Investigating effective psychological interventions in pregnant women’s sexual satisfaction: A systematic review

Abstract

Sexual satisfaction is an important factor in people’s lives, which is effective in all aspects of a couple’s life. During pregnancy, due to existing changes, sexual performance is affected, which will also change sexual satisfaction. By performing effective interventions, changes can be made in the level of sexual satisfaction. The aim of this study is to investigate effective psychological interventions in the sexual satisfaction of pregnant women, which has been conducted in the form of a systematic review. This study is performed in 2022 with the steps of design of study question, search in SID, PubMed, Magiran, Iran doc, Science Direct, Scopus, and Google Scholar search engine with keywords such as “interventions”, “sexual satisfaction”, “Sexual function”, “couples”, “pregnant women” and their English equivalents, and after that, related studies were identified from the period of 2012 to 2022 (the last 10 years), the selection of studies, which after screening the title, abstract, and full text. Among 821 studies, finally 13 studies were left to announce the results. Researches that had unclear sample size and method of implementation and whose full text was not available were initially excluded from the study process. Screening of the quality of the studies was done by the risk assessment checklist and the Jadad Scale of the intervention studies. Then the findings were classified. The results of the present study were taken from 13 articles, which included mindfulness, cognitive-behavioral therapy, therapy based on acceptance and commitment and group counseling, PLISSIT model intervention, and education and support package. As per the results of interventions, all interventions during pregnancy can increase sexual satisfaction in pregnant women. Therefore, such interventions are recommended but it is necessary to do more interventions with minimal bias and long-term follow-up and comprehensive examination of variables to reach stronger evidence.

Introduction

Sexual satisfaction in married life is one of the important components of life and one of the natural needs of couples.[1] Sexual satisfaction refers to each person’s perception, judgment, and analysis of their sexual behavior.[2] As per some great psychologists of the world, sexual desire is an important and physiological need in humans, which, if this need is not satisfied, can significantly affect human excellence.[3] Sexual desire is one of the main aspects of health, which is closely related to satisfaction in other aspects of life.[4] Satisfactory sex is considered an important factor in the survival of a family and can widely affect couples.[5] Lack of sexual satisfaction causes a feeling of failure and insecurity in couples and can ultimately destroy the foundation of the family. Researchers state that sexual dissatisfaction is related to divorce, social problems, and many physical and mental diseases.[6] Sexual dissatisfaction is reported to be the cause of 40% of divorces in Iran. Sexual desire and satisfaction are multifactorial and multidimensional phenomena and they differ depending on individual, cultural, and value differences in couples.[7,8] Sexual desire and satisfaction have an average level of correlation. In general, sexual desire is related to inner thoughts and sexual satisfaction is related to overall sexual and mental health and inner general thoughts.[9]

Pregnancy is accompanied by certain changes in physical and psychological dimensions, so that sexual satisfaction may be affected during this period.[10] The comparison of sexual performance domains in different trimesters of pregnancy showed that the lowest and highest average scores were reported for sexual desire and sexual satisfaction.[11] Decreased desire for sexual relations during pregnancy, which can continue for several months after delivery, may lead to the occurrence or exacerbation of sexual disorders in couples.[10] A study has reported the prevalence of decreased sexual desire in pregnancy around 57% to 75%.[12,13] Libido problems in the second trimester of pregnancy are less than other trimesters.[14] Sexual satisfaction decreases in the first trimester of pregnancy. This decrease is caused by acceptance processes, which are revealed by negative changes in mood.[15] The second trimester of pregnancy, when the condition of people is better, sexual satisfaction increases.[16] There is a significant relationship between sexual satisfaction in the third trimester of pregnancy and several factors such as couple’s age, wife’s education, family’s economic status, employment status, and planned pregnancy.[17] A study reported about 9% of women’s sexual dissatisfaction in the third trimester of pregnancy.[18] Another study showed that the average scores of sexual desire in different trimesters of pregnancy do not differ significantly, while the average score of sexual satisfaction in the third trimester was significantly higher than the first trimester of pregnancy.[19]

