Full Terms & Conditions of access and use can be found at
https://www.tandfonline.com/action/journalInformation?journalCode=usmt20
Journal of Sex & Marital Therapy
ISSN: 0092-623X (Print) 1521-0715 (Online) Journal homepage: https://www.tandfonline.com/loi/usmt20
The Sexual Beliefs of Turkish Men: Comparing
the Beliefs of Men With and Without Erectile
Dysfunction
Serap Ejder Apay, Elif Yagmur Özorhan, Sevban Arslan, Hava Özkan, Erdem
Koc & Isa Özbey
To cite this article: Serap Ejder Apay, Elif Yagmur Özorhan, Sevban Arslan, Hava Özkan, Erdem Koc & Isa Özbey (2015) The Sexual Beliefs of Turkish Men: Comparing the Beliefs of Men With and Without Erectile Dysfunction, Journal of Sex & Marital Therapy, 41:6, 661-671, DOI: 10.1080/0092623X.2014.966397
To link to this article: https://doi.org/10.1080/0092623X.2014.966397
Accepted author version posted online: 25 Sep 2014.
Published online: 03 Nov 2014. Submit your article to this journal
Article views: 249
View related articles
View Crossmark data
DOI: 10.1080/0092623X.2014.966397
The Sexual Beliefs of Turkish Men: Comparing the Beliefs
of Men With and Without Erectile Dysfunction
Serap Ejder Apay and Elif Yagmur ¨
Ozorhan
Department of Midwifery, Faculty of Health Science, Ataturk University, Erzurum, Turkey
Sevban Arslan
Cukurova University, Adana, Turkey
Hava ¨
Ozkan
Department of Midwifery, Faculty of Health Science, Ataturk University, Erzurum, Turkey
Erdem Koc and Isa ¨
Ozbey
Department of Urology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
Sexual beliefs underlying male sexual dysfunction are known to emphasize excessively high sexual performance, among other inaccuracies. The purpose of this study was to determine the frequency of certain sexual beliefs among Turkish men with and without erectile dysfunction. In this comparative-descriptive study, demographic data and participant views regarding 50 common sexual beliefs were collected with a questionnaire. The study was conducted at the urology clinic of a university hospital in Turkey between May 2011 and August 2013. Participants were 815 men: 304 with erectile dysfunction and 511 without. Men with erectile dysfunction endorsed 8 beliefs about sexual activity more frequently than did men without erectile dysfunction. Findings indicate the association of certain cognitions with erectile dysfunction. Most of these cognitions concerned high expectations of male sexual function.
Erectile dysfunction is defined as insufficiency in reaching and maintaining an erect penis as
required for sexual intercourse (Akkus et al., 2002; Wespes et al., 2006). Erectile dysfunction is one of the most frequent sexual dysfunctions in men (Akkus et al., 2002; Aschka et al., 2001; Rosen, 2000). It is generally accepted that the majority of cases of erectile dysfcuntion have organic and psychological components (Metz & Epstein, 2002; Ekmekc¸io˘glu & Demirtas¸, 2006; Ozbey, 2010). Among the organic factors that have a role in the origin of erectile dysfunction, the most important factors are vascular (arterial and venous insufficiency), neurological, iatrogenic (drugs, surgical interventions), metabolic, and endocrinological (Ekmekc¸io˘glu & Demirtas¸, 2006). The presence of a psychic disorder accompanied by an organic pathology (e.g., vascular insufficiency) should be kept in mind. Performance anxiety, extramarital affairs with the accompanying guilt,
sexual dysfunction of the individual’s partner, various sexual beliefs, exaggerated expectations, accidental failures, and marital problems may also cause erectile dysfunction with psychogenic characteristics (Metz & Epstein, 2002).
In studies conducted in Turkey, the erectile dysfunction incidence rate in men older than 40 years of age varied between 64% and 86%, and the majority were considered mild to moderate (Ekmekc¸io˘glu & Demirtas¸, 2006; G¨ulpınar, Halilo˘glu, Abdulmajed, Bogga, & Yaman, 2012; Gonulalan, Hayırlı, Kosan, Ozkan, & Yılmaz, 2013; Ozbey, 2010; Uluocak & Kadıo˘glu, 1999). Some studies in the literature have revealed that factors such as age, education, marital status, and sexual beliefs are related to sexual dysfunction (Akkus et al., 2002; Feldman et al., 1994; Kinsey, Pomeroy, & Martin, 1948; Zilbergeld, 1999).
