THIEME

Original Article 333

The Effectiveness of Psycho-Educational and

Cognitive-Behavioral Counseling on Female
Sexual Dysfunction
Firoozeh Mirzaee1 Atefeh Ahmadi1 Zahra Zangiabadi1 Moghaddameh Mirzaee2

1 Razi Nursing and Midwifery Faculty, Kerman University of Medical Address for correspondence Atefeh Ahmadi, PhD, Nursing Research
Sciences, Kerman, Iran center, Razi Nursing and Midwifery Faculty, Kerman University of
2 Department of Epidemiology and Biostatistics, School of Public Medical Sciences, Kerman, Iran
Health, Kerman University of Medical Sciences, Kerman, Iran (e-mail: a.ahmadi@kmu.ac.ir; atefeahmadi59@gmail.com).

Rev Bras Ginecol Obstet 2020;42(6):333–339.

Abstract Introduction Sexual function is a multidimensional phenomenon that is affected by

many biological and psychological factors. Cognitive-behavioral sex therapies are
among the most common nonpharmacological approaches to psychosexual problems.
The purpose of the present study was to investigate the effectiveness of psychoeduca-
tional and cognitive-behavioral counseling on female sexual dysfunction.
Methods The present study was a clinical trial with intervention and control groups.
The study population consisted of women referring to the general clinic of a
governmental hospital in Iran. After completing the demographic questionnaire and
Female Sexual Function Index (FSFI), those who obtained the cutoff score
28 were
contacted and invited to participate in the study. Convenience sampling method was
used and 35 subjects were randomly allocated for each group. Eight counseling
sessions were held for the intervention group (two/week/1.5 hour). Post-test was
taken from both groups after 1 month, and the results were statistically analyzed by
PASW Statistics for Windows, Version 18 (SPSS Inc., Chicago, IL, USA).
Results The total mean scores of FSFI and the subscales of sexual desire, arousal,
orgasm, and satisfaction were significantly higher in the intervention group than in the
Keywords control group after the intervention. In addition, postintervention pain mean scores in
► cognitive-behavioral the intervention group were significantly lower than in the control group (p < 0.05).
counseling Conclusion The results of the present study indicate that psychoeducational cogni-
► psychoeducational tive-behavioral counseling is effective in improving female sexual function. It is
counseling recommended to compare the effects of psychoeducational cognitive-behavioral
► female sexual counseling on sexual dysfunctions of couples and with a larger sample size in future
function index research.

Introduction Organization (WHO) considers that sexual health “is a state

of physical, emotional, mental and social wellbeing in
Sexual function, which is a part of the health of women, is a relation to sexuality; it is not merely the absence of disease,
multidimensional phenomenon that is affected by many dysfunction or infirmity.” This definition calls attention to
biological and psychological factors.1,2 The World Health the inter-related nature of the physical, mental and social

received DOI https://doi.org/ Copyright © 2020 by Thieme Revinter

December 28, 2019 10.1055/s-0040-1712483. Publicações Ltda, Rio de Janeiro, Brazil
accepted ISSN 0100-7203.
March 31, 2020
334 The Effectiveness of Psycho-Educational and Cognitive-Behavioral Counseling Mirzaee et al.