Stopping or reducing the number of sexual activities during pregnancy may affect the emotional relationships of couples and the quality of their sexual life and increase their irritability.[20] Lack of sexual satisfaction for any reason can be closely related to issues such as crimes, sexual assaults, mental illnesses, depression, anger, anxiety, fear, suicidal thoughts, and divorce.[18] Thus, by using psychological interventions to improve sexual satisfaction in pregnant women, it is possible to help them increase their sexual satisfaction during pregnancy.[21,22]

Systematic review studies have been created so that researchers, managers, and policy makers can use these types of studies to examine the effects of interventions in the health sector and reach an informed decision. A systematic review is considered as one way to overcome inconsistencies because it brings together a body of related research and allows readers to simultaneously consider the results of multiple studies on the same topic and make a better decision.[23,24] Despite the great importance of sexual satisfaction during pregnancy, promoting the health and wellbeing of society, the high efficiency of studies in answering the questions raised at the bedside and conducting a study with a systematic review design and collecting studies and classifying them in a study has received less attention. As per the available sources, a systematic review study that has not been conducted so far in the field of reviewing psychological interventions effective in sexual satisfaction of pregnant women, therefore, considering the information gap in this field, the present study aims effective psychological interventions in the sexual satisfaction of pregnant women and were conducted in a review.

Materials and Method

Study design and setting

This study is a systematic review. The research community includes all interventional scientific articles in the field of sexual satisfaction of pregnant women in the world, which are indexed in one of the databases. Searches performed by researchers in the international databases of Web of Science, Scopus, PubMed, EMBASE, and Cochrane library and Persian language databases such as Mag-Iran, Scientific Information Database or SID, and information technology of Iran (Iran Doc) and Barkat Knowledge Extension System (Iran MEDEX) and the Iranian Registry of Clinical Trials. All articles were reviewed by two independent researchers until the time of search. Also, in case of any disagreement, the final decision was made by the third researcher.

Search strategy

To find related articles in English databases, keywords were selected based on Mesh and included “Psychological interventions”, “pregnant women”, and “sexual satisfaction” which were combined with “OR” Boolean and “AND” operators. The keywords used for searching in Persian databases included the combination of the words “nonpharmacological interventions”, “pregnant women”, and “sexual satisfaction” and were combined with the operators “and” and “or”. To preserve all valuable data, no time limit was considered and all related articles published until November 5, 2022 were evaluated. To achieve the maximum comprehensiveness of the search, all the final articles related to the subject under review were manually searched so that other possible sources could also be found.

“pregnant women” AND “sexual satisfaction” AND [“Intervention” OR “Program” AND “Non-Pharmacological Intervention” AND “Psychological Intervention” AND “Supportive Intervention” AND “Supportive group” AND “Cognitive Behavioral Therapy” AND “Cognitive Therapy” AND “Mindfulness” AND “Mindfulness-based Stress Reduction” AND “Counseling” AND “Group Counseling” AND “Education” AND “Psychotherapy” AND “Behavior Therapy” AND “Psychoeducation” AND “Emotional Schema Therapy” AND “Telephone Intervention” AND “Social Intervention” AND “Religion Therapy” AND “Spiritual Therapy” AND “Hope Therapy” AND “Complementary and Alternative Medicine” AND “Acupuncture” AND “Acupressure” OR “Massage Therapy” OR “Yoga” OR “Hypnosis” OR “Exercise” OR “Music Therapy” OR “Reiki Therapy” AND “ART Therapy”].

