Socio-demographic determinants of sexual inactivity among reproductive heterosexual married women in Bangladesh: evidence from BDHS data 2022.

Socio-demographic determinants of sexual inactivity among reproductive heterosexual married women in Bangladesh: evidence from BDHS data 2022 - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. 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Learn more: PMC Disclaimer | PMC Copyright Notice Reprod Health . 2026 Mar 10;23:84. doi: 10.1186/s12978-025-02099-7 Search in PMC Search in PubMed View in NLM Catalog Add to search Socio-demographic determinants of sexual inactivity among reproductive heterosexual married women in Bangladesh: evidence from BDHS data 2022 Md Aslam Hossain Md Aslam Hossain 1 Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205 Bangladesh Find articles by Md Aslam Hossain 1 , A M Mujahidul Islam A M Mujahidul Islam 1 Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205 Bangladesh 3 Bangladesh Bureau of Statistics (BBS), Ministry of Planning, Khulna, 9240 Bangladesh Find articles by A M Mujahidul Islam 1, 3 , Md Zahidul Islam Md Zahidul Islam 2 Department of Public Health, First Capital University of Bangladesh, Chuadanga, 7200 Bangladesh Find articles by Md Zahidul Islam 2 , Md Shariful Islam Md Shariful Islam 2 Department of Public Health, First Capital University of Bangladesh, Chuadanga, 7200 Bangladesh Find articles by Md Shariful Islam 2 , Minhazul Abedin Minhazul Abedin 4 John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, USA Find articles by Minhazul Abedin 4 , Md Ashfikur Rahman Md Ashfikur Rahman 5 Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, HKSAR China 6 Development Studies Discipline, Social Science School, Khulna University, Khulna, 9208 Bangladesh Find articles by Md Ashfikur Rahman 5, 6, ✉ Author information Article notes Copyright and License information 1 Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205 Bangladesh 2 Department of Public Health, First Capital University of Bangladesh, Chuadanga, 7200 Bangladesh 3 Bangladesh Bureau of Statistics (BBS), Ministry of Planning, Khulna, 9240 Bangladesh 4 John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, USA 5 Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, HKSAR China 6 Development Studies Discipline, Social Science School, Khulna University, Khulna, 9208 Bangladesh ✉ Corresponding author. Received 2025 Jan 14; Accepted 2025 Jul 10; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13088637  PMID: 41808192 Abstract Background Sexual intercourse is integral part of physical well-being health especially in married couple's life. Unhappiness and life dissatisfaction can be positively influenced by sexual inactivity (SI). Sexual inactivity was defined as no sexual frequency among reproductive married women in the last month. This study aimed to assess the prevalence of sexual inactivity and its associated risk factors among Bangladeshi reproductive married women. Method Cross-sectional study design data from the most recent Bangladesh Health and Demographic Survey conducted in 2022 was utilized. The analysis included 14,650 reproductive heterosexual married women (RHMA). The associations between sexual inactivity and exposure variables were evaluated using Pearson’s Chi-square test, and the prediction model considered the multivariable logistic regression. Results The prevalence of sexual inactivity among RHMA in Bangladesh was 6.72% (95% CI 0.93–0.94). This study shows that in Bangladesh, reproductive heterosexual married women from the Dhaka region, Khulna region, and Sylhet region, who have a height below < 164 cm, who have a husband aged 30–40 years, are more likely to be sexually inactive. The odds of sexual inactivity were lower among RHMA who household heads were, who were aged ≥ 40 years, and whose husbands were unemployed. All these factors were statistically significant ( p < 0.05). Conclusion Women's age significantly affect sexual inactivity among the women in their reproductive age in Bangladesh. To overcome SI problem government and nongovernmental organization must take effective measures to improve women education level, reproductive health-care service, including sexual health of childbearing age. Keywords: Sexual intercourse, Health, Sexual inactivity, Reproductive, Women, Heterosexual Background Sexuality, governed by the neurological, vascular, and endocrine systems, is crucial for well-being [ 1 ]. Despite its connection to general satisfaction and increased longevity, many individuals worldwide find themselves