dimensions of sexuality, and importantly, the notion of

Methods
sexual well-being. Sexuality is a fundamental part of being
human. “Sexual health” requires “a positive and respectful Study Design and Setting
approach to sexuality and sexual relationships, as well as The present study is a clinical trial with intervention and
the possibility of having pleasurable and safe sexual expe- control groups in a general clinic of an educational hospital in
riences, free of coercion, discrimination and violence.” Zarand, Iran. The study population consisted of women
Sexual health as one’s harmony of mind, feeling, and referring to the general clinic with various problems, in 2018.
body that leads to the completion of personality, commu-
nication, and love.3 Sample Size
Therefore, any disorder that causes dissonance and, con- Initially, 31 women were estimated for each group (control
sequently, dissatisfaction with sex, can lead to sexual and intervention groups). Regarding the probability of drop-
dysfunction.4 out, 35 subjects were considered in each group. The follow-
Sexual dysfunction is defined as a person’s inability to ing formula was used to estimate the sample size.
have one or all stages of sexual activity including desire,
arousal, and erection/ejaculation for men, vaginal moisture
for women, and orgasm.5 Sexual dysfunction of women is
one of the most common problems that  between 40 and Based on the previous study by Salehzadeh et al,14 sd1 and
45% of women suffer from.6 These dysfunctions are a chain of sd2 values were set at 0.4 for the standard deviation (SD) of
psychosexual disorders that manifest as disorders of sexual the intervention group and 0.9 for the SD of the control
desire, arousal, orgasm, and pain during intercourse.7 These group, respectively. A test power of 80%, a test error of 0.05,
disorders have various origins such as anatomical, physio- and an accuracy of 0.5 were considered.
logical, and psychological factors.4,8
There are two general methods of pharmacological and
nonpharmacological interventions to treat sexual disor- Sampling
ders.8,9 Nonpharmacological measures include cognitive- The convenience sampling method was used. Subjects with
behavioral sex therapies, which are nowadays one of the inclusion criteria were included in the study and were
most common approaches in the treatment of psychosexual divided into intervention and control groups in a quasi-
and psychological disorders.10,11 Cognitive-behavioral ther- random manner based on sampling days (odd and even).
apy (CBT) is a combination of cognitive and behavioral The inclusion criteria (to remove secondary sexual dysfunc-
approaches that help the patient identify his distorted tions) included: 1) married, living with a spouse and
thinking patterns and inefficient behaviors. aged > 25 years old; 2) having no disease affecting sexual
Sex education is a process in which individuals acquire the function before the study (such as systemic diseases includ-
necessary information and knowledge about sexuality and ing liver failure, kidney failure, heart disease, diabetes,
form their attitudes, beliefs, and values. This process con- thyroid failure, malignant disease, and undesirable sexual
tributes to healthy sexual development, interpersonal rela- experience), 3) not taking antihypertensive drugs, antide-
tionships, body image, gender roles and maintains the pressants, antihistamines, contraceptive pills, alcohol and
mental health of individuals in the community. Lack of drug abuse before the study; 4) not having any previous
information or misinformation about sexuality increase sexual disorders diagnosed in the women or their spouses by
the risk of developing sexual disorders.12 the specialists based on the self-report of the individual 5)
A review study by ter Kuile et al,8 who examined CBTs in not suffering from infertility; 6) obtaining a Female Sexual
female sexual dysfunction, revealed that the best and most Function Index FSFI score lower than the cutoff point in the
common therapeutic approach is the cognitive-behavioral questionnaire16 and 7) not being in pregnancy, breastfeeding
approach. In their study on the effectiveness of cognitive- or menopause periods. The exclusion criteria for the present
behavioral therapy in patients with vaginismus, ter Kuile study included unwillingness to collaborate with the study as
et al13 showed that this type of treatment increased the well as absence in more than one session.
frequency and reduced fear of sexual intercourse. In addition,
in the studies by Salehzadeh et al14 and Hoyer et al,15 Instrument
cognitive-behavioral training significantly decreased sexual The data collection tools in the present study include:
disorders. 1- Demographic questionnaire
Sexuality and sexual behavior have become a taboo in Iran The demographic questionnaire included name, surname,
due to religious prohibitions. Therefore, addressing the issue age, education, number of children, marriage duration,
of sexual need has always been associated with social shame. method of contraception, and telephone number.
Concerning the attention to the training and counseling of 2- Female sexual function index (FSFI)
sexuality, a literature review did not find interventional Rosen et al developed the 19-item FSFI. The questionnaire
studies in Iran applying eclectic methods. The present study measures female sexual function in six independent domains,
aimed to investigate the effectiveness of psychoeducational namely desire, arousal, lubrication, orgasm, satisfaction, and
and cognitive-behavioral counseling on female sexual dys- pain. The answers to the questions are based on the Likert five-
function in a little city in the southeast of Iran. and six-point scales. The number of items in the domains is not

