Sexual Counseling and Breast Cancer: A Systematic Analysis of the Predictive Effect on Women's Health Outcomes

Sexual Counseling and Breast Cancer: A Systematic Analysis of the Predictive Effect on Women's Health Outcomes | 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 Sexual Counseling and Breast Cancer: A Systematic Analysis of the Predictive Effect on Women's Health Outcomes BÜŞRA DOLKUN, MERVE İÇÖZ, MUAZEZ KÜÇÜKKAYA, ZEKİYE TURAN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7813921/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective: This study aimed to determine the effects of model-based sexual counseling on the health of women diagnosed with breast cancer and those who have survived breast cancer. Methods: A comprehensive literature review was conducted using six databases, Google Scholar, Cochrane Library, PubMed, Web of Science, ScienceDirect, and Medline, covering all quantitative studies published up to December 15, 2024, that met the inclusion criteria. The keywords used were breast cancer, counseling models, ALLOW, PLISSIT, EX-PLISSIT, BETTER, GES, IMB, and ALARM. Results: Fifteen studies published between 2015 and 2024 were included, with a combined sample size of 1,350 participants. Sixteen distinct outcomes were reported regarding the positive impact of sexual counseling models on women’s health, including sexual desire, arousal, lubrication, orgasm, satisfaction, dyspareunia, anxiety levels, overall quality of life, sexual distress, sexual quality of life, sexual functioning, sexual compatibility, body image, couple satisfaction, and treatment-related side effects. This systematic review concluded that sexual counseling using established models can effectively improve women’s health in those diagnosed with or surviving breast cancer. Conclusion and Recommendations: This review shows that interventions based on sexual counselling models not only improve sexual problems but also address a range of issues including side effects, marital adjustment and body image. Midwives, nurses and all health professionals providing primary care to women with breast cancer are advised to use appropriate sexual counselling models in their practice. Further research is needed to clarify the broader impact of model-based sexual counselling on women’s overall health. Sexual counseling models breast cancer midwifery systematic review HİGHLİGHTS What is already known Breast cancer patients experience many bio-psycho-social problems. Counseling using sexual counseling models is effective in improving women's health in women with breast cancer. Multiple counseling models are used to improve health outcomes for women with breast cancer. What This Paper Adds The current study; It has been shown that interventions using the sexual counseling model not only improve sexual problems but also improve many problems affecting women's lives such as side effects, marital adjustment, and body image. To our knowledge, this is the first article to present the pooled results of model-based sexual counseling studies conducted with women with breast cancer or survivors. INTRODUCTION Breast cancer is the most common cause of cancer-related deaths among women in developed countries and the second leading cause of cancer-related deaths in developing countries (Zangeneh et al., 2023 ). According to Globocan 2020 data, its global incidence is 47.8 per 100,000, comparable to the 47.7 per 100,000 in Türkiye. As the breast symbolizes femininity and sexuality, alterations in breast tissue lead to significant psychological and social challenges (Nazarzadeh et al., 2024 ). Changes in both physical and emotional levels can cause deterioration of women’s social lives (Bokaei et al., 2023). Breast cancer negatively affects women’s sexual function and self-esteem, resulting in adverse body image, a diminished sense of femininity, and reduced sexual activity. Such negative perceptions make women more prone to low self-esteem, sexual dysfunction, and deteriorated quality of life (Farnam et al., 2021 ). Although the incidence of breast cancer has risen worldwide, advances in surgical interventions, chemotherapy, radiotherapy, and hormone therapy have increased the survival rate to approximately 90% (Zanganeh et al., 2023; Bahgeri & Mazaheri., 2015). While advanced treatments prolong life, they also expose women to the adverse effects of the disease and its treatment, such as psychological distress (anxiety and depression) and physical challenges (hair loss, pain, fatigue, sleep disturbances, and sexual dysfunction). Addressing these side effects is crucial for improving patient-centered outcomes and quality of life among women with breast cancer (Bokaei et al., 2023). Sexual health is an important component of the quality of life. However, the diagnosis and treatment of breast cancer can damage intimate relationships and sexual functioning, thereby lowering overall well-being (Olcer & Oskay, 2022 ).The prevalence of sexual problems among women with breast cancer ranges from 40% to 80% (Zangeneh et al., 2023 ; Cobo-Cuenca et al., 2018 ). Women may experience decreased sexual desire, dissatisfaction, loss of interest in their partner, vaginal atrophy, dryness, dyspareunia, difficulty with arousal, and anorgasmia (Zangeneh et al., 2023 ; Olcer & Oskay, 2022 ; Shalamzari et al., 2024 ). Moreover, loss or deformity of the breast, often considered a symbol of beauty, motherhood, and sexual attractiveness, can result in concerns related to body image, fear of cancer recurrence, fatigue, pain, and diminished self-esteem, leading to social withdrawal (Olcer & Oskay, 2022 ; Faghani & Ghaffari, 2016 ). Despite these impacts on sexual health, many patients with breast cancer face barriers to receiving relevant sexual counseling. Studies have shown that patients are often reluctant to discuss sexual matters, yet they need information about sexual problems both during and after treatment. Relationship challenges are also common; however, sexual counseling is rarely integrated into routine care by healthcare professionals. Using a structured model to assess sexual health helps professionals systematically guide history-taking and accurately identify sexual issues (Güdek & Yılmaz, 2024 ).The literature demonstrates that counseling or therapy provided by healthcare professionals not only enhances psychological adaptation, self-perception, and sexual functioning but also supports personal independence and quality of life in individuals undergoing cancer treatment (Işık, 2014 ). Midwives and nurses play a pivotal role in recognizing psychosocial problems in breast cancer patients. Given the necessity of a holistic bio-psychosocial approach in cancer care, medical treatment alone is insufficient. Model-based counseling delivered at the professional level can yield more tangible and desired outcomes. In light of these findings, the present study aimed to determine the effects of individual model-based sexual counseling on women’s health among those diagnosed with or surviving breast cancer. METHODS Research Strategy and Selection Process A systematic literature search was performed using Google Scholar, the Cochrane Library, PubMed, Web of Science, ScienceDirect, and Medline. These databases were selected because they index a broad array of health-related studies (Gray et al., 2016). The database search was conducted between December 5 and December 15, 2024, with the support of Sakarya University and Istanbul University-Cerrahpaşa libraries. The search encompassed all dates available in these databases up to December 15, 2024, without imposing any temporal restrictions. Quantitative studies—experimental, quasi-experimental, case-control, cohort, and randomized controlled trials—were eligible for inclusion. Systematic reviews follow a stringent methodology that involves searching the entire corpus of relevant research, applying inclusion criteria, and synthesizing findings (Higgins et al., 2011;,Hanley & Cutts, 2013). Systematic reviews are considered the gold standard because of their comprehensive literature screening and minimal author bias (Çınar, 2021). English-language searches used the strings “breast cancer” AND “counseling models” AND “ALLOW” and were repeated separately with “PLISSIT,” “EX-PLISSIT,” “BETTER,” “GES,” “IMB,” and “ALARM.” Similar terms were employed in Turkish: “meme kanseri” VE “danışmanlık modelleri” and then individually “PLISSIT,” “EX-PLISSIT,” “BETTER,” “GES,” “IMB,” “ALARM,” and “ALLOW.” The study selection was guided by the PICOS framework [16]: P (Participants): Women diagnosed with breast cancer or survivors without restrictions on disease stage or age. I (Interventions): Interventions involving recognized sexual counseling models. C (Comparisons): No passive (waiting list) or active (alternative therapies) comparison group. (Outcomes): Any quantitative measure of women’s health outcomes (such as sexual function, quality of life, and side effects). S (Study Designs): Experimental, case-control, cohort, quasi-experimental, or randomized controlled studies published in English or Turkish. No restrictions on publication date were included. The exclusion criteria were non-model-based counseling, qualitative research, meta-syntheses, studies on male participants, interventions other than breast cancer, and theses. A total of 378 studies were initially identified, of which 15 met the eligibility criteria. The PRISMA flow diagram (Liberati et al., 2009) illustrates the selection process. Three researchers (BD, Mİ, and MK) independently screened titles and abstracts. Any disagreements were resolved by consensus. EndNote software was used for reference management. This review was registered in the PROSPERO database (Registration ID: CRD42025633108). The study followed the PRISMA guidelines, which enhance transparency in study selection (Shamseer et al., 2015). Finally, 15 studies were included and numbered from 1 to 15. Quality Assessment The methodological quality of the included studies was independently evaluated by three researchers and verified by a fourth author. The Joanna Briggs Institute (JBI) Critical Appraisal Checklists were used for case-control, cross-sectional, and cohort studies (Moola et al., 2017). These checklists contain 8, 10, or 11 items