grappling with sexual inactivity or dysfunctions impacting their quality of life [ 2 ]. Marital satisfaction depends on the couple's sexuality. Inevitably, any marriage can face sexual activity problems. The problem of sexuality causes conflicts of marital satisfaction which ultimately leads to divorce [ 3 , 4 ]. Participation in sexual activity manifests potential health merits, encompassing the reduction of heart rate and blood pressure, along with stress alleviation through the release of oxytocin [ 5 , 6 ]. Sexual inactivity may be caused by diminished sexual desire to the absence of arousal, lubrication, orgasm, and overall satisfaction among reproductive-aged women [ 3 ]. Conversely, sexual activity contributes to pain reduction, enhanced function of the immune system, and sleep improvement [ 7 ]. Lubrication insufficiency, dyspareunia, vaginismus, and anorgasmia are the causes of women's sexual dysfunction [ 8 ]. Notably there's a general decrease in both the frequency and functionality of sexual activity, especially among individuals after the age of 45 years in men and after the age of 35 years in women, with women being more affected [ 9 ]. The landscape of sexual activity is shaped by a range of factors, including socio-demographic, medical, behavioral, psychological, religious, and lifestyle elements [ 10 – 13 ]. In married couples, sociocultural beliefs, physical health duration of the marriage, and mental well-being are influenced by the intricate fabric of the marital life which determines the frequency of sexual activity [ 14 ]. Sexual inactivity among women is associated with several influential factors including obesity, physical inactivity, tobacco smoking [ 2 ], depression, the presence of chronic diseases [ 3 ], older age, lowest education, younger menarche, [ 10 ] less favorable socioeconomic conditions, and underweight [ 15 ]. In Bangladesh, despite decades of progress in public health, deeply entrenched cultural stigma and taboos surrounding sexual health continue to constrain help-seeking behaviors and hinder research efforts in this domain [ 16 , 17 ]. While previous studies have explored sexual dysfunction in specific groups, such as post-menopausal women and those with type II diabetes mellitus [ 18 , 19 ] a broader understanding is lacking. One study focused on the frequency of sexual intercourse among residents of Bangladesh [ 14 ], and another delved into the knowledge, attitudes, and reproductive health performance practices among older teenage girls [ 20 ]. However, none of these studies covered the entire nation or investigated the factors influencing sexual inactivity among women of reproductive age. Despite the growing recognition of sexual health's importance, there's still a lack of comprehensive studies on why some women in Bangladesh are sexually inactive. This national survey aims to fill this gap, offering a detailed understanding of the social and demographic factors affecting sexual inactivity patterns among reproductive Bangladeshi married women. Methods Data source This study adopted secondary of cross-sectional data design from the Bangladesh Demography and Health Survey (BDHS) of 2022. This survey, conducted nationwide, encompasses the total populace dwelling within the borders of Bangladesh [ 21 ]. The BDHS employs a sampling technique using a two-phase approach, stratified by clusters, with enumeration areas (EAs) forming the primary units of selection, followed by household (HH) sampling within selected clusters. In the first stage, EAs were chosen, followed by the selection of HHs from each EA in the second stage, as per the criteria established by the DHS team. The survey interviewed approximately 30,078 women aged 15–49 years. This study utilized the women's individual record’s file (IR file), which provides comprehensive information on the sampling design, structure, and implementation procedures [ 22 ]. Exclusion criteria Of the 30,078 reproductive aged women, a total of 15,428 women were omitted from the analysis, based on the following criteria: 12,061 missing data; 2000 were not living with their husband at the time of the survey; 946 were pregnant; 421 were exclusive breastfeeding. The women not cohabiting with their husband were excluded to avoid misclassification, as their sexual inactivity may be due to physical separation rather than individual, relational, or health related reasons. After exclusions, a total of 14,650 reproductive heterosexual married women were considered for the final phase of the analysis. Outcome variable Sexual