The effect of extended PLISSIT model-based counseling on sexual satisfaction in women with systemic lupus erythematosus: A randomized controlled trial
,
Abstract
Background & Aim: Systemic Lupus Erythematosus has physiological, cognitive, and mental effects on sexual satisfaction in afflicted women. This study aimed to investigate the effect of sexual counseling based on the EX-PLISSIT model on sexual satisfaction in this group of patients.
Materials & Methods: A randomized controlled trial was conducted on 120 married women with SLE in Ahvaz, Iran. Eligible women were randomly assigned to the intervention group (four weeks of psychosexual counseling sessions based on EX-PLISSIT) and the control group, using block randomization with a 1:1 allocation ratio. Before the intervention and eight and twelve weeks after the completion of counseling sessions, the Larson Sexual Satisfaction Questionnaire was administered. Data was analyzed using independent t-tests, paired t-tests, Chi-square test, and repeated measures ANOVA.
Results: There was no significant difference in sexual satisfaction scores between the two groups before the intervention (p₌0.718). Following the intervention, the mean sexual satisfaction score in the intervention group significantly increased (from 93.8±15.59 to 104.5±13.32 after 12 weeks), while a significant decrease was observed in the control group. At the 12-week follow-up, the mean satisfaction in the intervention group was significantly higher than the control group (p<0.0001). Repeated Measures ANOVA confirmed a significant difference in the trend of changes between the two groups over time (p<0.0001).
Conclusion: The results demonstrated that sexual counseling based on the EX-PLISSIT model significantly enhanced sexual satisfaction in married women with SLE compared to the control group. Therefore, this type of counseling is recommended as an effective and simple adjunctive therapeutic service for enhancing sexual satisfaction in women with SLE.
Trial registration: This study has been registered with the Iranian Registry for Clinical Trials (IRCT20230626058592N2).
1. Rausch D, Rettenberger M. Predictors of sexual satisfaction in women: A systematic review. Sexual Medicine Reviews. 2021;9(3):365-80.
2. Cheng Z, Smyth R. Sex and happiness. Journal of Economic Behavior & Organization. 2015;112(4):26-32.
3. del Mar Sánchez-Fuentes M, Santos-Iglesias P, Sierra JC. A systematic review of sexual satisfaction. International journal of clinical and health psychology. 2014;14(1):67-75.
4. Gillespie BJ. Correlates of sex frequency and sexual satisfaction among partnered older adults. Journal of Sex & Marital Therapy. 2017;43(5):403-23.
5. Herbenick D, Eastman-Mueller H, Fu T-c, Dodge B, Ponander K, Sanders SA. Women’s sexual satisfaction, communication, and reasons for (no longer) faking orgasm: Findings from a US probability sample. Archives of Sexual Behavior. 2019;48(2):2461-72.
6. McNulty JK, Wenner CA, Fisher TD. Longitudinal associations among relationship satisfaction, sexual satisfaction, and frequency of sex in early marriage. Archives of sexual behavior. 2016;45(12):85-97.
7. McGrath M, Low MA, Power E, McCluskey A, Lever S. Addressing sexuality among people living with chronic disease and disability: a systematic mixed methods review of knowledge, attitudes, and practices of health care professionals. Archives of physical medicine and rehabilitation. 2021;102(5):999-1010.
8. Shami M, Montazeri A, Faezi ST, Behboodi Moghadam Z. The Effect of Sexual Counseling Based on EX‑PLISSIT Model on Improving the Sexual Function of Married Women with Systemic Lupus Erythematosus: A Randomized Controlled Trial. Sexuality and Disability. 2023;41(2):451-66.
9. Dörner T, Furie R. Novel paradigms in systemic lupus erythematosus. The Lancet. 2019;393(10188):2344-58.
10. Akbarian M, Faezi ST, Gharibdoost F, Shahram F, Nadji A, Jamshidi AR, et al. Systemic lupus erythematosus in Iran: a study of 2280 patients over 33 years. International journal of rheumatic diseases. 2010;13(4):374-9.
11. Liu M, Dou J, Wang Q. The effect of systemic lupus erythematosus on sexual function in women: an updated meta-analysis based on cross-sectional studies. Advances in Rheumatology. 2022;62(4):24-30.
