In an article titled 'Women's Perceptions and Experiences of Sexual Violence in Marital Relationships and Its Effect on Reproductive Health' that appeared in Health Care for Women International, experts, Rafat Hussain and Adeel Khan of the School of Health, University of New England, came up with approximately 40 hours of taped interviews, which included eight key informant interviews, three focus groups with 24 participants, and 10 in-depth interviews.
They opined that a woman's refusal to have sex could lead to varied responses—resentment, suspicion, anger, physical violence, and forced sex.
For some women, the ongoing psychological trauma due to repeated physical violence made them want to avoid sexual contact.
As one young participant put it, "My husband is often physically violent, never apologizes but expects me to have sex even though he may have beaten me up a few hours earlier. How can he expect me to be intimate and loving?"
Many of the participants spoke about the "hidden" nature of sexual violence especially in relationships where there was no outward sign of physical or psychological violence.
Young women talked about excessive fatigue related to long hours of work involving childrearing and doing household chores, which created a situation where sex on demand was seen as another task rather than as an intimate and pleasurable experience.
They said that women also feel embarrassed, especially as their daughters are growing old, by their husband's daily demand for sex.
As another woman, who has been a victim of domestic violence, said: "My husband still wants to have more children and wants to keep on having unprotected sex. I told him, "When you are not providing for these children, then you should not want more children," but the argument has little effect. I have no recourse but to stop having sex with him. This makes him very angry, and he resorts to insults and physical violence."
A 34-year-old said that her husband has had a vasectomy, and has become more aggressive in his demands for sex, almost on a daily basis and sometimes more than once.
And, when she refuses to have sex, he hits badly.