Obstetrics & Gynecology · Medical Literature
The effects of sexual counseling based on the EX-PLISSIT and BETTER models on female sexual function after assisted reproductive treatment failure: a randomized clinical trial.
Abstract
Women who experience assisted reproductive treatment failure may be at risk of developing sexual dysfunction. This study compared the effects of two different sexual counselling models, EX-PLISSIT and BETTER, on the sexual function of women after an unsuccessful assisted reproductive treatment. This randomized clinical trial included 66 infertile women, out of the 72 initially recruited following assisted reproductive treatment failure, who referred to the Infertility Clinic, Mashhad, Iran. The EX-PLISSIT and BETTER groups received sexual counselling individually in two online and two in-person sessions. Data were collected using a Female Sexual Function Index (FSFI). Data analysis was performed using SPSS 25 with a significance level of P = 0.05. There was no statistically significant difference in the total score of sexual function and the scores of subscales of desire, arousal, lubrication, orgasm, sexual satisfaction and pain between the two groups before the intervention (P > 0.05). Both groups showed significant improvement post-intervention. Their total mean scores for sexual function, desire, sexual satisfaction, arousal and lubrication were all higher than pre-intervention. Additionally, their scores for pain were significantly lower after the intervention (P < 0.001). Sexual counseling, using either the EX-PLISSIT or BETTER model, improved the sexual function of women who experienced a failed assisted reproductive treatment.
Clinical relevance
Women who experience failed assisted reproductive technology (ART) cycles are a vulnerable population at elevated risk for sexual dysfunction, yet structured sexual counseling is rarely integrated into post-failure care pathways. This RCT addresses a meaningful clinical gap by directly comparing two validated sexual counseling frameworks—EX-PLISSIT and BETTER—in infertile women following unsuccessful ART, a group frequently overlooked in psychosexual rehabilitation. Given the rising global utilization of ART and the psychological burden of treatment failure, these findings are immediately relevant to reproductive endocrinologists, gynecologists, and allied mental health professionals managing this cohort.
Key findings
1. The study enrolled 66 of 72 initially recruited infertile women post-ART failure (attrition n=6), randomized to either EX-PLISSIT or BETTER sexual counseling arms, with outcome measured via the validated Female Sexual Function Index (FSFI). 2. At baseline, there were no statistically significant between-group differences in total FSFI score or any subscale (desire, arousal, lubrication, orgasm, sexual satisfaction, pain; all P > 0.05), confirming adequate randomization and comparability. 3. Both intervention arms demonstrated statistically significant improvement in total FSFI score post-intervention compared to pre-intervention baseline (P < 0.001), indicating robust within-group effect for each model. 4. Significant post-intervention improvements were observed across multiple FSFI subscales in both groups: desire, arousal, lubrication, and sexual satisfaction scores all increased, while pain scores decreased significantly (P < 0.001 for all). 5. No statistically significant between-group difference in total sexual function score or individual subscale scores was detected post-intervention, suggesting clinical equivalence of EX-PLISSIT and BETTER models in this population; however, specific comparative effect sizes, confidence intervals, and NNT/NNH were not reported in the abstract. 6. The intervention format consisted of a brief, feasible hybrid delivery model—two online and two in-person individual sessions—suggesting that meaningful sexual function gains are achievable with a low-intensity, structured counseling protocol in a clinic-referred infertile population.
Practice implications
Reproductive medicine clinics should consider routinely integrating structured sexual counseling—using either the EX-PLISSIT or BETTER framework—into post-ART failure care protocols, as both models produced significant improvements in sexual function with a brief four-session (hybrid online/in-person) individual format that is feasible in outpatient infertility settings. Patient selection should prioritize women presenting after unsuccessful ART cycles, particularly those reporting symptoms across multiple sexual function domains (desire, arousal, lubrication, orgasm, pain, and satisfaction), as captured by routine FSFI screening. Since no significant difference in efficacy was found between the two models, clinicians and counselors may select the framework best aligned with their training and institutional resources, without compromising patient outcomes.