Abstract
Sexual dysfunction is one of the most common complaints of patients with multiple sclerosis (MS). The study aimed to determine the effect of counseling based on the extended PLISSIT model (Permission, Limited Information, Specific Suggestion, and Intensive Therapy) on sexual dysfunction and the quality of sexual life of married women with MS. This randomized clinical trial was performed on 70 married women with MS aged between 18 and 45 years referring to the MS Association of Tabriz, Iran. The data were collected using a demographic questionnaire, Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), Sexual Quality of Life for a Female, Fatigue Severity Scale, and Beck Depression Inventory-Short Form Items (BDI-13). A neurologist rated the disability level using the Expanded Disability Status Scale. Using randomization, the participants with a score of 4 or 5 in each item of MSISQ-19 were assigned to counseling and the control group, with block sizes of four and six and allocation ratio of 1:1. The intervention group attended a counseling session or more if needed, based on the EX-PLISSIT model. Data were analyzed using SPSS software (Version 25). Independent t test and ANCOVA were used to analyze the data. After intervention, there was a significant difference between the two groups in terms of primary and tertiary sexual dysfunctions [AMD, − 7.84; 95% CI − 14.82 to − 0.86; P = 0.02]. Despite an increased mean score of quality of sexual life in the intervention group after counseling, there was no statistically significant difference between the two groups [AMD, 9.29; 95% CI − 1.46 to 20.04; P = 0.08]. Although counseling based on EX-PLISSIT had a positive effect on decreasing sexual dysfunction, it could not improve the quality of sexual life of women suffering from MS. Applying sexual counseling approaches with a focus on couple counseling is suggested for improving the quality of sexual life.
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References
Calabrese, M., Magliozzi, R., Ciccarelli, O., Geurts, J.J., Reynolds, R., Martin, R.: Exploring the origins of grey matter damage in multiple sclerosis. Nat. Rev. Neurosci. 16, 147–158 (2015)
Bradley, W.G.: Neurology in Clinical Practice: Principles of Diagnosis and Management. Taylor & Francis, New York (2004)
Hinkle, J.L., Cheever, K.H.: Brunner & Suddarth’s Textbook of Medical–Surgical Nursing. Lippincott Williams & Wilkins, Philadelphia (2013)
Browne, P., Chandraratna, D., Angood, C., Tremlett, H., Baker, C., Taylor B.V., Thompson A.J.: Atlas of Multiple Sclerosis 2013: a growing global problem with widespread inequity. Neurology 83(11), 1022–1024 (2014)
Azari-Barzandig, R., Sattarzadeh-Jahdi, N., Mehrabi, E., Nourizadeh, R., Najmi, L.: Sexual dysfunction in Iranian Azeri Women with multiple sclerosis: levels and correlates. CJMB 6, 381–387 (2019)
McCabe, M.P.: Exacerbation of symptoms among people with multiple sclerosis: impact on sexuality and relationships over time. Arch. Sex. Behav. 33(6), 593–601 (2004)
Ashtari, F., Rezvani, R., Afshar, H.: Sexual dysfunction in women with multiple sclerosis: dimensions and contributory factors. J. Res. Med. Sci. 19(3), 228–233 (2014)
Gava, G., Visconti, M., Salvi, F., Bartolomei, I., Seracchioli, R., Cristina-Meriggiola, M.: Prevalence and psycho-pathological determinants of sexual dysfunction and related distress in women with and without multiple sclerosis. J. Sex. Med. 16(6), 833–842 (2019)
McCabe, M.P.: Relationship functioning and sexuality among people with multiple sclerosis. J. Sex. Res. 39(4), 302–309 (2002)
Tepavcevic, D., Kostic, J., Basuroski, I., Stojsavljevic, N., Pekmezovic, T., Drulovic, J.: The impact of sexual dysfunction on the quality of life measured by MSQoL-54 in patients with multiple sclerosis. Mult. Scler. J. 14(8), 1131–1136 (2008)
Sanders, A.S., Foley, F.W., LaRocca, N.G., Zemon, V.: The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19). Sex. Disabil. 18(1), 3–26 (2000)
Foley, F.W.: Assessment and treatment of sexual dysfunction in multiple sclerosis. A clinical bulletin from the Professional Resource Center of the National MS Society. Natl. Mult. Scler. Soc. Clin. Bull. 8, 1–11 (2006)
Symonds, T., Boolell, M., Quirk, F.: Development of a questionnaire on sexual quality of life in women. J. Sex Marital Ther. 31, 385–397 (2005)
World Health Organization: WHOQOL-BREF: Introduction, Administration, Scoring and Generic Version of the Assessment. World Health Organization, Geneva (1996)
Zamani, M., Tavoli, A., Khasti, B.Y., Sedighimornani, N., Zafar, M.: Sexual therapy for women with multiple sclerosis and its impact on quality of life. Iran J. Psychiatry 12(1), 58–65 (2017)