Study selection process

The order of the steps of this process was as follows: first, 818 articles were extracted and entered into the EndNote software by searching the relevant databases of other sources and then 796 duplicate articles were removed using this software and the abstract titles of 16 articles were checked. Two articles were removed due to being unrelated to the purpose of the research and then the full text of the remaining articles from the previous stages were read and finally 13 articles were selected to be presented in the results. To reduce the bias in the selection of studies, by two authors separately, from among the remaining articles, 13 articles that met the conditions for entering the study, the selection and quality of the articles using the relevant quality assessment tool (Risk of bias group tool [Cochrane, review]), and the discussion method was used to reach a consensus and an external referee was used in case of a difference in the declared score for the articles. Finally, if the articles were not included, the reasons were recorded.[25,26,27,28]

Endnote information resource management software was used to organize the studies. The inclusion criteria included articles published in English and Farsi of the type of randomized, nonrandomized clinical trials and semi-experimental articles comparing before and after results, whose research unit was pregnant women, educational interventions designed to promote sexual satisfaction. And finally, the result of the study was measured by measuring the level of sexual satisfaction. Review articles and letters to the editor were not selected due to lack of primary data. The exclusion criterion from the present study was the lack of access to the full text of the articles.

By carefully studying the title and abstract of the articles that met the inclusion criteria by the researcher, a large number of them were discarded due to being unrelated to the purpose of the study. To ensure the retrieval of all documents, the list of sources of articles was also searched. After completing the search of articles, based on the flowchart, 13 final articles were selected.

Quality assessment process

1. To evaluate the quality of the articles and studies included in the systematic review in terms of selection bias (random sequence generation and allocation concealment), implementation bias (blinding of participants and evaluators), detection bias (blinding of the statistical analyst), sample attrition (external exclusion from the study after randomization), selective reporting bias, and other biases were investigated. For this purpose, the Risk of bias tool of the Cochrane group was used. Based on this tool, the quality of the articles were classified into three categories: “High”, “Low”, and “Unclear”. Table 1 shows the quality of the articles[25,26] [Table 1].

2. In the second step, after searching in different databases, the desired data were extracted and the quality of the included studies was evaluated using the Jadad Score.[27] This checklist was adopted from a systematic review. The Jadad scale consists of two parts, direct and indirect, which are related to bias control and include three main terms, random assignment, double-blinding, and dropping samples in relation to bias control in experimental studies.[28] These three direct expressions of the Jadad scale are general and are used in all fields of medical sciences. Several studies have used only three direct expressions and some others have used both direct and indirect expressions.[27] In this study, three direct expressions were used. The scoring system in three direct statements is as follows: the first statement is related to the randomization of samples and the mention of randomization is given a score of 1 and the mention of the stages and description of how randomization is given a score of 2 (range of scores – 2 0). The second term is related to double blinding of the study. 1 point belongs to the mention of the word double blind in the study and 2 point belongs to the mention of blinding process (score range 0-2). In the third statement, which is related to mentioning the number and causes of sample drop, if the number of drop samples is reported in the study with the reason for it, 1 point is obtained and otherwise the point is 0 (the range of points is 1-0). The maximum overall score of this scale is 5 points as per the sum of the three direct statements, at the end of which the scores of the items are calculated and the jadad score less than 3 indicates poor study quality and a score of 3 or more indicates good study quality[27,28] [Table 2].

Table 1.

Hazard risk assessment

Ref.no	Adequate sequence generation (Selection Bias)	Allocation concealment (Selection Bias)	Blinding of participants and personnel (Performance Bias)	Blinding of outcome assessment (Detection Bias)	Incomplete outcome data addressed (Attrition Bias)	selective reporting for All outcomes Reporting Bias	Other risk of bias
Najiabhari et al. 2022	L	L	H	L	L	UN	L
Ghorbanzadeh et al. 2016	L	H	H	H	L	UN	L
Masoomi et al. 2016	L	H	H	L	L	UN	L
Amin et al. 2016	L	L	H	L	L	UN	UN
Navidad et al. 2016	H	H	H	H	L	UN	UN
Heifers et al. 2016	L	L	H	L	L	UN	L
Hosseini, Mansoureh et al. 2016	L	L	H	H	L	UN	L
Elsayed et al. 2018	L	H	H	H	L	UN	L
Sarbandi et al. 2018	L	H	H	H	L	UN	L
Ghavvami et al. 2019	L	L	H	H	L	UN	L
Saniei et al. 2019	L	L	H	L	L	UN	L
Alipour et al. 2019	H	H	H	H	L	UN	L

L: Low risk of bias, UN: Unclear risk of bias, H: High risk of bias

Table 2.