12. Davatchi F, Jamshidi A-R, Banihashemi AT, Gholami J, Forouzanfar MH, Akhlaghi M, et al. WHO-ILAR COPCORD study (stage 1, urban study) in Iran. The Journal of rheumatology. 2008;35(7):1384-90.
13. Baniotopoulos P, Pyrgidis N, Minopoulou I, Tishukov M, Sokolakis I, Hatzichristodoulou G, et al. Treatment of Sexual Dysfunction in Women with Systemic Autoimmune Rheumatic Disorders: A Systematic Review. Sexual Medicine Reviews. 2022;10(4):520-8.
14. Rady SA, Ahmed AR, Metwally SM, Abdelaleem EA. Sexual dysfunction and physical performance in female systemic lupus erythematosus patients. The Egyptian Rheumatologist. 2022;44(1):57-61.
15. Orzúa-de la Fuente WM, Salazar-Hernández GJ, Vega-Morales D, Garza-Alpírez A, Esquivel-Valerio JA. High prevalence of sexual dysfunction in women with rheumatic diseases: a not recognized health domain. Sexuality and Disability. 2018;36(6):407-16.
16. Jin Z, Yang C, Xiao C, Wang Z, Zhang S, Ren J. Systemic lupus erythematosus and risk of sexual dysfunction: a systematic review and meta-analysis. Lupus. 2021;30(2):238-47.
17. Annon JS. The PLISSIT model: A proposed conceptual scheme for the behavioral treatment of sexual problems. Journal of sex education and therapy. 1976;2(1):1-15.
18. Jamalianfar F, Riazi H, Firoozi A, Nasiri M, Montazeri A. The Effectiveness of ‘Good-Enough Sex Model’ on Sexual Satisfaction and Sexual Intimacy in Women with Multiple Sclerosis: A Randomized Trail. Sexuality and Disability. 2021;39(3):507-19.
19. Nurgitz R, Pacheco RA, Senn CY, Hobden KL. The impact of sexual education and socialization on sexual satisfaction, attitudes, and self-efficacy. The Canadian Journal of Human Sexuality. 2021;30(2):265-77.
20. Shahbazi A, Behboodi Moghadam Z, Maasoumi R, Saffari M, Mohammadi S, Montazeri A. Effect of a Health-Education Program Based on the BASNEF Model of Overall Sexual Health Satisfaction and Satisfaction with Quality of Sexual Relationship among Women with Infertility. International Journal of Women's Health. 2020;12(null):975-82.
21. Bilge Ç, Aslan E. The Effect of Post-Operative Sexual Counseling Carried out with PLISSIT Model on Sexual Function and Sexual Satisfaction in Gynecologic Cancers. Clinical and Experimental Health Sciences. 2023;13(3):623-9.
22. Nazari S, Keramatkar M, Moghdehipanah H, Olfati F. The Effect of Ex-PLISSIT Model on Sexual Satisfaction in Women with Multiple Sclerosis. Sexuality and Disability. 2023;41(2):467-77.
23. Zangeneh S, Savabi-Esfahani M, Taleghani F, Sharbafchi MR, Salehi M. Effectiveness of online sexual education based on the extended PLISSIT model on sexual function and sexual satisfaction in women undergoing breast cancer treatment. Journal of Education and Health Promotion. 2023;2(1):311-20.
24. Cicek Ozdemir S, Dogan Gangal A, Senturk Erenel A. The effect of sexual counseling based on PLISSIT and EX-PLISSIT models on sexual function, satisfaction, and quality of life: a systematic review and meta-analysis. Archives of Sexual Behavior. 2024;53(9):3485-513.
25. Lovibond SH. Manual for the depression anxiety stress scales. Sydney psychology foundation. 1995;2(1):30-7.
26. Siamak S, Bahram J. A study on the reliability and validity of the short form of the Depression Anxiety Stress Scale (DASS-21). Journal of social sciences and humanities of Shiraz University. 2007;26(3):52-61.
27. Larson JH, Anderson SM, Holman TB, Niemann BK. A longitudinal study of the effects of premarital communication, relationship stability, and self-esteem on sexual satisfaction in the first year of marriage. Journal of sex & marital therapy. 1998;24(3):193-206.