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 The Effectiveness of Psycho-Educational and Cognitive-Behavioral Counseling Mirzaee et al. 335

equal in the FSFI, so, the item scores in each domain were The objectives of the training sessions during eight ses-
added and then multiplied by the factor number to make the sions of psychoeducational and CBT counseling were as
domains equal in weight. The factor numbers for sexual desire, follows:
arousal, lubrication, orgasm, satisfaction, and pain are 0.6, 0.3, Session One: importance of sex in married women,
03, 0.4, 0.4 and 0.4, respectively. The scores considered for the understanding the concept of sexual dysfunction and cogni-
items are 1–5 and 0–5. A score of zero indicates that the person tive-behavioral counseling and its purpose, explaining the
has not been sexually active for 4 weeks. The total scale score is natural sex cycle, classifying sexual dysfunctions.
obtained by adding the scores of the six domains together. Session two: sexual desire disorders, factors affecting
Thus, the scoring is such that the higher the score, the better sexual desire in men and women, therapeutic interventions
the sexual function. The maximum score for each domain will based on replacing cognitive errors in sexuality and training
be 6, and it will be 36 for the whole scale to make the domains of behavioral techniques to improve sexual desire.
equal in weight. The minimum score for the sexual desire Session three: sexual arousal disorders, factors affecting
domain will be 1.2, it will be 0 for sexual arousal, lubrication, sexual arousal of males and females, therapeutic interven-
orgasm, and pain, it will be 0.8 for the satisfaction domain, and tions based on replacing cognitive errors in sexual arousal
it will be 2 for the whole scale. The cut off point for the whole and training of behavioral techniques for reinforcement of
scale is 28.18 arousal.
Validity and reliability: In the study by Rosen et al,18 the Session four: factors affecting lubrication in sex, thera-
retest validity coefficient was reported properly for all six peutic techniques to maintain and increase lubrication dur-
domains (r ¼ 0.79 to 0.86) and the whole questionnaire ing sex.
(r ¼ 0.88). The Cronbach α coefficient was in addition mea- Session five: Orgasm, affective factors and orgasmic dis-
sured to be  0.82 for internal reliability. Divergent validity orders in men and women, therapeutic interventions based
of this scale was obtained by the Locke-Wallace marital on replacing cognitive mental backgrounds which affect
adjustment test for the whole scale (p
0.001, r ¼ 0.41), orgasm problems and training of behavioral techniques for
indicating appropriate validity of this scale18. In the study reducing these problems such as sensate focused therapy,
of Wiegel et al,19 the Cronbach α coefficient for the internal on-and-off techniques.
reliability of the whole scale and all 6 domains was reported Session six: pain/penetration disorders in women (phys-
to be from good to excellent (> 9.0). The validity of the ical and nonphysical reasons) focusing on nonphysical cog-
questionnaire showed a significant difference between the nitive issues, fear and anxiety and training of behavioral
scores of the patient group and the control group in all 6 techniques such as Kegel exercises, systemic desensitization
domains (p < 0.001). Mohammadi et al17 investigated the and gradual dilatation for vaginismus and dyspareunia.
validity and reliability of this questionnaire in two groups of Session seven: Factors affecting sexual satisfaction focus-
female sexual dysfunction and control. The reliability of the ing in marital adjustment and intimacy, mindfulness on the
scale and subscales was obtained by calculating the Cron- pleasure of sex, behavioral techniques in afterplay.
bach α coefficient, which was calculated > 0.70 for all indi- Session eight: Discussing about women most common
viduals, indicating good reliability of this instrument.17 issues, summary of the previous sessions and conclusion.
The control group did not receive any intervention but
Data Collection they could apply for attending similar new counseling ses-
The researchers entered the research setting (The clinic of sions after the present study. Then, posttest was performed
Imam Ali Hospital) after obtaining the necessary permits in both groups after 1 month, and the results were statisti-
from the University (Code of Ethics: IR.KMU.REC.1397.429) cally analyzed.
and enrolling the study in the Iranian Registry of Clinical
Trials (IRCT) (IRCT20170611034452N6). Then the purpose of Data Analysis
the study was explained to women with inclusion criteria Data were analyzed by PASW Statistics for Windows, Version
referring to the research setting. After receiving verbal 18 (SPSS Inc., Chicago, IL, USA). Data have been reported
consent, pretest data were collected by a demographic based on frequency distribution tables (number and per-
questionnaire and the FSFI, which were completed in a cent), central tendency and dispersion (mean and SD). Mean
self-fulfillment manner. After receiving the questionnaires, and SD were used to describe the score of sexual dysfunction.
70 women (8 of whom were considered as dropouts) who The Mann-Whitney test was used to determine the homo-
obtained score
28 in the FSFI were contacted and invited to geneity of the two groups in terms of quantitative demo-
participate in the study. Written consent was taken from the graphic variables due to the non-normality of the
participants during a personal meeting. The objectives and quantitative data. The chi-squared and Fisher exact tests
methodology of the present study were in addition fully were used to determine the homogeneity of the two groups
explained to the participants. The subjects were then ran- in terms of qualitative variables. Parametric statistical tests
domly divided into intervention and control groups based on (independent t-test to compare intervention and control
sampling days (even and odd). The intervention group was groups, paired t-test to study the groups before and after
asked to participate in 8 counseling sessions (two/week/ intervention) were used according to the objectives of the
1.5 hour).18–20 The sessions were held in a 17-person group study and parametric conditions (normal distribution and
and in an 18-person group in the hospital hall. equality of variances).

