Abstract
Background:
Infertility and its treatments can adversely affect sexual health. This study aimed to evaluate the impact of couple-centered counseling based on the Ex-Plissit model on improving sexual satisfaction among infertile couples.
Materials and Methods:
Conducted at the Infertility Department of Fatemieh Hospital in Hamadan from 2022 to 2023, this study included 60 infertile couples randomly assigned to an intervention group (30 couples) or a control group (30 couples). Sexual satisfaction was assessed using the Lindaberg questionnaire. The intervention group received four counseling sessions based on the Ex-Plissit model, while the control group received routine care. Post intervention, both groups completed the questionnaire again. Data were analyzed using SPSS version 26 with descriptive and inferential statistics (paired t-tests, independent t-tests, Wilcoxon tests, and analysis of covariance) at a significance level of p < 0.05.
Results:
Before the intervention, no significant difference in sexual satisfaction was observed between groups (p = 0.925). Post intervention, the intervention group showed significant improvement compared to the control group (p = 0.001). Within the intervention group, both men and women reported significant increases in sexual satisfaction (p = 0.001). In contrast, the control group showed no significant changes (p = 0.893 for women, p = 0.144 for men).
Conclusions:
Couple-centered counseling using the Ex-Plissit model significantly enhances sexual satisfaction in infertile couples. It is recommended to assess sexual satisfaction in infertile couples and provide appropriate educational or therapeutic interventions.
Keywords: Infertility, sex counseling, sexual behavior
Introduction
Fertility and reproduction are fundamental aspects of human life, shaping both individual and societal wellbeing.[1] Infertility, a persistent challenge throughout history, profoundly impacts couples, leading to a range of adverse effects.[2] Defined as the inability to conceive after 1 year of regular, unprotected sexual intercourse, infertility can be attributed to either partner.[3] According to the World Health Organization’s 2023 report, approximately one in six individuals worldwide (about 17.5% of the adult population) experiences infertility during their lifetime.[4] In Iran, the prevalence is notably higher, with around 25% of couples affected, compared to the global average of 15%.[4] Beyond its physical and psychological toll, infertility intersects with Iran’s population policies, which emphasize increasing fertility rates, strengthening family structures, and reducing barriers to childbearing. Thus, infertility poses a significant obstacle to achieving national demographic goals.[4]
Infertility is associated with numerous social, emotional, and psychological challenges that can strain sexual and marital relationships.[5] The process of infertility evaluation and treatment often triggers feelings of turmoil, frustration, worthlessness, rejection, and failure.[6] These issues can undermine marital bonds and diminish sexual satisfaction, a critical factor in family stability and success.[7,8,9] Research indicates that infertility is linked to reduced sexual desire, intimacy, and increased feelings of guilt, hopelessness, depression, and emptiness, often leading to a significant decline in sexual activity.[10,11,12] Studies confirm that infertility negatively affects women’s sexual health and satisfaction, with infertile couples consistently reporting lower sexual satisfaction.[13] These findings highlight the need for targeted educational and therapeutic interventions to improve the quality of life for infertile couples.[14]
Couple-centered counseling, particularly using the Ex-PLISSIT model, offers a supportive, solution-focused approach to address these challenges by reducing conflicts and enhancing communication between partners.[15,16,17] This model encompasses stages of Permission, Limited Information, Specific Suggestions, and Intensive Therapy, requiring ongoing reflection and review of all patient interactions.[18,19,20,21] Research demonstrates that the Ex-PLISSIT model effectively reduces sexual issues and enhances sexual satisfaction and performance among couples.[22,23] This study aims to evaluate the impact of couple-centered counseling based on the Ex-PLISSIT model on the sexual satisfaction of infertile couples. By improving their sexual and psychological wellbeing, this research not only seeks to enhance the quality of life for infertile couples but also aligns with Iran’s population policies by promoting family stability and supporting higher fertility rates.[24,25,26]