28. Hudson WW, Harrison DF, Crosscup PC. A short‐form scale to measure sexual discord in dyadic relationships. Journal of Sex Research. 1981;17(2):157-74.
29. Bahrami N, Yaghoob Zadeh A, Sharif Nia H, Soliemani MA, Haghdoost AA. Validity and reliability of the persian version of Larson sexual satisfaction questionnaire in couples. Journal of kerman university of medical sciences. 2016;23(3):344-56.
30. Behboodi Moghadam Z, Zareiyan A, Faezi ST, Rezaei E. Development and psychometric properties of the Reproductive Health Assessment in Systemic Lupus Erythematosus: Mixed-Methods study. Lupus. 2024;33(1):5-16.
31. Ziaei T, Kharaghani R, Haseli A, Ahmadnia E. Comparing the Effect of Extended PLISSIT Model and Group Counseling on Sexual Function and Satisfaction of Pregnant Women: A Randomized Clinical Trial. Journal of Caring Sciences. 2022;11(1):7-16.
32. Ghodsi F, Bahrami N, Mafi M, Olfati F. The effect of sex Counseling based on (permission, limited information, specific suggestions, intensive therapy) model on sexual satisfaction in women with cyclic Mastalgia: a randomized controlled clinical trial. Iranian Journal of Nursing and Midwifery Research. 2021;26(6):562-8.
33. Sazesh S, Saeieh SE, Farid M, Refaei M, Yazdkhasti M. Effectiveness of group counseling with a client-centered approach based on the gather principles on sexual satisfaction in women with multiple sclerosis: A randomized clinical trial. Iranian Journal of Medical Sciences. 2021;46(2):103-9.
34. Di Stasi V, Verde N, Maseroli E, Scavello I, Cipriani S, Todisco T, et al. Female sexual dysfunction as a warning sign of chronic disease development. Current Sexual Health Reports. 2019;11(5):307-19.
35. Guo Z-N, He S-Y, Zhang H-L, Wu J, Yang Y. Multiple sclerosis and sexual dysfunction. Asian journal of andrology. 2012;14(4):530-9.
36. Ghafoori F, Bagheri M, Dehghan-Nayeri N, Khakbazan Z, Haghani H, Hedayatnejad M, et al. Effectiveness of sexual counseling using better model to promote sexual function and satisfaction of married women with multiple sclerosis. Sexuality and Disability. 2022;40(3):471-86.
37. Boquiren VM, Esplen MJ, Wong J, Toner B, Warner E, Malik N. Sexual functioning in breast cancer survivors experiencing body image disturbance. Psycho‐Oncology. 2016;25(1):66-76.
38. Rodrigues L, Sim‐Sim MM, Sousa L, Faria‐Schützer DB, Surita FG. Self‐concept and body image of people living with lupus: A systematic review. International Journal of Rheumatic Diseases. 2021;24(11):1339-53.
39. Campos LS, De Nardi SP, Limberger LF, Caldas JM. Sexual function, body image and quality of life of women with advanced cancer. Sexuality and Disability. 2022;40(1):141-51.
40. Shen B, He Y, Chen H, Zhao C, Zhu L, Gao Y, et al. Body image disturbances have impact on the sexual problems in Chinese systemic lupus erythematosus patients. Journal of immunology research. 2015;15(2):49-58.
41. Attaky A, Schepers J, Kok G, Dewitte M. The role of sexual desire, sexual satisfaction, and relationship satisfaction in the sexual function of Arab couples living in Saudi Arabia. Sexual Medicine. 2021;9(2):100303-.
42. Tavakol Z, Mirmolaei S, Movahed ZM. The survey of sexual function relationship with sexual satisfaction in referred to Tehran South City health centers. Avicenna Journal of Nursing and Midwifery Care. 2011;19(2):50-60.
43. Radhakrishna MH, Kayidhi S, Ravindran V. Sexual health in rheumatology. Rheumatology 2024;63(3):584-6.
44. Tsoi A, Gomez A, Boström C, Pezzella D, Chow JW, Girard-Guyonvarc’h C, et al. Efficacy of lifestyle interventions in the management of systemic lupus erythematosus: a systematic review of the literature. Rheumatology International. 2024:1-14.
45. Youssef MK. Effect of exercises training on fatigue, depression and physical activity in patients with systemic lupus erythematosus. Journal of Health and Medical Research. 2019;1(1):4-11.
