Effects of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer

Effects of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer Azadeh Jamshidi, Taiebeh Gharibi, Farzaneh Noroozi, Razieh Bagherzadeh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4196518/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The diagnosis and treatment of breast cancer are associated with side effects that can affect patients' self-efficacy and various aspects of their quality of life, including their sexual function. Therefore, this study was conducted with the aim of investigating the effect of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer. Method: This randomized controlled trial used a pretest, posttest, control group, and one-month follow-up design. It included 45 female breast cancer survivors, recruited from the clinics and hematology wards of Bushehr, Iran. The inclusion criterion was that at least three months should have passed since the last chemotherapy/radiotherapy. The participants were randomly assigned to two experimental and control groups. The experimental group received two training sessions and three counseling sessions based on efficacy theory. A demographic information form and a female sexual function index questionnaire were used for data collection, and the participants completed the questionnaire in the pretest, posttest, and follow-up stages. Chi-square, Mann–Whitney U, repeated-measures ANOVA, and Fisher's Least Significant Difference (LSD) test were used to analyze the data. P<0.05 was considered statistically significant. Result: At the posttest stage, statistically significant improvements were noted in the intervention group for arousal (P<0.001), orgasm (P = 0.008), sexual satisfaction (P<0.001), and overall FSFI score (P<0.001), which did not have a significant statistical difference until the follow-up stage. In the control group, the overall FSFI score, orgasm, and sexual satisfaction decreased at follow-up compared to those of the pretest and posttest. Conclusion: The scores of overall FSFI and most of its domains were higher in the experimental group than in the control group, an ability that can be attributed to the effect of sexual education and counseling. It is recommended to use this non-invasive, low-cost, and easy method together with other medical procedures. Breast cancer Self-efficacy theory Sexual counseling Sexual education Sexual function Figures Figure 1 Background Breast cancer (BC) is the most common malignancy among women worldwide, with approximately 1.7 million new cases per year. It accounts for 25% of all cancers in Iran, and its incidence is increasing globally and in Iran ( 1 – 4 ). The age of onset of breast cancer in Iran is a decade younger than that in women in developed countries ( 1 ). Therefore, breast cancer poses a significant health challenge in the Eastern Mediterranean region, including Iran ( 5 ). Nowadays, significant efforts are being made to improve the diagnosis and treatment of breast cancer. As a result, the survival rate of breast cancer patients has increased in recent years. However, breast cancer treatment is associated with side effects ( 6 – 8 ). Side effects such as nausea and vomiting, weakness, fatigue, hair loss, skin burns and lesions, changes in breast appearance (which are considered as a sexual identity in various cultures), ovarian dysfunction, and subsequent decrease in estrogen levels leading to vaginal atrophy, decreased vaginal lubrication, reduced vascular congestion, and decreased libido. These side effects have a profound negative impact on individuals' body image and self-esteem ( 9 – 11 ). Ultimately, breast cancer and its treatment side effects, through physical debilitation, reduced ability to perform daily tasks, frequent and prolonged hospitalizations, disruption of feminine identity and personality, issues such as fatigue, anxiety, depression, feelings of isolation and social limitations, fear of disease progression and death, sleep disturbances, psychological distress, irritability, and in the case of being married, fear of infertility and concerns about spousal reactions, significantly diminish the self-efficacy of these patients ( 8 , 12 – 15 ). Self-efficacy refers to an individual's belief in their ability to cope with cancer and its treatment. Several studies have reported that highly self-efficacious patients experience less anxiety and depression and are able to adapt to stressful situations and maintain a good quality of life ( 16 ). Conversely, low levels of self-efficacy have a negative impact on all dimensions of quality of life ( 8 ). Meanwhile, sexual function has received particular attention among the various components of quality of life( 11 ). Sexual function is an important aspect of health and an integral part of a satisfying life, aiming to achieve sexual pleasure ( 17 , 18 ). Studies have shown that at least 68 to 70 percent of women with breast cancer experience some form of sexual dysfunction( 19 ). In Iran, a study has shown that 47 percent of Iranian women with breast cancer have sexual dysfunction ( 20 ). Sexual dysfunction can have detrimental effects on quality of life, self-esteem, sense of completeness, and interpersonal relationships for women, leading to emotional problems, family conflicts, divorce, and fertility-related issues ( 21 ). In general, sexual function is an important aspect of quality of life that is directly affected by the psychological burden of breast cancer and its treatment, as well as through the reduction of self-efficacy ( 8 , 18 , 20 , 22 ). However, in societies like Iran where sexual issues are considered taboo, there have been limited studies on the psychological aspects of the disease, such as sexual problems ( 20 ). Among these studies, only a few interventions have been conducted using educational theories ( 23 – 27 ). The most effective educational programs are based on theory-driven approaches that stem from behavior change models ( 28 ). One of the behavior change theories in the field of learning is Bandura's Social-Cognitive Theory ( 29 ). According to this theory, self-efficacy, which is an individual's belief in their ability to perform a specific task, is one of the strongest determinants in regulating human behavior. When self-efficacy levels are high, there is a greater likelihood that an individual will effectively perform a specific behavior. Conversely, low levels of self-efficacy are associated with pessimistic thoughts about one's abilities, leading to an inability to control emotional states, creating feelings of emptiness, sadness, and vulnerability to life events and pressures ( 30 ). Since self-efficacy is considered a key psychological resource for coping with chronic illnesses ( 8 , 12 , 31 ), sexual self-efficacy is essential for having a satisfactory and desirable sexual performance ( 32 , 33 ). It has been found that the sexual self-efficacy of women with breast cancer is lower compared to healthy women ( 14 ) and interventions based on self-efficacy theory have not been conducted in this population. It seems necessary to conduct such research in these patients to determine the effectiveness of counseling and education based on this theory. If the effectiveness of this intervention is proven, counseling and education using this theory can be used as an easy and cost-effective method alongside other medical interventions, leading to an improvement in the quality of life for these patients. Methods Design This was a randomized controlled trial with an experimental and a control group, using the pretest, posttest, and follow-up design. Patient population and sampling The sample included all women with BC visiting the hematology wards of hospitals and clinics in Bushehr, Iran, in 2023–2024. With the mean and standard deviation of sexual function in the experimental group (M = 49.21, SD = 7.6) and control group (M = 10.14, SD = 1.8) based on Fatehi et al, ( 34 ) the alpha Type I error (α = 0.05), and 90% power, a sample size of 42 was obtained. After considering a 20% dropout rate, a sample size of 50 (25 for each group) was determined. Purposive sampling was then performed, and 50 women with BC volunteered to participate in the study. The participants were randomly assigned to the experimental and control groups by block randomization using 5 blocks (25 participants per group). Inclusion and exclusion criteria The inclusion criteria were consent and willingness to participate in the study, having BC for the first time, undergoing breast surgery or at least lobectomy, being married, being of reproductive age, no use of drugs affecting sexual activity and antidepressants, having the physical ability to attend the meetings, at least three months having passed since the last chemotherapy/radiotherapy, having at least one domain of sexual dysfunction (score below 3.9), and not having attended any formal education about sexual issues over the past six months. The exclusion criteria were pregnancy or initiation of psychiatric pharmacotherapy at the time of our intervention, recurrence of disease, and disorders interfering with sexual functioning (psychological problems, Alzheimer's, mental retardation, and multiple sclerosis). Measures Data gathering tools consisted of a demographic questionnaire and the female sexual function index (FSFI) ( 35 ). The FSFI included 19 items evaluating six domains of female sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain during intercourse) over 4 weeks. Sexual desire was assessed with two items. Arousal and lubrication were assessed with four items. Orgasm, satisfaction, and pain were assessed with three items. Response