rated as “Yes,” “No,” “Unclear,” or “Not Applicable.” A study was deemed: Poor quality if fewer than 50% of items were marked “Yes.” Moderate quality if 51–80% of items were marked “Yes.” High quality if more than 80% of items were marked “Yes.” Moderate quality and High quality studies were included in the study. Data Extraction The primary author developed a data extraction form, capturing each study’s author(s), year, intervention type(s), intervention groups, duration, follow-up, dependent variables, and main outcomes. Missing data were categorized as unavailable if the database provided no information. RESULTS AND DISCUSSION Fifteen studies were included in this review to evaluate the effects of sexual counseling models on women diagnosed with or surviving breast cancer. Table I presents the author(s), publication year, country, title, study aim, sample, research design, measurement tools, primary findings, and conclusions. Overall, 16 main outcomes were reported regarding the positive effects of sexual counseling models on women’s health: sexual desire, arousal, lubrication, orgasm, satisfaction, dyspareunia, anxiety, quality of life, sexual distress, sexual quality of life, sexual function, sexual compatibility, body image, couple satisfaction, marital adjustment, and treatment-related side effects. These findings collectively highlight that the use of sexual counseling models positively affects women’s health in the context of breast cancer. Sexual Function and Functioning This study demonstrated that sexual function and functioning are affected in women diagnosed with or surviving breast cancer (Khoei et al., 2022; Keshavarz et al., 2021; Korkutan & Taylan, 2024; Nazarzadeh et al., 2024; Güdek & Yılmaz, 2024; Olcer & Oskay 2022; Faghani & Ghaffari F 2016; Almeida et al., 2020 ; Zangeneh et al., 2023; Shalamzari el at., 2024; Shahin et al., 2021). Sexual dysfunction refers to problems arising from psychophysiological changes in the sexual response cycle and sexual desire; such issues both reduce an individual’s quality of life and pose significant challenges (Turhan & Akcan, 2022).The physiological response to sexual stimuli comprises arousal, plateau, orgasm, and resolution stages, and a healthy sexual life depends on all of these phases functioning together (Güdek & Yılmaz, 2024). In this study, the PLISSIT-model counseling provided to women was effective in improving sexual function and alleviating sexual distress. The PLISSIT Model is designed such that healthcare professionals can discuss sexual matters with clients and identify sexual problems. The model consists of four steps: beginning with taking an individual’s sexual history and assessing sexuality, offering targeted suggestions, and finally, more intensive treatments. It was developed by Annon in 1976 to address sexual health care needs, and its conceptual schema, Permission, Limited Information, Specific Suggestions, and Intensive Therapy are referred to by the acronym “PLISSIT” (Güdek & Yılmaz, 2024; Annon, 1975; Annon, 2013). In the study by Keshavarz et al. (2021), a PLISSIT-based counseling intervention was conducted with women in seven 60-minute sessions over four weeks, with scales administered before the intervention and again at weeks 2 and 4. Post-intervention findings indicated a statistically significant increase in sexual function scores. In their evaluation of the effectiveness of the PLISSIT Counseling Model on female sexuality, body image, and couple satisfaction in women undergoing breast cancer treatment, Saboula and El-Sayed (2015) reported statistically significant differences in arousal, lubrication, orgasm, satisfaction, and pain among participants. They also found a statistically significant change in the total FSFI scores before and after the intervention. Similarly, in a PLISSIT-based study targeting sexual problems in women diagnosed with breast cancer, Güdek and Yılmaz (2024) noted a statistically significant difference between the initial and final assessment mean scores in desire, arousal, lubrication, orgasm, satisfaction, and pain subdimensions, as well as in the total FSFI scores. In another study, Faghani and Ghaffari (2016) provided PLISSIT-model sexual counseling for post-mastectomy women in four 90-minute sessions—organized by a female researcher for the women and a male researcher for the husbands. The results revealed a statistically significant difference between pre- and post-test scores on the Female Sexual Function Index (FSFI) for the experimental group. A meta-analysis by Korkutan F. (2024) also showed that PLISSIT-based sexual counseling improves sexual function during the postoperative treatment period in breast cancer patients. Moreover, Farnam et al. (2014), who assessed the effectiveness of PLISSIT counseling on sexual problems, reported that sexual distress scores decreased from 22.7 at the start to 6.8 by the end of the study. Developed as an extension of the PLISSIT Model, the EX-PLISSIT Model places the “permission” component at the center of other steps through an integrated rather than strictly sequential approach. This structure allows individuals to express themselves in every phase of the model, not just in a single step (Akcan & Turhan, 2022). One study indicated that online sexual education, based on the EX-PLISSIT Model, significantly increased women’s post-intervention sexual satisfaction scores during breast cancer treatment (Zangeneh et al., 2023). Similarly, Mohammadi et al. (2022), in a study evaluating the EX-PLISSIT Model for female sexual function (FSFI) among cancer survivors, found a notable improvement in sexual function (Mohammadi et al., 2023). Based on the study by Bober et al. (2019), BETTER model interviews helped reduce stress and anxiety in sexual relationships. Consistent with the literature, a controlled study by Olcer and Oskay (2021) aimed to determine the impact of a BETTER model-based counseling program on sexual problems among women with breast cancer. Following the steps of the BETTER Model, the counseling program was implemented in four sessions, each lasting an average of 45–60 minutes at one-week intervals. The study results showed no statistically significant difference between the groups’ initial Female Sexual Function Index (FSFI) subscale or total scores. However, the final assessment revealed a statistically significant difference in lubrication, orgasm, and pain subscales, as well as total FSFI scores. In a separate study using four stages of BETTER-based counseling (introduction, explanation, discussion, and timing), Shahin et al. (2021) demonstrated improved sexual function among participants. Another study involving WhatsApp-based BETTER sexual counseling for breast cancer survivors indicated a significant increase in mean sexual function index scores in the intervention group (Nazarzadeh et al., 2023). Findings by Hummel et al. (2019), which align with the current study, show that coupled sexual counseling based on cognitive behavioral therapy effectively enhances sexual performance, intimacy, and relationship satisfaction in women with breast cancer (Hummel et al., 2019). In yet another study evaluating a BETTER Model–based counseling program for women with breast cancer, researchers observed statistically significant improvements in the lubrication, orgasm, and pain subscales, as well as in total FSFI scores (Olcer & Oskay, 2022) Karakaş and Aslan (2019), who examined the effect of BETTER Model–based counseling on sexual dysfunction in infertile women, found that the experimental group had significantly higher overall FSFI scores on the final assessment compared to the control group. Their study also showed marked increases in orgasm, sexual desire, and lubrication in the intervention group (Karakaş & Aslan, 2019). Moreover, BETTER model interviews have been reported to alleviate stress and anxiety in sexual relationships (Bober et al., 2019). The BETTER Model was developed by Mick and Hughes (2003) for use with oncology nurses. It is a sexual health model comprising six steps emphasizing understanding the individual and promoting respect. The name “BETTER” is formed from the initial letters of its key components—(B)ringing up the topic, (E)xplaining that sex is part of quality of life, (T)elling patients that resources will be found to address their concerns, (T)iming of intervention, (E)ducation regarding sexual side effects of treatment, and (R)ecording (Turhan & Akcan, 2022; Mick et al., 2004). In a study by Shalamzari et al., (2024) comparing the sexual outcomes of the BETTER and PLISSIT models, the BETTER counseling group received four individual sessions of 60–90 minutes each at one-week intervals, all based on the BETTER Model. Another group provided PLISSIT-based counseling over four 60–90 minute sessions at one-week intervals. Four weeks after the intervention, a significant difference in the mean sexual stability scores was found between the two groups, with the BETTER group showing higher scores (54.8 vs. 48.6). In a parallel finding, Karimi et al. (2021) compared BETTER and PLISSIT counseling methods for women with postpartum sexual problems and found that the BETTER Model was more effective than PLISSIT in increasing women’s sexual assertiveness [31].However, the literature review revealed limited studies focusing on the superiority of one model over another. In this study, Khoei et al. (2022), using a Good Enough Sex (GSE) group design for breast cancer patients, observed statistically significant improvements in sexual behavior at 6 and 12 weeks compared with the control group; however, similar improvements were not recorded in the group that received the PLISSIT Model. The effectiveness of PLISSIT compared to GSE has not been previously evaluated in women with breast cancer. Nonetheless, a study by Ahmed et al. (2016) that examined group counseling interventions found that group counseling effectively improved sexual function and alleviated anxiety in cancer survivors (Ahmed et al., 2016). Sexual Quality of Life and Overall Quality of Life This study found that PLISSIT model–based counseling increased women’s sexual quality of life after the intervention (Faghani & Ghaffari, 2016 ; Keshavarz et al., 2021; Korkutan & Taylan ; Almeida et al., 2020). Almeida