Materials and Methods
The present study was conducted as a randomized controlled clinical trial (IRCT20120215009014N443) with a control group from 2022 to 2023 on 60 couples referred to the infertility clinic of Fatemieh Hospital in Hamadan City. After obtaining the necessary permits and approvals from the relevant authorities, infertile couples meeting the criteria were selected through convenience sampling based on entry criteria, including willingness to participate in the study, primary infertility, and a history of at least one failed infertility treatment using assisted reproductive techniques (such as IVF). The cause of infertility in women, men, or both is either known or unknown. A minimum of 1 year and a maximum of 5 years have passed since the onset of primary infertility. Couples living together during the study (no barriers to the spouse’s presence at home such as having a job in a city other than the spouse’s residence), monogamy, an age range of 18–40 years in women and 18–60 years in men, residing in Hamadan city, ability to speak Persian, obtaining a score of 17–67 in the sexual satisfaction questionnaire by the couples (poor to moderate sexual satisfaction), no history of mental disorders, and no use of antidepressant and any herbal or chemical drugs that could affect their sexual activity were chosen for the study. Additionally, exclusion criteria included not attending multiple counseling sessions, experiencing an unexpected accident during counseling, refusing to cooperate further, having only one partner participate in the study, and conceiving naturally without assisted reproductive methods during treatment. The age criteria of 18–40 years for women and 18–60 years for men were established based on medical and epidemiological standards related to infertility and sexual health. For women, the age range of 18–40 years was selected due to the significant decline in fertility that occurs after age 40, along with the increased risks associated with pregnancy at older ages. This decision aligns with the guidelines set forth by the World Health Organization and findings from various fertility studies. In contrast, the broader age range of 18–60 years for men was chosen because male fertility declines more gradually with age, allowing for the maintenance of sexual and reproductive function into older ages. Furthermore, these age ranges were determined while considering the prevalence of primary infertility within the general population and the demographic characteristics of Hamedan city. This approach aims to enhance the generalizability of the study results and ensure coverage of reproductively active age groups.[27] After explaining the study’s objectives to the research units, written informed consent was obtained from them. The sample size was determined using data from Malakouti et al. and a formula accounting for 30% attrition, resulting in 30 couples in each group.[27] Sixty selected couples and individuals were then randomly assigned to control and intervention groups based on a predetermined allocation sequence. An allocation sequence was established using six blocks of 4 with different ABB, BBAA, ABAB, BABA, BAAB, and ABBA combinations. The sequence was used to randomly select 60 couples with primary infertility and medical records at the infertility center of Fatimieh Hospital. These couples had similar demographic characteristics and had experienced a single failed IVF treatment. They were divided into two groups – a control group (30 couples) and an intervention group (30 couples) – to begin the treatment cycle. The type of intervention was determined by a random selection process and coded in sealed envelopes. Figure 1 shows the flowchart of the randomized controlled clinical trial process to evaluate the effect of couple-based counseling using the Ex-PLISSIT model on the sexual satisfaction of infertile couples. This flowchart illustrates the steps of sample selection, random allocation, intervention, and outcome assessment.
Figure 1.