Quality evaluation table with Jadad Jacklist

Quality study	Total score	Jadad Scale Items (Directly)			Authors/Year	Row
		Was there a description of withdrawals and drop outs?	Was the study described as double-blinded?	Was the study described as randomized?
1	Najiabhari et al. 2022	2	1	1	4	Good
2	Ghorbanzadeh et al. 2016	1	0	1	2	Poor
3	Masoomi et al. 2016	2	1	1	4	Good
4	Amin et al. 2015	1	0	1	2	Poor
5	Navidian et al. 2016	1	0	1	2	Poor
6	Heydari et al. 2016	2	1	1	4	Good
7	Hosseini, Mansoureh et al. 2016	1	0	1	2	Poor
8	Elsayed et al. 2018	1	0	1	2	Poor
9	Sarbandi et al. 2011	1	0	1	2	Poor
10	Ghavami et al. 2019	2	1	1	4	Good
11	Saniei et al. 2019	2	1	1	4	Good
12	Alipour et al. 2019	1	0	1	2	Poor
13	Nadizadeh 2014	1	0	1	2	Poor

Extraction of information: Finally, to extract data from the text of these articles, two researchers using a research form extracted independently information such as the general characteristics of the articles, the location of the research, the number of samples and the target group, the characteristics of the participants, and interventions based on art therapy in the peri period Natal and authors’ conclusions [Table 3].

Table 3.