inactivity was the primary outcome variable in this study. In the BDHS 2022 survey, reproductive heterosexual married women were asked "About how many times did you have sex during the last month?" Based on the response, a binary outcome variable was formulated. “. Women who reported no sexual activity during the past month were considered sexually inactive (coded as 1), and those who reported at least one or two instances or more instances of sexual activity were regarded as sexually active (coded as 0). Exposure variable Exposure variables in this study were selected based on previous literatures, domain knowledge, and availability in the BDHS datasets [ 2 , 5 , 23 ]. Geographical region (Barisal, Chittagong, Dhaka, Khulna, Mymensingh, Rajshahi, Rangpur, Sylhet), place of residence (urban, rural), religion (Muslim, Non-Muslim), sex of household head (male, female), watching television (no, yes), usage of internet last 12 month (no, yes), wealth status (poorest, poorer, middle, richer, richest), women current age (years) (below 30, 30–40, above 40), women’s education level (less than high school, high school, more than high school), women’s height (< 164 cm, ≥ 164 cm), women’s age at sexarche (years) (< 15, 15–17, ≥ 18), women’s occupation (homemakers, service holder, others), women continue studies after marriage (no, yes), husband's age (years) (below 30, 30–40, above 40), husband's education level (no education, primary, secondary, higher), husband's occupation (unemployed, farmer/labour, business, service holder) were included as independent variable in this study. Statistical analysis All investigations were performed by using Stata v14.2 (StataCorp, CollegeStation, TX, USA). We used'Svy' command to adjust the complex nature of BDHS survey incorporating sampling weights, stratification, and clustering. Before the formal data analysis, we cleaned the dataset by eliminating instances with missing data and redefining variables as necessary. Descriptive statistics were executed to assess the rate of sexual inactivity among reproductive heterosexual married women. Pearson's chi-square test was conducted for comparative analysis of the prevalence of sexual inactivity among categorical variables. The value of test-statistic was: where, =Pearson's cumulative test statistic, which asymptotically approaches a distribution, =an observed frequency, =an expected (theoretical) frequency, asserted by the null hypothesis, n = the number of cells in the table. Fitting the model of "independence" reduces the number of degrees of freedom by p = r + c-1. Where r is the number of levels for one categorical variable, and c is the number of levels for the other categorical variable. Besides, we assessed the associated baseline factors of sexual inactivity. The underlying multiple logistic regression model was: where, p = probability of sexual inactivity (coded 0), 1 − p = probability of non-sexual inactivity (coded 1) = geographical region; = sex of household head; = watching television; = usage of internet last 12 months; = women current age (years); = women education level; = women height; = women age at first intercourse (years); = husband's current age (years); = husband's occupation intercept term; coefficient of independent variables (i = 1, 2, 3,……,10). The parameter refers to the effect of on the log odds such that Y = 0, controlling the other . Finally, the logistic regression model was used to calculate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals and determine the association between the study variable and sexual inactivity. The final model underwent testing for collinearity. Statistical tests were considered two-sided, and significance was inferred at a p -value < 0.05. Results Socio-demographic characteristics of reproductive heterosexual married women Predominantly, the participants hailed from the Dhaka division (15.02%) and were settled in rural areas (63.77%). A large majority adhered to the Islamic faith (88.41%). Furthermore, a considerable segment of women aged 30–40 years (40.24%), while a significant number of their spouses were above 40 years (46.55%). Additionally, most women possessed the educational qualification of a secondary level (51.22%) and predominantly occupied the role of homemakers (83.86%). In terms of household leadership, male heads notably dominated (95.31%) over their female counterparts (4.69%). Moreover, it is worth mentioning that a substantial portion had usage of the internet in the last 12 months (23.00%) and had access to television (57.50%) [Table 1 ]. Table 1. Prevalence