ranges were 1–5 for items 1, 2, 15, 16, and 0–5 for other items. The score for a domain with two, three, and four questions was 0.6, 0.4, and 0.3, respectively. The translations and cultural adaptation of this tool were previously done, and its validity was examined using the experts' opinion. Also, its reliability was confirmed by a Cronbach's alpha coefficient of 0.85 ( 36 ). Data collection The intervention was administered from 2023 to 2024. Eligible patients were asked to participate in the study and received information about the trial and voluntary participation. They had the right to discontinue participation or withdraw their consent at any time. Patients who wanted to participate signed a written informed consent form before the start of the study. The patients willing to participate in the study filled out the demographic information form and the Female Sexual Function Index (FSFI) questionnaire. Then, the patients with dysfunction in at least one domain of sexual function (score below 3.9), who had other inclusion criteria, were included in the study and assigned to the experimental and control groups by block randomization. The intervention group received 2 group training sessions for 90–120 minutes. Then, patients were divided into groups of 3–4 people, and each group received 3 counseling sessions for 2 hours (one session per week) during one month. Finally, weekly follow-up was done by phone in the intervention group for one month. The content of the educational and counseling sessions was designed based on the four main aspects of self-efficacy theory, which include individual successful experiences, vicarious experiences (observing or expressing experiences of successful models), verbal persuasion, and attention to patients' physiological and emotional reactions ( 37 ). The contents presented in the training and counseling sessions are listed in Table 1 . The Intervention method included group education, group counseling, group discussions, question and answer sessions, participatory learning techniques, and sharing positive experiences. The educational media used included photographs, videos, and PowerPoint presentations. No intervention was provided to the control group. To respect ethical considerations, at the end of the study, the educational booklet, collected based on reliable references, was given to the control group. The FSFI questionnaire was filled out by both groups before the intervention, immediately after the intervention, and at the follow-up (one month after the intervention). Table 1 Educational and Consulting intervention based on Self-efficacy theory Sessions Content/Techniques to increase self-efficacy First - Offering insights into the advantages of enhancing sexual performance (Raising awareness and motivating the audience by recalling positive past experiences to boost self-confidence and encourage behavior) - Acquiring knowledge about Anatomy and function of the male and female reproductive systems, understanding how sexual organs influence the development of satisfying sexual relationships, and comprehension of the sexual cycle (Breaking down behavior into simple components) Second - Describing common sexual disorders in both men and women. - Providing solutions for sexual dysfunction and creating a satisfying relationship (helping alleviate concerns, anxiety, and depression related to sexual performance issues, paying attention to physiological responses) - Offering interviews or the presence of successful patients in this field to build self-confidence (providing role models or surrogate experiences) Third to fifth - Familiarizing oneself with effective interpersonal skills in creating a sexual relationship - Providing solutions for sexual dysfunction (helping alleviate concerns, anxiety, and depression related to sexual performance issues, paying attention to physiological responses) - Identifying personal barriers (false beliefs) and paying attention to physiological responses (anxiety and depression) - Offering strategies to overcome obstacles in sexual relationship disorders after surgery and expressing the experiences of successful individuals (providing role models or surrogate experiences) - Providing positive feedback and verbal encouragement in response to patients' efforts to change false beliefs Data analysis At the outset of the study, the intention-to-treat analysis was taken into account. Out of 50 participants, two cases from the control group and three cases from the experimental group refused to continue the study, and the analysis was performed on 45 individuals (22 in the intervention and 23 in the control group) (Fig. 1 ). All the participants remained in their respective groups. All the participants in the experimental groups (n = 22) participated in all the sessions. Therefore, the intention-to-treat analysis was similar to the per-protocol. The data were analyzed in SPSS 20. To evaluate the normality of the distribution of the variables, the Shapiro-Wilk test was carried out. All variables showed a normal distribution in both groups and at all three evaluation times. In line with the research objectives, descriptive statistical indices (mean, standard deviation, percentage, frequency) and analytical tests including the Independent T-test, Mann-Whitney U, Chi-square, and Fisher's exact test were used to compare demographic variables. Additionally, repeated-measures analysis of variance (ANOVA), Least Significant Difference (LSD) test, and Mann-Whitney U were performed for within- and between-groups comparisons. The significance level was set at < 0.05. Results The mean age of the intervention and control groups was 42.64 ± 4.88 and 43.44 ± 5.20 years, respectively. There was no significant difference between the groups in terms of mean age (P = 0.57, Z = − 0.561). Other demographic data were similar, and the groups were homogeneous (Table 2 ). Within-group comparison using repeated-measures ANOVA showed that the group-by-time interaction is not significant for the sexual desire, lubrication, and pain domains (Table 3 ). The follow-up LSD test showed that in the posttest stage, statistically significant improvements were noted in the intervention group for the arousal (P < 0.001), orgasm (P = 0.008), sexual satisfaction (P < 0.001), and overall FSFI score (P < 0.001), which did not have a significant statistical difference until the follow-up stage. In the control group, overall FSFI score, orgasm, and sexual satisfaction decreased at the follow-up stage compared to those of the pretest and posttest (Table 4 ). Between-groups comparison using Mann-Whitney U showed that the average changes in sexual desire and pain domains did not have a statistically significant difference between the two groups. The average changes in overall FSFI score and other domains from pretest to posttest and follow-up significantly increased in the intervention group and decreased in the control group. The average score of changes between posttest and follow-up in the two groups did not show a statistically significant difference (Table 5 ). Table 2 Comparison of demographic variables and the variables related to disease between intervention and control groups Intervention group frequency (%) Control group frequency (%) P value (Fisher or x 2 ) Education level Primary school 5(22.7) 8(34.8) 0.528(2.682 * ) Secondary school 5(22.7) 8(34.8) Diploma 8(36.4) 5(21.7) Academic 4(18.2) 2(8.7) Job Employed 5(22.7) 5(21.7) 0.636(0.006) Housewife 17(77.3) 18(78.3) Husband's education level Primary school 2(9.1) 3( 13 ) 0.395(3.163 * ) Secondary school 4(18.2) 7(30.4) Diploma 9(40.9) 4(17.4) Academic 7(31.8) 9(39.1) Husband's Job Worker 0 1(4.3) 0.441(3.721 * ) Unemployed 0 1(4.3) Emloyee 5(22.7) 3( 13 ) Retired 2(9.1) 5(21.7) Freelancer 15(68.2) 13(56.5) Income status Less than expenses 8(36.4) 9(39.1) 0.989(0.314 * ) Equivalent expenses 13(59.1) 13(56.5) More than expenses 1(4.5) 1(4.3) Breast surgery Unilateral mastectomy 11(50) 10(43.5) 0.879(0.476 * ) Bilateral mastectomy 1(4.5) 1(4.3) Lumpectomy 10(45.5) 12(52.2) Tamoxifen use None 13(59.1) 16(69.6) 0.422(1.828 * ) 20 mg 4(18.2) 5(21.7) 20 mg 5(22.7) 2(8.7) The statistic tests used is the chi-square or Fisher’s exact test *Fisher exact test is done Table 3 Determining the effect of time and group-by-time interaction on sexual function and its domains Domain Time Group The effect of time Group-by-time interaction Intervention Control Mean ± SD Mean ± SD Mean square F Sig Mean square F Sig Desire Pre-test 2.75 ± .92 2.71 ± 1.01 1.184 2.262 0.121 0.595 1.136 0.318 Post-test 3.03 ± .60 2.61 ± .92 Follow-up 2.73 ± .73 2.45 ± .94 Arousal Pre-test 2.21 ± 1.41 2.33 ± 1.41 0.998 3.232 0.057 2.111 6.835 0.004 Post-test 2.65 ± 1.45 2.27 ± 1.42 Follow-up 2.51 ± 1.37 2.00 ± 1.26 Lubrication Pre-test 2.92 ± 1.81 2.77 ± 1.89 .550 1.474 0.236 1.188 3.185 0.055 Post-test 3.27 ± 1.74 2.75 ± 1.90 Follow-up 3.22 ± 1.74 2.65 ± 1.85 Orgasm Pre-test 2.42 ± 1.51 2.35 ± 1.79 1.675 6.041 0.005 1.399 5.045 0.011 Post-test 2.69 ± 1.54 2.28 ± 1.78 Follow-up 2.49 ± 1.44 1.93 ± 1.50 Satisfaction Pre-test 3.09 ± 1.41 2.92 ± 1.51 1.922 4.402 0.025 2.669 6.112 0.008 Post-test 3.65 ± 1.56 2.90 ± 1.67 Follow-up 3.47 ± 1.76 2.67 ± 1.53 Pain Pre-test 3.11 ± 2.00 2.96 ± 1.95 0.611 0.822 0.401 0.611 0.822 0.401 Post-test 3.38 ± 1.89 3.03 ± 1.92 Follow-up 3.38 ± 1.85 2.91 ± 1.91 Total score of FSFI Pre-test 16.50 ± 8.30 16.04 ± 8.24 29.873 4.758 0.016 45.703 6.112 0.002 Post-test 18.67 ± 8.20 15.84 ± 8.55 Follow-up 17.80 ± 8.36 14.61 ± 8.08 The statistical test used is repeated measures ANOVA P < 0.05 is significant Table 4 Comparing pairwise within-group variables where the group-by-time interaction