46. Basson R, O’Loughlin JI, Weinberg J, Young AH, Bodnar T, Brotto LA. Dehydroepiandrosterone and cortisol as markers of HPA axis dysregulation in women with low sexual desire. Psychoneuroendocrinology. 2019;104:259-68.
47. Vigl J, Strauß H, Talamini F, Zentner M. Trajectories of relationship and sexual satisfaction over 2 years in the Covid‐19 pandemic: A latent class analysis. Journal of Personality. 2024;14(3):48-56.
48. Voutskidou A, Kirkou G, Dagla M, Orovou E, Sarella A, Palaska E, et al. COVID-19 pandemic and its impact on the quality of women’s sexual life: a systematic review. Healthcare. 2023;11(2):185-99.
2. Cheng Z, Smyth R. Sex and happiness. Journal of Economic Behavior & Organization. 2015;112(4):26-32.
3. del Mar Sánchez-Fuentes M, Santos-Iglesias P, Sierra JC. A systematic review of sexual satisfaction. International journal of clinical and health psychology. 2014;14(1):67-75.
4. Gillespie BJ. Correlates of sex frequency and sexual satisfaction among partnered older adults. Journal of Sex & Marital Therapy. 2017;43(5):403-23.
5. Herbenick D, Eastman-Mueller H, Fu T-c, Dodge B, Ponander K, Sanders SA. Women’s sexual satisfaction, communication, and reasons for (no longer) faking orgasm: Findings from a US probability sample. Archives of Sexual Behavior. 2019;48(2):2461-72.
6. McNulty JK, Wenner CA, Fisher TD. Longitudinal associations among relationship satisfaction, sexual satisfaction, and frequency of sex in early marriage. Archives of sexual behavior. 2016;45(12):85-97.
7. McGrath M, Low MA, Power E, McCluskey A, Lever S. Addressing sexuality among people living with chronic disease and disability: a systematic mixed methods review of knowledge, attitudes, and practices of health care professionals. Archives of physical medicine and rehabilitation. 2021;102(5):999-1010.
8. Shami M, Montazeri A, Faezi ST, Behboodi Moghadam Z. The Effect of Sexual Counseling Based on EX‑PLISSIT Model on Improving the Sexual Function of Married Women with Systemic Lupus Erythematosus: A Randomized Controlled Trial. Sexuality and Disability. 2023;41(2):451-66.
9. Dörner T, Furie R. Novel paradigms in systemic lupus erythematosus. The Lancet. 2019;393(10188):2344-58.
10. Akbarian M, Faezi ST, Gharibdoost F, Shahram F, Nadji A, Jamshidi AR, et al. Systemic lupus erythematosus in Iran: a study of 2280 patients over 33 years. International journal of rheumatic diseases. 2010;13(4):374-9.
11. Liu M, Dou J, Wang Q. The effect of systemic lupus erythematosus on sexual function in women: an updated meta-analysis based on cross-sectional studies. Advances in Rheumatology. 2022;62(4):24-30.
12. Davatchi F, Jamshidi A-R, Banihashemi AT, Gholami J, Forouzanfar MH, Akhlaghi M, et al. WHO-ILAR COPCORD study (stage 1, urban study) in Iran. The Journal of rheumatology. 2008;35(7):1384-90.
13. Baniotopoulos P, Pyrgidis N, Minopoulou I, Tishukov M, Sokolakis I, Hatzichristodoulou G, et al. Treatment of Sexual Dysfunction in Women with Systemic Autoimmune Rheumatic Disorders: A Systematic Review. Sexual Medicine Reviews. 2022;10(4):520-8.
14. Rady SA, Ahmed AR, Metwally SM, Abdelaleem EA. Sexual dysfunction and physical performance in female systemic lupus erythematosus patients. The Egyptian Rheumatologist. 2022;44(1):57-61.
15. Orzúa-de la Fuente WM, Salazar-Hernández GJ, Vega-Morales D, Garza-Alpírez A, Esquivel-Valerio JA. High prevalence of sexual dysfunction in women with rheumatic diseases: a not recognized health domain. Sexuality and Disability. 2018;36(6):407-16.