et al. (2020) and Esmkhani M. (2021) investigated PLISSIT-based sexual counseling for women surviving breast cancer. Improvements in the quality of life were observed, along with an indication that PLISSIT interventions enhanced arousal and showed a trend toward better sexual function (Almeida et al., 2020). Many studies also indicate that survivors of this disease experience a decline in sexual attractiveness and pleasure, which affects their sexual quality of life (SQL) (Karakaş & Aslan, 2019; Karimi et al., 2021). Consistent with these findings, a meta-analysis by Cicek Ozdemir S. (2024) reported that sexual counseling based on the PLISSIT and EX-PLISSIT models improved sexual quality of life in women (Çiçek et al., 2024). Indeed, sexual quality of life is a significant concern for women with breast cancer due to factors such as body image issues and their impact on sexual function. A literature review reveals that healthcare professionals often do not adequately address this topic, potentially due to insufficient communication between patients and providers. For instance, in a study assessing sexual quality of life in younger women with breast cancer, Bobrie et al. (2022) revealed that these women experienced reduced sexual quality of life and weak communication with healthcare professionals. Similarly, the present study shows that quality of life is adversely affected in women with breast cancer. Numerous additional studies have likewise demonstrated that breast cancer and its treatment process negatively influence women’s overall quality of life (Ho et al., 2017; Bouya et al., 2018). According to the findings of Nazarzadeh et al. (2024) regarding the impact of BETTER-based sexual counseling on sexual quality of life, there was a statistically significant difference in the mean sexual quality of life scores at different time points in the intervention group. In contrast, in a study by Olcer and Oskay (2021) using the BETTER Model, the initial evaluation of the “EORTC Quality of Life Questionnaire-BR23” functional scale sub-dimension scores showed that the two groups were similar. Apart from the studies included in this review, no other study has specifically investigated women’s sexual quality of life using the BETTER model. In a quasi-experimental study comparing the BETTER and PLISSIT models, Shalamzari et al. (2022) examined the pre- and post-intervention mean change scores in sexual quality of life. Among the participants who received counseling based on the BETTER model, the mean change in sexual quality of life was significantly higher than that of those who received PLISSIT-based counseling, indicating that the BETTER model was more effective in enhancing sexual quality of life than PLISSIT. However, the literature on model-based sexual counseling for women with breast cancer or other populations, as well as its impact on overall quality of life, remains limited. While the current study suggests that interventions using model-based sexual counseling improve quality of life, it also underscores the need for further research in this area. Body Image This study showed that women’s sexual compatibility and body image are affected by breast cancer and that the counseling interventions implemented have a positive impact on both. In the reviewed studies, PLISSIT-based counseling was found to yield statistically significant improvements in body image sub-dimensions for the participating women (Olcer & Oskay, 2022; Güdek & Yılmaz, 2024; saboula & El Sayed, 2015). In their BETTER Model–based counseling intervention, Olcer and Oskay (2021) observed higher scores on the body image subscale of the EORTC Quality of Life Questionnaire’s functional scale among women in the intervention group. However, when they examined the mean scores of the “Body Contribution Scale,” no statistically significant differences were found between the two groups. In another study, Shahin et al. (2021) provided counseling to women through four phases (introduction, explanation, discussion, and timing) based on the BETTER Model, and the intervention was shown to improve body image. Similarly, Farnam et al. (2021) reported that, in a counseling intervention using the GES model, women’s mean body image scores were higher in the intervention group than in the control group. Developed by Metz and McCarthy, the Good Enough Sex (GES) model aims to reduce sexual problems. It was adapted for couples experiencing sexual issues and is built upon two central concepts: (1) engaging in mutual sexual relations to enjoy intimacy and (2) achieving maximum pleasure within an individual’s capacity when coping with sexual dysfunction, focusing on closeness and mutual admiration. Overall, the model emphasizes developing intimacy and establishing a strong sexual bond rather than focusing solely on intercourse. In the GES Model, each partner is responsible for their own sexuality, working together as a cohesive and intimate team to create a comfortable and functional sexual style (McCarthy & Metz, 2008; Jamalianfar et al., 2021). Breast cancer is the most commonly diagnosed type of cancer in women (Taylan & Kolaç, 2021) Surgical intervention is the most prevalent treatment for breast cancer (American Cancer Society. 2023) and such procedures can profoundly affect women’s body image. Because breasts are widely viewed as symbolic of femininity, sexuality, and attractiveness, surgical treatment for breast cancer may be perceived as a threat to body image, maternal identity, and sexual appeal (Taylan & Kolaç, 2021); these surgeries can negatively influence patients’ perceptions of their bodies, and changes in physical appearance often complicate their psychological well-being (Archangelo et al., 2019; Sel & Beydağ, 2022). Indeed, various studies have confirmed that women who undergo breast surgery experience detrimental effects on their body image (Taylan & Kolaç, 2021; Archangelo et al., 2019; Lundberg. & Phoosuwan, 2022; Bodur & Katran, 2024). Research further indicates that body image concerns in breast cancer patients are associated with depression, anxiety, and changes in social relationships, ultimately affecting the overall quality of life (Taylan & Kolaç, 2021; Ahn & Suh, 2023). This study found that interventions using sexual counseling models contributed positively to body image; however, much of the literature on model-based counseling interventions has focused primarily on sexual health, demonstrating limited research specifically addressing body image. Treatment-Related Side Effects According to Saboula et al. (2015), applying the PLISSIT model to women yielded improvements in all the reported side effects. A statistically significant relationship was identified between pre- and post-intervention side effects, including nausea/vomiting, diarrhea, and pain. Globally, the number of women diagnosed with breast cancer continues to rise, and many must cope with the physical, emotional, and social challenges arising from both the disease and its treatment (Başkaya & Rizalar, 2024). The present study also revealed that sexual counseling positively influenced treatment side effects. This outcome may stem from counseling interventions—grounded in sexual counseling models—enhancing psychosocial well-being, including body image, couple harmony, and marital adaptation. Indeed, in a systematic review of 35 articles, D’egidio et al. (2017) noted that various counseling interventions helped achieve social and psychological rehabilitation in women with breast cancer, suggesting that enhanced social and psychological well-being could ameliorate treatment side effects (D’egidio et al., 2017). Nonetheless, the limited number of studies on this topic highlights a gap in the current literature. Couple Satisfaction, Sexual Harmony, and Marital Adjustment In the study by Saboula, N. and El-Sayed, S. (2015), it was shown that couple satisfaction increased among participating women following the application of the PLISSIT counseling model. There were statistically significant differences in couple satisfaction before and after implementing the PLISSIT model. The total couple satisfaction scores post-PLISSIT counseling improved from 31.90% to 220.0%. Several studies included in this review similarly found that sexual counseling models enhance couple harmony and marital adjustment (Shahin et al., 2021; Saboula & El-Sayed, 2015). Breast cancer and its subsequent treatment may lead to functional changes within the family. Because a woman may be intensely focused on her illness during this period, her capacity to fulfill her spousal role could diminish (Gao et al., 2024).Breast cancer diagnosis may also upset the family’s usual balance, preventing the healthy partner from meeting certain familial and societal expectations (Daniel et al., 2022; Adejoh et al., 2021). Studies have shown that avoidance-focused and self-blaming coping strategies in couples with breast cancer negatively affect overall well-being (Valente et al., 2021).Women with breast cancer may develop concerns over their body image and appearance, which, coupled with confronting a life-threatening disease and significant role changes, can lead to psychological distress (Oers & Schlebusch, 2020). Moreover, hormonal therapy and psychological well-being significantly influence sexual function; therefore, disruptions in these areas can reduce marital adjustment (Favez et al., 2016; Di Mattei et al., 2021). A decline in marital adjustment, role changes, body image concerns, and sexual dysfunction can also detrimentally affect couples’ harmony. Similarly, breast cancer and its treatment have a negative effect on women’s sexual harmony. Indeed, existing research has discovered that the disease and its treatments influence women’s psychological health and marital adaptation, thereby decreasing sexual harmony (Başkaya &Rizalar, 2024; Arıkan et al., 2020). Consistent with the results of this study, Güdek and Yılmaz (2024) examined the effectiveness of a PLISSIT-based counseling intervention for the sexual problems of women with breast cancer and found that the approach improved women’s sexual harmony. Sexual harmony, couple satisfaction, and marital cohesion are interrelated concepts, and difficulties in one area can adversely affect