Effectiveness of Group Psychosexual Training for Marital Adjustment and Sexual Self-Efficacy of Infertile Women: A Randomized Controlled Trial
-
Sara Banaha
,
Hajar Pasha
,
Afsaneh Bakhtiari
,
Shabnam Omidvar
,
Fereshteh Behmanesh
,
Mahbobeh Faramarzi
,
Sedigheh Esmailzadeh
Abstract
Objective: Infertility can be associated with unfavorable psychological consequences such as a sense of marital incompatibility and sexual inadequacy. To address these issues, this study aimed to assess the effectiveness of group psycho-sexual training in improving marital adjustment and sexual self-efficacy of infertile women.
Method: A randomized controlled clinical trial (RCT) study was conducted in Babol, Iran, with 72 infertile women, randomly assigned to either the intervention group (n = 36) or the control group (n = 36). The intervention group underwent psychosexual training, while the control group received routine care. The Dyadic Adjustment Scale (DAS) and Sexual Self-Efficacy Scale (SSES) were used to assess their marital adjustment and sexual self-efficacy. Data analysis was performed using various tests, including the independent t-test, Chi-squared test, paired t-test, ANCOVA, and MANCOVA.
Results: Most infertile women had moderate sexual self-efficacy (80%). The intervention group had a significantly better response to group psycho-sexual training compared to the control group. This intervention improved sexual self-efficacy and marital adjustment and its subscales including marital consensus, satisfaction, cohesion (P < 0.0001), and affectional expression (P < 0.001). The mean pre-to-post treatment scores of sexual self- efficacy, marital adjustment, and its subscales increased significantly in the intervention group, while no significant difference was observed in the control group (P < 0.0001).
Conclusion: Based on the findings, it is recommended to provide educational services alongside the infertility treatment process for enhancing the quality of marital adjustment and promoting sexual self-efficacy.
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2. Monga M, Alexandrescu B, Katz SE, Stein M, Ganiats T. Impact of infertility on quality of life, marital adjustment, and sexual function. Urology. 2004;63(1):126-30.
3. Matsubayashi H, Hosaka T, Izumi S, Suzuki T, Kondo A, Makino T. Increased depression and anxiety in infertile Japanese women resulting from lack of husband's support and feelings of stress. Gen Hosp Psychiatry. 2004;26(5):398-404.
4. Yang T, Wongpakaran N, Wongpakaran T, Saeng-Anan U, Singhapreecha C, Jenraumjit R, Peisah C. Factors Associated with Anxiety and Depression in Infertile Couples-Study Protocol. Healthcare (Basel). 2022 Jul 21;10(7):1352.
5. Ashrafi M, Jahangiri N, Sadatmahalleh SJ,Mirzaei N,Hesari NG,Rostami F, et al. Does prevalence of sexual dysfunction differ among the most common causes of infertility? A cross-sectional study. BMC Women's Health.2022; 22, 140: 1-8.
6. Pasha H, Basirat Z, Faramarzi M, Kheirkhah F. Is psychosexual therapy a reliable alternative to bupropion extended-release to promote the sexual function in infertile women? An RCT. Int J Reprod Biomed. 2020;18(3):175-86.
7. Nene UA, Coyaji K, Apte H. Infertility: a label of choice in the case of sexually dysfunctional couples. Patient Educ Couns. 2005;59(3):234-8.
8. Jamshidimanesh M, Alimanesh N, Moghaddam ZB, Haghani H. Effect of an educational package on self-efficacy of infertile women. Payesh (Health Monitor). 2015;14(2):227-37.
9. Pasha H, Basirat Z, Esmailzadeh S, Faramarzi M, Adibrad H. Marital Intimacy and Predictive Factors Among Infertile Women in Northern Iran. J Clin Diagn Res. 2017;11(5):Qc13-qc7.
10. Omani-Samani R, Amini P, Navid B, Sepidarkish M, Maroufizadeh S, Almasi-Hashiani A. Prevalence of Sexual Dysfunction among Infertile Women in Iran: A Systematic Review and Meta-analysis. Int J Fertil Steril. 2019 ;12(4):278-83.
11. Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007;21(2):293-308.
12. Najafi M, Soleimani A, Ahmadi K, Javidi N, Hoseni E, Pirjavid F. The study of the effectiveness of couple emotionally focused therapy (EFT) on increasing marital adjustment and improving the physical and psychological health of the infertile couples. Iran J Obstet Gynecol Infertil. 2015;17(133):8-21.
13. Brezsnyak M, Whisman MA. Sexual desire and relationship functioning: the effects of marital satisfaction and power. J Sex Marital Ther. 2004;30(3):199-217.
14. Berscheid ES, Regan PC. The Psychology of Interpersonal Relationships: XT CT Chinese Simplified Co-Pub Translation. 2016.1st Edition. New York.
15. Rahmani A, Merghati KE, Sadeghi N, Allahgholi L. Relationship between sexual pleasure and marital satisfaction. Iran J Nurs. 2011, 24(70): 82-90.
16. Shakarami M, Davarnia R, ZahraKar K, Gohari SH. The effect of sex education on sexual intimacy of married women. Iran J Psychiat Nurs. 2014; 2(1):34-42.
17. Dastaran F, Maasoumi R. Development and psychometric properties of a questionnaire to assess the Iranian women’s sexual self-efficacy. Nurs Pract Today. 2019; 6(4):176-89.
18. Pakpour AH, Yekaninejad MS, Zeidi IM, Burri A. Prevalence and risk factors of the female sexual dysfunction in a sample of infertile Iranian women. Arch Gynecol Obstet. 2012;286(6):1589-96.
19. Forutan K, Akhavan Taghavi M. The role of sexual health in Iranian families. Ghazavat.2011; 71:28-33.
20. BostaniKhalesi Z, GhanbariKhaneghah A. Perception and experience of married women of reproductive age about the importance of sexual health education: A content analysis study. Iran J Obstet Gynecol Infertil. .2015;18(172):7-17.
21. Bakhshayesh A, Mortazavi M. The Relationship between Sexual Satisfaction, General Health and Marital Satisfaction in Couples. J Appl Psychol. 2010; 3(4): 73-85.
22. Khanjani Veshki S, Botlani S, Shahsiah M,Shahsiah M, Sharifi E. The effect of sex education on marital quality improvement in couples of Qom. Interdiscip J Contemp Res Bus. 2012; 4(7):134-47.
23. Chehri A, Shahgoli N, Saberi M. Sampling and sample size calculation in medical research. 3 nd edition ed. Tehran: Pejvac Elm Aria. 2007:112 [In Persian].
24. Golmakani N, Zare Z, Khadem N, Shareh H, Shakeri MT. The effect of pelvic floor muscle exercises program on sexual self-efficacy in primiparous women after delivery. Iran J Nurs Midwifery Res. 2015;20(3):347-53.
25. Mohammadizade S, Moradi-joo M, Shamsedini Lort S, Jamshidifar Z. The effectiveness of mindfulness training on sexual self-efficacy in women with breast cancer. Thoughts and Behavior in Clinical Psychology. 2014;9(31):7-16.
26. Nusbaum M, Rosenfeld JA. Sexual health and health from childhood to old age. A Practical Guide for Therapists. Translators: Shirmohammadi M, Firoozi R.Tehran: Arjomand publication; 2014:1-208 [In Persian].
27. Jahanfar Sh, Molaeinejad M. Textbook of Sexual Disorders, Tehran: Jamehnegar publication, 2014; 2 th ed: 1-224 [In Persian].
28. Bahadoran K, Pournaseh M. A path to tranquility 5, Mindfulness and Medication. Tehran: Mehr Kavian publication; 2009 [In Persian].