Sexual beliefs might have adverse effects on the sexual, and consequently, the general health of individuals (Baker & DeSilva, 1988). These misinformed beliefs and false expectations can affect the attitudes and behaviors of individuals regarding their sexuality (Baker & DeSilva, 1988; Nobre, Pinto-Gouveia, & Gomes, 2003; Nyanzi, Nyanzi, & Kalina, 2005). The exact effect of beliefs on sexual functioning is beginning to attract attention following some clinical studies. In terms of clinical data, Zilbergeld’s studies deserve special attention (Zilbergeld, 1999). Zilbergeld stated that men with erectile disorders present a set of beliefs about sexuality that work as a factor of vulnerability in the development of their difficulties, such as “a man always wants and is ready to have sex”; “a real man is sexually functional”; “sex is centered in a rigid penis and what we can do with it”; and “sex equals intercourse” (Zilbergeld, 1992, 1999). According to Zilbergeld, a man who presents with this set of beliefs about sexuality is more susceptible to the development of catastrophic ideas about the potential consequences of an eventual sexual failure (Zilbergeld, 1999). When confronted with these situations, men who hold strongly to beliefs such as those previously mentioned usually develop a negative self image manifested in thoughts such as “I’m less than a man,” “I’m a sexual failure,” or “I will never solve this problem.” These beliefs, and the subsequent negative self-image, not only predispose these men to develop sexual difficulties but also play a central role in perpetuating the problem. Wincze and Barlow (1997) identified a set of sexual beliefs underlying male sexual dysfunction by emphasizing excessively high sexual performance and other inaccuracies. Hawton presented a list of sexual beliefs conceptualized as predisposing factors to the development of sexual dysfunction (Hawton, 1985). Other previous studies have assessed similar concepts (Baker & DeSilva, 1988; Hawton, 1985; Wincze & Barlow, 1997). Baker and De Silva (1988) showed that dysfunctional men have a higher rate of erroneous beliefs than do functional men. In other studies, Ejder Apay and colleagues revealed that the ratio of Turkish students upholding such incorrect sexual beliefs as truths was very high (Ejder Apay, Balcı Akpınar, & Aslan, 2013; Ejder Apay, Nagorska, Balcı Akpınar, Sis C¸ elik, & Binkowska-Bury, 2013). The purpose of this study was to determine the frequency of such inaccurate sexual beliefs among Turkish men with and without erectile dysfunction.
METHOD
We conducted a comparative-descriptive study in the urology clinic of a university hospital located in northeastern Turkey. Participants were 815 men: 304 with erectile dysfunction and 511 without. The study was conducted between May 2011 and August 2013. Between the dates of this study, all men who were sexually active, who were admitted to the urology clinic,
and who accepted the study conditions were included in the study. The International Index of Erectile Function was applied in all men included in the study. According to the International Index of Erectile Function, erectile dysfunction is evaluated as follows: 1–7: severe erectile dysfunction, 8–11: moderate erectile dysfunction, 12–16: mild-moderate erectile dysfunction, 17–21: mild erectile dysfunction, 22–25: no erectile dysfunction (http://surgery.arizona.edu/sites/ surgery.arizona.edu/files/pdf/SHIM%20score.pdf). Sexually active male patients who had been diagnosed with erectile dysfunction by urologists (Erdem Koc, Isa ¨Ozbey), according to the International Index of Erectile Function scoring system, were included in the study. The mean score of the male patients with erectile dysfunction was determined as 17.15 (SD = 16.03). Sexually active male patients who had been determined to not have erectile dysfunction by a urologist, according to the aforementioned scoring system, and who applied to the clinic with varying complaints, such as urinary infection or renal problems, were also included in the study. The score of the male patients without erectile dysfunction was determined as 26.88 (SD= 6.91). During the study, 476 men with erectile dysfunction applied to the clinic, and 342 of them agreed to participate in the study. A questionnaire was given to 342 patients with erectile dysfunction, and 304 of them returned the form, for a return rate of 89%. Of the 542 men without erectile dysfunction who agreed to participate in the study, 511 returned the questionnaire, for a return rate of 94%.