of sexual inactivity by individual and household level of socio-demographic characteristics among reproductive married women in Bangladesh Study variables N (%) Sexual inactivity χ 2 -values ( p -values) Weighted prevalence (95% CI) Yes (%) No (%) Geographical region 37.54 (< 0.001) Barisal 1496 (10.21) 135 (9.02) 1361 (90.98) 9.74 (8.00–12.00) Chittagong 1894 (12.93) 144 (7.60) 1750 (92.40) 7.81 (6.79–8.97) Dhaka 2200 (15.02) 123 (5.59) 2077 (94.41) 5.56 (4.87–6.35) Khulna 1998 (13.64) 108 (5.41) 1890 (94.59) 5.96 (4.26–6.30) Mymensingh 1643 (11.22) 99 (6.03) 1544 (93.97) 5.96 (4.73–7.48) Rajshahi 2038 (13.91) 127 (6.23) 1911 (93.77) 6.42 (5.45–7.56) Rangpur 1923 (13.13) 162 (8.42) 1761 (91.58) 8.73 (7.52–10.12) Sylhet 1458 (9.95) 86 (5.90) 1372 (94.10) 5.91 (4.45–7.8) Place of residence 1.79 (0.180) Urban 5308 (36.23) 647 (6.93) 8695 (93.07) 6.1 (5.43–6.86) Rural 9342 (63.77) 337 (6.35) 4971 (93.65) 6.94 (6.46–7.44) Religion 0.16 (0.684) Muslim 12,952 (88.41) 866 (6.69) 12,086 (93.31) 6.56 (6.14–7.00) Non-Muslim 1698(11.59) 118 (6.95) 1580 (93.05) 7.78 (6.56–9.22) Sex of household head 188.14 (< 0.001) Male 13,963 (95.31) 850 (6.09) 13,113 (95.95) 6.09 (5.70–6.5) Female 687 (4.69) 134 (19.51) 553 (80.49) 19.1 (16.24–22.15) Watching television 5.72 (0.017) No 6226 (42.50) 454 (7.29) 5772 (92.71) 7.22 (6.60–7.89) Yes 8424 (57.50) 530 (6.29) 7894 (93.71) 6.29 (5.79–6.83) Usage of the internet last 12 months 9.98 (0.002) No 11,281 (77.00) 798 (7.07) 10,483 (92.93) 7.11 (6.65–7.61) Yes 3369 (23.00) 186 (5.52) 3183 (94.48) 5.29 (4.59–6.1) Wealth status 3.88 (0.423) Poorest 2754 (18.80) 198 (7.19) 2556 (92.81) 7.33 (6.42–8.37) Poorer 2885 (19.69) 197 (6.83) 2688 (93.17) 6.83 (5.98–7.8) Middle 2920 (19.93) 207 (7.09) 2713 (92.91) 7.10 (6.24–8.08) Richer 2981 (20.35) 192 (6.44) 2789 (93.56) 6.13 (5.33–7.05) Richest 3110 (21.23) 190 (6.11) 2920 (93.89) 6.08 (5.26–7.02) Women's current age (years) 79.13 (< 0.000) Median (IQR) 33.0 (26.0–40.0) 35.0 (25.0–43.0) 33.0 (26.0–40.0) Below 30 5530 (37.75) 326 (5.90) 5204 (94.10) 6.01 (5.42–6.66) 30–40 5895 (40.24) 330 (5.6) 5565 (94.40) 5.63 (5.07–6.26) above 40 3225 (22.01) 328 (10.17) 2897 (89.83) 9.83 (8.84–10.92) Women education level 9.53 (0.009) Less than high school 4100 (32.76) 296 (7.22) 3804 (92.78) 6.86 (6.12–7.67) High school 6410 (51.22) 398 (6.21) 6012 (93.79) 6.41 (5.84–7.03) More than high school 2005 (16.02) 105 (5.24) 1900 (94.76) 4.97 (4.06–6.07) Women height 6.60 (0.010) Median (IQR) 151.5 (147.9–155.3) 151.2 (147.4–154.6 151.6 (148.0–155.3) Below average (< 164 cm) 6951 (47.45) 428 (6.16) 6523 (93.84) 6.02 (5.48–6.61) Average/above (≥ 164 cm) 7699 (52.55) 556 (7.22) 7143 (92.78) 7.29 (6.73–7.89) Women age at sexarche (years) 10.95 (0.004) Median (IQR) 16.0 (14.0–18.0) 16.0 (14.0–18.0) 16.0 (14.0–18.0) < 15 3970 (27.10) 311 (7.83) 3659 (92.17) 7.53 (6.76–8.39) 15–17 5965 (40.72) 380 (6.37) 5585 (93.63) 6.58 (5.98–7.23) ≥ 18 4715 (32.18) 293 (6.21) 4422 (93.79) 6.08 (5.41–6.81) Women occupation 7.29 (0.063) Homemakers 12,285 (83.86) 847 (6.89) 11,438 (93.11) 6.92 (6.48–7.39) Business 1001 (6.83) 54 (5.39) 947 (94.61) 5.12 (3.92–6.66) Service Holder 326 (2.23) 13 (3.99) 313 (96.01) 3.22 (1.74–5.88) Others 1037 (7.08) 70 (6.75) 967 (93.25) 6.56 (5.23–8.21) Women continue studies after marriage 0.06 (0.805) No 7687 (82.12) 504 (6.56) 7183 (93.44) 6.64 (6.10–7.21) Yes 1674 (17.88) 107 (6.39) 1567 (93.61) 6.19 (5.10–7.49) Husband's current age (years) 102.69 (< 0.000) Median (IQR) 40.0 (33.0–49.0) 45.0 (34.0–54.0) 40.0 (33.0–48.0) Below 30 2220 ( 15.15) 136 (6.13) 2084 (93.87) 6.07 (5.16–7.16) 30–40 5610 (38.29) 243 (4.33) 5367 (95.67) 4.41 (3.90–4.98) above 40 6820 (46.55) 605 (8.87) 6215 (91.13) 8.81 (8.15–9.51) Husband's education level 3.49 (0.321) No education 3384 (23.29) 215 (6.35) 3169 (93.65) 6.39 (5.62–7.26) Primary 4206 (28.95) 259 (6.16) 3947 (93.84) 6.19 (5.5–6.95) Secondary 4371 (30.09) 268 (6.13) 4103 (93.87) 6.13 (5.46–6.88) Higher 2566 (17.66) 135 (5.26) 2431 (94.74) 5.08 (4.27–6.03) Husband's occupation 22.06 (< 0.001) Unemployed 499 (3.44) 51 (10.22) 448 (89.78) 9.36 (7.07–12.3) Farmer/Labour 7470 (51.45) 467 (6.25) 7003 (93.75) 6.20 (5.69–6.77) Business 5493 (37.84) 311 (5.66) 5182 (94.34) 5.82 (5.22–6.49) Service Holder 1056 (7.27) 47 (4.45) 1009 (95.55) 4.21 (3.13–5.64) Open in a new tab N total; % Percentages; CI Confidence interval; IQR Interquartile range Prevalence of sexual inactivity Table 1 presents the prevalence of sexual inactivity across selected socio-demographic characteristics. During the survey period in Bangladesh, the