CONSORT flowchart
Questionnaires were also coded in sequential order for data collection. Upon enrolment in the study, participants received an envelope containing a demographic characteristics checklist and a self-reported sexual satisfaction questionnaire. This initial step helped identify infertile couples with varying levels of sexual satisfaction. Subsequently, the intervention group couples agreed on a counseling session time. The questionnaires utilized were the demographic information checklist and the Lindaberg sexual satisfaction questionnaire. The scale comprises 17 questions, and responses are categorized as always, most of the time, sometimes, rarely, or never. Responses with always receive 5 points, while never receive 1 point. Responses are typically awarded 4, 3, and 2 points, respectively. The total score can range from 17 to 85, with scores between 17 and 51 indicating poor sexual satisfaction, 52–67 indicating moderate satisfaction, and 68–85 indicating good satisfaction. The Lindaberg Sexual Satisfaction Questionnaire was developed by Lindaberg in 1997. This instrument was designed to assess the level of sexual satisfaction in both women and men. The validity and reliability of the Persian version of this questionnaire were first evaluated and confirmed by Javad Salehi Fadari in 1998 (1377 in the Iranian calendar). Additionally, the questionnaire was used in a study conducted by Maryam Hosseini in Mashhad during the years 2002–2003 (1381–1382). In another study by Saadeddin, the test–retest reliability of the questionnaire was reported with a correlation coefficient of r = 0.89, indicating an acceptable level of stability for measuring sexual satisfaction, and its reliability was established in this study with a Cronbach’s alpha coefficient of 0.94.[28] The research midwife conducted a sexual counseling intervention for infertile couples in the intervention group throughout four sessions, following the EX_PLISSIT model. The counselor in this study holds a Master’s degree in Midwifery Counseling and has received valid certification and specialized training related to the EX-PLISSIT model. She/he has acquired the necessary skills to provide specialized counseling aimed at improving sexual function and satisfaction among infertile couples. Before commencing the study, the necessary certificates and documents were provided to the School of Nursing and Midwifery at Hamadan University of Medical Sciences to secure approval and the required research permit.
Each session, lasting 1 hour (45 min of counselling and 15 min for questions), was held in person with the couple weekly. It is worth mentioning that in the intervention group, counseling was provided separately for each couple and not in a group setting, while the control group only received routine treatments. The content of the sessions was prepared by the researcher, collecting information from participating in sexual counseling training courses, couple therapy, and the book Couple Therapy by Mrs Maryam Najafi and Esfandiar Shahbazi from Ghanoun Yar Publications in the form of a pamphlet.[29] The counseling sessions were as follows:
First Stage: Permission (60 min): In the first session, a safe, trustworthy, and nonjudgmental environment was created to discuss the couple’s issues. The counseling was conducted in a private room with both partners present. After introductions and establishing rapport between the counselor and the couple, the counselor initiated the discussion on sexual issues, sexual self-concept, and sexual satisfaction by asking open-ended questions. Each partner was encouraged to share their sexual perceptions, concerns, and problems. The counselor reflected and reviewed the couple’s statements and information to clarify ambiguities, providing more opportunities for permission and acceptance. During the discussion, the counselor identified the couple’s misconceptions, false beliefs, limited or incomplete knowledge, and concerns. By taking a sexual history and asking questions related to mental perceptions, sexual self-concept, and sexual satisfaction (aligned with the study’s questionnaires), the couple’s sexual issues were identified. The session concluded with a final question-and-answer segment
Second Stage: Limited Information (60 min): The counselor provided limited information directly related to the couple’s sexual issues and concerns. This included information on female sexual anatomy and physiology, stages of the sexual response cycle, sexual function, an individual’s mindset regarding their sexual relationship (sexual self-concept), and an explanation of sexual satisfaction. The definition and types of sexual self-concept, its impact on marital life and sexual relationships, the consequences of a negative sexual self-concept on fertility, the effect of sexual self-concept on sexual satisfaction, and the influence of a partner’s behavior on the sexual self-concept of an infertile woman or man (and vice versa) were discussed. Couples were asked to share their understanding of the provided information during the session. This helped the researcher ensure that the couples correctly understood the content, allowing opportunities to correct any misconceptions. The session ended with a question-and-answer segment
Third Stage: Specific Suggestions (60 min): Specific suggestions tailored to the couple’s issues and solutions were provided, with feedback collected at each stage to enhance self-awareness. The counseling process was guided by reviewing and exchanging viewpoints and beliefs. These suggestions consisted of the counselor’s specialized knowledge in sexual matters, such as the role of mental beliefs and psychological factors in sexual satisfaction and activity, and factors affecting sexual desire. Reflecting on the content of the discussions during the session allowed for a comprehensive review of all interactions with the couple, enabling the correction of the counselor’s assumptions and increasing the couple’s self-awareness. The session concluded with a question-and-answer segment
Fourth Stage: Intensive Counseling (60 min): This stage involved reviewing the couples’ sexual self-concept and subsequent sexual satisfaction, discussing factors affecting sexual self-concept and sexual satisfaction, and summarizing all counseling stages. The session ended with a question-and-answer segment, and, as in previous sessions, the content of the discussions was reflected upon.