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336 The Effectiveness of Psycho-Educational and Cognitive-Behavioral Counseling Mirzaee et al.

Table 1 Demographic characteristics of subjects in two groups of intervention and control

Group Variable Intervention Control p-value

Frequency Percent Frequency Percent
Age (years old)
31 18 54.5 21 60.0 0.64
> 31 15 45.5 14 40.0
Education School 7 21.2 9 25.7 0.33
Diploma 13 39.4 18 51.4
Higher 13 39.4 8 22.9
Children (number)
1 6 18.2 6 17.1 0.95
2 14 42.4 14 40.0
3 13 39.4 15 42.9
Marriage duration
5 14 42.4 18 51.4 0.45
>5 19 57.6 17 48.6
Contraception method None 4 12.1 6 17.1 0.84
Condom 18 54.5 18 51.4
IUD 11 33.3 11 31.4

Abbreviation: IUD, intrauterine device.

Ethical Considerations two groups in demographic characteristics (p > 0.05)

The present study was approved by the Ethics Committee of (►Table 1).
the Kerman University of Medical Sciences with the Code of The sexual function score was not significantly different
Ethics (IR.KMU.REC.1397.429), and it was registered in the between the intervention and control groups before the
IRCT (IRCT20170611034452N6). At the beginning of the intervention (p < 0.05). The total score of sexual function
sampling process, the study objectives were explained to was significantly higher in the intervention group than in the
the target population, and verbal consent was obtained. After control group after the intervention. In addition, the Mann-
completing the initial sampling, the aims and method of the Whitney test showed that except for the lubrication domain,
study were fully explained to the participants who met the the scores of sexual desire, arousal, orgasm, and satisfaction
inclusion criteria and written consent was taken from them. were significantly higher in the intervention group than in
In addition, the participants were assured that their infor- the control group. In addition, the postintervention pain
mation was kept confidential and anonymous and that the score in the intervention group was significantly lower than
research results would be used and published only for in the control group (p < 0.05) (►Table 2).
research purposes and they could withdraw at any time. There was a statistically significant increase in the mean
scores of sexual desire, arousal, and satisfaction in the
intervention group compared with before intervention as
Results
well as a significant reduction in the mean score of the pain
►Table 1 shows the demographic characteristics of the domain. The mean score of lubrication did not change
subjects. There was no significant difference between the significantly after the intervention compared with before