incidence of being sexually inactive married women of childbearing age was 6.72%. A considerably higher prevalence was observed among women living in female-headed households (19.51%), those whose husbands were unemployed (10.22%), and those whose husbands were aged over 40 years (8.87%). Sexual inactivity was also more common among women aged above 40 years (10.17%), those with less than high school education (7.22%), and residents of the Barisal region (9.02%). In addition, increased prevalence was noted among women who initiated sexual activity before the age of 15 (7.83%), those who reported watching television (6.29%) or using the internet in the last 12 months (5.52%), and women whose height was below 164 cm (6.16%). Bivariate analysis showed that geographical region, sex of the household head, women's age, education level, husband’s age, and husband’s occupation were significantly associated with sexual inactivity ( p < 0.001) among reproductive heterosexual married women. Furthermore, media exposure, height, and age at first sexual intercourse were also significant ( p < 0.05) [see Table 1 ]. As shown in Fig. 1 , the distribution of sexually inactive women varies significantly by age group. The highest proportion of sexual inactivity is observed in women aged 45–49 years (21.3%), followed by those aged 40–44 years (16.7%), 35–39 years (15.6%), 30–34 years (13.2%), and 25–29 years (10.6%). Fig. 1. Open in a new tab Prevalence of sexual inactivity categorized by age of married women Figure 2 presents the weighted prevalence of sexual inactivity among reproductive married women across household wealth quintiles, showing that approximately 7.33% (95% CI 6.42–8.37) of women in the lowest wealth quintile were sexually inactive, compared to 6.1% (95% CI 5.26–7.02) in the richest quintile. A declining trend in sexual inactivity was observed as household wealth increased from the middle to the highest quintile. Fig. 2. Open in a new tab Weighted Prevalence of SI by household wealth category among married women Socio-demographic factors influencing sexual inactivity The logistic regression analysis, as presented in Table 2 , identified several socio-demographic factors independently associated with sexual inactivity. Women residing in Dhaka (AOR = 1.47, 95% CI 1.09–1.97, p = 0.011), Khulna (AOR = 1.59, 95% CI 1.17–2.16, p = 0.003), and Sylhet (AOR = 1.46, 95% CI 1.04–2.04, p = 0.028) regions had significantly higher odds of sexual inactivity compared to those from the Chattogram region. In contrast, women from female-headed households had significantly lower odds of being sexually inactive (AOR = 0.37, 95% CI 0.28–0.48, p < 0.001). Women aged above 40 years were also less likely to report sexual inactivity compared to those below 30 years (AOR = 0.57, 95% CI 0.42–0.78, p < 0.001). A positive association was observed between shorter stature and sexual inactivity, with women having a height below 164 cm exhibiting higher odds (AOR = 1.33, 95% CI 1.14–1.56, p < 0.001). Moreover, having a husband aged 30–40 years was associated with increased odds of sexual inactivity (AOR = 1.30, 95% CI 1.02–1.67, p = 0.036) compared to those whose husbands were younger than 30 years. Interestingly, women whose husbands were unemployed had significantly lower odds of being sexually inactive (AOR = 0.56, 95% CI 0.35–0.89, p = 0.014), suggesting a complex relationship between spousal employment and marital sexual activity. Table 2. The impact of socio-demographic factors on sexual inactivity among married women of childbearing age in Bangladesh Study variables Unadjusted Adjusted UOR (95% CI) p -Values AOR (95% CI) p -Values Geographical region Barisal 0.83 (0.65–1.06) 0.135 0.84 (0.63–1.11) 0.211 Chittagong Reference Reference Dhaka 1.38 (1.08–1.78) 0.010 1.47 (1.09–1.97) 0.011 Khulna 1.44 (1.11–1.86) 0.006 1.59 (1.17–2.16) 0.003 Mymensingh 1.28 (0.98–1.67) 0.065 1.38 (0.99–1.90) 0.051 Rajshahi 1.24 (0.97–1.58) 0.090 1.24 (0.92–1.67) 0.148 Rangpur 0.89 (0.71–1.13) 0.350 0.88 (0.67–1.17) 0.392 Sylhet 1.31 (0.99–1.73) 0.054 1.46 (1.04–2.04) 0.028 Sex of household head Male Reference Reference Female 0.27 (0.22–0.33) < 0.001 0.37 (0.28–0.48) < 0.001 Watching television No Reference Reference Yes 1.17 (1.03–1.33) 0.017 1.14 (0.97–1.34) 0.107 Usage of internet last 12 months No Reference Reference Yes 1.30 (1.10–1.53) 0.002 1.11 (0.91–1.37) 0.302 Women current age (years) Below 30 Reference Reference 30–40 1.06 (0.90–1.24) 0.495 1.04 (0.81–1.33) 0.744 Above 40 0.55 (0.47–0.65) < 0.001 0.57 (0.42–0.78) < 0.001 Women education