Participants in the intervention group were followed up via phone calls and received weekly feedback after the counseling sessions concluded. The intervention group also received an educational pamphlet on the final day of counseling. Both the intervention and control groups completed the sexual satisfaction questionnaire in person through self-reporting 4 weeks after the counseling sessions ended. To adhere to ethical guidelines, the control group was provided with a training package containing the session content at the study’s conclusion. Data were extracted and analyzed using IBM SPSS Statistics, Version 16 (IBM Corporation, Armonk, NY, USA). The normality of quantitative data distribution was assessed using the Kolmogorov–Smirnov test. For comparisons between the two groups based on demographic and background variables, the independent t-test or Mann–Whitney test was applied to quantitative data, depending on the data distribution.
In contrast, the Chi-square test was used for qualitative data. The analysis of covariance (ANCOVA) test was employed to examine differences between the two groups in terms of the studied outcomes. Intragroup comparisons were conducted with the paired t-test, while between-group comparisons were carried out with the independent t-test. A significance level of P < 0.05 was considered.
Ethical considerations
The ethical considerations in this study were based on the standards of medical and clinical research ethics. The study was conducted after obtaining the ethics code (IR.UMSHA.REC.1401.461) from the Ethics Committee of Hamadan University of Medical Sciences. Additionally, written informed consent was obtained from all participants after explaining the study’s objectives. Ensuring the confidentiality of information, the right to withdraw from the study, and providing an educational package to the control group at the end of the study were among the other ethical measures. These actions align with the principles of the Declaration of Helsinki and international and national ethical guidelines.
Results
The independent t-test showed no statistically significant differences in demographic variables between the intervention and control groups. The mean (standard deviation [SD]) age of men was 35.40 (5.82) years in the intervention group and 36.60 (4.22) years in the control group (p = 0.365). The mean (SD) age of women was 31.30 (5.88) years in the intervention group and 33.17 (4.89) years in the control group (p = 0.187). The mean (SD) duration of marriage was 6.97 (2.03) years in the intervention group and 7.53 (2.26) years in the control group (p = 0.310). The mean (SD) duration of infertility was 4.03 (1.16) years in the intervention group and 4.48 (0.91) years in the control group (p = 0.086). Most women in the intervention group had cycle-level education (40%), while most in the control group had a diploma (40%), with no significant difference (p = 0.945, Fisher’s exact test). Similarly, most men in both groups had a diploma (43.3% intervention, 46.7% control), with no significant difference (p = 0.562, Fisher’s exact test). A significant difference was observed in male smoking habits, with 0% in the intervention group and 20% in the control group (p = 0.024, Fisher’s exact test). Causes of infertility were similar, with combined causes in 53% of the intervention group and 50% of the control group (p = 0.836, Fisher’s exact test). Other demographic characteristics are presented in Table 1.
Table 1.