Table 2 Comparison of female sexual function in the intervention and control groups before and after the intervention

Before After
Variable Intervention Control p-value Intervention Control p-value
Mean SD Mean SD Mean SD Mean SD
Sexual desire 6.03 2.31 6.17 2.51 0.79 7.61 1.32 6.00 2.10 0.001
Arousal 12.00 3.64 13.40 3.30 0.1 16.24 1.94 12.97 2.87 < 0.0001
Lubrication 11.03 1.88 11.54 1.69 0.25 11.09 1.18 11.40 1.29 0.38
Orgasm 9.61 2.09 9.26 1.75 0.46 10.18 1.01 9.40 1.22 <0.01
Satisfaction 9.45 2.32 9.69 2.19 0.52 12.76 1.06 9.94 2.25 < 0.0001
Pain 9.09 2.84 8.94 3.0 0.91 5.70 1.29 9.14 2.70 < 0.0001
Total 21.80 2.77 22.34 2.93 0.32 24.22 1.72 22.31 2.47 < 0.0001

Abbreviation: SD, standard deviation.

Z¼ Mann-Whitney test; T¼ independent-t-test.

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 The Effectiveness of Psycho-Educational and Cognitive-Behavioral Counseling Mirzaee et al. 337

Table 3 Comparison of female sexual function in the intervention group

Variable Before intervention After intervention Test statistic p-value

Mean SD Mean SD
Sexual desire 6.03 2.31 7.61 1.32 Z¼ - 4.23 < 0.0001
Arousal 12.00 3.64 16.24 1.94 Z¼ - 4.87 < 0.0001
Lubrication 11.03 1.88 11.09 1.18 Z¼ - 0.21 0.82
Orgasm 9.61 2.09 10.18 1.01 Z¼ - 1.95 0.051
Satisfaction 9.48 2.32 12.76 1.06 Z¼ - 4.8 < 0.0001
Pain 9.09 2.84 5.70 1.29 Z¼ - 4.87 < 0.0001
Total 21.80 2.77 24.22 1.72 T¼ - 7.99 < 0.0001

Abbreviation: SD, standard deviation.

Z¼ Wilcoxon test; T¼ paired t-test.

the intervention, and the increase in the mean score of the study. The reasons for this difference can be at the different
orgasm was not statistically significant. Furthermore, the statistical population of the two studies as well as the
total mean of sexual function scores was significant before duration of marriage because, in the study of Ziaee et al,20
and after the intervention. (p < 0.05) (►Table 3). the mean duration of marriage in the intervention and
There was no statistically significant decrease in the mean control groups was 29.4 and 22.4 months, respectively.
scores of sexual desire, arousal, and lubrication in the control However, in the present study, 48.6% of individuals in the
group after the intervention compared with before the control group and 57.6% of individuals in intervention group
intervention (p > 0.05). An increase in the mean score of had been married for > 5 years.20 One possible reason may
orgasm, satisfaction, and pain in the control group was not be lack of proper information and experience of young
statistically significant after the intervention compared with couples regarding marital sexual relationships.20–28 In addi-
before the intervention (p > 0.05). There was no significant tion, in the study of Ziaee et al,20 as well as in the study of
difference in the total mean score of sexual function in the Babakhani et al,21 the mean scores of all six domains of
control group before and after the intervention (p > 0.05) sexual desire, arousal, lubrication, orgasm, satisfaction and
(►Table 4). pain had a significant difference in the experimental group
before and after the intervention. Furthermore, the mean
total score of sexual function in the intervention group
Discussion
increased in two previous studies as well as in the present
The present study investigated the effectiveness of psycho- study after the intervention compared with before the
educational cognitive-behavioral counseling on female sex- intervention, and this difference was statistically signifi-
ual function. The results of the present study suggest that cant.20,21 In the study by ter Kuile et al,8, cognitive-behav-
this type of counseling is effective in improving female sexual ioral counseling increased female sexual function in all six
function. components and the total score of sexual function that was
Ziaee et al20 studied the sexual dysfunction of married consistent with the results of the present study. In the study
female students. Their results showed that the mean score of of Brotto et al,22 the mean total score of sexual function in the
sexual function was lower in both control and intervention intervention group was 20.19 before the intervention, which
groups in all six components compared with the present reached 25.39 after the intervention. This difference was