has been found to be significant for them Domain Group Time A Time B Mean difference (A – B) SE Sig Confidence Interval 95% for Mean difference minimum maximum Arousal Intervention Post-test Pre-test 0.436 0.097 < 0.001 0.240 0.632 Follow-up Pre-test 0.300 0.145 0.045 0.007 0.593 Post-test -0.136 0.108 0.214 -0.354 0.082 Control Post-test Pre-test -0.055 0.097 0.577 -0.250 0.141 Follow-up Pre-test -0.273 0.145 0.067 -0.565 0.020 Post-test -0.218 0.108 0.050 -0.436 < 0.001 Orgasm Intervention Post-test Pre-test 0.273 0.099 0.008 0.074 0.472 Follow-up Pre-test 0.073 0.128 0.572 -0.185 0.331 Post-test -0.200 0.109 0.073 -0.419 0.019 Control Post-test Pre-test -0.073 0.099 0.464 -0.272 0.126 Follow-up Pre-test -0.418 0.128 0.002 -0.676 -0.160 Post-test -0.345 0.109 0.003 -0.565 -0.126 Satisfaction Intervention Post-test Pre-test 0.564 0.131 < 0.001 0.299 0.828 Follow-up Pre-test 0.382 0.176 0.035 0.027 0.736 Post-test -0.182 0.107 0.098 -0.398 0.035 Control Post-test Pre-test 0.000 0.131 1.000 -0.265 0.265 Follow-up Pre-test -0.255 0.176 0.155 -0.609 0.100 Post-test -0.255 0.107 0.022 -0.471 -0.038 Total score of FSFI Intervention Post-test Pre-test 2.173 0.461 < 0.001 1.243 3.102 Follow-up Pre-test 1.300 0.639 0.048 0.011 2.589 Post-test -0.873 0.486 0.080 -1.854 0.108 Control Post-test Pre-test -0.168 0.461 0.717 -1.098 0.761 Follow-up Pre-test -1.327 0.639 0.044 -2.616 -0.038 Post-test -1.159 0.486 0.022 -2.140 -0.178 The statistical test used is follow-up LSD test P < 0.05 is significant Table 5 Mean changes comparisons of total sexual function and its domain between intervention and control groups Variable Time Group Intervention Control Z Sig Mean SD Mean SD Desire post-test \(-\) pre-test 0.27 0.78 -0.10 0.62 -1.943 0.052 follow-up—pre-test -0.03 0.80 -0.22 0.94 -1.007 0.314 follow-up—post-test -0.30 0.55 -0.16 0.62 -0.641 0.522 Arousal post-test \(-\) pre-test 0.44 0.58 -0.07 0.29 -3.758 < 0.001 follow-up—pre-test 0.30 0.73 -0.27 0.63 -2.742 0.006 follow-up—post-test -0.14 0.41 -0.22 0.59 -0.736 0.461 Lubrication post-test \(-\) pre-test 0.35 0.69 -0.01 0.37 -2.053 0.040 follow-up—pre-test 0.30 0.65 -0.11 0.79 -2.062 0.039 follow-up—post-test -0.05 0.37 -0.07 0.67 -0.145 0.885 Orgasm post-test \(-\) pre-test 0.27 0.54 -0.07 0.35 -2.167 0.030 follow-up—pre-test 0.07 0.66 -0.42 0.53 -2.531 0.011 follow-up—post-test -0.20 0.37 -0.35 0.62 -0.753 0.451 Satisfaction post-test \(-\) pre-test 0.56 0.67 -0.02 0.55 -2.964 0.003 follow-up—pre-test 0.38 0.93 -0.25 0.70 -2.174 0.030 follow-up—post-test -0.18 0.50 -0.25 0.50 -0.879 0.379 Pain post-test \(-\) pre-test 0.27 0.58 0.07 0.35 -1.129 0.259 follow-up—pre-test 0.27 0.69 -0.05 1.30 -0.881 0.379 follow-up—post-test 0.00 0.21 -0.11 1.33 -0.745 0.456 Total FSFI post-test \(-\) pre-test 2.17 2.77 -0.20 1.28 -3.783 < 0.001 follow-up—pre-test 1.30 2.92 -1.33 3.07 -2.924 0.003 follow-up—post-test -0.87 1.24 -1.16 2.97 -0.717 0.474 The statistical test used is Maan-whitney P < 0.05 is significant Discussion This study was conducted with the aim of investigating the effect of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer. The results indicated that in the intervention group, the intervention resulted in an increase in the overall FSFI score compared to before the intervention until the post-test and follow-up stages. This finding is consistent with the results of studies conducted by Shahin et al. ( 26 ), Keshavarz et al. ( 27 ), Zangeneh et al. ( 38 ), and Alimohammadi et al. ( 37 ). The results indicate that the intervention had no effect on the desire domain, which contradicts the mentioned studies and aligns with the study by Saboula et al. ( 25 ). Considering that a study in Switzerland using the FSFI demonstrated that the only predictor of sexual desire is the quality of the relationship. However, in addition to breast cancer, various factors can influence the quality of the relationship and ultimately sexual desire, and it is not possible to control all of these factors ( 39 ). The results showed that the intervention improved the arousal domain, which contradicts the studies conducted by Alimohammadi et al. ( 37 ) and Marvi et al. ( 40 ). The target group in the study by Ali Mohammadi et al. had no physical or mental disorders, and in the study by Moravi et al. they had not experienced any stressful conditions in the past 6 months. Perhaps the reason for the lack of impact of interventions on the arousal domain was the high average motivation score at the beginning of the study, while in the current study, the arousal domain had the lowest initial average score. In the current study, sensory-focused exercises, both sexual and non-sexual, along with challenging false beliefs, which are two main mechanisms in cognitive-behavioral interventions, were taught based on the self-efficacy theory ( 41 ). It seems reasonable to suggest that this intervention can enhance the arousal domain.The findings indicated an increase in lubrication levels in the experimental group compared to the control group, which contradicts the study conducted by Bagherzadeh et al. ( 42 ). This difference could potentially be attributed to the differences in the interventions used in the respective studies. Lubrication is not solely caused by psychological disorders and has a predominantly physical nature, requiring interventions that address the physical aspect as well ( 25 ). Therefore, in the current study, local estrogen therapy, which is the most effective method for treating vaginal atrophy after breast cancer ( 43 ), was used, along with the use of lubricants. The results showed that the intervention improved orgasm and sexual satisfaction domains, which contradicts the study by Alimohammadi et al. ( 37 ). In the study by Alimohammadi et al. ,the participants were newly married women, and since gaining experience with a sexual partner is effective in achieving orgasm ( 44 ), this may be the reason for the difference in results between the two studies. Considering that the number of orgasms during each sexual encounter is directly related to sexual satisfaction ( 45 ), the reason for the effect of the current study and the lack of effect in the study by Alimohammadi et al. on sexual satisfaction may be orgasms. In the study conducted by Shahin et al. ( 26 ), there was no change in the orgasm domain compared to before the intervention. The reason for this difference may be due to the target group. In the current study, about 45% of the patients had only a part of the breast removed, while in the study by Shahin et al. all patients had undergone mastectomy surgery, resulting in more significant changes in the body. These changes could potentially hinder focus during sexual intercourse due to negative body image, whereas orgasms occur when a woman is able to maintain her focus. The results showed that the intervention had no effect on the pain domain, which is consistent with the studies by Alimohamadi et al. ( 37 ), Marvi et al. ( 40 ), and Bagherzadeh et al. ( 42 ). The reason for this could be the limitation of research tools ( 46 ). The Female Sexual Function Index measures the presence of pain rather than its intensity and severity. Perhaps using a tool that measures the intensity of pain could demonstrate the impact of the intervention on pain management ( 47 ). In the control group, the overall FSFI score and most of its domains showed a decreasing trend, which is consistent with the study by Baqerzadeh et al ( 42 ). This can be explained as follows: If effective psychological interventions are not performed on breast cancer patients, their sexual performance will show a decreasing trend. This study had some limitations. One of the limitations was the lack of participation of husbands in the research. Since sexual function depends on the performance of both partners, studies that involve interventions for both parties may yield better results. The second limitation was the sample size. It appears that the sample is small and may not allow us to easily generalize the findings to larger populations. Additionally, considering the limited duration of the follow-up period, which was one month, caution should be exercised when making statements about the long-term effects of this intervention. Conclusion The scores of the overall FSFI and most of its domain were higher in the experimental group than in the control group, an ability that can be attributed to the effect of Sexual education and counseling. It is recommended to use this non-invasive, low-cost, and easy method together with other medical procedures. Although some of the findings were not statistically significant, this intervention is clinically important. Declarations Acknowledgements The authors would like to thank all participant females and thank Dr Rekabpour (Oncologist) for his guidance. Author contributions TG, FN and RB designed the study. Intervention and Data collection: AJ and TG. Data analysis: RB. AJ Drafted the manuscript and R.B prepared tables. TG, FN and RB read, edited for scientific accuracy, and approved the final manuscript. Funding This research was funded by Bushehr University of Medical Sciences. Availability of data and materials The anonymized datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors report no conflicts of interest in this work. Ethics approval and consent to participate This paper is extracted from a master’s degree thesis of the Faculty of Nursing and Midwifery; which was approved in 2023 and was Research Ethics Committee (Code: IR.BPUMS.REC.1402.071) and IRCT code (IRCT20231102059930N1). All methods were carried out in performed in accordance with the Declaration of Helsinki. A written consent was further obtained from all the study samples and was assured of data confidentiality. Consent for publication Not applicable. Author details [1]Student Research Committee, Bushehr University of Medical Sciences, Bushehr, Iran. 2 Department of Midwifery, Nursing and Midwifery Faculty, Bushehr University of Medical Sciences, Bushehr, Iran References Alizadeh M, Ghojazadeh M, Piri R, Mirza Aghazadeh Attari M, Mohammadi S, Naghavi Behzad M. Age at Diagnosis of Breast Cancer in Iran: A Systematic Review and Meta-Analysis. Iranian journal of public health. 