29. Hosseini Birjandi B. Family therapy and marriage counseling and marriage. 2002, Asatir Publications.Tehran.
30. Jalali Shahkouh S, Mazaheri MA, Kiamanesh A, Ahadi H. The compilation of an educational package for enrichment of marital life based on emotional focused therapy and investigation of its efficacy on newly-married couples’s marital adjustment. J Fundam Mental Health. 2017; 19: 155-61.
31. Mollaiynejad M, Jaaferpour Alavi M, Jahanfar SH, Jamshidi R. Relationship between marital adjustment and stress related Infertility in women who referred to Isfahan infertility and treatmeny treatment Center. J Reprod Infertil. 2001; 2(1):26–39.
32. Spanier GB. Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976:15-28.
33. Vaziri SH, Lotfi Kashani F. Study of Factor Structure, Reliability and Validity of Sexual Self-efficacy Questionnaire. Thought and Behavior in Clinical Psychology. 2013; 8(29):47-56.
34. Jalilian N, Mokari Z. The effectiveness of sexual skills training with a Cognitive-Behavioral Approach on sexual dysfunction among infertile women.World Family Medicine Journal/Middle East Journal of Family Medicine. 2017; 15(7):126-32.
35. Padash Z, Yousefi Z, Abedi MR, Torkan H. Efficacy of Gottman’s marital Counseling on marital satisfaction and marital adjustment of married women willing to get divorced. Psychol Sci. 2021; 20(104): 1423-1436.
36. Behboodi Moghadam Z, Rezaei E, Khaleghi Yalegonbadi F, Montazeri A, Arzaqi SM, Tavakol Z, et al. The effect of sexual health education program on women sexual function in Iran. J Res Health Sci. 2015;15(2):124-8.
37. Tan SA,Goh YS, Sharmilah R, Tan JP. Sexual compatability and marital satisfaction among married couples in Malaysia: the mediating role of sexual satisfaction. Proceedings of the Next Generation Global Workshop. 2020; 13:14. https://doi.org/10.14989/pnggw_13_14
38. Davoodi Z, Etemadi O, Bahrami F, Shahsiah M. The effect of brief solution-focused couple therapy approach on couples’ marital adjustment in men and women prone to divorce in 2010-2011 in Isfahan. Journal of Fundamentals of Mental Health Autumn. 2012; 14, 3(55):190-9.
39. Asghari M, Moradi M, Nekoolaltak M, Jamali J, Danesh F. The Effect of Counseling Based on Sexual Health Model on Sexual Compatibility of Women at Risk of Emotional Divorce. J midwifery reproductive health. 2023; 11(1): 3580-91.
40. Foroutan SK, Jadid Milani M. The prevalence of sexual dysfunction among divorce requested. Daneshvar Medicine. 2008;15(5):39-44.
41. Clayton AH. The pathophysiology of hypoactive sexual desire disorder in women. Int J Gynaecol Obstet. 2010;110(1):7-11.
42. McFarland MJ, Uecker JE, Regnerus MD. The role of religion in shaping sexual frequency and satisfaction: evidence from married and unmarried older adults. J Sex Res. 2011;48(2-3):297-308.
43. Kockott G. [Psychotherapy for sexual dysfunctions and desire disorders]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007;50(1):11-8.
44. Jamali S, Jahromi AR, Javadpour S. Sexual function in fertile and infertile women referring to the Jahrom Infertility in 2011. Jundishapur Journal of Chronic Disease Care. 2014;3(1): 11-20.
45. Shekar A, Gross A, Luebbers E, Honsky J. Effects of an Interprofessional Student-Led Sexual Education Program on Self-Efficacy and Attitudes About Sexual Violence in Youths in Juvenile Detention. J Pediatr Adolesc Gynecol. 2020;33(3):302-6.
46. Mazinani R, Akbari Mehr M, Kaskian A, Kashanian M. Evaluation of prevalence of sexual dysfunctions and its related factors in women. Razi Journal of Medical Sciences. 2013;19(105):59-66.
47. Vaziri S, Lotfi KF, Hosseinian S, Bahram GS. Sexual efficacy and marital satisfaction. Thought and Behavior in Clinical Psychology. 2010; 4(16): 75-81.