Table 4 Comparison of female sexual function in the control group

Variable Before intervention After intervention Test statistic p-value

Mean SD Mean SD
Sexual desire 6.17 2.51 6.00 2.10 Z¼ - 0.67 0.49
Arousal 13.40 3.30 12.97 2.87 Z¼ - 0.91 0.36
Lubrication 11.54 1.69 11.40 1.29 Z¼ - 0.91 0.35
Orgasm 9.26 1.75 9.40 1.22 Z¼ - 1.05 0.29
Satisfaction 9.69 2.19 9.94 2.25 Z¼ - 1.14 0.25

Pain 8.94 3.0 9.14 2.70 T ¼ - 0.85 0.4
Total 22.34 2.93 22.31 2.47 Z¼ 0.38 0.7

Abbreviation: SD, standard deviation.

Z¼ Wilcoxon test; t¼ paired-t-test.

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338 The Effectiveness of Psycho-Educational and Cognitive-Behavioral Counseling Mirzaee et al.

statistically significant, and this increase was in line with the increasing female sexual function. These results may be usable
results of the present study.22 for healthcare institutions to improve sexual function and
Jalilian et al23 studied the effect of sexual skills training satisfaction in women. It is recommended to compare the
with the cognitive-behavioral method on sexual dysfunction effects of psychoeducational cognitive-behavioral counseling
in 40 infertile women aged between 22 and 36 years old. The on sexual dysfunction of couples and to use more subjects in
results showed that the mean scores of sexual desire, arousal, future researches.
satisfaction, orgasm, and lubrication significantly improved
after three training sessions per week. However, pain score
Conflict of Interests
changes were not significant. The mean total score of sexual
The authors have no conflict of interests to declare.
function in the intervention group increased from 21.80 to
24.22. This mean decreased in the control group.23 However,
in the present study, the two domains of orgasm and References
lubrication did not improve significantly, but the improve- 1 Yıldız H. The relation between prepregnancy sexuality and sexual