16. Jin Z, Yang C, Xiao C, Wang Z, Zhang S, Ren J. Systemic lupus erythematosus and risk of sexual dysfunction: a systematic review and meta-analysis. Lupus. 2021;30(2):238-47.
17. Annon JS. The PLISSIT model: A proposed conceptual scheme for the behavioral treatment of sexual problems. Journal of sex education and therapy. 1976;2(1):1-15.
18. Jamalianfar F, Riazi H, Firoozi A, Nasiri M, Montazeri A. The Effectiveness of ‘Good-Enough Sex Model’ on Sexual Satisfaction and Sexual Intimacy in Women with Multiple Sclerosis: A Randomized Trail. Sexuality and Disability. 2021;39(3):507-19.
19. Nurgitz R, Pacheco RA, Senn CY, Hobden KL. The impact of sexual education and socialization on sexual satisfaction, attitudes, and self-efficacy. The Canadian Journal of Human Sexuality. 2021;30(2):265-77.
20. Shahbazi A, Behboodi Moghadam Z, Maasoumi R, Saffari M, Mohammadi S, Montazeri A. Effect of a Health-Education Program Based on the BASNEF Model of Overall Sexual Health Satisfaction and Satisfaction with Quality of Sexual Relationship among Women with Infertility. International Journal of Women's Health. 2020;12(null):975-82.
21. Bilge Ç, Aslan E. The Effect of Post-Operative Sexual Counseling Carried out with PLISSIT Model on Sexual Function and Sexual Satisfaction in Gynecologic Cancers. Clinical and Experimental Health Sciences. 2023;13(3):623-9.
22. Nazari S, Keramatkar M, Moghdehipanah H, Olfati F. The Effect of Ex-PLISSIT Model on Sexual Satisfaction in Women with Multiple Sclerosis. Sexuality and Disability. 2023;41(2):467-77.
23. Zangeneh S, Savabi-Esfahani M, Taleghani F, Sharbafchi MR, Salehi M. Effectiveness of online sexual education based on the extended PLISSIT model on sexual function and sexual satisfaction in women undergoing breast cancer treatment. Journal of Education and Health Promotion. 2023;2(1):311-20.
24. Cicek Ozdemir S, Dogan Gangal A, Senturk Erenel A. The effect of sexual counseling based on PLISSIT and EX-PLISSIT models on sexual function, satisfaction, and quality of life: a systematic review and meta-analysis. Archives of Sexual Behavior. 2024;53(9):3485-513.
25. Lovibond SH. Manual for the depression anxiety stress scales. Sydney psychology foundation. 1995;2(1):30-7.
26. Siamak S, Bahram J. A study on the reliability and validity of the short form of the Depression Anxiety Stress Scale (DASS-21). Journal of social sciences and humanities of Shiraz University. 2007;26(3):52-61.
27. Larson JH, Anderson SM, Holman TB, Niemann BK. A longitudinal study of the effects of premarital communication, relationship stability, and self-esteem on sexual satisfaction in the first year of marriage. Journal of sex & marital therapy. 1998;24(3):193-206.
28. Hudson WW, Harrison DF, Crosscup PC. A short‐form scale to measure sexual discord in dyadic relationships. Journal of Sex Research. 1981;17(2):157-74.
29. Bahrami N, Yaghoob Zadeh A, Sharif Nia H, Soliemani MA, Haghdoost AA. Validity and reliability of the persian version of Larson sexual satisfaction questionnaire in couples. Journal of kerman university of medical sciences. 2016;23(3):344-56.
30. Behboodi Moghadam Z, Zareiyan A, Faezi ST, Rezaei E. Development and psychometric properties of the Reproductive Health Assessment in Systemic Lupus Erythematosus: Mixed-Methods study. Lupus. 2024;33(1):5-16.
31. Ziaei T, Kharaghani R, Haseli A, Ahmadnia E. Comparing the Effect of Extended PLISSIT Model and Group Counseling on Sexual Function and Satisfaction of Pregnant Women: A Randomized Clinical Trial. Journal of Caring Sciences. 2022;11(1):7-16.
32. Ghodsi F, Bahrami N, Mafi M, Olfati F. The effect of sex Counseling based on (permission, limited information, specific suggestions, intensive therapy) model on sexual satisfaction in women with cyclic Mastalgia: a randomized controlled clinical trial. Iranian Journal of Nursing and Midwifery Research. 2021;26(6):562-8.