Data extraction table

Row	Year and name of author	Location	Title	Sample size	Type of study	Tools	Results
1	Najiabhari et al. 2022	Iran	Investigating the impact of mindfulness group counseling based on stress reduction on sexual satisfaction of pregnant women[10	60 women at the gestational age of 20 to 26 weeks	Clinical trial	Sexual Satisfaction (SSSW) and Depression, Anxiety and Stress Scale (DASS-21)	The average sexual satisfaction score of the studied pregnant women in the two intervention groups (83.80±16.49) and control (85.82±11.46) did not have a statistically significant difference (P<0.05). But after the intervention, the average sexual satisfaction score of pregnant women in the intervention group (110.65±6.53) compared to the control group (95.18±15.12) increased significantly (P<0.001)
2	Ghorbanzadeh et al. 2016	Iran	The effect of sexual health education along with pelvic floor muscle exercise on the performance and sexual satisfaction of pregnant women[11	60 pregnant women from 6 to 28 weeks	Experimental	Hudson sexual satisfaction questionnaire Rosen sexual performance questionnaire	The average sexual function in the intervention group changed from 26.3 to 33.7 and P is reported to be significant and equal to 0.001. Also, sexual satisfaction changed from 20.7 to 29.5 and P was equal to 0.001.
3	Masoomi et al. 2016	Iran	Investigating the effect of sexual counseling on the marital satisfaction of pregnant women[12	80 pregnant women 26 to 28 weeks	Clinical trial	Enrich Marital Satisfaction Questionnaire 47	The average marital satisfaction in the intervention group was 50.20, in the second week was 52.54 and in the fourth week was 59.20, and P 0.001 was reported as significant.
4	Amin et al. 2015	Iran	The effectiveness of treatment based on acceptance and commitment on depression and marital satisfaction of pregnant women[13	30 pregnant women	Semi experimental	Enrich Marital Satisfaction Questionnaire 47 Beck depression questionnaire	The average marital satisfaction in the intervention group was 111.4 before the intervention and 145.8 after the intervention, and P is significant and <0.001.
5	Navidian et al. 2016	Iran	The effect of sex education on the quality of marital relations of pregnant women[14	100 pregnant women 15 to 28 weeks	Semi experimental	Perceived Relationship Quality components	The average sexual satisfaction has increased from 99 to 112 in 4 weeks after the training, and P is reported to be less than 0.001 and significant.
6	Heidari et al. 2016	Iran	Investigating the effect of training based on the PLISSIT model on the sexual satisfaction of pregnant women in the trimesters of pregnancy[15	88 pregnant women from 8 to 10 weeks	Clinical trial	MWSSQ sexual satisfaction	The average sexual satisfaction after the intervention has increased from 115 to 119 and P is 0.02 and significant.
7	Hosseini, Mansoureh et al. 2016	Iran	Effectiveness of group training program of practical application of intimate communication skills on marital satisfaction of pregnant women[16	24 couples	Semi experimental	Enrich Marital Satisfaction Questionnaire 47	The average sexual satisfaction increased from 27 to 32 after the intervention, and P 0.007 was reported to be significant.
8	Elsayed et al. 2018	Egypt	The effect of the sexual education package on the awareness and sexual performance of pregnant women[17	100 pregnant women	Semi experimental	FSFI Sexual Function Questionnaire	The average sexual performance after the intervention has increased from 0.186 to 0.621 and P 0.03 means significant.
9	Sarbandi et al. 2011	Iran	The effect of childbirth and parenting program training based on mindfulness on pregnancy anxiety and marital satisfaction of pregnant women[18	10 pregnant women in the second and third trimester	Semi experimental	Enrich Marital Satisfaction Questionnaire 47 and PRAQ Pregnancy Anxiety Questionnaire	After the intervention, the average sexual satisfaction has increased from 128 to 158, and P 0.001 is reported to be significant, and anxiety during pregnancy has changed from 272 to 185, and P 0.001 is also reported to be significant.
10	Ghavami et al. 2019	Iran	The effect of group cognitive behavioral therapy on dysfunctional beliefs and marital satisfaction of pregnant women with fear of first delivery[19	39 pregnant women	Semi experimental	Childbirth Attitude Questionnaire (CAQ) Afrooz Marital Satisfaction Scale (AMSS)	After the intervention, the average sexual satisfaction has increased from 91 to 126, and P 0.001 is reported to be significant, and negative beliefs have changed from 123 to 104, and P 0.001 is reported to be significant.
11	Saniei et al. 2019	Iran	Investigating the effect of mindfulness on sexual desire and sexual satisfaction of primiparous pregnant women[20	72 pregnant women in 14 to 24 weeks	Clinical trial	FSFI Sexual Function Questionnaire	The average sexual satisfaction after the intervention has increased from 3.9 to 4.3, and P 0.02, which is significant, has been reported.
12	Alipour et al. 2019	Iran	Teaching marital communication skills to improve marital satisfaction and mental health during pregnancy: a couple-centered approach[21	60 pregnant women in 14 to 24 weeks	Clinical trial	Enrich Marital Satisfaction Questionnaire 47 and general health questionnaire	The average marital satisfaction in the intervention group changed from 155 to 170 in the post-test and 177 in the follow-up, and P is reported to be less than 0.05, which means it is significant. Depression has changed from 2.8 to 0.7, and anxiety has changed from 3.8 to 3.2, and P<0.05, which is significant.
13	Nadizadeh 2014	Iran	The effectiveness of sexual performance training on increasing sexual satisfaction of couples during pregnancy in Qom 2015 (22)	40 women of 10 to 15 weeks	Experimental	ASEX questionnaire And FSFI questionnaire	Evaluation of FSFI domains, the level of disturbance in satisfaction, arousal, moisture, and sexual desire was lower in the intervention group than in the control group, this difference was significant (P=0.05).

Data extraction and final report

After studying the abstract and the full text of the eligible articles, the desired data were extracted to write the present study. The necessary data for each study included the name of the author/year, location, purpose, age, sample size, tools, and results, and finally, the data extracted from the articles were classified and reported as the full text of this systematic review article [Table 3].

Ethical consideration

The utmost care was taken in mentioning the results of the studied studies.