others. Consequently, improving sexual harmony is expected to enhance marital harmony or couple satisfaction. This study showed that model-based interventions positively affected couple satisfaction, sexual harmony, and marital adjustment. In line with the current findings, an investigation of an EX-PLISSIT-based counseling approach in postpartum women demonstrated that model-based interventions heightened marital satisfaction (Dangesaraki et al., 2019). Conclusion and Recommendations Sexual counseling involves providing information about sexual concerns and facilitating a safe return to normal sexual activities with psychosexual assessment and support as integral components ( Mangolian et al., 2021).Healthcare professionals should routinely screen patients for body image and sexual health issues, ensure they feel comfortable discussing such topics, and be prepared to offer information and resources (Wilson et al., 2022). Although numerous sexual counseling models are available, few have been rigorously studied in women with breast cancer. The limited research to date suggests that model-based interventions not only alleviate sexual dysfunction but also positively influence side effects, marital adjustment, and body image. However, existing studies have predominantly focused on sexual outcomes, and other domains remain underexplored. Midwives, nurses, and other health professionals who provide primary care for women with breast cancer are strongly encouraged to integrate model-based sexual counseling into routine practice. Further research is essential to clarify the broader impact of counseling, particularly on body image, treatment-related side effects, and partner relationships. By incorporating diverse models and designs, healthcare professionals can address the complex needs of women with breast cancer more comprehensively and significantly improve their quality of life. Declarations Data availability This is a systematic review; all data have already been published. Conflict of Interest: The authors declare that they have no financial conflict of interest with any institution, organization or person related to this study. Financial Support : The authors declare that the study has not received financial support from any person, institution or organization Author Contribution Study design: BD, Mİ, MK, ZTData collection: BD, MİData analysis: BD, Mİ, MKStudy supervision: BD, Mİ, MKManuscript writing: BD,MİCritical revisions for important intellectual content: BD, ZT References Adejoh S.O., Olorunlana A., Adejayan A. (2021). Patients' experiences of family members' reactions to diagnosis of breast cancer and support in the management of breast cancer in Lagos, Nigeria. Palliat Support Care, 19(5):592–597. doi: 10.1017/S147895152000070X. Ahmed K, Marchand E, Williams V, Coscarelli A, & Ganz PA (2016). Development and pilot testing of a psychosocial intervention program for young breast cancer survivors. PMC, 99(3), 414–420. Ahn, J., & Suh, E. E. (2023). Body image alteration in women with breast cancer: A concept analysis using an evolutionary method. Asia-Pacific Journal of Oncology Nursing, 10, 2-8. https://doi.org/10.1016/j.apjon.2023.100214. Akcan, K., Turhan, İ. (2022). Sexual counseling models. Gevher Nesibe Journal of Medical and Health Sciences, 7(17), 50-56, https://doi.org/10.46648/gnj.382. Almeida, N. G., Knobf, T. M., de Oliveira, M. R., d Salvetti, M., Oriá, M. O., & Fialho, A. V. (2020). A pilot intervention study to improve sexuality outcomes in breast cancer survivors. Asia-Pacific Journal of Oncology Nursing , 7 (2), 161-166. American Cancer Society. (2023). Mastectomy. https://www.cancer.org/cancer/types/breastcancer/treatment/surgery-for-breast-cancer/mastectomy.html Annon, J. (1975). A proposed conceptual scheme for behavioral treatment of sexual problems. J Sex Educ Ther , 2 , 1-15. Annon JS.(2013) The PLISSIT model: a proposed conceptual. General procedures: handbook of behavior therapy with sexual problems.;1:70. Archangelo, S. D. C. V., Sabino, M., Veiga, D. F., Garcia, E. B., & Ferreira, L. M. (2019). Sexuality, depression and body image after breast reconstruction. Clinics, 74, e883. https://doi.org/10.6061/clinics/2019/e883. Arıkan F, Körükçü Ö, Küçükçakal A, Coşkun HŞ.(2020). Determination of Self-Efficacy, Body Image and Sexual Adjustment of Women with Breast Cancer. Eur J Breast Health, 30;16(4):282-289. doi: 10.5152/ejbh.2020.5188. PMID: 33062970; PMCID: PMC7535985. Bober, S. L., Michaud, A. L., & Recklitis, C. J. (2019). Finding sexual health aids after cancer: are cancer centers supporting survivors’ needs?. Journal of Cancer Survivorship , 13 , 224-230. Bobrie A, Jarlier M, Moussion A, Jacot W, D'Hondt V. (2022).Sexual quality of life assessment in young women with breast cancer during adjuvant endocrine therapy and patient-reported supportive measures. Support Care Cancer. 30(4):3633-3641. doi: 10.1007/s00520-022-06810-3. Bodur, B. Y., & Katran, H. B. (2024). Changes in Body Image Perceptions of Patients Who Underwent Surgery Due to Breast Cancer. Fenerbahce University Journal of Health Sciences, 4(2), 315-324. Bagheri, M., & Mazaheri, M. (2015). Body image and quality of life in female patients with breast cancer and healthy women. Journal of Midwifery and Reproductive Health , 3 (1), 285-292. Başkaya, K., & Rizalar, S. (2024). Determination of body image and sexual adjustment in women with breast cancer after surgery. Health Care for Women International , 45(12), 1367-1383. Bokaie, M., Hejazi, N. S., Jafari, M., & Shabani, M. (2023). Effect of online solution-focused counseling on the sexual quality of life of women with a history of breast cancer: a clinical trial. BMC Women's Health , 23 (1), 326. Bouya S, Koochakzai M, Rafiemanesh H, Balouchi A, Taheri S, Badakhsh M.(2018).Health-related quality of life of Iranian breast cancer patients: a meta-analysis and systematic review. Breast Cancer Res Treat. 70(2):205–212. doi: 10.1007/s10549-018-4750-x. Cobo-Cuenca, A. I., Martín-Espinosa, N. M., Sampietro-Crespo, A., Rodríguez-Borrego, M. A., & Carmona-Torres, J. M. (2018). Sexual dysfunction in Spanish women with breast cancer. PloS one , 13 (8), e0203151. Çınar, N. (2021). How to write a good systematic review?. Online Turkish Journal of Health Sciences, 6(2), 310-314. Cicek Ozdemir S, Dogan Gangal A, Senturk Erenel A. (2024).The Effect of Sexual Counseling Based on PLISSIT and EX-PLISSIT Models on Sexual Function, Satisfaction, and Quality of Life: A Systematic Review and Meta-Analysis. Arch Sex Behav , 53(9):3485-3513. doi: 10.1007/s10508-024-02898-2. Epub 2024 Jun 18. Daniel S., Venkateswaran C., Singh C., Hutchinson A., Johnson M.J.(2022). “So, when a woman becomes ill, the total structure of the family is affected, they can't do anything…” Voices from the community on women with breast cancer in India: a qualitative focus group study. Support Care Cancer , 30(1):951–963. doi: 10.1007/s00520-021-06475-4. Dangesaraki, M. M., Maasoumi, R., Hamzehgardeshi, Z., & Kharaghani, R. (2019). Effect of the EX-PLISSIT model on sexual function and sexual quality of life among women after hysterectomy: a randomised controlled trial. Sexual health , 16 (3), 225-232. D’egidio, V., Sestili, C., Mancino, M., Sciarra, I., Cocchiara, R., Backhaus, I., ... & Return To Breast Collaborative group Francesca Di Murro Vanessa Palmeri Lorenza Lia Giulia Paradiso Valerio Aceti Annarita Libia. (2017). Counseling interventions delivered in women with breast cancer to improve health-related quality of life: a systematic review. Quality of Life Research, 26, 2573-2592. Di Mattei VE, Perego G, Taranto P, Mazzetti M, Marotta E, Candiani M, Salvatore S.(2021) The Long-Term Effects of Cancer Treatment on Sexuality and Couple Relationships. Fam Process. ;60(3):853-865. doi: 10.1111/famp.12604. Epub 2020 Oct 8. PMID: 33030242.) Esmkhani, M., Kharaghani, R., Shakibazadeh, E., Faghihzadeh, S., Korte, J. E., & Merghati-Khoei, E. (2021). 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 , 39 , 85-96. Favez N, Cairo Notari S, Charvoz L, Notari L, Ghisletta P, Panes Ruedin B, Delaloye JF. (2016).Distress and body image disturbances in women with breast cancer in the immediate postsurgical period: The influence of attachment insecurity. J Health Psychol, 21(12):2994-3003. doi: 10.1177/1359105315589802. Farnam, F., Khakbazan, Z., Nedjat, S., Dizaji, S. R., & Barjasteh, S. (2021). The effect of good enough sex (GES) model-based sexual counseling intervention on the body image in women surviving breast cancer: a randomized clinical trial. Asian Pacific Journal of Cancer Prevention: APJCP , 22 (7), 2303. Faghani, S., & Ghaffari, F. (2016). Effects of sexual rehabilitation using the PLISSIT model on quality of sexual life and sexual functioning in post-mastectomy breast cancer survivors. Asian Pacific journal of cancer prevention: APJCP , 17 (11), 4845. Gao W, Zhang Q, Wang D, Li X, Zhang L, Xu M, Han J.(2024). The role expectations of young women as wives after breast cancer treatment: A qualitative study. Int J Nurs Sci, 29;11(3):366-373. doi: 10.1016/j.ijnss.2024.05.001. PMID: 39156686; PMCID: PMC11329045. Güdek, G., & Yılmaz, S. (2024). Effectiveness of sexual education given in line with the PLISSIT model for sexual problems of women with breast cancer. Andrology Bullettin) , 26 (2). Gray, J. R., Grove, S. K., & Sutherland, S. (2016). Burns and grove's the practice of nursing research-E-book: Appraisal, synthesis, and generation of evidence. Elsevier Health Sciences. Hanley, T., & Cutts, L. (2013). What is a systematic review?. Counselling Psychology Review , 28 (4), 3-6. Higgins, J. P., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., ... & Sterne, J. A. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj , 343 . Hummel, S. B., van Lankveld, J. J., Oldenburg, H. S., Hahn, D. E., Kieffer, J. M., Gerritsma, M. A., ... & Aaronson, N. K. (2019). Sexual functioning and relationship satisfaction of partners of breast cancer survivors who receive internet-based sex therapy. Journal of sex & marital therapy , 45 (2), 91-102. Ho PJ, Gernaat SAM, Hartman M, Verkooijen HM.