33. Sazesh S, Saeieh SE, Farid M, Refaei M, Yazdkhasti M. Effectiveness of group counseling with a client-centered approach based on the gather principles on sexual satisfaction in women with multiple sclerosis: A randomized clinical trial. Iranian Journal of Medical Sciences. 2021;46(2):103-9.
34. Di Stasi V, Verde N, Maseroli E, Scavello I, Cipriani S, Todisco T, et al. Female sexual dysfunction as a warning sign of chronic disease development. Current Sexual Health Reports. 2019;11(5):307-19.
35. Guo Z-N, He S-Y, Zhang H-L, Wu J, Yang Y. Multiple sclerosis and sexual dysfunction. Asian journal of andrology. 2012;14(4):530-9.
36. Ghafoori F, Bagheri M, Dehghan-Nayeri N, Khakbazan Z, Haghani H, Hedayatnejad M, et al. Effectiveness of sexual counseling using better model to promote sexual function and satisfaction of married women with multiple sclerosis. Sexuality and Disability. 2022;40(3):471-86.
37. Boquiren VM, Esplen MJ, Wong J, Toner B, Warner E, Malik N. Sexual functioning in breast cancer survivors experiencing body image disturbance. Psycho‐Oncology. 2016;25(1):66-76.
38. Rodrigues L, Sim‐Sim MM, Sousa L, Faria‐Schützer DB, Surita FG. Self‐concept and body image of people living with lupus: A systematic review. International Journal of Rheumatic Diseases. 2021;24(11):1339-53.
39. Campos LS, De Nardi SP, Limberger LF, Caldas JM. Sexual function, body image and quality of life of women with advanced cancer. Sexuality and Disability. 2022;40(1):141-51.
40. Shen B, He Y, Chen H, Zhao C, Zhu L, Gao Y, et al. Body image disturbances have impact on the sexual problems in Chinese systemic lupus erythematosus patients. Journal of immunology research. 2015;15(2):49-58.
41. Attaky A, Schepers J, Kok G, Dewitte M. The role of sexual desire, sexual satisfaction, and relationship satisfaction in the sexual function of Arab couples living in Saudi Arabia. Sexual Medicine. 2021;9(2):100303-.
42. Tavakol Z, Mirmolaei S, Movahed ZM. The survey of sexual function relationship with sexual satisfaction in referred to Tehran South City health centers. Avicenna Journal of Nursing and Midwifery Care. 2011;19(2):50-60.
43. Radhakrishna MH, Kayidhi S, Ravindran V. Sexual health in rheumatology. Rheumatology 2024;63(3):584-6.
44. Tsoi A, Gomez A, Boström C, Pezzella D, Chow JW, Girard-Guyonvarc’h C, et al. Efficacy of lifestyle interventions in the management of systemic lupus erythematosus: a systematic review of the literature. Rheumatology International. 2024:1-14.
45. Youssef MK. Effect of exercises training on fatigue, depression and physical activity in patients with systemic lupus erythematosus. Journal of Health and Medical Research. 2019;1(1):4-11.
46. Basson R, O’Loughlin JI, Weinberg J, Young AH, Bodnar T, Brotto LA. Dehydroepiandrosterone and cortisol as markers of HPA axis dysregulation in women with low sexual desire. Psychoneuroendocrinology. 2019;104:259-68.
47. Vigl J, Strauß H, Talamini F, Zentner M. Trajectories of relationship and sexual satisfaction over 2 years in the Covid‐19 pandemic: A latent class analysis. Journal of Personality. 2024;14(3):48-56.
48. Voutskidou A, Kirkou G, Dagla M, Orovou E, Sarella A, Palaska E, et al. COVID-19 pandemic and its impact on the quality of women’s sexual life: a systematic review. Healthcare. 2023;11(2):185-99.
| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| sexual satisfaction counseling EX-PLISSIT model systemic lupus erythematous | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Shami M, Behboodi Moghadam Z, Ghanbaran A, Montazeri A, Javadnoori M. The effect of extended PLISSIT model-based counseling on sexual satisfaction in women with systemic lupus erythematosus: A randomized controlled trial. Nurs. pract. today. 2026;:X-X.