Result

Search results and description of studies

Initially, 818 articles were obtained using search strategies. Also, three articles were found in manual search. In the next step, duplicate and unrelated studies were removed and 35 studies remained. Then 16 studies were removed after reviewing the summary of the articles and two other studies after reading the full text of the articles and finally 13 studies were selected [Figure 1].

Figure 1.

Diagram of selection of articles

The results of the present study are taken from 13 articles, which included mindfulness, cognitive-behavioral therapy, therapy based on acceptance and commitment and group counseling, PLISSIT model intervention, education, and support package (10-10 22).

Review of studies

Participants

The participants in all studies consisted of pregnant women, and only one study in which the intervention was conducted as a couple, spouses were also included along with the women. There were a total of 809 participants, of which only 24 were men. The age range of the participants was 14 to 44 years (22-10).

Tool

The tools used in this study are:

• Enrich Marital Satisfaction Questionnaire

• Pregnancy anxiety questionnaire

• Sexual satisfaction (SSSW)

• Depression, anxiety and stress scale (DASS-21)

• Hudson’s sexual satisfaction questionnaire

• Rosen’s sexual performance questionnaire

• Beck depression questionnaire

• Perceived marital relationship quality

• MWSSQ sexual satisfaction

• FSFI sexual performance questionnaire

• and PRAQ Pregnancy Anxiety Questionnaire

• and general health questionnaire

• ASEX questionnaire

• Childbirth Attitude Questionnaire (CAQ) Afrooz Marital Satisfaction Scale (AMSS).

Psychological interventions

CBT (Cognitive Behavioral Therapy)

In one study, the effectiveness of cognitive behavioral therapy (CBT) on sexual satisfaction in pregnant women was examined.[19] In a study, the effectiveness of psychological interventions based on CBT on improving the level of sexual satisfaction of pregnant women was measured. Intervention sessions were held as 8 weekly sessions (1 session each week) for 2 hours. In the first 1 hour of each session, patients underwent physical therapy including body awareness training[1], breathing exercises [2], relaxation techniques [3], Pineal muscle strength [4], massage, and self-massage. In the continuation of the sessions, psychological intervention based on CBT and topics such as providing information about sexual satisfaction, stress management [5], cognitive-behavioral techniques to increase sexual satisfaction [6], social relations [7], and family and couple were discussed. It should be noted that the intervention sessions were conducted by an experienced psychologist in a safe and comfortable environment with relaxing music.[21] In another study, the effect of group cognitive behavioral therapy on dysfunctional beliefs and marital satisfaction of pregnant women with fear of the first birth was discussed. The intervention sessions were designed and implemented as 10 weekly sessions (1 session each week) and for 90 minutes. Providing information about sexual satisfaction, connection between mind and body [8], coping strategies [9], stress management, cognitive techniques [10], problem solving techniques [11], and relationships with family and sexual issues, among others. It was addressed. Also, the intervention sessions were conducted by a trained psychologist and trainer.[19]

Mindfulness

Three studies investigated the effect of mindfulness on sexual satisfaction of pregnant women.[10,18,29] In a study, the effectiveness of psychological interventions based on mindfulness in increasing the sexual satisfaction of pregnant women was investigated. The intervention sessions were designed and implemented as 8 weekly sessions (1 session each week) for 2 hours. Mindfulness training [1], body scanning [2], breathing techniques, music and biofeedback support [3], group counseling and Psycho-education [4] which include psychological challenges [5], grief processes [6], emotions associated with adapting to chronic pain [7], stress and pain, health habits including food and exercise [8], and mind-body interaction [9] were among the issues discussed in the group sessions. Also, other things such as mindfulness techniques, counseling, and supportive treatments that were in line with the goals and individual challenges of pregnant women and focusing on their sexual challenges were addressed. Also, one of the intervention sessions took place with the presence of the patient’s wife. It should be noted that the intervention sessions were conducted by a psychologist.[10] In another study, the effect of psychological intervention based on mindfulness on the sexual satisfaction of pregnant women was investigated. In this study, each group received six 90-minute sessions per week under the supervision of a consultant professor. The educational content of the training sessions was planned as follows: the first session: general content and focus on the present moment; the second session: physical mindfulness; the third session: emotional mindfulness; the fourth session: mindfulness; the fifth session: body and thought mindfulness and emotions; and session 6: mindfulness regimen. At the end of each session, subjects received a pamphlet summarizing the contents and skills taught and they were asked to practice the contents at least twice a day.[18] Another study on 60 pregnant mothers aged 18-35 years with a gestational age of 20-26 weeks, weekly and intervention of 8 group counseling sessions of 60 minutes twice a week through Skyroom in groups of 10-12 people, mindfulness counseling based on Stress reduction was implemented.[29]