48. Shokrani S, Moeini Mehr M, Shayan Manesh M. The Effect of Education Based on Sexual Self-Efficacy on Marital Satisfaction in Women. Arch Pharma Pract 2020;11(S1):138-42.
49. Bakhshayesh AR. Mortazavi M. The Relationship between Sexual Satisfaction, General Health and Marital Satisfaction in Couples. J Appl Psychol. 2010; 3(4): 73-85[English Abstract].
50. Salazar-Molina A, Klijn TP, Delgado JB. Sexual satisfaction in couples in the male and female climacteric stage. Cad Saude Publica. 2015;31(2):311-20.
2. Monga M, Alexandrescu B, Katz SE, Stein M, Ganiats T. Impact of infertility on quality of life, marital adjustment, and sexual function. Urology. 2004;63(1):126-30.
3. Matsubayashi H, Hosaka T, Izumi S, Suzuki T, Kondo A, Makino T. Increased depression and anxiety in infertile Japanese women resulting from lack of husband's support and feelings of stress. Gen Hosp Psychiatry. 2004;26(5):398-404.
4. Yang T, Wongpakaran N, Wongpakaran T, Saeng-Anan U, Singhapreecha C, Jenraumjit R, Peisah C. Factors Associated with Anxiety and Depression in Infertile Couples-Study Protocol. Healthcare (Basel). 2022 Jul 21;10(7):1352.
5. Ashrafi M, Jahangiri N, Sadatmahalleh SJ,Mirzaei N,Hesari NG,Rostami F, et al. Does prevalence of sexual dysfunction differ among the most common causes of infertility? A cross-sectional study. BMC Women's Health.2022; 22, 140: 1-8.
6. Pasha H, Basirat Z, Faramarzi M, Kheirkhah F. Is psychosexual therapy a reliable alternative to bupropion extended-release to promote the sexual function in infertile women? An RCT. Int J Reprod Biomed. 2020;18(3):175-86.
7. Nene UA, Coyaji K, Apte H. Infertility: a label of choice in the case of sexually dysfunctional couples. Patient Educ Couns. 2005;59(3):234-8.
8. Jamshidimanesh M, Alimanesh N, Moghaddam ZB, Haghani H. Effect of an educational package on self-efficacy of infertile women. Payesh (Health Monitor). 2015;14(2):227-37.
9. Pasha H, Basirat Z, Esmailzadeh S, Faramarzi M, Adibrad H. Marital Intimacy and Predictive Factors Among Infertile Women in Northern Iran. J Clin Diagn Res. 2017;11(5):Qc13-qc7.
10. Omani-Samani R, Amini P, Navid B, Sepidarkish M, Maroufizadeh S, Almasi-Hashiani A. Prevalence of Sexual Dysfunction among Infertile Women in Iran: A Systematic Review and Meta-analysis. Int J Fertil Steril. 2019 ;12(4):278-83.
11. Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007;21(2):293-308.
12. Najafi M, Soleimani A, Ahmadi K, Javidi N, Hoseni E, Pirjavid F. The study of the effectiveness of couple emotionally focused therapy (EFT) on increasing marital adjustment and improving the physical and psychological health of the infertile couples. Iran J Obstet Gynecol Infertil. 2015;17(133):8-21.
13. Brezsnyak M, Whisman MA. Sexual desire and relationship functioning: the effects of marital satisfaction and power. J Sex Marital Ther. 2004;30(3):199-217.
14. Berscheid ES, Regan PC. The Psychology of Interpersonal Relationships: XT CT Chinese Simplified Co-Pub Translation. 2016.1st Edition. New York.
15. Rahmani A, Merghati KE, Sadeghi N, Allahgholi L. Relationship between sexual pleasure and marital satisfaction. Iran J Nurs. 2011, 24(70): 82-90.
16. Shakarami M, Davarnia R, ZahraKar K, Gohari SH. The effect of sex education on sexual intimacy of married women. Iran J Psychiat Nurs. 2014; 2(1):34-42.