Demographic characteristics of the couples participating in the study in the intervention and control groups
| Variable | Intervention group, mean (standard deviation) | Control group, mean (standard deviation) | Test statistics (independent t-test) | p |
|---|---|---|---|---|
| Male age (years) | 35.40 (5.82) | 36.60 (4.22) | 0.91 | 0.365 |
| Female age (years) | 31.30 (5.88) | 33.17 (4.89) | 1.34 | 0.187 |
| Duration of marriage (years) | 6.97 (2.03) | 7.53 (2.26) | 1.02 | 0.310 |
| Duration of infertility (years) | 4/03 (1.16) | 4/48 (0.91) | −1.72 | 0.086 |
| Occupation (female) | ||||
| Employee | 24 (80.00) | 27 (90.00) | - | 0.472 |
| Housewife | 6 (20.00) | 3 (10.00) | - | |
| Education (female) | ||||
| Cycle | 12 (40.00) | 11 (36.70) | 0.60 | 0.945 |
| Diploma | 10 (33.30) | 12 (40.00) | ||
| Bachelor’s degree | 7 (23.30) | 6 (20.00) | ||
| Master’s degree | 1 (3.30) | 1 (3.30) | ||
| Occupation (male) | ||||
| Employee | 8 (26.70) | 2 (6.70) | 4.32 | 0.038 |
| Freelance | 22 (73.30) | 28 (93.30) | ||
| Education (male) | ||||
| Cycle | 8 (26.70) | 11 (36.70) | 2.14 | 0.562 |
| Diploma | 13 (43.30) | 14 (46.70) | ||
| Bachelor’s degree | 8 (26.70) | 5 (16.70) | ||
| Master’s degree | 1 (3.30) | 0 (0.00) | ||
| Smoking (male) | ||||
| Yes | 0 (0.00) | 6 (20.00) | - | 0.024 |
| No | 30 (100.00) | 24 (80.00) | ||
| The economic situation | ||||
| Low level | 9 (30.00) | 14 (46.70) | 2.95 | 0.198 |
| Medium | 19 (63.30) | 16 (53.30) | ||
| High level | 2 (6.70) | 0 (0.00) | ||
| Causes of infertility | ||||
| Female | 7 (23.30) | 6 (20.00) | 0.36 | 0.836 |
| Man | 7 (23.30) | 9 (30.00) | ||
| Both | 16 (53.30) | 15 (50.00) |
*Independent t-test
The mean (SD) sexual satisfaction score for women before the intervention was 49.83 (5.05) in the intervention group and 49.67 (8.16) in the control group, with no significant difference (p = 0.925, independent t-test). Post intervention, the mean (SD) score for women in the intervention group increased to 57.17 (6.88), significantly higher than the control group’s 49.63 (8.34) (p = 0.001, independent t-test). For men, the mean (SD) sexual satisfaction score before the intervention was 50.03 (4.94) in the intervention group and 50.37 (8.57) in the control group, with no significant difference (p = 0.854, independent t-test). Post intervention, the mean (SD) score for men in the intervention group rose to 57.77 (5.31), significantly higher than the control group’s 49.30 (7.54) (p = 0.001, independent t-test) [Table 2].
Table 2.
Comparison of the average sexual satisfaction scores among women and men in the intervention and control groups
| Variable | Intervention group, mean (standard deviation) | Control group, mean (standard deviation) | Test statistics (independent t-test) | p* |
|---|---|---|---|---|
| Women’s sexual satisfaction before the intervention | 49.83 (5.05) | 49.67 (8.16) | −0.10 | 0.925 |
| Women’s sexual satisfaction after the intervention | 57.17 (6.88) | 49.63 (8.34) | −3.82 | 0.001 |
| Sexual satisfaction of men before the intervention | 50.03 (4.94) | 50.37 (8.57) | 0.19 | 0.854 |
| Sexual satisfaction of men after the intervention | 57.77 (5.31) | 49.30 (7.54) | −5.03 | 0.001 |
*Independent t-test
Paired t-test results showed a significant increase in the mean (SD) sexual satisfaction scores for women in the intervention group from 49.83 (5.05) to 57.17 (6.88) postintervention (p = 0.001), while no significant change was observed in the control group (from 49.67 [8.16] to 49.63 [8.34], p = 0.893). Similarly, men in the intervention group showed a significant increase in mean (SD) scores from 50.03 (4.94) to 57.77 (5.31) postintervention (p = 0.001), while no significant change was observed in the control group (from 50.37 [8.57] to 49.30 [7.54], p = 0.144) [Table 3].
Table 3.