2021;50(8):1564-76. 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Sexual dysfunction and its correlation with quality of life among women affected with cancer. Iranian journal of obstetrics, gynecology and infertility. 2009;12(2):39-46. Mohammadi N, Pazhoohnia H, Khodaveisi M, Soltanian A, Niknam S. The relationship between self-efficacy and mental health in women with breast cancer referred to health centers in hamadan 2016-2017. Avicenna journal of nursing and midwifery care (scientific journal of hamadan nursing & midwifery faculty). 2018;26(2):72-81. Nasiri F, Keshavarz Z, Davazdahemami M, Karimkhanizandi S, Nasiri M. The effectiveness of spiritual care on the self-efficacy of women with breast cancer. Nursing and Midwifery Journal. 2019;16(12):856-64. Shoaa Kazemi M, Mehravar Momeni J. A Comparative Study On Self-Efficacy And Empowerment In Women With Breast Cancer And Healthy Women. Iranian Journal of Breast Diseases. 2012;5(1):45-53. BorjAlilu S, Kaviani A, Helmi S, Karbakhsh M, Mazaheri MA. Exploring the role of self-efficacy for coping with breast cancer: A systematic review. Archives of Breast Cancer. 2017;4(2):42-57. Ali R, Draman N, Mohd Yusoff SS, Norsa'adah B. Self-Efficacy for Coping with Breast Cancer in North-Eastern State of Peninsular Malaysia. Asian Pacific journal of cancer prevention : APJCP. 2020;21(10):2971-8. Fourcroy JL. Female sexual dysfunction: potential for pharmacotherapy. Drugs. 2003;63(14):1445-57. Panahi R, Anbari M, Javanmardi E, Ghoozlu KJ, Dehghankar L. The effect of women's sexual functioning on quality of their sexual life. Journal of preventive medicine and hygiene. 2021;62(3):776-81. Del Pup L, Villa P, Amar I, Bottoni C, Scambia G. Approach to sexual dysfunction in women with cancer. International Journal of Gynecologic Cancer. 2019;29(3):630-4. Fouladi N, Feizi I, Nadermohammadi M, Mehrara E, Adldoosti R, Alimohammadi S. The predictors of sexual satisfaction among Iranian women with breast cancer. Asian Pac J Cancer Prevention. 2021;22(2):391-6. Jaafarpour M, Khani A, Khajavikhan J, Suhrabi Z. Female sexual dysfunction: prevalence and risk factors. Journal of clinical and diagnostic research : JCDR. 2013;7(12):2877-80. Morteza H, Ghorbani R, Alibeigi M, Mirakhorloo S, Arjaneh M. Relationship between marital and occupational satisfaction in the Iranian health center employees. Koomesh journal. 2018;20(2):300-9. Esmkhani M, Kharaghani R, Shakibazadeh E, Faghihzadeh S, Korte JE, Merghati-Khoei E. Comparison of the effects of the PLISSIT model versus the sexual health model on quality of life among women with breast cancer. Sexuality and Disability. 2021;39(1):85-96. Jalambadani Z, Garmaroudi G, Tavousi M. Education based on theory of planned behavior over sexual function of women with breast cancer in Iran. Asia-Pacific journal of oncology nursing. 2018;5(2):201-7. Saboula N, El-Sayed S. Effectiveness of application of PLISSIT counseling model on sexuality for breast cancer's women undergoing treatment. Am J Nurs Sci. 2015;4(4):218-30. Shahin MA, Gaafar HAA, Alqersh DLA. Effect of Nursing Counseling Guided by BETTER Model on Sexuality, Marital Satisfaction and Psychological Status among Breast Cancer Women. Translational andrology and urology. 2021;4(2):160-8. Keshavarz Z, Karimi E, Golezar S, Ozgoli G, Nasiri M. The effect of PLISSIT based counseling model on sexual function, quality of life, and sexual distress in women surviving breast cancer: a single-group pretest–posttest trial. BMC women's health. 2021;21(1):1-8. Ghahramani M, Moodi M, Alami A, Moasheri N. Stages of pap smear screening change behavior based on TTM in women referring to health centers in Gonabad - years 1393. Modern Care Journal. 2015;11(4):304-15. Kadivar P, Nemat Tavoosi M, Yousefi N. The relationship of review between cognitive learning styles and self-efficacy beliefs with achievement math. Journla of psychological researches. 2010;2(5):107-22. Behnam Vashani HR, Hekmati Pour N, Vaghee S, Asghari Nekah SM. Effect of storytelling on self-efficacy in children with thalassemia: Application of bandura s social cognitive theory. Journal of health and care. 2015;17(3):230-9. Heravi Karimoui M, Pourdehghan M, Jadid Milani M, Foroutan SA, aein F. Effect of group counseling on sexual health of patients with breast cancer. Scientific Journal of Forensic Medicine. 2006;11(4):201-6. Brezsnyak M, Whisman MA. Sexual desire and relationship functioning: The effects of marital satisfaction and power. Journal of Sex & Marital Therapy. 2004;30(3):199-217. Steinke EE, Mosack V, Hertzog J, Wright DW. A Social‐Cognitive Sexual Counseling Intervention Post‐MI—Development and Pilot Testing. Perspectives in Psychiatric Care. 2013;49(3):162-70. Fatehi S, Maasoumi R, Atashsokhan G, Hamidzadeh A, Janbabaei G, Mirrezaie SM. The effects of psychosexual counseling on sexual quality of life and function in Iranian breast cancer survivors: a randomized controlled trial. Breast Cancer Research and Treatment. 2019;175(1):171-9. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191-208. Bagherzadeh R, Zahmatkeshan N, Gharibi T, Akaberian S, Mirzaei K, Kamali F, et al. Prevalence of Female Sexual Dysfunction and Related Factors for Under Treatment in Bushehrian Women of Iran. Sexuality and Disability. 2010;28(1):39-49. Alimohammadi L, Mirghafourvand M, Zarei F, Pirzeh R. The effectiveness of group counseling based on Bandura's self-efficacy theory on sexual function and sexual satisfaction in Iranian newlywed women: A randomized controlled trial. Applied Nursing Research. 2018;42:62-9. 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;12:311. Harirchi I, Montazeri A, Zamani Bidokhti F, Mamishi N, Zendehdel K. Sexual function in breast cancer patients: a prospective study from Iran. Journal of experimental & clinical cancer research : CR. 2012;31(1):20. Marvi N, Golmakani N, Miri HH, Esmaily H. The Effect of Sexual Education based on Sexual Health Model on the Sexual Function of Women with Infertility. Iranian Journal of Nursing and Midwifery Research. 2019;24(6):444-50. Boswell EN, Dizon DS. Breast cancer and sexual function. Translational andrology and urology. 2015;4(2):160. Bagherzadeh R, Sohrabineghad R, Gharibi T, Mehboodi F, Vahedparast H. Effect of mindfulness-based stress reduction training on revealing sexual function in Iranian women with breast cancer. Sexuality and Disability. 2021;39:67-83. Moegele M, Buchholz S, Seitz S, Lattrich C, Ortmann O. Vaginal Estrogen Therapy for Patients with Breast Cancer. Geburtshilfe und Frauenheilkunde. 2013;73(10):1017-22. Rostamkhani F, Ozgoli G, Merghati Khoei E, Jafari F, Alavi Majd H. Effectiveness of the PLISSIT-based Counseling on sexual function of women. Advances in Nursing & Midwifery. 2012;21(76):1-9. Greenberg JS, Bruess CE, Oswalt SB. Exploring the dimensions of human sexuality: Jones & Bartlett Publishers; 2014. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA: a cancer journal for clinicians. 2019;69(1):7-34. Brotto LA, Basson R. Group mindfulness-based therapy significantly improves sexual desire in women. Behaviour Research and Therapy. 2014;57:43-54. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4196518","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":286631691,"identity":"e019edf0-c5d9-42fb-ae4b-caa77d8b8210","order_by":0,"name":"Azadeh Jamshidi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYJACCQYeBgY2+ccHQGwZ4rXwMaQlgNg8RGoBAjmGHAMQTVgLf//hhzc+yNhFszGc+fzqRo0FDwP74aMb8Npw4Jix5Qye5Nw2xt5t1jnHgA7jSUu7gdeagw1m0jw8zLltzLzbjHPYgFokeMzwapE/zP5N+g9PfW4bG88z45x/RGgxOMZjJs3Aczi3DWjV49w2IrQYnuEptuzhOQ5UzGbGnNsnwcNGyC9y549vvPGzpzp3/gzmx59zvtXJ8bMfPobf+yDA2AOm2MARxEZQORj8AJPMH4hTPQpGwSgYBSMNAAC86UMDhl2PYwAAAABJRU5ErkJggg==","orcid":"","institution":"Bushehr University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Azadeh","middleName":"","lastName":"Jamshidi","suffix":""},{"id":286631693,"identity":"521b58c4-b23e-4e58-b0e0-0b8a0193ea7a","order_by":1,"name":"Taiebeh Gharibi","email":"","orcid":"","institution":"Bushehr University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Taiebeh","middleName":"","lastName":"Gharibi","suffix":""},{"id":286631694,"identity":"3d8fccd9-086f-4a46-a07c-edce4b11a6b3","order_by":2,"name":"Farzaneh Noroozi","email":"","orcid":"","institution":"Bushehr University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Farzaneh","middleName":"","lastName":"Noroozi","suffix":""},{"id":286631695,"identity":"4e86b7a4-c7cd-4e1c-a1a8-c4ef9d5d38a7","order_by":3,"name":"Razieh Bagherzadeh","email":"","orcid":"","institution":"Bushehr University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Razieh","middleName":"","lastName":"Bagherzadeh","suffix":""}],"badges":[],"createdAt":"2024-03-31 16:44:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4196518/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4196518/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54107822,"identity":"9c48b03d-f532-4c38-bca0-6e9f1c6c1415","added_by":"auto","created_at":"2024-04-04 17:31:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25474,"visible":true,"origin":"","legend":"\u003cp\u003eThe consort diagram of the