All participants were informed about the study and questionnaire via a letter, and the decision to participate was voluntary. They sent this information via a letter and returned the completed questionnaire in a sealed envelope.
Data Collection Tool
Data were collected via a questionnaire prepared by the authors on the basis of the results of a literature review (Baker & Desilva, 1988; Bostancı et al., 2007; Ejder Apay, Balcı Akpınar, & Arslan, 2013; Ejder Apay, Nagorska, et al., 2013; G¨ulec¸, Kılıc¸, & Bilgic¸, 2007; Hawton, 1985; Kukulu, G¨ursoy, & Ak S¨ozer, 2009; Motavallı, Y¨ucel, Kayır, & ¨Uc¸ok, 1991; Nobre et al., 2003; Nyanzi et al., 2005; Torun, Dilek Torun, & ¨Ozaydın, 2011; Wincze & Barlow, 1997; Yas¸an, & G¨urgen, 2004; Zilbergeld, 1992, 1999). After a review of the related literature, two researchers (Serap Ejder Apay, Sevban Arslan) determined that these statements are commonly accepted sexual beliefs. In consultation, the researchers decided which of these beliefs were to be used in the study. The questionnaire form was prepared in Turkish, and then the manuscript in its entirety and the sexual belief statements were translated into English. There were no challenges in translating the sexual belief statements, which have also been used by other authors in similar studies. The questionnaire form included two parts: the first, regarding data collection, included 12 questions regarding the participant’s age, educational level, place of residence, family type, and their sources of information regarding sexuality. The second part consisted of 50 sexual belief statements, which participants were asked to evaluate as either true or false. A response of “true” showed that the participant accepted the belief as factual. Participants with and without erectile dysfunction were compared with regard to their acceptance or not of each belief. An initial pilot study was conducted with 20 sexually active men without erectile dysfunction, age 20 years and older. On the basis of this pilot study, the questionnaire form was revised; the data from the pilot study were not included in the present study. Two beliefs that remained unanswered
(“Masturbation is not a proper activity for respectable people” and “Sexual activity must be initiated by a man”) were removed from the questionnaire form.
Data Analysis
We used SPSS 16 for statistical analysis. Percentages were used for examining the descriptive characteristics of groups, and chi-square was used to compare beliefs and the groups. Because of multiple statistical comparisons, a probability of less than .01 was required to be considered as statistically significant.
Ethical Considerations
Before commencing the study, ethical approval was received from the Ataturk University, Faculty of Health Sciences, Ethics Committee, as well as the written permission of the hospital in which the study would be conducted and the verbal consent of the participants. All participants were informed about the purpose of the study, that the collected information would be used solely for scientific purposes, and that such information would be kept confidential and not shared with others outside the researchers.
RESULTS
When the sociodemographic characteristics of men with and without erectile dysfunction were examined, it was determined that 71.1% of men with erectile dysfunction and 67.6% of men without erectile dysfunction were older than 40 years of age; 44.1% of men with erectile dys-function and 42.5% of men without erectile dysdys-function were primary school graduates, and the majority of both groups resided in urban areas. Of men with erectile dysfunction, 88.9% had a middle income level, 89.8% were from a nuclear family, and 68.1% had received information about sexuality. Of men without erectile dysfunction, 86.9% had a middle income level, 90.0% were from a nuclear family, and 67.9% had received information about sexuality. Most of the study participants indicated that they had obtained information about sexuality from their friends. It was determined that the difference between groups was not statistically significant, and the groups had similar features in terms of variables (p > .05).
Eight sexual beliefs were held more commonly by men with erectile dysfunction as compared with men without erectile dysfunction (Table 1) These beliefs1were as follows:
• Good lovemaking connotes a constant sexual excitement and orgasm as a consequence. • Sexual intercourse is forbidden during pregnancy.