Comparison of the mean scores of sexual satisfaction for women and men within the intervention and control groups
| Variable | Consent before intervention | Consent before intervention | Test statistics (t-paired test) | p |
|---|---|---|---|---|
| Intervention group, mean (standard deviation) of women | 49.83 (5.05) | 49.83 (5.05) | 8.34 | 0.001 |
| Control group, mean (standard deviation) of women | 49.67 (8.16) | 49.67 (8.16) | 0.14 | 0.893 |
| Intervention group, mean (standard deviation) of men | 50.03 (4.94) | 50.03 (4.94) | −8.56 | 0.001 |
| Control group, mean (standard deviation) of men | 50.37 (8.57) | 50.37 (8.57) | 1.5 | 0.144 |
*t-paired test
ANCOVA, controlling for preintervention scores, showed that the mean (SD) postintervention sexual satisfaction score for women was 57.08 (3.57) in the intervention group, significantly higher than 49.72 (3.57) in the control group (p = 0.001). Similarly, for men, controlling for preintervention scores, smoking habits, and occupation, the mean (SD) postintervention score was 57.73 (4.21) in the intervention group, significantly higher than 49.33 (4.21) in the control group (p = 0.001) [Table 4].
Table 4.
The results of the analysis of covariance for the sexual satisfaction scores of women and men were assessed after the intervention
| Variable name | The postintervention phase adjusted mean (SD) | F | p |
|---|---|---|---|
| Intervention group (women) | 57.08 (3.57) | 63.94 | 0.001 |
| Control group (women) | 49.72 (3.57) | ||
| Intervention group (men) | 57.73 (4.21) | 55.07 | 0.001 |
| Control group (men) | 49.33 (4.21) |
*ANCOVA test. ANCOVA=Analysis of covariance, SD=Standard deviation
Discussion
The present study is a randomized clinical trial aimed at determining the impact of couple-based counseling based on the Ex-PLISIT model on the sexual satisfaction of infertile couples. The most important finding of the present study indicates the effect of couple-based counseling based on the EX-PLISSIT model in increasing the sexual satisfaction of infertile couples. This research marks the initial investigation using the EX-PLISSIT model to assess sexual satisfaction among infertile couples in Iran. To support these outcomes, it draws on global studies that demonstrate how couple-based sexual counseling informed by the EX-PLISSIT model can mitigate sexual challenges in couples dealing with other chronic conditions.[27,30]
Keshavarz et al. demonstrated that counseling based on the PLISSIT model reduces sexual dysfunction and sexual distress as well as improves the quality of life in female breast cancer survivors.[30]
The findings of Malakouti et al. indicated that sexual counseling based on the Ex-PLISSIT model can increase women’s sexual function and marital satisfaction after childbirth.[27] The findings of the aforementioned studies are in line with the aim of the present study, which is that sexual counseling based on the Ex-PLISSIT model can increase women’s marital satisfaction.[30,31]
A study conducted by Mostafa et al. revealed that sexual problems experienced by newly married women included painful intercourse, arousal disorders, decreased libido, and anorgasmia. Counseling using the PLISSIT model had a positive impact on the sexual satisfaction of newly married women.[32]
A study has shown that providing sexual counseling with any approach during routine antenatal care by community midwives may improve the sexual health of couples.[33] Jodouin et al. demonstrated that self-directed sexual approach motivations are associated with higher sexual satisfaction in women.[34] Farnam et al. compared the PLISSIT method with routine educational methods and showed that both methods were effective in improving sexual satisfaction.[35] Heidari et al. showed that the PLISSIT method is effective in improving sexual satisfaction.[36] The results of the study by Heidari et al. and Farnam et al. confirm the findings of the present study in the field of enhancing the sexual satisfaction of couples after counseling using the Ex-PLISSIT method.[35,36] The findings from Rostamkhani (2012) and Karimi et al. align with the current study, showing that counseling using the PLISSIT model can enhance women’s sexual satisfaction.[37,38] A systematic review and meta-analysis study by Mashhadi et al. emphasized that all studies have shown a positive impact of counseling based on the PLISSIT model on sexual performance. However, further studies should be conducted in different countries with different sexual cultures to clarify the issue as much as possible.[39] The findings of Mirghafourvand et al. showed that addressing sexual problems and inefficiencies and improving marital satisfaction can increase the quality of life for couples and help create a strong and long-term family life.[40] On the other hand, according to a systematic review, sexual counseling interventions based on the PLISSIT and EX-PLISSIT models have been shown to significantly improve sexual functioning. However, these interventions did not produce a statistically significant effect on overall sexual satisfaction.[41]