trial\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4196518/v1/de684196555594ee9c446d58.png"},{"id":56655291,"identity":"e8726bfe-ef60-40f9-b77b-1ad317c7890a","added_by":"auto","created_at":"2024-05-17 09:44:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":924634,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4196518/v1/a77042bd-9da0-476a-8061-b37eb32935b0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer","fulltext":[{"header":"Background","content":"\u003cp\u003eBreast cancer (BC) is the most common malignancy among women worldwide, with approximately 1.7\u0026nbsp;million new cases per year. It accounts for 25% of all cancers in Iran, and its incidence is increasing globally and in Iran (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The age of onset of breast cancer in Iran is a decade younger than that in women in developed countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Therefore, breast cancer poses a significant health challenge in the Eastern Mediterranean region, including Iran (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Nowadays, significant efforts are being made to improve the diagnosis and treatment of breast cancer. As a result, the survival rate of breast cancer patients has increased in recent years. However, breast cancer treatment is associated with side effects (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Side effects such as nausea and vomiting, weakness, fatigue, hair loss, skin burns and lesions, changes in breast appearance (which are considered as a sexual identity in various cultures), ovarian dysfunction, and subsequent decrease in estrogen levels leading to vaginal atrophy, decreased vaginal lubrication, reduced vascular congestion, and decreased libido. These side effects have a profound negative impact on individuals' body image and self-esteem (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Ultimately, breast cancer and its treatment side effects, through physical debilitation, reduced ability to perform daily tasks, frequent and prolonged hospitalizations, disruption of feminine identity and personality, issues such as fatigue, anxiety, depression, feelings of isolation and social limitations, fear of disease progression and death, sleep disturbances, psychological distress, irritability, and in the case of being married, fear of infertility and concerns about spousal reactions, significantly diminish the self-efficacy of these patients (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Self-efficacy refers to an individual's belief in their ability to cope with cancer and its treatment. Several studies have reported that highly self-efficacious patients experience less anxiety and depression and are able to adapt to stressful situations and maintain a good quality of life (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Conversely, low levels of self-efficacy have a negative impact on all dimensions of quality of life (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Meanwhile, sexual function has received particular attention among the various components of quality of life(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Sexual function is an important aspect of health and an integral part of a satisfying life, aiming to achieve sexual pleasure (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Studies have shown that at least 68 to 70 percent of women with breast cancer experience some form of sexual dysfunction(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In Iran, a study has shown that 47 percent of Iranian women with breast cancer have sexual dysfunction (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Sexual dysfunction can have detrimental effects on quality of life, self-esteem, sense of completeness, and interpersonal relationships for women, leading to emotional problems, family conflicts, divorce, and fertility-related issues (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In general, sexual function is an important aspect of quality of life that is directly affected by the psychological burden of breast cancer and its treatment, as well as through the reduction of self-efficacy (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). However, in societies like Iran where sexual issues are considered taboo, there have been limited studies on the psychological aspects of the disease, such as sexual problems (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Among these studies, only a few interventions have been conducted using educational theories (\u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The most effective educational programs are based on theory-driven approaches that stem from behavior change models (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). One of the behavior change theories in the field of learning is Bandura's Social-Cognitive Theory (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). According to this theory, self-efficacy, which is an individual's belief in their ability to perform a specific task, is one of the strongest determinants in regulating human behavior. When self-efficacy levels are high, there is a greater likelihood that an individual will effectively perform a specific behavior. Conversely, low levels of self-efficacy are associated with pessimistic thoughts about one's abilities, leading to an inability to control emotional states, creating feelings of emptiness, sadness, and vulnerability to life events and pressures (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Since self-efficacy is considered a key psychological resource for coping with chronic illnesses (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), sexual self-efficacy is essential for having a satisfactory and desirable sexual performance (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). It has been found that the sexual self-efficacy of women with breast cancer is lower compared to healthy women (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and interventions based on self-efficacy theory have not been conducted in this population. It seems necessary to conduct such research in these patients to determine the effectiveness of counseling and education based on this theory. If the effectiveness of this intervention is proven, counseling and education using this theory can be used as an easy and cost-effective method alongside other medical interventions, leading to an improvement in the quality of life for these patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eDesign\u003c/p\u003e \u003cp\u003eThis was a randomized controlled trial with an experimental and a control group, using the pretest, posttest, and follow-up design.\u003c/p\u003e \u003cp\u003ePatient population and sampling\u003c/p\u003e \u003cp\u003eThe sample included all women with BC visiting the hematology wards of hospitals and clinics in Bushehr, Iran, in 2023\u0026ndash;2024. With the mean and standard deviation of sexual function in the experimental group (M\u0026thinsp;=\u0026thinsp;49.21, SD\u0026thinsp;=\u0026thinsp;7.6) and control group (M\u0026thinsp;=\u0026thinsp;10.14, SD\u0026thinsp;=\u0026thinsp;1.8) based on Fatehi et al, (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) the alpha Type I error (α\u0026thinsp;=\u0026thinsp;0.05), and 90% power, a sample size of 42 was obtained. After considering a 20% dropout rate, a sample size of 50 (25 for each group) was determined. Purposive sampling was then performed, and 50 women with BC volunteered to participate in the study. The participants were randomly assigned to the experimental and control groups by block randomization using 5 blocks (25 participants per group).\u003c/p\u003e \u003cp\u003eInclusion and exclusion criteria\u003c/p\u003e \u003cp\u003eThe inclusion criteria were consent and willingness to participate in the study, having BC for the first time, undergoing breast surgery or at least lobectomy, being married, being of reproductive age, no use of drugs affecting sexual activity and antidepressants, having the physical ability to attend the meetings, at least three months having passed since the last chemotherapy/radiotherapy, having at least one domain of sexual dysfunction (score below 3.9), and not having attended any formal education about sexual issues over the past six months. The exclusion criteria were pregnancy or initiation of psychiatric pharmacotherapy at the time of our intervention, recurrence of disease, and disorders interfering with sexual functioning (psychological problems, Alzheimer's, mental retardation, and multiple sclerosis).