• It is challenging to insert the penis into the vagina.
• Strong men are able to make love a few times successively.
1The eight beliefs statistically significantly different at the .01 level of significance. Researchers who want to use
TABLE 1
Distribution and Comparison of Sexual Beliefs Between the Groups
ED (n= 304)
Without ED (n= 511)
No. Belief n % n % Test and p valuea
1 As long as the partners love each other, they will know how to find pleasure in making love.
221 72.7 361 70.6 p> 0.05
2 Couples know what they think and want during sexual intercourse.
206 67.8 336 65.8 p> 0.05
3 Men desire and are ready for sexual intercourse all the time.
198 65.1 337 65.9 p> 0.05
4 Every man should know how to give pleasure to every woman.
202 66.4 303 59.3 p< 0.05
5 Erection is always a sign of sexual desire and stimulation.
177 58.2 269 52.6 p> 0.05
6 Sexuality is instinctive and cannot be learned.
171 56.3 299 58.5 p> 0.05
7 Good lovemaking connotes a constant sexual excitement and orgasm as a consequence.b
164 53.9 197 38.6 p< 0.0001
8 Regarding sexual intercourse, men prioritize the sexual act and orgasm; on the other hand, women prioritize sentimentality.
153 50.3 219 42.9 p< 0.05
9 The first sexual intercourse is very dangerous for women.
138 45.4 250 48.9 p> 0.05
10 Masturbation during sexual intercourse is wrong.
137 45.1 243 47.6 p> 0.05
11 A good lover should be able to help her/his partner achieve orgasm in every act of intercourse.
126 41.4 205 40.1 p> 0.05
12 Taking testosterone definitely increases sexual potency.
115 37.8 208 40.7 p> 0.05
13 Simultaneous orgasm should be the most important goal for a couple.
137 45.1 175 34.2 p< 0.05
14 The size of male genitalia is important sexually.
110 36.2 223 43.6 p< 0.05
15 Sexual intercourse is forbidden during pregnancy.b
114 37.5 273 53.4 p< 0.0001
16 An erect penis is the key for good intercourse.
110 36.2 184 36.0 p> 0.05
17 Women should obviously have vaginal orgasm.
105 34.5 181 35.4 p> 0.05
18 The most natural position for sexual intercourse is man-on-top/missionary position.
104 34.2 144 28.2 p> 0.05
19 Masturbation is harmful. 98 32.2 192 37.6 p> 0.05 20 It is challenging to insert the penis into the
vagina.b
91 29.9 111 21.7 p< 0.0001
TABLE 1
Distribution and Comparison of Sexual Beliefs Between the Groups (Continued)
ED (n= 304)
Without ED (n= 511)
No. Belief n % n % Test and p valuea
21 Men who have suffered a heart attack or paralysis are no longer sexually active.
93 30.6 164 32.1 p> 0.05
22 Strong men are able to make love a few times successively.b
96 31.6 72 14.1 p< 0.0001
23 Some men make love very well, while others are incapable of doing so, no matter the extent to which they may increase their sexual knowledge and skills.b
223 73.4 220 43.1 p< 0.0001
24 Sexual performance of a man cannot be spoiled under any condition.
83 27.3 161 31.5 p> 0.05
25 Women have less sexual desire. 78 25.7 146 28.6 p> 0.05 26 Making love requires erection of the sexual
organ.
75 24.7 92 18.0 p< 0.05
27 If difficulty in erection is experienced at the beginning of sexual intercourse, it will probably result in impotence.
70 23.0 132 25.8 p> 0.05
28 Menopause completely removes sexual desire.
71 23.4 137 26.8 p> 0.05
29 The hymen could be ruptured by dry humping.
72 23.7 130 25.4 p> 0.05
30 Neither the man nor woman can refuse sexual intercourse.
69 22.7 124 24.3 p> 0.05
31 Sexuality in men culminates during the adolescence period.b
59 19.4 143 28.0 p< 0.0001
32 If no bleeding occurs during the first sexual intercourse, this means the woman is not a virgin.
49 16.1 113 22.1 p< 0.05
33 Sexual action should always be started and sustained by the man.
50 16.4 88 17.2 p> 0.05
34 Aging completely destroys sexual desire. 52 17.1 96 18.8 p> 0.05 35 Adult men lose their interest in fantasy and
masturbation.