ment of the pain score was significant, which is inconsistent function during pregnancy and the postpartum period: a pro-
spective study. J Sex Marital Ther. 2015;41(01):49–59. Doi:
with the results of Jalilian et al.23 One of the reasons for this
10.1080/0092623X.2013.811452
inconsistency in these two domains may be the duration of 2 Torkzahrani S, Banaei M, Ozgoli G, Azad M, Emamhadi MA.
the intervention, which was 10 sessions (one session/week) Postpartum sexual function; conflict in marriage stability: a
in their study, longer than in the present study. systematic review. Int J Med Toxicol Forensic Med.. 2016;6(02):
In addition, the results of the present study indicate that 88–98. Doi: 10.22037/ijmtfm.v6i2(Spring).10351
3 World Health Organization. Defining sexual health: report of a
the mean scores of the six components of sexual desire,
technical consultation on sexual health, 28–31 January 2002.
arousal, lubrication, orgasm, satisfaction, and pain were not
Geneva: WHO; 2006
significantly different in the control group before and after 4 Chang JH, Shin DW, Jeon MJ, Hong H, Kim SM, An A, et al. Uterine
the intervention. However, in the study by Ziaee et al,20 the leiomyoma is associated with female sexual dysfunction in post-
mean scores of sexual pain, satisfaction and orgasm de- menopausal women. Yonsei Med J. 2019;60(08):791–795. Doi:
creased after the intervention. In the study of Ziaee et al.20 10.3349/ymj.2019.60.8.791
5 Fond G, Godin O, Dumontaud M, Faget C, Schürhoff F, Berna F, et al;
the mean score of sexual function decreased 2 months and
FACE-SZ (FondaMental Academic Centers of Expertise for Schizo-
10 weeks after the intervention. However, re-evaluation and phrenia) group. Sexual dysfunctions are associated with major
follow-up were performed after 1 month in the present depression, chronic inflammation and anticholinergic consump-
study.20,23 tion in the real-world schizophrenia FACE-SZ national cohort.
Although we provided a comprehensive explanation in the Prog Neuropsychopharmacol Biol Psychiatry. 2019;94:109654.
counseling and training package on the factors affecting lubri- Doi: 10.1016/j.pnpbp.2019.109654
6 Cunningham SD, Smith A, Kershaw T, Lewis JB, Cassells A, Tobin
cation and therapeutic interventions, counseling did not have a
JN, Ickovics JR. Prenatal depressive symptoms and postpartum
significant effect on the lubrication factor in the present study. sexual risk among young urban women of color. J Pediatr Adolesc
Cultural factors, shyness, embarrassment, poor sexual function Gynecol. 2016;29(01):11–17. Doi: 10.1016/j.jpag.2015.04.011
of the partner,24 and poor sex education of the partner25 are 7 Wright JJ, O’Connor KM. Female sexual dysfunction. Med Clin North
factors that may influence lubrication, and these factors might Am. 2015;99(03):607–628. Doi: 10.1016/j.mcna.2015.01.011
8 ter Kuile MM, Both S, van Lankveld JJ. Cognitive behavioral
have influenced our ineffective consultation about lubrication.
therapy for sexual dysfunctions in women. Psychiatr Clin North
On the other hand, the results of the structured review by
Am. 2010;33(03):595–610. Doi: 10.1016/j.psc.2010.04.010
Weinberger et al26 showed that, despite significant improve- 9 Jayasena CN, Alkaabi FM, Liebers CS, Handley T, Franks S, Dhillo
ment in certain areas of sexual dysfunction in women, neither WS. A systematic review of randomized controlled trials investi-
drug therapy nor psychotherapy interventions lead to com- gating the efficacy and safety of testosterone therapy for female
plete improvement of the disease. Furthermore, some studies sexual dysfunction in postmenopausal women. Clin Endocrinol
(Oxf). 2019;90(03):391–414. Doi: 10.1111/cen.13906
did not support the effect of sex consultation on female sexual
10 Rahimi E, Shafiabadi A, Yunesi F. The effect of sexual cognitive-
function with female genital mutilation.27 behavioral therapy on females’ sexual knowledge, sexual attitude,
There were in addition limitations to the present study and sexual self-confidence. A case study in Shiraz, Iran. Arma-
because of the relatively small number of individuals in each ghane Danesh.. 2009;14(03):103–111
group. Therefore, the results of the present study are less 11 Mofid V, Ahmadi A, Etemadi O. The comparison of cognitive-
generalizable to the female community. Studies with more behavioral counseling and solution-oriented counseling on wom-
en’s sexual satisfaction in Isfahan. Sociol Women J Women Soc..
subjects, time framework, and financial opportunities are
2015;5(03):67–83
required. In addition, the researchers had some difficulty in 12 Mahmodi G, Hassanzadeh R, Heidari G. The effect of sex education
justifying people to participate and continue the research at on family health on Mazandran medical university students.
the sampling and data gathering stages because of the taboo Horizon Med Sci.. 2007;13(02):64–70
of sexuality in our society. 13 ter Kuile MM, van Lankveld JJ, de Groot E, Melles R, Neffs J,
Zandbergen M. Cognitive-behavioral therapy for women with
lifelong vaginismus: process and prognostic factors. Behav Res
Conclusion Ther. 2007;45(02):359–373. Doi: 10.1016/j.brat.2006.03.013
14 Salehzadeh M, Kajbaf MB, Moulavi H, Zolfaghari M. Effectiveness
The results indicated that the psychoeducational cognitive- of cognitive - behavior therapy on sexual dysfunction in women.
behavioral counseling had a significant positive effect on Psychol Stud (Mysore). 2011;7(01):11–31