(2017). Health-related quality of life in Asian patients with breast cancer: a systematic review. BMJ Open. 2018;8:e020512. doi: 10.1136/bmjopen-2017-020512. Işık, I. (2014). Psychosocial problems developing in breast cancer patients in the post-treatment period and supportive nursing interventions. Education and Research in Nursing, 11(3), 58-64. Jamalianfar, F., Riazi, H., Firoozi, A., Nasiri, M., & Montazeri, A. (2021). The Effectiveness of ‘Good-Enough Sex Model’on Sexual Satisfaction and Sexual Intimacy in Women with Multiple Sclerosis: A Randomized Trail. Sexuality and Disability , 39 (3), 507-519. Karakas, S., & Aslan, E. (2019). Sexual counseling in women with primary infertility and sexual dysfunction: Use of the BETTER model. Journal of sex & marital therapy , 45 (1), 21-30. Karimi, F., Babazadeh, R., Roudsari, R. L., Asgharipour, N., & Esmaily, H. (2021). Comparing the effectiveness of sexual counseling based on PLISSITand BETTER models on sexual selfdisclosure in women with sexual problems after childbirth: A randomized trial. Iranian Journal of Nursing and Midwifery Research , 26 (1), 68-74. Keshavarz, Z., Karimi, E., Golezar, S., Ozgoli, G., & Nasiri, M. (2021). 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 , 21 , 1-8. Khoei, E. M., Kharaghani, R., Shakibazadeh, E., Faghihzadeh, S., Aghajani, N., Korte, J. E., & Esmkhani, M. (2022). Sexual health outcomes of PLISSIT-based counseling versus grouped sexuality education among Iranian women with breast cancer: A randomized clinical trial. Sexual and Relationship Therapy , 37 (4), 557-568 Korkutan, F., & Taylan, S. (2024). Effects of PLISSIT-based sexual counselling on the sexual lives of women with breast cancer: meta-analysis study. Current Psychology , 43 (44), 33844-33855. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., ... & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals of internal medicine , 151 (4), W-65. Lundberg, P. C. & Phoosuwan, N. (2022). Life situations of Swedish women undergoing mastectomy for breast cancer: A qualitative study. European Journal of Oncology Nursing , 57 , 102116. https://doi.org/10.1016/j.ejon.2022.102116. Mangolian Shahrbabaki, P, Mehdipour-Rabori, R, Gazestani, T, Forouzi, M.A. (2021). Iraniannurses' perspective of barrierstosexualcounseling for patientswithmyocardialinfarction. BMC nursing , 20(1), 196. Mick, J., Hughes, M., Cohen, M. Z., & Brant, J. M. (2004). Using the BETTER Model to assess sexuality. Clinical journal of oncology nursing , 8 (1). McCarthy, B. W., & Metz, M. E. (2008). The “Good-Enough Sex” model: a case illustration. Sexual and Relationship Therapy , 23 (3), 227-234. Moola, S., Munn, Z., Tufanaru, C., Aromataris, E., Sears, K., Sfetcu, R., et al. (2017). Checklist for analytical crosssectional studies. Joanna Briggs Inst. 2017; Rev. Man. 6. AvaiableFrom: https://doi.org/10.17221/96/2009-CJGPB. Mohammadi Z, Maasoumi R, Vosoughi N, Eftekhar T, Soleimani M, Montazeri A. (2022). Effect of psychosexual counseling based on the PLISSIT model in improving sexual function and quality of sexual life in gynecologic cancer survivors: a randomized controlled clinical trial. Supportive Care Cancer , 30(11):9117–9126. doi: 10.1007/s00520-022-07332-8. Momeni ES, Danesh M, Moosazadeh M, Hamidi F, Shahhosseini Z.(2023). Sexual Quality of Life of Breast Cancer Survivors: A Cross-Sectional Study. Asian Pac J Cancer Prev. 1;24(5):1621-1627. doi: 10.31557/APJCP.2023.24.5.1621 Nazarzadeh, S., Moghaddam-Tabrizi, F., Haghighi, M., & Gharaaghaji-Asl, R. (2024). Effect of WhatsApp-based BETTER model sexual counselling on sexual function and sexual quality of life in breast cancer survivors: a randomized control trial. BMC women's health , 24 (1), 452. Olcer, Z. O., & Oskay, U. (2022). Effects of the better model based counseling on sexuality of women with breast cancer. International Journal of Sexual Health , 34 (1), 41-54. Oers, H., & Schlebusch, L. (2020). Indicators of psychological distress and body image disorders in female patients with breast cancer. Journal of Mind and Medical Sciences, 7(2), 179-187. https://doi.org/10.22543/7674.72.P179187. Saboula, N., & El-Sayed, S. (2015). Effectiveness of application of PLISSIT counseling model on sexuality for breast cancer’s women undergoing treatment. Am J Nurs Sci , 4 (4), 218-30. Sel, Z., & Beydağ, K. D. (2022). Relationship between body perception, sexual quality of life and marital adjustment in women who underwent surgery for breast cancer. Bandırma Onyedi Eylül University Journal of Health Sciences and Research, 4(2), 119-127. Shalamzari, K. H., Asgharipour, N., Jamali, J., Kermani, A. T., & Babazadeh, R. (2024). Comparing the effect of sexual counseling based on BETTER and PLISSIT models on sexual assertiveness in women with breast cancer after mastectomy. Journal of Education and Health Promotion , 13 (1), 55. Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., & Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Bmj , 349 . Shahin, MA., Amin Ali Gaafar, H., & Lotfi Afifi Alqersh, D. (2021). Effect of nursing counseling guided by BETTER model on sexuality, marital satisfaction and psychological status among breast cancer women. Egyptian Journal of Health Care , 12 (2), 75-95. Shalamzari, K. H., Asgharipour, N., Jamali, J., Kermani, A. T., & Babazadeh, R. (2022). The Effect of Sexual Counseling Based on BETTER and PLISSIT Model on Quality of Sexual Life in Women with Breast Cancer after Mastectomy. Journal of Midwifery & Reproductive Health , 10 (4). Taylan, S., & Kolaç, N. (2021). Body image and sexual adjustment of women who underwent breast cancer surgery. Andrology Bulletin, 23(3), 163-169. Turhan, İ., & Akcan, K. (2022). Current Diagnosis and Treatments for Female Sexual Dysfunction. Gevher Nesibe Journal of Medical and Health Sciences, 7(17), 57-63. Valente M, Chirico I, Ottoboni G, Chattat R.(2021). Relationship Dynamics among Couples Dealing with Breast Cancer: A Systematic Review. Int J Environ Res Public Health. 7;18(14):7288. doi: 10.3390/ijerph18147288. PMID: 34299738; PMCID: PMC8303482. Wilson, C. M., Gee, A., & Mooney, K. (2022). Clinician and patient communication about body image, sexuality, and sexual function in gynecologic cancer patients: An integrative review. Sexuality and Disability , 40 (2), 363–379. https://doi.org/10.1007/s11195-022-09736-0. Zangeneh, S., Savabi-Esfahani, M., Taleghani, F., Sharbafchi, M. R., & Salehi, M. (2023). 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 , (1), 311. Table Table I. Characteristics of the Studies Evaluated in the Study Number Author/Year/Country Type of Study Article Title Purpose Sample Measurement Tools Findings-Results 1 Keshavarz Z. (2021) / Iran Pretest-Posttest, Single-Group Quasi-Experimental The effect of PLISSIT based counseling model on sexual function, quality of life, and sexual distress in women surviving breast cancer Aimed to determine the effect of PLISSIT-based counseling on sexual function, sexual distress, and QoL in women surviving breast cancer. 65 women FSFI BDI-II, STAI WHOQOL-BREF FSDS-R Sexual function and various dimensions of quality of life scores increased significantly, while sexual distress scores decreased after the intervention. 2 Korkutan F. (2024) / Global Meta-Analysis Effects of PLISSIT-based sexual counselling on the sexual lives of women with breast cancer: meta-analysis study To evaluate the effects of PLISSIT-based sexual counseling on the sexual lives of women with breast cancer. 325 women Comprehensive Meta-Analysis (CMA) software version 3 Shows that PLISSIT-based sexual counseling improves the sexual lives of breast cancer patients in their postoperative treatment period. Both sexual life and sexual function outcomes were significantly better in the PLISSIT-based counseling group than in the routine counseling group. 3 Nazarzadeh S. (2024) / Iran RCT Effect of WhatsApp-based BETTER model sexual counselling on sexual function and sexual quality of life in breast cancer survivors: a randomized control trial Investigates the effect of WhatsApp-based BETTER model sexual counseling on sexual function and sexual quality of life in breast cancer survivors. women:45 men: 45 SQOL-F FSFI-BC Found successful improvement in women’s sexual quality of life and sexual function among breast cancer patients. 4 Güdek, G., & Yılmaz, S. (2024) / Turkey RCT The effectiveness of sexual education provided in line with PLISSIT model for sexual problems of women with breast cancer To determine the effectiveness of PLISSIT-model-based sexual education for addressing the sexual problems of women diagnosed with breast cancer. women:34 men:32 ASEX FSFI SABIS The study concluded that, after PLISSIT-model-based sexual education, women in the intervention group had higher FSFI scores; the CUBİÖ subscale scores for sexual function were improved, and subsequent body image results were better. 5 Olcer Z.O., Oskay U. (2021) / Turkey Experimental and Control Groups Effects of the Better Model Based Counseling on Sexuality of Women with Breast Cancer. To determine the impact of a BETTER Model–based counseling program on the sexual problems of women with breast cancer. women:30 men:30 EORTC Quality of Life Questionnaire-BR23 FSFI BCS After the “Better Model” counseling program, lubrication, orgasm, pain subscale scores, and total FSFI scores were higher in the intervention group. Women in the intervention group also scored higher on the body image subscale of the functional section of the quality of life questionnaire. 6 Faghani S, Ghaffari F (2016) / Iran Quasi-Experimental Effects of Sexual Rehabilitation Using the PLISSIT Model on Quality of Sexual Life and Sexual Functioning in Post-Mastectomy Breast Cancer Survivors. Conducted to determine the effect of sexual rehabilitation using the PLISSIT model on post-mastectomy breast cancer survivors. women:50 men:50 SQOL-F FSFI Indicates that nurses can use the PLISSIT model alongside chemotherapy and radiotherapy to teach women with breast cancer coping and problem-solving skills, encouraging them to participate in group programs to express their feelings and attitudes about their current sexual life, thereby helping improve sexual quality of life and sexual function. 7 Saboula, N., & El-Sayed, S. (2015) / Egypt Quasi-Experimental Effectiveness of Application of PLISSIT Counseling Model on Sexuality for Breast Cancer’s Women Undergoing Treatment Examines the effectiveness of the PLISSIT Counseling Model on female sexuality, body image, and couple satisfaction among women undergoing breast cancer treatment. 