17. Dastaran F, Maasoumi R. Development and psychometric properties of a questionnaire to assess the Iranian women’s sexual self-efficacy. Nurs Pract Today. 2019; 6(4):176-89.
18. Pakpour AH, Yekaninejad MS, Zeidi IM, Burri A. Prevalence and risk factors of the female sexual dysfunction in a sample of infertile Iranian women. Arch Gynecol Obstet. 2012;286(6):1589-96.
19. Forutan K, Akhavan Taghavi M. The role of sexual health in Iranian families. Ghazavat.2011; 71:28-33.
20. BostaniKhalesi Z, GhanbariKhaneghah A. Perception and experience of married women of reproductive age about the importance of sexual health education: A content analysis study. Iran J Obstet Gynecol Infertil. .2015;18(172):7-17.
21. Bakhshayesh A, Mortazavi M. The Relationship between Sexual Satisfaction, General Health and Marital Satisfaction in Couples. J Appl Psychol. 2010; 3(4): 73-85.
22. Khanjani Veshki S, Botlani S, Shahsiah M,Shahsiah M, Sharifi E. The effect of sex education on marital quality improvement in couples of Qom. Interdiscip J Contemp Res Bus. 2012; 4(7):134-47.
23. Chehri A, Shahgoli N, Saberi M. Sampling and sample size calculation in medical research. 3 nd edition ed. Tehran: Pejvac Elm Aria. 2007:112 [In Persian].
24. Golmakani N, Zare Z, Khadem N, Shareh H, Shakeri MT. The effect of pelvic floor muscle exercises program on sexual self-efficacy in primiparous women after delivery. Iran J Nurs Midwifery Res. 2015;20(3):347-53.
25. Mohammadizade S, Moradi-joo M, Shamsedini Lort S, Jamshidifar Z. The effectiveness of mindfulness training on sexual self-efficacy in women with breast cancer. Thoughts and Behavior in Clinical Psychology. 2014;9(31):7-16.
26. Nusbaum M, Rosenfeld JA. Sexual health and health from childhood to old age. A Practical Guide for Therapists. Translators: Shirmohammadi M, Firoozi R.Tehran: Arjomand publication; 2014:1-208 [In Persian].
27. Jahanfar Sh, Molaeinejad M. Textbook of Sexual Disorders, Tehran: Jamehnegar publication, 2014; 2 th ed: 1-224 [In Persian].
28. Bahadoran K, Pournaseh M. A path to tranquility 5, Mindfulness and Medication. Tehran: Mehr Kavian publication; 2009 [In Persian].
29. Hosseini Birjandi B. Family therapy and marriage counseling and marriage. 2002, Asatir Publications.Tehran.
30. Jalali Shahkouh S, Mazaheri MA, Kiamanesh A, Ahadi H. The compilation of an educational package for enrichment of marital life based on emotional focused therapy and investigation of its efficacy on newly-married couples’s marital adjustment. J Fundam Mental Health. 2017; 19: 155-61.
31. Mollaiynejad M, Jaaferpour Alavi M, Jahanfar SH, Jamshidi R. Relationship between marital adjustment and stress related Infertility in women who referred to Isfahan infertility and treatmeny treatment Center. J Reprod Infertil. 2001; 2(1):26–39.
32. Spanier GB. Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976:15-28.
33. Vaziri SH, Lotfi Kashani F. Study of Factor Structure, Reliability and Validity of Sexual Self-efficacy Questionnaire. Thought and Behavior in Clinical Psychology. 2013; 8(29):47-56.
34. Jalilian N, Mokari Z. The effectiveness of sexual skills training with a Cognitive-Behavioral Approach on sexual dysfunction among infertile women.World Family Medicine Journal/Middle East Journal of Family Medicine. 2017; 15(7):126-32.
35. Padash Z, Yousefi Z, Abedi MR, Torkan H. Efficacy of Gottman’s marital Counseling on marital satisfaction and marital adjustment of married women willing to get divorced. Psychol Sci. 2021; 20(104): 1423-1436.