To increase the sexual satisfaction of infertile couples, healthcare providers, women’s health and midwifery specialists, and midwives should inquire about the nature of the sexual relationships and satisfaction of the couples during their history-taking. They should incorporate sexual relationship education into the standard education and tailor their sexual inquiries to the specific circumstances of their clients. This way, by providing sexual skills training, the emotional and sexual needs of the couples during this crucial period can be met.[42] Furthermore, the results of the study by Perz et al. demonstrated that sexual education based on the PLISSIT model was beneficial and effective for couples as it increased their awareness of sexual preferences, improved their relationships, and helped them manage sexual changes.[42] In the present study, it seems that increasing the awareness of both the woman and her spouse in implementing the proposed strategies in counseling sessions leads to the spouse paying more attention to ensuring the woman’s comfort and increasing sexual satisfaction. The couple-centered counseling approach in the current study is a strength that takes steps to establish a connection with the spouse and assist the couple in resolving existing problems. Additionally, by educating and involving the spouse, who is considered the most influential family member, it is possible to increase the sexual satisfaction, quality of life, and sexual function of the couple during the period of infertility.
In this study, we encountered several limitations. First, encouraging infertile couples to participate in the study was challenging due to their numerous personal concerns and issues, so much so that many of them were initially unwilling to take part in the research. In Iranian culture, attending sexual counseling sessions is considered a private and sometimes taboo subject, which has affected the level of participation. Moreover, the focus of the study on couples residing in the city of Hamadan may limit the generalizability of the findings to other regions with different cultural and social characteristics. Additionally, the lack of long-term follow-up after the intervention reduced the ability to assess the sustainability of the therapeutic effects. For future research, it is suggested to conduct a similar study using the current methodology and the Ex-PLISSIT model, but considering the type and cause of infertility (e.g. female-factor, male-factor, or combined infertility) to investigate the model’s impact on specific subgroups and provide more targeted interventions. Additionally, conducting studies with long-term follow-up (beyond 4 weeks) is recommended to assess the sustainability of counseling effects on the sexual satisfaction of infertile couples. Furthermore, expanding the study scope to various regions of Iran with diverse cultural and social backgrounds could enhance the generalizability of findings. Finally, designing combined interventions involving both group and individual counseling based on the Ex-PLISSIT model and comparing their effectiveness could help identify the optimal approach for improving sexual satisfaction among infertile couples.
Conclusion
The findings of this study suggest that utilizing couple-centred counseling with the Ex-PLISSIT model can enhance the sexual satisfaction of infertile couples. This highlights the need for improved counseling, educational programs, and therapeutic interventions to be developed for women’s health specialists, midwives, psychologists, and healthcare providers in specialized clinics and counseling centers. It is important to regularly assess the sexual satisfaction of infertile couples attending infertility treatment centers to provide appropriate support and information as needed.
Conflicts of interest
Nothing to declare.
Acknowledgments
The current research is a component of the MSc. Razieh Dalvand’s master’s thesis in midwifery counseling. We would like to extend our appreciation for the valuable collaboration and support from the respected deputy, as well as the midwifery team at the Faculty of Nursing and Midwifery at Hamadan University of Medical Sciences, supervisor Ms. Arezoo Shayan, staff at the infertility center at Fatemieh Hospital in Hamadan, and all the research participants.
Funding Statement
Hamadan University of Medical Sciences.
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