level Less than high school Reference Reference High school 1.17 (1.01–1.37) 0.042 0.99 (0.83–1.19) 0.970 More than high school 1.41 (1.12–1.77) 0.003 1.16 (0.85–1.58) 0.337 Women height Below average (< 164 cm) 1.19 (1.04–1.35) 0.010 1.33 (1.14–1.56) < 0.001 Average or above (≥ 164 cm) Reference Reference Women age at sexarche (Years) < 15 0.78 (0.66–0.92) 0.003 0.87 (0.69–1.08) 0.213 15–17 0.97 (0.83–1.14) 0.741 1.05 (0.86–1.28) 0.610 ≥ 18 Reference Reference Husband's current age (Years) Below 30 Reference Reference 30–40 1.44 (1.16–1.79) 0.001 1.30 (1.02–1.67) 0.036 above 40 0.67 (0.55–0.81) < 0.001 1.03 (0.74–1.42) 0.874 Husband's occupation Unemployed 0.41 (0.27–0.62) < 0.001 0.56 (0.35–0.89) 0.014 Farmer/Labour 0.69 (0.51–0.95) 0.022 0.81 (0.57–1.14) 0.224 Business 0.78 (0.57–1.06) 0.114 0.84 (0.59–1.19) 0.336 Service holder Reference Reference Open in a new tab UOR Unadjusted odd ratios; CI Confidence interval; AOR Adjusted odd ratios Discussion A nationwide survey of BDHS data from 2022 was used for this research. We assessed 6.72% of reproductive married women sexually inactive in the past month. Arafat et al. study revealed that sexual inactivity among married couples in Bangladesh is 5.6%. However, our study depicted that sexual inactivity among married women in Bangladesh is increasing comparing the prior study of Bangladesh. Several high-income countries such as Finland, [ 24 ] Australia, [ 25 ] and United States [ 5 ] have increased the sexual inactivity among married women. Reproductive married women can increase the frequency of sexual intercourse through an escalation in the amount of ascorbic acid. Since Ascorbic acid improves women's vascular function, reduces stress reactivity & approaches anxiety, and raises oxytocin & prolactin release [ 26 ]. The fundamental part of life is a Sexual task. A robust positive relationship exists between sexual behavior and the excellence of life [ 27 ]. A British cohort study reported that married women lessen the intercourse for declined the quality of sex life [ 28 ]. The local build of environmental characteristics significantly influences health outcomes [ 29 ]. Our analysis shows the geographical region was significantly related with sexually inactive. Women who live in Dhaka region, Khulna region or Sylhet region were more prone to sexual inactive comparing Chittagong region residents. Women who live in urban areas were significantly related to higher sexual intercourse frequency compared to rural women [ 30 ]. Besides, an Egyptian study reported that the purpose of intercourse among urban women was to have pleasure for themselves and their husbands and more initiation of coitus [ 31 ]. A household head female designates a woman in charge of handling the family. As a result, she gets the power of separation, immigration, and divorce [ 32 ]. Intensely in developing countries had increased the number of female-headed households [ 33 ]. Low-income and physical disorders and mental, neurological, etc. problems faced by female-headed households [ 34 ]. Female-headed households involve many risk factors upsetting their sexual life [ 35 ]. Women-headed households face the challenge of intra-family tension [ 36 ]. Whereas, women in the high-stress group had lower levels of genital sexual arousal [ 37 ]. Our research depicted that households' female-headed have more chance of sexually inactive than male-headed households. Our investigation is consistent with a qualitative study in Iran [ 35 ]. Partner-balanced intimacy relationships can promote mental and physical health [ 38 ]. Consistently, both men and women in sexual activity decrease with age [ 39 ]. The incidence of sexual activity among women is lower than among men [ 40 ]. Approximately, our study shows one in fifteen women were sexually inactive between ages 15 and 49 years. Additionally, our study revealed reproductive married women aged above 40 years are significantly associated with sexual inactivity. Our simple regression analysis revealed that women whose husbands aged above 40 years are less likely to be sexually inactive. Our result is contradictory to the Iranian analysis. Additionally, Iranian analysis showed that female sexual dysfunction was significantly more likely to be those who had husbands aged 40 years or older [ 41 ]. Besides, above 40 years men and women around one in eleven and one in ten are reported being sexually inactive. These findings clarified the higher likelihood of sexual inactivity of women who are living partner's current age of 30–40 years. For the incidence of