\u003c/p\u003e \u003cp\u003eMeasures\u003c/p\u003e \u003cp\u003eData gathering tools consisted of a demographic questionnaire and the female sexual function index (FSFI) (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). The FSFI included 19 items evaluating six domains of female sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain during intercourse) over 4 weeks. Sexual desire was assessed with two items. Arousal and lubrication were assessed with four items. Orgasm, satisfaction, and pain were assessed with three items. Response ranges were 1\u0026ndash;5 for items 1, 2, 15, 16, and 0\u0026ndash;5 for other items. The score for a domain with two, three, and four questions was 0.6, 0.4, and 0.3, respectively. The translations and cultural adaptation of this tool were previously done, and its validity was examined using the experts' opinion. Also, its reliability was confirmed by a Cronbach's alpha coefficient of 0.85 (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003eThe intervention was administered from 2023 to 2024. Eligible patients were asked to participate in the study and received information about the trial and voluntary participation. They had the right to discontinue participation or withdraw their consent at any time. Patients who wanted to participate signed a written informed consent form before the start of the study. The patients willing to participate in the study filled out the demographic information form and the Female Sexual Function Index (FSFI) questionnaire. Then, the patients with dysfunction in at least one domain of sexual function (score below 3.9), who had other inclusion criteria, were included in the study and assigned to the experimental and control groups by block randomization. The intervention group received 2 group training sessions for 90\u0026ndash;120 minutes. Then, patients were divided into groups of 3\u0026ndash;4 people, and each group received 3 counseling sessions for 2 hours (one session per week) during one month. Finally, weekly follow-up was done by phone in the intervention group for one month. The content of the educational and counseling sessions was designed based on the four main aspects of self-efficacy theory, which include individual successful experiences, vicarious experiences (observing or expressing experiences of successful models), verbal persuasion, and attention to patients' physiological and emotional reactions (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The contents presented in the training and counseling sessions are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The Intervention method included group education, group counseling, group discussions, question and answer sessions, participatory learning techniques, and sharing positive experiences. The educational media used included photographs, videos, and PowerPoint presentations. No intervention was provided to the control group. To respect ethical considerations, at the end of the study, the educational booklet, collected based on reliable references, was given to the control group. The FSFI questionnaire was filled out by both groups before the intervention, immediately after the intervention, and at the follow-up (one month after the intervention).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEducational and Consulting intervention based on Self-efficacy theory\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSessions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContent/Techniques to increase self-efficacy\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Offering insights into the advantages of enhancing sexual performance (Raising awareness and motivating the audience by recalling positive past experiences to boost self-confidence and encourage behavior)\u003c/p\u003e \u003cp\u003e- Acquiring knowledge about Anatomy and function of the male and female reproductive systems, understanding how sexual organs influence the development of satisfying sexual relationships, and comprehension of the sexual cycle (Breaking down behavior into simple components)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Describing common sexual disorders in both men and women.\u003c/p\u003e \u003cp\u003e- Providing solutions for sexual dysfunction and creating a satisfying relationship (helping alleviate concerns, anxiety, and depression related to sexual performance issues, paying attention to physiological responses)\u003c/p\u003e \u003cp\u003e- Offering interviews or the presence of successful patients in this field to build self-confidence (providing role models or surrogate experiences)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird to fifth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Familiarizing oneself with effective interpersonal skills in creating a sexual relationship\u003c/p\u003e \u003cp\u003e- Providing solutions for sexual dysfunction (helping alleviate concerns, anxiety, and depression related to sexual performance issues, paying attention to physiological responses)\u003c/p\u003e \u003cp\u003e- Identifying personal barriers (false beliefs) and paying attention to physiological responses (anxiety and depression)\u003c/p\u003e \u003cp\u003e- Offering strategies to overcome obstacles in sexual relationship disorders after surgery and expressing the experiences of successful individuals (providing role models or surrogate experiences)\u003c/p\u003e \u003cp\u003e- Providing positive feedback and verbal encouragement in response to patients' efforts to change false beliefs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eAt the outset of the study, the intention-to-treat analysis was taken into account. Out of 50 participants, two cases from the control group and three cases from the experimental group refused to continue the study, and the analysis was performed on 45 individuals (22 in the intervention and 23 in the control group) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All the participants remained in their respective groups. All the participants in the experimental groups (n\u0026thinsp;=\u0026thinsp;22) participated in all the sessions. Therefore, the intention-to-treat analysis was similar to the per-protocol. The data were analyzed in SPSS 20. To evaluate the normality of the distribution of the variables, the Shapiro-Wilk test was carried out. All variables showed a normal distribution in both groups and at all three evaluation times. In line with the research objectives, descriptive statistical indices (mean, standard deviation, percentage, frequency) and analytical tests including the Independent T-test, Mann-Whitney U, Chi-square, and Fisher's exact test were used to compare demographic variables. Additionally, repeated-measures analysis of variance (ANOVA), Least Significant Difference (LSD) test, and Mann-Whitney U were performed for within- and between-groups comparisons. The significance level was set at \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the intervention and control groups was 42.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.88 and 43.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.20 years, respectively. There was no significant difference between the groups in terms of mean age (P\u0026thinsp;=\u0026thinsp;0.57, Z\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.561). Other demographic data were similar, and the groups were homogeneous (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Within-group comparison using repeated-measures ANOVA showed that the group-by-time interaction is not significant for the sexual desire, lubrication, and pain domains (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The follow-up LSD test showed that in the posttest stage, statistically significant improvements were noted in the intervention group for the arousal (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), orgasm (P\u0026thinsp;=\u0026thinsp;0.008), sexual satisfaction (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and overall FSFI score (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), which did not have a significant statistical difference until the follow-up stage. In the control group, overall FSFI score, orgasm, and sexual satisfaction decreased at the follow-up stage compared to those of the pretest and posttest (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Between-groups comparison using Mann-Whitney U showed that the average changes in sexual desire and pain domains did not have a statistically significant difference between the two groups. The average changes in overall FSFI score and other domains from pretest to posttest and follow-up significantly increased in the intervention group and decreased in the control group. The average score of changes between posttest and follow-up in the two groups did not show a statistically significant difference (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of demographic variables and the variables related to disease between intervention and control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention group frequency (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group frequency (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value (Fisher or x\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.528(2.682\u003csup\u003e*\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(34.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(21.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(8.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.636(0.006)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(77.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(78.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHusband's education level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.395(3.163\u003csup\u003e*\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(30.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(17.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(39.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHusband's Job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.441(3.721\u003csup\u003e*\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmloyee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(21.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFreelancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(56.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncome status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than expenses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.989(0.314\u003csup\u003e*\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEquivalent expenses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(59.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(56.