66 women FSDI Body Image Scale RDAS The application of the PLISSIT model was effective in improving sexual function, body image, and couple satisfaction for women undergoing treatment for breast cancer. 8 Almeida, N. G. D., Britto, D. F. (2019) / Brazil Case Study PLISSIT model: sexual counseling for breast cancer survivors Reports on the experience of using the PLISSIT model as a tool in nursing care for breast cancer patients with sexual dysfunction. 15 women FSFI With counseling based on the PLISSIT Model, women’s FSFI scores increased by 36.79%. 9 Zangeneh S. et al. (2023) / Iran Quasi-Experimental Effectiveness of online sexual education based on the extended PLISSIT model on sexual function and sexual satisfaction in women undergoing breast cancer treatment Aims to determine the effect of online sexual education based on the Ex-PLISSIT model on sexual function and satisfaction in women undergoing breast cancer treatment. women:40 men:40 FSFI Larson’s Sexual Satisfaction Questionnaire The study demonstrated a significant increase in the mean scores for sexual satisfaction and function in the intervention group after the intervention. 10 Shalamzari K.H. (2024) / Iran Quasi-Experimental Comparing the effect of sexual counseling based on BETTER and PLISSIT models on sexual assertiveness in women with breast cancer after mastectomy Conducted to compare the effects of sexual counseling based on two models—PLISSIT (Permission, Limited Information, Specific Suggestion, Intensive Therapy) and BETTER (Bringing up, Explaining, Telling, Timing, Educating, Recording)—on sexual assertiveness in post-mastectomy women. 78 women HISA The study showed that BETTER sexual counseling was more effective than PLISSIT counseling in increasing sexual assertiveness among women who had undergone mastectomy. 11 Khoei (2022) / Iran RCT Sexual health outcomes of PLISSIT-based counseling versus grouped sexuality education among Iranian women with breast cancer: A randomized clinical trial The aim of this study is to compare the impact of individual therapy (PLISSIT) vs. group therapy (Sexual Health model) on sexual behavior scores in Iranian women with breast cancer. 75 women SB The study showed that the PLISSIT model was effective in improving women’s sexual behavior scores. 12 Esmkhani M. (2021) / Iran RCT Comparison of the Effects of the PLISSIT Model Versus the Sexual Health Model on Quality of Life Among Women with Breast Cancer Aims to assess the effect of individual therapy (PLISSIT Model) vs. group therapy (Sexual Health Model) on the quality of life in Iranian women with breast cancer. 75 women EORTC QLQ-C30V.3 Sexual Distress Questionnaire The study showed that the PLISSIT Model was effective in improving women’s quality of life. 13 Shalamzari, K. H. (2022) / Iran Quasi-Experimental The Effect of Sexual Counseling Based on BETTER and PLISSIT Model on Quality of Sexual Life in Women with Breast Cancer after Mastectomy Conducted to compare the effect of counseling based on two models, PLISSIT and BETTER, on sexual quality of life in women with breast cancer after mastectomy. 78 women SQOL-F BETTER-model-based sexual counseling is more effective than the PLISSIT model in improving sexual quality of life. 14 Farnam, F. (2021) / Iran RCT The Effect of Good Enough Sex (GES) Model-Based Sexual Counseling Intervention on the Body Image in Women Surviving Breast Cancer: A Randomized Clinical Trial The objective of this study is to determine the effect of a counseling intervention based on the Good Enough Sex (GES) model on body image in women who have survived breast cancer. women:50 men:50 Disease-related information Body Image Scale (BIS) Results showed a statistically significant difference in average body image scores between the intervention and control groups. The GES model–based counseling intervention improved body image in women. 15 A. Shahin (2021) / Egypt Quasi-Experimental Effect of Nursing Counseling Guided by BETTER Model on Sexuality, Marital Satisfaction, and Psychological Status among Breast Cancer Women Evaluates the effect of nursing counseling guided by the BETTER model on sexuality, marital satisfaction, and psychological status among women with breast cancer. 87 women FSFI Body Image Scale ENRICH Marital Satisfaction Scale The Arabic version of the Tylor Anxiety Scale PSS Demonstrated a highly significant difference in marital satisfaction, sexual orientation, and psychological well-being among study participants before and after implementing BETTER-model-based nursing counseling. Additional Declarations No competing interests reported. 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18:15:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":734436,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7813921/v1/ebe769e1-d388-41aa-8a54-f3dce3a48677.pdf"},{"id":94518458,"identity":"e94c6b5c-8c8e-42d5-a4e4-0c80436d5c03","added_by":"auto","created_at":"2025-10-28 16:46:04","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":30589,"visible":true,"origin":"","legend":"","description":"","filename":"prisma.docx","url":"https://assets-eu.researchsquare.com/files/rs-7813921/v1/922e55e780968806e3461ed6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sexual Counseling and Breast Cancer: A Systematic Analysis of the Predictive Effect on Women's Health Outcomes","fulltext":[{"header":"HİGHLİGHTS","content":"\u003cp\u003e\u003cstrong\u003eWhat is already known\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eBreast cancer patients experience many bio-psycho-social problems.\u003c/li\u003e\n \u003cli\u003eCounseling using sexual counseling models is effective in improving women's health in women with breast cancer.\u003c/li\u003e\n \u003cli\u003eMultiple counseling models are used to improve health outcomes for women with breast cancer.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eWhat This Paper Adds\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current study;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eIt has been shown that interventions using the sexual counseling model not only improve sexual problems but also improve many problems affecting women's lives such as side effects, marital adjustment, and body image.\u003c/li\u003e\n \u003cli\u003eTo our knowledge, this is the first article to present the pooled results of model-based sexual counseling studies conducted with women with breast cancer or survivors.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eBreast cancer is the most common cause of cancer-related deaths among women in developed countries and the second leading cause of cancer-related deaths in developing countries (Zangeneh et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). According to Globocan 2020 data, its global incidence is 47.8 per 100,000, comparable to the 47.7 per 100,000 in T\u0026uuml;rkiye. As the breast symbolizes femininity and sexuality, alterations in breast tissue lead to significant psychological and social challenges (Nazarzadeh et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Changes in both physical and emotional levels can cause deterioration of women\u0026rsquo;s social lives (Bokaei et al., 2023). Breast cancer negatively affects women\u0026rsquo;s sexual function and self-esteem, resulting in adverse body image, a diminished sense of femininity, and reduced sexual activity. Such negative perceptions make women more prone to low self-esteem, sexual dysfunction, and deteriorated quality of life (Farnam et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough the incidence of breast cancer has risen worldwide, advances in surgical interventions, chemotherapy, radiotherapy, and hormone therapy have increased the survival rate to approximately 90% (Zanganeh et al., 2023; Bahgeri \u0026amp; Mazaheri., 2015). While advanced treatments prolong life, they also expose women to the adverse effects of the disease and its treatment, such as psychological distress (anxiety and depression) and physical challenges (hair loss, pain, fatigue, sleep disturbances, and sexual dysfunction). Addressing these side effects is crucial for improving patient-centered outcomes and quality of life among women with breast cancer (Bokaei et al., 2023). Sexual health is an important component of the quality of life. However, the diagnosis and treatment of breast cancer can damage intimate relationships and sexual functioning, thereby lowering overall well-being (Olcer \u0026amp; Oskay, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).The prevalence of sexual problems among women with breast cancer ranges from 40% to 80% (Zangeneh et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Cobo-Cuenca et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Women may experience decreased sexual desire, dissatisfaction, loss of interest in their partner, vaginal atrophy, dryness, dyspareunia, difficulty with arousal, and anorgasmia (Zangeneh et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Olcer \u0026amp; Oskay, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Shalamzari et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Moreover, loss or deformity of the breast, often considered a symbol of beauty, motherhood, and sexual attractiveness, can result in concerns related to body image, fear of cancer recurrence, fatigue, pain, and diminished self-esteem, leading to social withdrawal (Olcer \u0026amp; Oskay, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Faghani \u0026amp; Ghaffari, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite these impacts on sexual health, many patients with breast cancer face barriers to receiving relevant sexual counseling. Studies have shown that patients are often reluctant to discuss sexual matters, yet they need information about sexual problems both during and after treatment. Relationship challenges are also common; however, sexual counseling is rarely integrated into routine care by healthcare professionals. Using a structured model to assess sexual health helps professionals systematically guide history-taking and accurately identify sexual issues (G\u0026uuml;dek \u0026amp; Yılmaz, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).The literature demonstrates that counseling or therapy provided by healthcare professionals not only enhances psychological adaptation, self-perception, and sexual functioning but also supports personal independence and quality of life in individuals undergoing cancer treatment (Işık, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMidwives and nurses play a pivotal role in recognizing psychosocial problems in breast cancer patients. Given the necessity of a holistic bio-psychosocial approach in cancer care, medical treatment alone is insufficient. Model-based counseling delivered at the professional level can yield more tangible and desired outcomes. In light of these findings, the present study aimed to determine the effects of individual model-based sexual counseling on women\u0026rsquo;s health among those diagnosed with or surviving breast cancer.