sexual inactivity, our study is consistent with previous studies [ 23 , 40 ]. Testosterone starts to decrease slowly with age, which affects bone density, obesity, insulin resistance, prostate disease, and aggression etc. Besides, testosterone traditionally leads to sexual behavior [ 42 ]. So, males can increase serum concentrations of testosterone through boron supplementation, which helps to decrease sexual inactivity [ 43 ]. Men can increase boron by eating fruits, tubers, coffee, milk, dried and cooked beans, potatoes, legumes etc [ 44 ]. Body shape for women is a contributing factor to sexual attraction [ 45 ]. Additionally, height plays a significant role in human companion preferences [ 46 ]. Mid-range women's leg-to-body ratios were observed as extremely attractive [ 47 ]. Besides, women's height has been proven to be an element of reproductive accomplishment [ 48 ]. Our study depicted that reproductive married women were significantly more likely to be sexually inactive whose height was shorter than average. Our investigation is consistent with a cross-sectional probability sample survey data study in Britain [ 40 ]. Body figure and stature can also reflect overall fitness that may be related to poor sexual function [ 49 ]. Women who have higher body appreciation positively predicted better sexual function [ 50 ]. The advent of sexarche is the essential course of a good health life [ 51 ]. Early sexarche is associated with higher rates of current mental distress and smoking among adult women [ 52 , 53 ]. The problem of depression and marriage-related difficulties are faced later in life when initiation of sexual intercourse during adolescence [ 54 ]. Besides, Senn et al. study depicted that sexual abuse is a strong forecaster of early sexual initiation [ 55 ]. However, the prevalence of sexual violence in a lifetime in urban and rural areas of Bangladesh was 37% and 50%, respectively [ 56 ]. Besides, in the past year, the prevalence of sexual violence in the rural Sylhet District of Bangladesh among reproductive married women was 13.2% [ 57 ]. Sexual violence badly affects women's health, such as women's pelvic pain, reproductive tract infections, and symptoms of irritable bowel syndrome [ 58 ]. Abuse histories in women report higher rates of sexual dysfunction and reduction of sexual desire [ 59 ]. Our unadjusted odds ratio showed that women are more likely to be sexually inactive who complete sexarcheat early age. Public programs and family life education should concentrate on sexual health elevation considering the physical and psychosocial changes that can prevent perilous sexual behaviors among adolescent girls [ 60 ]. Experiential research shows that the condition of unemployment has negative effects on health [ 61 ]. Unemployed young men who live with their parents are less feasible in dating markets and less equipped for sensitive intimacy, the logic follows that they will be less able to obtain healthy loving and sexual relations with participants of the opposite sex [ 62 , 63 ]. Many studies depict that unemployed men are more distressed [ 64 ]. However, an energetic sex life is positively associated with mental and bodily health [ 6 ]. Pitta et.al study showed that depressive symptoms are strongly associated with erectile dysfunction [ 65 ]. The present study finds substantiation that unemployed husbands/partners have more chances to be sexually inactive compared to employed husbands/partners. Several realistic studies show consistently that unemployed men are more likely to abstain from sexual intercourse [ 5 , 66 ]. So, unemployed men can do physical exercise which has a positive impact on sexual function in men and promotes sexual health [ 67 ]. Policy implications and recommendations The results of this study hold noteworthy policy implications for public health efforts in Bangladesh. Policymakers should prioritize sexual health education and awareness campaigns that address the socio-cultural taboos surrounding discussions on sexual health. Efforts should be made to promote open communication between couples and encourage help-seeking behaviors for sexual health issues. Furthermore, policies aimed at improving access to education, particularly for women, may empower people to make knowledgeable decisions about their sexual and reproductive well-being. Additionally, policies targeting poverty alleviation and employment generation, especially in rural areas, may indirectly contribute to reducing sexual inactivity by addressing socio-economic disparities. In light of the discoveries