36. Behboodi Moghadam Z, Rezaei E, Khaleghi Yalegonbadi F, Montazeri A, Arzaqi SM, Tavakol Z, et al. The effect of sexual health education program on women sexual function in Iran. J Res Health Sci. 2015;15(2):124-8.
37. Tan SA,Goh YS, Sharmilah R, Tan JP. Sexual compatability and marital satisfaction among married couples in Malaysia: the mediating role of sexual satisfaction. Proceedings of the Next Generation Global Workshop. 2020; 13:14. https://doi.org/10.14989/pnggw_13_14
38. Davoodi Z, Etemadi O, Bahrami F, Shahsiah M. The effect of brief solution-focused couple therapy approach on couples’ marital adjustment in men and women prone to divorce in 2010-2011 in Isfahan. Journal of Fundamentals of Mental Health Autumn. 2012; 14, 3(55):190-9.
39. Asghari M, Moradi M, Nekoolaltak M, Jamali J, Danesh F. The Effect of Counseling Based on Sexual Health Model on Sexual Compatibility of Women at Risk of Emotional Divorce. J midwifery reproductive health. 2023; 11(1): 3580-91.
40. Foroutan SK, Jadid Milani M. The prevalence of sexual dysfunction among divorce requested. Daneshvar Medicine. 2008;15(5):39-44.
41. Clayton AH. The pathophysiology of hypoactive sexual desire disorder in women. Int J Gynaecol Obstet. 2010;110(1):7-11.
42. McFarland MJ, Uecker JE, Regnerus MD. The role of religion in shaping sexual frequency and satisfaction: evidence from married and unmarried older adults. J Sex Res. 2011;48(2-3):297-308.
43. Kockott G. [Psychotherapy for sexual dysfunctions and desire disorders]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007;50(1):11-8.
44. Jamali S, Jahromi AR, Javadpour S. Sexual function in fertile and infertile women referring to the Jahrom Infertility in 2011. Jundishapur Journal of Chronic Disease Care. 2014;3(1): 11-20.
45. Shekar A, Gross A, Luebbers E, Honsky J. Effects of an Interprofessional Student-Led Sexual Education Program on Self-Efficacy and Attitudes About Sexual Violence in Youths in Juvenile Detention. J Pediatr Adolesc Gynecol. 2020;33(3):302-6.
46. Mazinani R, Akbari Mehr M, Kaskian A, Kashanian M. Evaluation of prevalence of sexual dysfunctions and its related factors in women. Razi Journal of Medical Sciences. 2013;19(105):59-66.
47. Vaziri S, Lotfi KF, Hosseinian S, Bahram GS. Sexual efficacy and marital satisfaction. Thought and Behavior in Clinical Psychology. 2010; 4(16): 75-81.
48. Shokrani S, Moeini Mehr M, Shayan Manesh M. The Effect of Education Based on Sexual Self-Efficacy on Marital Satisfaction in Women. Arch Pharma Pract 2020;11(S1):138-42.
49. Bakhshayesh AR. Mortazavi M. The Relationship between Sexual Satisfaction, General Health and Marital Satisfaction in Couples. J Appl Psychol. 2010; 3(4): 73-85[English Abstract].
50. Salazar-Molina A, Klijn TP, Delgado JB. Sexual satisfaction in couples in the male and female climacteric stage. Cad Saude Publica. 2015;31(2):311-20.
| Files | ||
| Issue | Vol 18 No 3 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v18i3.13004 | |
| Keywords | ||
| Adjustment Infertility Marital Relationship Sexual Health Self Efficacy Sex Education | ||
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How to Cite
1.
Banaha S, Pasha H, Bakhtiari A, Omidvar S, Behmanesh F, Faramarzi M, Esmailzadeh S. Effectiveness of Group Psychosexual Training for Marital Adjustment and Sexual Self-Efficacy of Infertile Women: A Randomized Controlled Trial. Iran J Psychiatry. 2023;18(3):275-284.