49 16.1 106 20.7 p> 0.05
36 Having sexual fantasies is an immoral and unfaithful behavior.
46 15.1 81 15.9 p> 0.05
37 Making love has some certain and explicit rules.
48 15.8 55 10.8 p< 0.05
38 The success in the first sexual intercourse is an indicator for success throughout one’s sexual life thereafter.
41 13.5 77 15.1 p> 0.05
39 How often and how many times
successively a man can make love shows his potency.
36 11.8 57 11.2 p> 0.05
40 Women should not show their emotions. 37 12.2 95 18.6 p< 0.05 (Continued on next page)
TABLE 1
Distribution and Comparison of Sexual Beliefs Between the Groups (Continued)
ED (n= 304)
Without ED (n= 511)
No. Belief n % n % Test and p valuea
41 Loss of penile erection means that he does not find his partner attractive.
33 10.9 71 13.9 p> 0.05
42 If a sexual problem is experienced once, this means that it will repeat.
39 12.8 48 9.4 p> 0.05
43 A woman who starts sexual intercourse is vicious.
26 8.6 66 12.9 p> 0.05
44 Men should not show their emotions. 30 9.9 26 5.1 p< 0.05
45 All physical intimacies should result in sexual intercourse.b
28 9.2 17 3.3 p< 0.0001
46 The man who “fails” the first sexual intercourse is not a man.b
20 6.6 64 12.5 p< 0.0001
47 Pre-ejaculation in men is an indicator of manhood.
21 6.9 31 6.1 p> 0.05
48 It is only the woman’s responsibility to prevent unintended pregnancies.
20 6.6 54 10.6 p> 0.05
49 Women can get pregnant through intimate acts such as kissing, touching.
12 3.9 29 5.7 p> 0.05
50 Sexual life and sexual pleasure are only for men.
13 4.3 23 4.5 p> 0.05
aChi-square test was used. bp level was 0.01.
Bold text is significance level. Significant level was 0.05.
• Some men make love very well, whereas others are incapable of doing so, no matter the extent to which they may increase their sexual knowledge and skills.
• Sexuality in men culminates during the adolescence period. • All physical intimacies should result in sexual intercourse. • The man who “fails” the first sexual intercourse is not a man.
This study revealed that most of the sexually active men included in the study held as true a number of sexual beliefs, but there were many differences in the beliefs between men with and without erectile dysfunction.
DISCUSSION
We will discuss the false beliefs that men in the erectile dysfunction and non–erectile dysfunction groups reported as true, considering how these beliefs may increase men’s likelihood of developing erectile dysfunction and how these beliefs may change between men with erectile dysfunction and without erectile dysfunction. In the literature, men with erectile dysfunction have been shown to hold as true a number of false sexual beliefs (Zilbergeld, 1999).
Responses to Belief 7 (“Good lovemaking connotes a constant sexual excitement and orgasm as a consequence”) revealed a statistical difference between the groups with and without erectile dysfunction. Acceptance of this belief may be higher in men with erectile dysfunction when compared with those without. Penile erection required for sexual intercourse is not fully functional in men with erectile dysfunction. However, in studies conducted among men without erectile dysfunction, it has been reported that belief in this myth is quite high (Bostancı et al., 2007; Ejder Apay, Nagorska, et al., 2013; Torun, Dilek, Torun, & ¨Ozaydın, 2011). A goal of orgasm during every act of intercourse may eliminate the sincerity between couples and expectations may create a basis for disappointment. Acceptance of this belief may have been found at a higher rate among men with than without erectile dysfunction because penile erection during lovemaking, which is necessary for sexual intercourse, is not always achieved in men with erectile dysfunction.