gleaned from this investigation, it is advisable that interventions and programs designed to address sexual inactivity among Bangladeshi reproductive married women must consider the socio-demographic factors identified as significant determinants. Specifically, efforts should focus on regions with higher prevalence rates of sexual inactivity, such as the Barishal region. Strategies to empower women, particularly those in female-headed households, may help mitigate sexual inactivity. Additionally, targeted interventions should be designed to support women who marry at younger ages, as they are at increased risk of sexual inactivity. Furthermore, initiatives to promote economic opportunities for men, particularly those aimed at reducing unemployment, may contribute to reducing sexual inactivity among married couples. Strengths and limitations A key strength of this study was the use of a nationally representative sample with women as participants. Utilizing nationally adopted and internationally validated surveys such as the BDHS enhanced the robustness of our findings. Our study emphasized the significance of making valid statistical inferences for continuous variables. The study includes a wide range of socio-demographic variables, enabling a detailed analysis of various determinants influencing sexual inactivity among reproductive married women. This is the first known study in Bangladesh to explore sexual inactivity among married women of reproductive age using nationally representative data, filling a critical gap in sexual and reproductive health research. There were some limitations of the study. Firstly, this study focused on sexual inactivity among married heterosexual women of reproductive age, excluding unmarried women, divorced women, and pregnant women in Bangladesh. Secondly, this was a cross-sectional study; it was not possible to determine the cause-and-effect relationship between sexual inactivity and socio-demographic variables. Thirdly, dependence on data reported by individuals themselves, which is collected based on recall bias or social allure bias. Fourthly, our analysis only considered existing variables in the BDHS data, neglecting potential confounders such as various genetic hormones, cervical length, psychological or relational factors, which might also be associated with SI. Lastly, sexual inactivity is defined based on the absence of sexual activity in the last month, which may not reflect longer-term patterns or chronic sexual inactivity. Conclusion Sexual inactivity (SI) among reproductive heterosexual married women (RHMW) is a great problem for self-esteem. Our findings reveal that approximately 1 in 15 RHMW were sexually inactive in the past month. We found that women’s age and height, geographical region, household head’s sex, husband’s age, and employment status were significant predictors of SI among RHMW. Reducing stigma for sexual health, improving sexual health education, and enhancing support for women in vulnerable households are necessary to raise awareness about the adverse effects of SI among RHMW in Bangladesh. Besides, RHMW and their husbands can lessen SI by nurturing a more integral marital relationship. Acknowledgements The writers are grateful for accessing data from the Demographic and Health Surveys (DHS) Program and the Ministry of Health and Family Welfare, Dhaka, Bangladesh. Author contributions MAH conceptualized the study design. MAH had all access to the data and validation of the statistical analysis. MAH and MSI did the formal analysis. MAH, MZI and AMMI drafting the original manuscript. MAH, MZI, AMMI, MSI, MA and MAR critically reviewed the manuscript. MAH and MAR supervised the whole study. Funding We don’t have any funding from specific grant agencies in the public or commercial sectors. Data availability No datasets were generated or analysed during the current study. Declarations Ethics approval and consent to participate BDHS for 2022 is a cross-sectional secondary publicly accessible data approved by the Ministry of Health and Family Welfare. Consequently, the current study was released from ethics support. Competing interests The authors declare no competing interests. Footnotes Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Avasthi A, Grover S, Rao TSS. Clinical practice guidelines for management of sexual dysfunction. Indian J Psychiatry. 2017;59(Suppl 1):S91–115. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 2. Christensen BS, Grønbæk M, Pedersen BV, Graugaard C, Frisch M. 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