Treatment based on acceptance and commitment

In one study, Acceptance and Commitment Training [1] is mentioned. In this study, eight group sessions were conducted in a group format. In these meetings, issues such as observing events mentally and accepting them, being present in the moment and paying attention to interests, discovering the transcendental self, psychological flexibility, and committed action toward achieving values were discussed. At the end of the study, it was shown that this treatment method can be effective on sexual satisfaction.[13]

Education

In seven studies, the effect of various types of education on the sexual satisfaction of pregnant women has been mentioned.[11,12,14,16,17,18,21] In these studies, by providing information related to sexual satisfaction, sexual relations during pregnancy, prohibiting relations in some situations, using appropriate positions in pregnancy to establish sexual relations, teaching danger signs, and responding to women’s challenges. Pregnancy helped to increase their satisfaction, for example, in a study to some basic concepts in sexual health, anatomy and physiology of the reproductive system in the female sex, anatomy and physiology of the reproductive system in the male sex, an overview of the human sexual response cycle, and sexual intercourse. In natural conditions, factors affecting sexual response, factors threatening sexual health, the concept of sexual health in pregnancy, the role of pelvic floor muscles, and Kegel exercises were mentioned.[11,12,14,16,17,18,21]

PLISSIT model

An intervention was conducted based on the PLISS model. PLISSIT is formed from the first letters of the words permission, limited information, specific suggestion, and intensive therapy. This model is the most commonly used tool for evaluating sexual satisfaction and can be used for all people, including pregnant women.[15] This model can also help the healthcare provider to understand what the patient experiences in sex, what his problem is, and how he can improve his sexual health. In this study, two sessions of 90 minutes were conducted, which included, among other things, presenting information about the anatomy of the reproductive system in men and women and giving information in the field, discussing the sexual skills of courtship, teaching appropriate sexual positions in pregnancy, different methods and ways of flirting, and making love in pregnancy and… have been mentioned.[15]

Discussion

In this systematic review, 13 interventional studies were evaluated to investigate the effect of psychological interventions in promoting sexual satisfaction during pregnancy, which can be used to formulate and implement effective psychological interventions in promoting sexual satisfaction in pregnant women and improving their marital relationships to be available to health service providers. Among the 13 articles, two of their interventions were paired.[10,11,12,13,14,15,16,17,18,19,20,21,22] Thirteen articles have group interventions (22-10) and one article has conducted interventions online.[10] Two articles that were reported as clinical trials investigated mindfulness in sexual satisfaction.[10,20] Mindfulness interventions were conducted in consistent and weekly group sessions.[10,20] Seven studies were conducted as training.[11,12,14,16,17,18,21] Education was presented to women in a different way in each study. Giving a training package, holding online and face-to-face training classes, conducting meetings with the PLISSIT model[15] were among these things. The results of Heidari et al.’s[15] research, which was conducted using a controlled clinical trial, showed that the satisfaction of pregnant women increases after the intervention, so that the sexual satisfaction score of pregnant women in the intervention group four weeks after the intervention and at the end of the trimester. The second was much more than the previous study. Navidian stated in his educational study that due to the mother’s nausea and fatigue in the first trimester and the fear of abortion, sexual desire usually decreases, however, with the training of pregnant women, their sexual satisfaction at the end. It increased in the first trimester and continued in the second trimester, but in the third trimester due to the fear of premature birth and the fear of rupture of the water sac, sexual satisfaction decreased despite receiving education.[14] Other studies in the field of education also showed that by presenting educational materials in the form of educational pamphlets, women’s sexual satisfaction increases.[11] In the cognitive-behavioral intervention that was carried out in the study of Ghavami et al.,[19] the effect of this treatment in significantly increasing sexual satisfaction during pregnancy was pointed out. Other results that were presented in the collected articles were the employment status of pregnant women and their husbands, which in some studies showed a significant difference in the average score difference. In this way, working pregnant women and women whose husbands had government jobs had a higher increase in grades compared to housewives and those whose husbands were self-employed. The effectiveness of marital satisfaction from receiving information had a direct relationship with the education of pregnant women and their husbands. It seems that working women and men with government jobs who had higher education, educated people show more interest in knowing ways to improve marital satisfaction and also gain knowledge about changes during pregnancy.[19]