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eResearch Strategy and Selection Process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA systematic literature search was performed using Google Scholar, the Cochrane Library, PubMed, Web of Science, ScienceDirect, and Medline. These databases were selected because they index a broad array of health-related studies (Gray et al., 2016). The database search was conducted between December 5 and December 15, 2024, with the support of Sakarya University and Istanbul University-Cerrahpaşa libraries. The search encompassed all dates available in these databases up to December 15, 2024, without imposing any temporal restrictions. Quantitative studies\u0026mdash;experimental, quasi-experimental, case-control, cohort, and randomized controlled trials\u0026mdash;were eligible for inclusion. Systematic reviews follow a stringent methodology that involves searching the entire corpus of relevant research, applying inclusion criteria, and synthesizing findings (Higgins et al., 2011;,Hanley \u0026amp; Cutts, 2013). \u0026nbsp;Systematic reviews are considered the gold standard because of their comprehensive literature screening and minimal author bias (\u0026Ccedil;ınar, 2021).\u003c/p\u003e\n\u003cp\u003eEnglish-language searches used the strings \u0026ldquo;breast cancer\u0026rdquo; AND \u0026ldquo;counseling models\u0026rdquo; AND \u0026ldquo;ALLOW\u0026rdquo; and were repeated separately with \u0026ldquo;PLISSIT,\u0026rdquo; \u0026ldquo;EX-PLISSIT,\u0026rdquo; \u0026ldquo;BETTER,\u0026rdquo; \u0026ldquo;GES,\u0026rdquo; \u0026ldquo;IMB,\u0026rdquo; and \u0026ldquo;ALARM.\u0026rdquo; Similar terms were employed in Turkish: \u0026ldquo;meme kanseri\u0026rdquo; VE \u0026ldquo;danışmanlık modelleri\u0026rdquo; and then individually \u0026ldquo;PLISSIT,\u0026rdquo; \u0026ldquo;EX-PLISSIT,\u0026rdquo; \u0026ldquo;BETTER,\u0026rdquo; \u0026ldquo;GES,\u0026rdquo; \u0026ldquo;IMB,\u0026rdquo; \u0026ldquo;ALARM,\u0026rdquo; and \u0026ldquo;ALLOW.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eThe study selection was guided by the PICOS framework [16]:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eP (Participants): Women diagnosed with breast cancer or survivors without restrictions on disease stage or age.\u003c/li\u003e\n \u003cli\u003eI (Interventions): Interventions involving recognized sexual counseling models.\u003c/li\u003e\n \u003cli\u003eC (Comparisons): No passive (waiting list) or active (alternative therapies) comparison group.\u003c/li\u003e\n \u003cli\u003e(Outcomes): Any quantitative measure of women\u0026rsquo;s health outcomes (such as sexual function, quality of life, and side effects).\u003c/li\u003e\n \u003cli\u003eS (Study Designs): Experimental, case-control, cohort, quasi-experimental, or randomized controlled studies published in English or Turkish.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNo restrictions on publication date were included. The exclusion criteria were non-model-based counseling, qualitative research, meta-syntheses, studies on male participants, interventions other than breast cancer, and theses. A total of 378 studies were initially identified, of which 15 met the eligibility criteria. The PRISMA flow diagram (Liberati et al., 2009) illustrates the selection process.\u003c/p\u003e\n\u003cp\u003eThree researchers (BD, Mİ, and MK) independently screened titles and abstracts. Any disagreements were resolved by consensus. EndNote software was used for reference management. This review was registered in the PROSPERO database (Registration ID:\u0026nbsp;CRD42025633108). The study followed the PRISMA guidelines, which enhance transparency in study selection (Shamseer et al., 2015). Finally, 15 studies were included and numbered from 1 to 15.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality Assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe methodological quality of the included studies was independently evaluated by three researchers and verified by a fourth author. The Joanna Briggs Institute (JBI) Critical Appraisal Checklists were used for case-control, cross-sectional, and cohort studies (Moola et al., 2017). These checklists contain 8, 10, or 11 items rated as \u0026ldquo;Yes,\u0026rdquo; \u0026ldquo;No,\u0026rdquo; \u0026ldquo;Unclear,\u0026rdquo; or \u0026ldquo;Not Applicable.\u0026rdquo; A study was deemed:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePoor quality if fewer than 50% of items were marked \u0026ldquo;Yes.\u0026rdquo;\u003c/li\u003e\n \u003cli\u003eModerate quality if 51\u0026ndash;80% of items were marked \u0026ldquo;Yes.\u0026rdquo;\u003c/li\u003e\n \u003cli\u003eHigh quality if more than 80% of items were marked \u0026ldquo;Yes.\u0026rdquo;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eModerate quality and High quality studies were included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Extraction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary author developed a data extraction form, capturing each study\u0026rsquo;s author(s), year, intervention type(s), intervention groups, duration, follow-up, dependent variables, and main outcomes. Missing data were categorized as unavailable if the database provided no information.\u003c/p\u003e"},{"header":"RESULTS AND DISCUSSION","content":"\u003cp\u003eFifteen studies were included in this review to evaluate the effects of sexual counseling models on women diagnosed with or surviving breast cancer. Table I presents the author(s), publication year, country, title, study aim, sample, research design, measurement tools, primary findings, and conclusions. Overall, 16 main outcomes were reported regarding the positive effects of sexual counseling models on women\u0026rsquo;s health: sexual desire, arousal, lubrication, orgasm, satisfaction, dyspareunia, anxiety, quality of life, sexual distress, sexual quality of life, sexual function, sexual compatibility, body image, couple satisfaction, marital adjustment, and treatment-related side effects. These findings collectively highlight that the use of sexual counseling models positively affects women\u0026rsquo;s health in the context of breast cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSexual Function and Functioning\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study demonstrated that sexual function and functioning are affected in women diagnosed with or surviving breast cancer (Khoei et al., 2022; Keshavarz et al., 2021; Korkutan \u0026amp; Taylan, 2024; Nazarzadeh et al., 2024; G\u0026uuml;dek \u0026amp; Yılmaz, 2024; Olcer \u0026amp; Oskay 2022; Faghani \u0026amp; Ghaffari F 2016; Almeida et al., \u0026nbsp;2020 ; Zangeneh et al., 2023; Shalamzari el at., 2024; Shahin et al., \u0026nbsp;2021). Sexual dysfunction refers to problems arising from psychophysiological changes in the sexual response cycle and sexual desire; such issues both reduce an individual\u0026rsquo;s quality of life and pose significant challenges (Turhan \u0026amp; Akcan, 2022).The physiological response to sexual stimuli comprises arousal, plateau, orgasm, and resolution stages, and a healthy sexual life depends on all of these phases functioning together (G\u0026uuml;dek \u0026amp; Yılmaz, 2024).\u003c/p\u003e\n\u003cp\u003eIn this study, the PLISSIT-model counseling provided to women was effective in improving sexual function and alleviating sexual distress. The PLISSIT Model is designed such that healthcare professionals can discuss sexual matters with clients and identify sexual problems. The model consists of four steps: beginning with taking an individual\u0026rsquo;s sexual history and assessing sexuality, offering targeted suggestions, and finally, more intensive treatments. It was developed by Annon in 1976 to address sexual health care needs, and its conceptual schema, Permission, Limited Information, Specific Suggestions, and Intensive Therapy are referred to by the acronym \u0026ldquo;PLISSIT\u0026rdquo; (G\u0026uuml;dek \u0026amp; Yılmaz, 2024; Annon, 1975; Annon, 2013).\u003c/p\u003e\n\u003cp\u003eIn the study by Keshavarz et al. (2021), a PLISSIT-based counseling intervention was conducted with women in seven 60-minute sessions over four weeks, with scales administered before the intervention and again at weeks 2 and 4. Post-intervention findings indicated a statistically significant increase in sexual function scores. In their evaluation of the effectiveness of the PLISSIT Counseling Model on female sexuality, body image, and couple satisfaction in women undergoing breast cancer treatment, Saboula and El-Sayed (2015) reported statistically significant differences in arousal, lubrication, orgasm, satisfaction, and pain among participants. They also found a statistically significant change in the total FSFI scores before and after the intervention. Similarly, in a PLISSIT-based study targeting sexual problems in women diagnosed with breast cancer, G\u0026uuml;dek and Yılmaz (2024) noted a statistically significant difference between the initial and final assessment mean scores in desire, arousal, lubrication, orgasm, satisfaction, and pain subdimensions, as well as in the total FSFI scores. In another study, Faghani and Ghaffari (2016) provided PLISSIT-model sexual counseling for post-mastectomy women in four 90-minute sessions\u0026mdash;organized by a female researcher for the women and a male researcher for the husbands. The results revealed a statistically significant difference between pre- and post-test scores on the Female Sexual Function Index (FSFI) for the experimental group. A meta-analysis by Korkutan F. (2024) also showed that PLISSIT-based sexual counseling improves sexual function during the postoperative treatment period in breast cancer patients. Moreover, Farnam et al. (2014), who assessed the effectiveness of PLISSIT counseling on sexual problems, reported that sexual distress scores decreased from 22.7 at the start to 6.8 by the end of the study.