Belief 15 (“Sexual intercourse is forbidden during pregnancy”) was accepted at a higher rate among men without erectile dysfunction compared with those with erectile dysfunction. This may be attributed to the fact that the frequency of sexual intercourse among men without erectile dysfunction may be greater than among men with erectile dysfunction. The rate of those accepting this belief as true was 38.5% in Ejder Apay, Balcı Akpınar, and Arslan’s study. In another study conducted by Ejder Apay and colleagues, the acceptance rate was 37.0% among Turkish participants and 13.8% among Polish participants (Ejder Apay, Nagorska, et al., 2013). This result was explained as follows: “As a pregnant woman is viewed in our society as being in the process of attaining the sacred role of motherhood and it is believed that intercourse could harm the baby, the couple does not engage in an active sex life during pregnancy, and this absence of intercourse during pregnancy is accepted as a belief.”
Belief 20 (“It is challenging to insert the penis into the vagina”) showed a statistically significant difference in responses. This belief was higher in men with erectile dysfunction when compared with men without. Men with erectile dysfunction may have difficulty penetrating the vagina becuase they lack the penile erection required for sexual intercourse, and this may explain the difference in responses between the groups.
Belief 22 (“Strong men are able to make love a few times successively”) showed greater acceptance by men with erectile dysfunction. In the literature, Ejder Apay, Nagorska, and colleagues (2013) reported the same results for men without erectile dysfunction, which was similarly reported by Ejder Apay, Balcı Akpınar, and Arslan (2013). Experiencing a sexual function disorder such as erectile dysfunction may cause men to feel lightheaded, weak, and incapable. Belief 39, “How often a man can make love successfully shows his potency” was also supported.
Belief 23 (“Some men make love very well, while others are incapable of doing so, no matter the extent to which they may increase their sexual knowledge and skills”) showed a great difference between groups. This may be because men with erectile dysfunction consider this problem untreatable, regardless of how much therapy they receive, and they cannot compare themselves with healthy men. However, results of other studies were not in line with ours (Bostancı et al., 2007; Ejder Apay, Nagorska, et al., 2013; G¨ulec¸ et al., 2007; Motavallı et al., 1991; Torun et al., 2011; Yas¸an, & G¨urgen, 2004). The reason for the differences between these studies may be that in the latter studies, no sexual dysfunction was determined in the sampling groups. Ejder Apay, Balcı Akpınar, and Arslan (2013) determined this rate as 29.5%, and no statistically significant difference was found between students. The belief “Sexuality is instinctive and unteachable”
used in the study conducted by Yas¸an and G¨urgen (2004) also supported the results of this study, becuase sexuality is instinctive.
Belief 31 (“Sexuality in men culminates during the adolescence period”) received the highest positive response rate in the group without erectile dysfunction. This may be explained by the fact that men without erectile dysfunction had a greater number of experiences and opportunities during their adolescence to explore their sexuality. This result is supported by findings of other studies (Ejder Apay, Balcı Akpınar, & Arslan, 2013; Ejder Apay, Nagorska, et al., 2013). The perspective regarding sexuality prevalent in the society in which the individual lives is the most important factor affecting an individual’s sexual beliefs (Sungur, 1999). Even though the society in which the individual lives ignores the necessity of an individual being properly informed about sexuality, natural impulses force every individual to learn about their sexuality, beginning from childhood and continuing through adolescence. An individual’s sexual curiosity starts in childhood, while knowledge about sexual matters is obtained mostly in adolescence. Insufficient or inaccurate sexual knowledge obtained during the psychosexual development period of childhood and adolescence and inaccurate and exaggerated expectations regarding sexuality are reflected in the sexual beliefs and behaviors of the individual in adulthood, thus contributing to sexual problems later in life (Miller, 1992).
Belief 45 (“All moments of physical intimacy should result in sexual intercourse”) was found to be accepted as true at a higher rate among men with erectile dysfunction compared with those without erectile dysfunction; however, many studies have reported contradictory results (Bostancı et al., 2007; Ejder Apay, Nagorska, et al., 2013; G¨ulec¸ et al., 2007; Kora & Kayır, 1996). This difference may have been caused by the sample group in these studies including healthy persons without erectile dysfunction, given that sexual intercourse fails because of the lack of penile erection in erectile dysfunction. In this case, the focus of the men diagnosed with erectile dysfunction was the whole sexual relationship—they believe that focus should be not only on sexual intercourse but also on physical intimacy.
