GENDER POWER AND MARITAL RELATIONSHIP AS PREDICTORS OF SEXUAL DYSFUNCTION AND SEXUAL SATISFACTION AMONG YOUNG MARRIED COUPLES IN RURAL CHINA: A POPULATION-BASED STUDY JOSEPH T. F. LAU, XILIN YANG, QINGSHENG WANG, YIMIN CHENG, HI YI TSUI, LANCELOT W. H. MUI, AND JEAN H. KIM ABSTRACT Objectives. To investigate associations between gender relationships and sexual dysfunction (SD) of younger married couples living in rural China. Methods. An anonymous cross-sectional population-based survey study was conducted in a rural area in Hunan, China. A random sample of 298 couples were recruited. Self-reported SD, sexual satisfaction, and variables related to gender power and marital relationship were measured. Results. Of the respondents, 28.2% and 45.6% of the husbands and wives were having at least one of the studied SDs, respectively. The results of the multivariate analyses showed that husbands not reporting a quality marital relationship (odds ratio [OR] 4.27, 95% confidence interval [CI] 2.13 to 8.57), who mis- trusted their wives (OR 9.14, 95% CI 4.22 to 19.78), who claimed themselves as the decision-maker regarding condom use (OR 2.41, 95% CI 1.20 to 4.85), and whose wife scored lower in the relationship control subscale of the sexual relationship power scale (OR 2.83, 95% CI 1.15 to 6.95) were more likely than other husbands to have at least one SD. Wives who were not trusted by their husbands (OR 2.94, 95% CI 1.39 to 6.25), whose husbands were more powerful than they were in general decision-making (OR 1.98, 95% CI 1.14 to 3.43), and who scored lower in the relationship control subscale (OR 3.77, 95% CI 1.65 to 8.62) were more likely than other wives to have at least one SD. Conclusions. Gender relationships, including the quality of the marital relationship, mutual trust, decision- making, and relationship control, were significantly associated with SD. Gender inequality has been observed and needs to be taken into account in promoting sexual health among married couples living in rural China. UROLOGY 67: 579–585, 2006. © 2006 Elsevier Inc. T he prevalence of sexual dysfunction (SD) has been reported in Western 1–3 and Asian 4,5 coun- tries. The prevalence of having at least one SD among young married women in rural China is reported to be around 43%. 6 Gender inequality has been observed in Asian countries, 7,8 with men tak- ing control over the marital relationship. 9 It is as- sociated with decisions on condom use and human immunodeficiency virus risk 9 –11 and sexual health. 12 In rural China, the male-dominant traditional cul- ture is still intact. 13 This study investigated whether gender rela- tionships (quality of marital relationship, per- ceived sexual suppression toward women, rela- tionship control, and decision power in general and decisions over sexual matters) are signifi- cantly associated with SD and sexual satisfaction among younger husbands and wives of couples living in rural China. This topic has not been previously reported. MATERIAL AND METHODS POPULATION AND SAMPLING The study was conducted in the Dengfeng County of the Hunan Province in China, during August through Novem- From the Centre for Epidemiology and Biostatistics, School of Public Health, Chinese University of Hong Kong Faculty of Med- icine, Hong Kong, China; Tianjin Cancer Institute and Hospital, Tianjin, China; and National Research Institute for Family Plan- ning of China, Beijing, China Reprint requests: Joseph T. F. Lau, Ph.D., Centre for Epidemiology and Biostatistics, 5/F, School of Public Health, Prince of Wales Hos- pital, Shatin, N.T., Hong Kong. E-mail: jlau@cuhk.edu.hk Submitted: May 12, 2005, accepted (with revisions): Septem- ber 26, 2005 ADULT UROLOGY © 2006 ELSEVIER INC. 0090-4295/06/$32.00 ALL RIGHTS RESERVED doi:10.1016/j.urology.2005.09.039 579