Rev Bras Ginecol Obstet Vol. 42 No. 6/2020

 The Effectiveness of Psycho-Educational and Cognitive-Behavioral Counseling Mirzaee et al. 339

15 Hoyer J, Uhmann S, Rambow J, Jacobi F. Reduction of sexual with gynecologic cancer. Arch Sex Behav. 2008;37(02):317–329.
dysfunction: a by-product of cognitive-behavioral therapy for Doi: 10.1007/s10508-007-9196-x
psychological disorders? Sex Relationship Ther. 2009;24(01): 23 Jalilian N, Mokari Z. The effectiveness of sexual skills training with
64–73. Doi: 10.1080/14681990802649938 a cognitive-behavioral approach on sexual dysfunction among
16 Moradi M, Geranmaye M, Mirmohamadali M, Mehran A. The infertile women. World Fam Med J Middle East J Fam Med.. 2018;
effect of counseling on the sexual function of women with type 15(07):126–132
2 diabetes mellitus. Hayat (Tihran). 2016;22(02):148–158 24 Jaafarpour M, Khani A, Khajavikhan J, Suhrabi Z. Female sexual
17 Mohammadi K, Heydari M, Faghihzadeh S. The female sexual dysfunction: prevalence and risk factors. J Clin Diagn Res. 2013;7
function index (FSFI): validation of the Iranian version. Payesh. (12):2877–2880. Doi: 10.7860/JCDR/2013/6813.3822
2008;7(03):269–278 25 Jafarzadeh Esfehani R, Fazel N, Dashti S, Moshkani S, Hasanamab
18 Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The FH, Foji S, Kamalimanesh B. Female sexual dysfunction and its
Female Sexual Function Index (FSFI): a multidimensional self-report associated risk factors: an epidemiological study in the North-
instrument for the assessment of female sexual function. J Sex Marital East of Iran. J Midwifery Reprod Health.. 2016;4(01):498–505.
Ther. 2000;26(02):191–208. Doi: 10.1080/009262300278597 Doi: 10.22038/jmrh.2016.6041
19 Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): 26 Weinberger JM, Houman J, Caron AT, Anger J. Female sexual
cross-validation and development of clinical cutoff scores. J Sex dysfunction: a systematic review of outcomes across various
Marital Ther. 2005;31(01):1–20. Doi: 10.1080/00926230590475206 treatment modalities. Sex Med Rev. 2019;7(02):223–250. Doi:
20 Ziaee P, Shamlou ZS, Mashhadi A. The effectiveness of sexual 10.1016/j.sxmr.2017.12.004
education focused on cognitive schemas, on the Improvement of 27 Okomo U, Ogugbue M, Inyang E, Meremikwu MM. Sexual coun-
sexual functioning among female married students. Evid Based selling for treating or preventing sexual dysfunction in women
Care J.. 2014;4(02):73–82. Doi: 10.22038/ebcj.2014.2921 living with female genital mutilation: A systematic review. Int J
21 Babakhani N, Taravati M, Masoumi Z, Garousian M, Faradmal J, Gynaecol Obstet. 2017;136(Suppl 1):38–42. Doi: 10.1002/
Shayan A. The effect of cognitive-behavioral consultation on ijgo.12049
sexual function among women: a randomized clinical trial. J 28 Soltani F, Azizi R, Sourinegad H, Shayan A, Mohammadi Y, Khoda-
Caring Sci. 2018;7(02):83–88. Doi: 10.15171/jcs.2018.013 karami B. Sexual knowledge and attitude as predictors of female
22 Brotto LA, Heiman JR, Goff B, Greer B, Lentz GM, Swisher E, et al. A sexual satisfaction. Biomed Res Ther. 2017;4(12):1874–1884. Doi:
psychoeducational intervention for sexual dysfunction in women 10.15419/bmrat.v4i12.398

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