking of people, and 3. failure to provide reproductive health services without judgment.
Stigma was one of the concerns seen in the participants. "When I say somewhere that I'm not married, people totally change their opinions about me ... They think I must have a problem that I'm single” (42 years old).
Never-married women believed that people's opinions about them should change. "When people know a single women lives in an apartment, they have negative opinions about her ... they think their husbands are in danger" (39 years old).
At the same time, the stigma of receiving reproductive health services and Iranian laws and traditions regarding the hymen was one of the obstacles for participants attending a woman's clinics for problems with their reproductive system. "... Once when I went to the hospital for my vaginal infection, the ladies asked me why did you get the infection!?” (37 years old).
- Being overlooked in society
This category had three sub-categories: 1. need to set up partner-finding agencies for singles, 2. need for skills to live alone, and 3. need for financial support. Under this heading are the following observations by interviewees:
"It is necessary to establish institutions for never-married people where they can receive some services ... to find someone to marry"(42 years old).
"Educational institutions should be established to teach never-married women how to have a single life because no one has taught us this before ...” (52 years old).
Other responses referred to the need to have income and concerns about financial problems. "My problem today is an economic problem. If I had a salary, I could live very well ...” (64 years old).
Loneliness arising from Disability- associated loneliness was the third theme in the concerns of most of the participants. The theme consisted of two categories: 1. aging, and 2. disease. They felt that aging and disease are difficult given that everyone experiences one if not both, but they are much more difficult for a single person.
Two subcategories, 1. fear of aging due to disability and 2. fear of losing fertility formed this category.
One of the things that never-married women mentioned was fear of aging associated with disability. "When you grow older, your efficiency and power decline. I hope it doesn't happen to me, but if it does, a bitter future awaits me" (42 years old).
At the same time, fear of losing fertility with age was another important issue in the lives of the participants. "One of my worries is that my reproductive age is coming to an end" (45 years old).
This category also had two subcategories: 1. fear of emerging diseases, and 2. fear of diseases without a supporter. Participants stated:
"... I always say thank God that I am healthy now, but what should I do if I come down with a disease in the future? ..." (58 years old).
"The only person who takes care of me is my mother, and if one day she dies, who will take care of me when I come down with a disease" (37 years old).