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than expenses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnilateral mastectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.879(0.476\u003csup\u003e*\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral mastectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLumpectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(52.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTamoxifen use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(59.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(69.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.422(1.828\u003csup\u003e*\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20 mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(21.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20 mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(8.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eThe statistic tests used is the chi-square or Fisher\u0026rsquo;s exact test\u003c/p\u003e \u003cp\u003e*Fisher exact test is done\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDetermining the effect of time and group-by-time interaction on sexual function and its domains\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c7\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003eThe effect of time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c10\" namest=\"c8\" rowspan=\"2\"\u003e \u003cp\u003eGroup-by-time interaction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSig\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSig\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDesire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.61\u0026thinsp;\u0026plusmn;\u0026thinsp;.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eArousal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e6.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLubrication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOrgasm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e6.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e5.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.922\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e4.402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e6.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTotal score of FSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.04\u0026thinsp;\u0026plusmn;\u0026thinsp;8.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e29.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e4.758\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e45.703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e6.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.67\u0026thinsp;\u0026plusmn;\u0026thinsp;8.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.84\u0026thinsp;\u0026plusmn;\u0026thinsp;8.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.80\u0026thinsp;\u0026plusmn;\u0026thinsp;8.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.61\u0026thinsp;\u0026plusmn;\u0026thinsp;8.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003eThe statistical test used is repeated measures ANOVA\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Comparing pairwise within-group variables where the group-by-time interaction has been found to be significant for them\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTime A\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTime B\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean difference\u003c/p\u003e \u003cp\u003e(A \u0026ndash; B)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eConfidence Interval 95% for Mean difference\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eminimum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003emaximum\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eArousal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.593\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eOrgasm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.331\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eSatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.828\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.736\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.265\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.471\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eTotal score of FSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.589\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.761\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eThe statistical test used is follow-up LSD test\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean changes comparisons of total sexual function and its domain between intervention and control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eZ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDesire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epost-test\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(-\\)\u003c/span\u003e\u003c/span\u003epre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;pre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;post-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eArousal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epost-test\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(-\\)\u003c/span\u003e\u003c/span\u003epre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-3.758\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;pre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;post-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.461\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLubrication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epost-test\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(-\\)\u003c/span\u003e\u003c/span\u003epre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;pre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;post-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.885\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOrgasm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epost-test\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(-\\)\u003c/span\u003e\u003c/span\u003epre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;pre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;post-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.753\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epost-test\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(-\\)\u003c/span\u003e\u003c/span\u003epre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.964\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;pre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;post-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.379\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epost-test\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(-\\)\u003c/span\u003e\u003c/span\u003epre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;pre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.881\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.379\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;post-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.456\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTotal FSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epost-test\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(-\\)\u003c/span\u003e\u003c/span\u003epre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-3.783\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;pre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efollow-up\u0026mdash;post-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.474\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eThe statistical test used is Maan-whitney\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study was conducted with the aim of investigating the effect of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer.\u003c/p\u003e \u003cp\u003eThe results indicated that in the intervention group, the intervention resulted in an increase in the overall FSFI score compared to before the intervention until the post-test and follow-up stages. This finding is consistent with the results of studies conducted by Shahin et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), Keshavarz et al. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), Zangeneh et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), and Alimohammadi et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The results indicate that the intervention had no effect on the desire domain, which contradicts the mentioned studies and aligns with the study by Saboula et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Considering that a study in Switzerland using the FSFI demonstrated that the only predictor of sexual desire is the quality of the relationship. However, in addition to breast cancer, various factors can influence the quality of the relationship and ultimately sexual desire, and it is not possible to control all of these factors (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The results showed that the intervention improved the arousal domain, which contradicts the studies conducted by Alimohammadi et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) and Marvi et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). The target group in the study by Ali Mohammadi et al. had no physical or mental disorders, and in the study by Moravi et al. they had not experienced any stressful conditions in the past 6 months. Perhaps the reason for the lack of impact of interventions on the arousal domain was the high average motivation score at the beginning of the study, while in the current study, the arousal domain had the lowest initial average score. In the current study, sensory-focused exercises, both sexual and non-sexual, along with challenging false beliefs, which are two main mechanisms in cognitive-behavioral interventions, were taught based on the self-efficacy theory (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). It seems reasonable to suggest that this intervention can enhance the arousal domain.The findings indicated an increase in lubrication levels in the experimental group compared to the control group, which contradicts the study conducted by Bagherzadeh et al. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). This difference could potentially be attributed to the differences in the interventions used in the respective studies. Lubrication is not solely caused by psychological disorders and has a predominantly physical nature, requiring interventions that address the physical aspect as well (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Therefore, in the current study, local estrogen therapy, which is the most effective method for treating vaginal atrophy after breast cancer (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e), was used, along with the use of lubricants. The results showed that the intervention improved orgasm and sexual satisfaction domains, which contradicts the study by Alimohammadi et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). In the study by Alimohammadi et al. ,the participants were newly married women, and since gaining experience with a sexual partner is effective in achieving orgasm (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), this may be the reason for the difference in results between the two studies. Considering that the number of orgasms during each sexual encounter is directly related to sexual satisfaction (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), the reason for the effect of the current study and the lack of effect in the study by Alimohammadi et al. on sexual satisfaction may be orgasms. In the study conducted by Shahin et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), there was no change in the orgasm domain compared to before the intervention. The reason for this difference may be due to the target group. In the current study, about 45% of the patients had only a part of the breast removed, while in the study by Shahin et al. all patients had undergone mastectomy surgery, resulting in more significant changes in the body. These changes could potentially hinder focus during sexual intercourse due to negative body image, whereas orgasms occur when a woman is able to maintain her focus. The results showed that the intervention had no effect on the pain domain, which is consistent with the studies by Alimohamadi et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), Marvi et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), and Bagherzadeh et al. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). The reason for this could be the limitation of research tools (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). The Female Sexual Function Index measures the presence of pain rather than its intensity and severity. Perhaps using a tool that measures the intensity of pain could demonstrate the impact of the intervention on pain management (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). In the control group, the overall FSFI score and most of its domains showed a decreasing trend, which is consistent with the study by Baqerzadeh et al (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). This can be explained as follows: If effective psychological interventions are not performed on breast cancer patients, their sexual performance will show a decreasing trend.\u003c/p\u003e \u003cp\u003eThis study had some limitations. One of the limitations was the lack of participation of husbands in the research. Since sexual function depends on the performance of both partners, studies that involve interventions for both parties may yield better results. The second limitation was the sample size. It appears that the sample is small and may not allow us to easily generalize the findings to larger populations. Additionally, considering the limited duration of the follow-up period, which was one month, caution should be exercised when making statements about the long-term effects of this intervention.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe scores of the overall FSFI and most of its domain were higher in the experimental group than in the control group, an ability that can be attributed to the effect of Sexual education and counseling. It is recommended to use this non-invasive, low-cost, and easy method together with other medical procedures. Although some of the findings were not statistically significant, this intervention is clinically important.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all participant females and thank Dr Rekabpour (Oncologist) for his guidance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTG, FN and RB designed the study. Intervention and Data collection: AJ and TG. Data analysis: RB. AJ Drafted the manuscript and R.B prepared tables. TG, FN and RB read, edited for scientific accuracy, and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by Bushehr University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe anonymized datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no conflicts of interest in this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis paper is extracted from a master\u0026rsquo;s degree thesis of the Faculty of Nursing and Midwifery; which was approved in 2023 and was Research Ethics Committee (Code:\u0026nbsp;IR.BPUMS.REC.1402.071) and IRCT code (IRCT20231102059930N1). All methods were carried out in performed in accordance with the Declaration of Helsinki. A written consent was further obtained from all the study samples and was assured of data confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[1]Student Research Committee, Bushehr University of Medical Sciences, Bushehr, Iran. \u003csup\u003e2\u003c/sup\u003eDepartment of Midwifery, Nursing and Midwifery Faculty, Bushehr University of Medical Sciences, Bushehr, Iran\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlizadeh M, Ghojazadeh M, Piri R, Mirza Aghazadeh Attari M, Mohammadi S, Naghavi Behzad M. Age at Diagnosis of Breast Cancer in Iran: A Systematic Review and Meta-Analysis. 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Behaviour Research and Therapy. 2014;57:43-54.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, Self-efficacy theory, Sexual counseling, Sexual education, Sexual function","lastPublishedDoi":"10.21203/rs.3.rs-4196518/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4196518/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The diagnosis and treatment of breast cancer are associated with side effects that can affect patients' self-efficacy and various aspects of their quality of life, including their sexual function. Therefore, this study was conducted with the aim of investigating the effect of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer. \u003cbr\u003e\n \u003cstrong\u003eMethod:\u003c/strong\u003e This randomized controlled trial used a pretest, posttest, control group, and one-month follow-up design. It included 45 female breast cancer survivors, recruited from the clinics and hematology wards of Bushehr, Iran. The inclusion criterion was that at least three months should have passed since the last chemotherapy/radiotherapy. The participants were randomly assigned to two experimental and control groups. The experimental group received two training sessions and three counseling sessions based on efficacy theory. A demographic information form and a female sexual function index questionnaire were used for data collection, and the participants completed the questionnaire in the pretest, posttest, and follow-up stages. Chi-square, Mann–Whitney U, repeated-measures ANOVA, and Fisher's Least Significant Difference (LSD) test were used to analyze the data. P\u0026lt;0.05 was considered statistically significant. \u003cbr\u003e\n \u003cstrong\u003eResult:\u003c/strong\u003e At the posttest stage, statistically significant improvements were noted in the intervention group for arousal (P\u0026lt;0.001), orgasm (P = 0.008), sexual satisfaction (P\u0026lt;0.001), and overall FSFI score (P\u0026lt;0.001), which did not have a significant statistical difference until the follow-up stage. In the control group, the overall FSFI score, orgasm, and sexual satisfaction decreased at follow-up compared to those of the pretest and posttest. \u003cbr\u003e\n \u003cstrong\u003eConclusion:\u003c/strong\u003e The scores of overall FSFI and most of its domains were higher in the experimental group than in the control group, an ability that can be attributed to the effect of sexual education and counseling. It is recommended to use this non-invasive, low-cost, and easy method together with other medical procedures.\u003c/p\u003e","manuscriptTitle":"Effects of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-04 17:31:21","doi":"10.21203/rs.3.rs-4196518/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c9972342-9856-491a-8c48-08d24a22807d","owner":[],"postedDate":"April 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-17T09:36:04+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-04 17:31:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4196518","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4196518","identity":"rs-4196518","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}