Gestational age has also been significantly reported in learning and having sexual satisfaction in the intervention group in all studies. The group who were in the first or third trimester of pregnancy had a greater change in marital satisfaction compared to the second trimester after providing information. Considering that the first and third trimesters of pregnancy are associated with more physical and mental changes, it seems. At the same time, the confusion of couples in dealing with these changes is more. On the other hand, pregnancy, fatigue, sleep disturbance, and decreased sexual desire in the first trimester and the fear of harming the fetus, especially in the last trimester of pregnancy, make many couples reduce their sexual relations, which plays an important role. It reduces marital satisfaction and it raises the need to educate couples about the safety of sexual relations in this era and ways to improve relationships. The study results confirm this issue.[7,16,19]

Women who did not have the support of those around them, received a significant effect from education. Women, especially those who are pregnant for the first time, face questions in many matters and feel the need for more education; therefore, this group has shown a greater increase in marital satisfaction after receiving information.[21,22]

In women who were more worried about their beauty when faced with the changes of pregnancy, the average increase in scores was significantly higher. In a study, they came to the conclusion that by providing sufficient information about the transience of changes during pregnancy and reducing the worries of pregnant women about beauty, it is possible to increase the feeling of marital satisfaction.[16,17] The mental image of one’s own body affects all psychological aspects of a pregnant woman and can affect marital satisfaction by creating problems in the pregnant woman’s feeling of wellbeing and attractiveness.[18] Also, mothers who are expecting a child with a specific gender will have problems in adapting to the natural changes during pregnancy.[19]

In general, the review of studies shows that psychological interventions such as treatment based on acceptance and commitment and cognitive-behavioral therapy and nonpsychological interventions such as education and providing a support package can be used as effective interventions to increase the sexual satisfaction of pregnant women (15-45).[30,31,32,33] In all the reviewed studies, the interventions were carried out by specialized people such as psychiatrists, psychologists, trained social workers, and trained trainers in the field. In addition, long-term follow-ups in some reviewed studies (3 months, 6 months, 6 weeks, and 12 weeks) and the relative stability of the results in follow-ups [except for one study (18)] can be considered as one of the main reasons for Use these interventions as effective interventions in promoting sexual satisfaction during pregnancy.

Limitations and recommendation

One of the limitations of this study is the lack of access to the full text of some studies and the lack of entering studies in a language other than Persian and English. Although there are many studies in the follow-up periods and also psychological interventions such as treatment based on acceptance and commitment and cognitive-behavioral therapy and nonpsychological interventions such as training and providing a support package have been investigated, it is recommended that future studies be conducted as a combination of psychological and nonpsychological interventions.

Conclusion

The results of the present study show that all the psychological and nonpsychological interventions mentioned in the studies are effective in improving sexual satisfaction in the short term. But due to the fact that the number of studies in this field has been limited, it seems that more and better quality studies are needed to access stronger evidence to implement effective interventions to improve sexual satisfaction.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.