Belief 46 (“The man who ‘fails’ the first sexual intercourse is not a man”) was accepted as true by 6.6% in the group with erectile dysfunction and by 12.5% in group without erectile dysfunction. This belief focused on the sexual performance of a healthy and capable man, not failing in any circumstance. In G¨ulec¸ and colleagues’ (2007) study, this belief was found to be statistically significant among male students and supportive of our result. As stated previously, one study was not compatible with the results of this study (Ejder Apay, Nagorska, et al., 2013). Men without erectile dysfunction usually experience no problems during sexual intercourse and see themselves as strong and “male,” which may explain this difference. Success in one’s first sexual encounter is accepted in our society as an indicator of success throughout one’s subsequent sexual life; this success is perceived as a symbol of power, and this power is attributed to men. In contrast, if a man fails in his first sexual intercourse experience, it is believed that he will not be successful throughout his life and he is considered weak and not a man, as this is contrary to the nature of manhood.
This study revealed that participants believed in and approved a similar number of sexual beliefs. However, with respect to three sexual beliefs related with sexual intercourse and or-gasm (Beliefs 7, 8, 23), men with erectile dysfunction accept these to be true at a greater rate when compared with men without erectile dysfunction. These findings are important be-cause these results will serve as the basis for studies among different cultures and groups. Sexuality, which concerns every individual, has considerable effects on a person’s physical
and mental health, can cause social problems that are difficult to resolve, and is a delicate health issue. Being informed about sexuality from accurate sources is an important factor to-ward experiencing sexuality in a healthy way. Psychoeducation should be offered for those who hold these sexual beliefs, because it can strengthen the capabilities, resources, and coping skills of men with erectile dysfunction and can contribute to their health and well-being on a long-term basis. Analytic studies can be conducted to determine whether sexual beliefs are associated with psychological causes of erectile dysfunction. We suggest that clinicians and re-searchers undertake studies to compare patient groups with different types of sexual dysfunction. Findings of studies on sexual beliefs need to be taken into consideration when preparing the content of sex education programs. Training for qualified health educators (psychologists, physi-cians, nurses, midwives) regarding the beliefs that are commonly upheld in society should be provided.
REFERENCES
Akkus, E., Kadıo˘glu, A., Esen, A., Doran, S., Ergen, A., Anafarta, K., & Hattat, H. (2002). Turkish Erectile Dysfunction Prevalence Study Group. Prevalence and correlates of erectile dysfunction in Turkey: A population-based study.
European Urology, 41, 125–133.
Aschka, C., Himmel, W., Ittner, E., & Kochen, M. M. (2001). Sexual problems of male patients in family practice. The
Journal of Family Practice, 50, 773–778.
Baker, C., & DeSilva, P. (1988). The relationship between male sexual dysfunction and belief in Zilbergeld’s myths: An empirical investigation. Journal of Sex & Marital Therapy, 3, 229–238.
Bostancı, N., Buzlu, S., Tufek, F., Kalaycıo˘glu, D., Yıldırım, N., & Yılmaz, S. (2007). Evaluation of university students by gender in sexual myths: Preliminary results. Andrology Bulletin, 31, 362–364.
Ejder Apay, S., Balcı Akpınar, R., & Arslan, S. (2013). Investigation of students’ sexual myths. Journal of Anatolia
Nursing and Health Sciences, 16, 96–102.
Ejder Apay, S., Nagorska, M., Balcı Akpınar, R., Sis C¸ elik, A., & Binkowska-Bury, M. (2013). Student comparison of sexual myths: Two-country case. Sexualty and Disability. doi:10.1007/s11195–013–9301–0.
Ekmekc¸io˘glu, O., & Demirtas¸, A. (2006). Diagnosis and therapy of erectile dysfunction in man. Erciyes Medical Journal,
28, 220–225.
Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, N. J., & McKinlay, J. B. (1994). Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. Journal of Urology, 151, 54–61. Gonulalan, U., Hayırlı, A., Kosan, M., Ozkan, O., & Yılmaz, H. (2013). Erectile dysfunction and depression in patients
with chronic lead poisoning. Andrologia, 45, 397–401.
G¨ulec¸, G., Kılıc¸, Y., & Bilgic¸, S. (2007). The sexual myths comparison between first and sixth class students of the medical faculty of ESOGU. Journal of the Faculty of Medicine at Osmangazi, 29, 136–145.
G¨ulpinar, O., Halilo˘glu, A. H., Abdulmajed, M. I., Bogga, M. S., & Yaman, O. (2012). Help-seeking interval in erectile dysfunction: Analysis of attitudes, beliefs, and factors affecting treatment-seeking interval in Turkish men with previously untreated erectile dysfunction. Journal of Andrology, 33, 624–628.
Hawton, K. (1985). Sex therapy: A practical guide. Oxford, UK: Oxford University Press.
Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Age and sexual outlet. In A. C. Kinsey (Ed.), Sexual behavior in
the human male (pp. 213–262). Philadelphia, PA: Saunders.
Kora, K., & Kayır, A. (1996). Sex roles and sexual myths. Journal of Psychiatry and Neurological Sciences, 9, 55–58. Kukulu, K., G¨ursoy, E., & Ak S¨ozer, G. (2009). Turkish university students’ beliefs in sexual myths. Sexuality and
Disability, 27, 49–59.
Metz, M. E., & Epstein, N. (2002). Assessing the role of relationship conflict in sexual dysfunction. Journal of Sex &
Marital Therapy, 28, 139–164.
Miller, P. H. (1992). Theories of developmental psychology. New York, NY: Freeman.
Motavallı, M., Y¨ucel, B., Kayır, A., & ¨Uc¸ok, A. (1991).Three groups of married women’s sexual beliefs and life evaluation.
Nobre, P. J., Pinto-Gouveia, J., & Gomes, F. A. (2003). Sexual dysfunctional beliefs questionnaire: An instrument to assess sexual dysfunctional beliefs as vulnerability factors to sexual problems. Sex Relation Therapy, 18, 171– 204.
Nyanzi, S., Nyanzi, B., & Kalina, B. (2005). Contemporary myths, sexuality misconceptions, information sources, and risk perceptions of bodabodamen in southwest Uganda. Sex Roles, 52, 111–119.
Ozbey I. (2010). The role of androgen replacement therapy in erectile dysfunction. Turkish Urology Seminars, 1, 112–118. Rosen, R. C. (2000). Prevalence and risk factors of sexual dysfunction in men and women. Current Psychiatry Reports,
2, 189–195.
Sungur, M. Z. (1999). Cultural factors in sex therapy: The Turkish experience. Journal of Sex & Marital Therapy, 14, 165–171.
Torun, F., Dilek Torun, S., & ¨Ozaydın, N. (2011). Men’s belief in sexual myths and factors affecting these myths.
J Psychiatry Neurological Sci, 24, 24–31.
Uluocak, N., & Kadıo˘glu, A. (1999). The epidemiology of erectile dysfunction. Sexual Dysfunction Monograph Series,
4, 3–5.
Wespes, E., Amar, E., Hatzichristou, D., Hatzimouratidis, K., Montorsi, F., Pryor, J., & Vardi, Y. (2006). EAU guidelines on erectile dysfunction: An update. European Urology, 49, 806–815.
Wincze, J. P., & Barlow, D. H. (1997). Enhancing sexuality: A problem solving approach. Client workbook (pp. 60–66). San Antonio, TX: Graywind.
Yas¸an, A., & G¨urgen, F. (2004). Comparison of prevalence of sexual myths and methods of acquiring sexual information in a group of nurses with and without sexual partners. New Symposium, 42, 72–76.
Zilbergeld, B. (1992). The man behind the broken penis: Social and psychological determinants of erectile failure. In R. C. Rosen & S. R. Leiblum (Eds.), Erectile disorders: Assessment and treatment (1st ed., pp. 27–55). New York, NY: Guilford Press.