Khakbazan, Z., Daneshfar, F., Behboodi Moghadam, Z.: The Effectiveness of the Permission, Limited Information, Specific suggestions, Intensive Therapy (PLISSIT) model based sexual counseling on the sexual function of women with multiple sclerosis. Mult. Scler. Relat. Dis. 8, 113–119 (2016)
Daneshfar, F., Behboodi-Moghadam, Z., Khakbazan, Z., Nabavi, S.M., Nayeri, N.D., Ghasemzadeh, S., et al.: The influence of Ex-PLISSIT (Extended Permission, Limited Information, Specific Suggestions, Intensive Therapy) model on intimacy and sexuality of married women with multiple sclerosis. Sex. Disabil. 35(4), 399–414 (2017)
Crayton, H.J., Rossman, H.S.: Managing the symptoms of multiple sclerosis: a multimodal approach. Clin. Ther. 28(4), 445–460 (2006)
Annon, J.: The PLISSIT Model: a proposed conceptual scheme for the behavioural treatment of sexual problems. J. Sex. Educ. Ther. 2(1), 1–15 (1976)
Taylor, B., Davis, S.: The extended PLISSIT model for addressing the sexual wellbeing of individuals with an acquired disability or chronic illness. Sex. Disabil. 25, 135–139 (2007)
Tzortzis, V., Skriapas, K., Hadjigeorgiou, G., Mitsogiannis, I., Gravas, S., et al.: Sexual dysfunction in newly diagnosed multiple sclerosis women. Mult. Scler. 14, 561–563 (2008)
Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., Ferguson, D., D’Agostino Jr., R.: The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J. Sex Marital Ther. 26(2), 191–208 (2000)
Kurtzke, J.F.: Rating neurologic instrument in multiple sclerosis: an Expanded Disability Status Scale (EDSS). Neurology 33, 1444–1445 (1983)
Beck, A.T., Steer, R.A., Brown, G.K.: Beck Depression Inventory-II. Psychological Corporation, San Antonio (1996)
Rostamkhani, F., Jafari, F., Ozgoli, G., Shakeri, M.: Addressing the sexual problems of Iranian women in a primary health care setting: a quasi-experimental study. Iran. J. Nurs. Midwifery Res. 20(1), 139–146 (2015)
Bronner, G., Elran, E., Golomb, J., Korczyn, A.: Female sexuality in multiple sclerosis: the multidimensional nature of the problem and the intervention. Acta Neurol. Scand. 121(5), 289–301 (2010)
Shahvarughie-Farahani, A., Azimian, M., Fallahpour, M., Karimlou, M.: Evaluation of reliability and validity of the persian version of Fatigue Severity Scale (FSS) among persons with multiple sclerosis. J. Rehabil. 10(4), 66 (2010). (in Persian)
Mohammadi, K.H., Rahnama, P., Mohammadi-Tabar, S.H., Montazeri, A.: Validation of the Persian version of Multiple Sclerosis Intimacy and Sexuality Questionnaire-19. Payesh 13, 601–607 (2014). (in Persian)
Masoumi, R., Lamyian, M., Montazeri, A., Azin, S.A., Aguilar-Vafaie, M.E., Hajizadeh, E.: The sexual quality of life-female (SQOL-F) questionnaire: translation and psychometric properties of the Iranian version. Reprod. Health 10, 25–29 (2013)
Markowitz, C.E., Hughes, M.D., Mikol, D.D., Shi, L., Oleen-Burkey, M., Denney, D.R.: Expanded Disability Status Scale calculator for handheld personal digital assistant: reliability study. Int. J. MS Care 10, 33–39 (2008)
Krupp, L.B., LaRocca, N.G., Muir-Nash, J., Steinberg, A.D.: The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch. Neurol. 46, 1121–1123 (1989)
Rajabi, Gh.: Psychometric properties of Beck Depression Inventory Short Form Items (BDI-13). J. Iran. Psychol. 1, 291–298 (2005)
Kruis, A.L., Smidt, N., Assendelft, W.J.J., Gussekloo, J., Boland, M.R.S., Rutten-vanMolken, M., Chavannes, N.H.: Integrated condition management interventionsfor patients with chronic obstructive pulmonary condition (review). Cochrane Database Syst. Rev. 10, CD009437 (2013). https://doi.org/10.1002/14651858
Coulter, A., Entwistle, V.A., Eccles, A., Ryan, S., Shepperd, S., Perera, R.: Personalisedcare planning for adults with chronic or long-term health conditions (review). Cochrane Database Syst. Rev. 3, CD010523 (2015). https://doi.org/10.1002/14651858
Acknowledgements
This study is derived from a master’s thesis in midwifery. We acknowledge the research deputy of Tabriz University of Medical Sciences and MS association of Tabriz. We would like to show our gratitude to those women who cooperated in this study.
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Azari-Barzandig, R., Sattarzadeh-Jahdi, N., Nourizadeh, R. et al. The Effect of Counseling Based on EX-PLISSIT Model on Sexual Dysfunction and Quality of Sexual Life of Married Women with Multiple Sclerosis: A Randomized Controlled Clinical Trial. Sex Disabil 38, 271–284 (2020). https://doi.org/10.1007/s11195-020-09617-4
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DOI: https://doi.org/10.1007/s11195-020-09617-4