\u003c/p\u003e\n\u003cp\u003eDeveloped as an extension of the PLISSIT Model, the EX-PLISSIT Model places the \u0026ldquo;permission\u0026rdquo; component at the center of other steps through an integrated rather than strictly sequential approach. This structure allows individuals to express themselves in every phase of the model, not just in a single step (Akcan \u0026amp; Turhan, 2022). One study indicated that online sexual education, based on the EX-PLISSIT Model, significantly increased women\u0026rsquo;s post-intervention sexual satisfaction scores during breast cancer treatment (Zangeneh et al., 2023). Similarly, Mohammadi et al. (2022), in a study evaluating the EX-PLISSIT Model for female sexual function (FSFI) among cancer survivors, found a notable improvement in sexual function (Mohammadi et al., 2023).\u003c/p\u003e\n\u003cp\u003eBased on the study by Bober et al. (2019), BETTER model interviews helped reduce stress and anxiety in sexual relationships. Consistent with the literature, a controlled study by Olcer and Oskay (2021) aimed to determine the impact of a BETTER model-based counseling program on sexual problems among women with breast cancer. Following the steps of the BETTER Model, the counseling program was implemented in four sessions, each lasting an average of 45\u0026ndash;60 minutes at one-week intervals. The study results showed no statistically significant difference between the groups\u0026rsquo; initial Female Sexual Function Index (FSFI) subscale or total scores. However, the final assessment revealed a statistically significant difference in lubrication, orgasm, and pain subscales, as well as total FSFI scores. In a separate study using four stages of BETTER-based counseling (introduction, explanation, discussion, and timing), Shahin et al. (2021) demonstrated improved sexual function among participants. Another study involving WhatsApp-based BETTER sexual counseling for breast cancer survivors indicated a significant increase in mean sexual function index scores in the intervention group (Nazarzadeh et al., 2023). Findings by Hummel et al. (2019), which align with the current study, show that coupled sexual counseling based on cognitive behavioral therapy effectively enhances sexual performance, intimacy, and relationship satisfaction in women with breast cancer (Hummel et al., 2019). In yet another study evaluating a BETTER Model\u0026ndash;based counseling program for women with breast cancer, researchers observed statistically significant improvements in the lubrication, orgasm, and pain subscales, as well as in total FSFI scores (Olcer \u0026amp; Oskay, 2022) Karakaş and Aslan (2019), who examined the effect of BETTER Model\u0026ndash;based counseling on sexual dysfunction in infertile women, found that the experimental group had significantly higher overall FSFI scores on the final assessment compared to the control group. Their study also showed marked increases in orgasm, sexual desire, and lubrication in the intervention group (Karakaş \u0026amp; Aslan, 2019). Moreover, BETTER model interviews have been reported to alleviate stress and anxiety in sexual relationships (Bober et al., 2019).\u003c/p\u003e\n\u003cp\u003eThe BETTER Model was developed by Mick and Hughes (2003) for use with oncology nurses. It is a sexual health model comprising six steps emphasizing understanding the individual and promoting respect. The name \u0026ldquo;BETTER\u0026rdquo; is formed from the initial letters of its key components\u0026mdash;(B)ringing up the topic, (E)xplaining that sex is part of quality of life, (T)elling patients that resources will be found to address their concerns, (T)iming of intervention, (E)ducation regarding sexual side effects of treatment, and (R)ecording (Turhan \u0026amp; Akcan, 2022; Mick et al., 2004).\u003c/p\u003e\n\u003cp\u003eIn a study by Shalamzari et al., (2024) comparing the sexual outcomes of the BETTER and PLISSIT models, the BETTER counseling group received four individual sessions of 60\u0026ndash;90 minutes each at one-week intervals, all based on the BETTER Model. Another group provided PLISSIT-based counseling over four 60\u0026ndash;90 minute sessions at one-week intervals. Four weeks after the intervention, a significant difference in the mean sexual stability scores was found between the two groups, with the BETTER group showing higher scores (54.8 vs. 48.6). In a parallel finding, Karimi et al. (2021) compared BETTER and PLISSIT counseling methods for women with postpartum sexual problems and found that the BETTER Model was more effective than PLISSIT in increasing women\u0026rsquo;s sexual assertiveness [31].However, the literature review revealed limited studies focusing on the superiority of one model over another.\u003c/p\u003e\n\u003cp\u003eIn this study, Khoei et al. (2022), using a Good Enough Sex (GSE) group design for breast cancer patients, observed statistically significant improvements in sexual behavior at 6 and 12 weeks compared with the control group; however, similar improvements were not recorded in the group that received the PLISSIT Model. The effectiveness of PLISSIT compared to GSE has not been previously evaluated in women with breast cancer. Nonetheless, a study by Ahmed et al. (2016) that examined group counseling interventions found that group counseling effectively improved sexual function and alleviated anxiety in cancer survivors (Ahmed et al., 2016).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSexual Quality of Life and Overall Quality of Life\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study found that PLISSIT model\u0026ndash;based counseling increased women\u0026rsquo;s sexual quality of life after the intervention (Faghani \u0026amp; Ghaffari, 2016 \u0026nbsp;; Keshavarz et al., 2021; Korkutan \u0026amp; Taylan ; \u0026nbsp;Almeida et al., 2020). Almeida et al. (2020) and Esmkhani M. (2021) investigated PLISSIT-based sexual counseling for women surviving breast cancer. Improvements in the quality of life were observed, along with an indication that PLISSIT interventions enhanced arousal and showed a trend toward better sexual function (Almeida et al., 2020). Many studies also indicate that survivors of this disease experience a decline in sexual attractiveness and pleasure, which affects their sexual quality of life (SQL) (Karakaş \u0026amp; Aslan, 2019; Karimi et al., 2021). Consistent with these findings, a meta-analysis by Cicek Ozdemir S. (2024) reported that sexual counseling based on the PLISSIT and EX-PLISSIT models improved sexual quality of life in women (\u0026Ccedil;i\u0026ccedil;ek et al., 2024). Indeed, sexual quality of life is a significant concern for women with breast cancer due to factors such as body image issues and their impact on sexual function. A literature review reveals that healthcare professionals often do not adequately address this topic, potentially due to insufficient communication between patients and providers. For instance, in a study assessing sexual quality of life in younger women with breast cancer, Bobrie et al. (2022) revealed that these women experienced reduced sexual quality of life and weak communication with healthcare professionals. Similarly, the present study shows that quality of life is adversely affected in women with breast cancer. Numerous additional studies have likewise demonstrated that breast cancer and its treatment process negatively influence women\u0026rsquo;s overall quality of life (Ho et al., 2017; Bouya et al., 2018).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the findings of Nazarzadeh et al. (2024) regarding the impact of BETTER-based sexual counseling on sexual quality of life, there was a statistically significant difference in the mean sexual quality of life scores at different time points in the intervention group. In contrast, in a study by Olcer and Oskay (2021) using the BETTER Model, the initial evaluation of the \u0026ldquo;EORTC Quality of Life Questionnaire-BR23\u0026rdquo; functional scale sub-dimension scores showed that the two groups were similar. Apart from the studies included in this review, no other study has specifically investigated women\u0026rsquo;s sexual quality of life using the BETTER model.\u003c/p\u003e\n\u003cp\u003eIn a quasi-experimental study comparing the BETTER and PLISSIT models, Shalamzari et al. (2022) examined the pre- and post-intervention mean change scores in sexual quality of life. Among the participants who received counseling based on the BETTER model, the mean change in sexual quality of life was significantly higher than that of those who received PLISSIT-based counseling, indicating that the BETTER model was more effective in enhancing sexual quality of life than PLISSIT. However, the literature on model-based sexual counseling for women with breast cancer or other populations, as well as its impact on overall quality of life, remains limited. While the current study suggests that interventions using model-based sexual counseling improve quality of life, it also underscores the need for further research in this area.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBody Image\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study showed that women\u0026rsquo;s sexual compatibility and body image are affected by breast cancer and that the counseling interventions implemented have a positive impact on both. In the reviewed studies, PLISSIT-based counseling was found to yield statistically significant improvements in body image sub-dimensions for the participating women (Olcer \u0026amp; Oskay, 2022; G\u0026uuml;dek \u0026amp; Yılmaz, 2024; saboula \u0026amp; El Sayed, 2015).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn their BETTER Model\u0026ndash;based counseling intervention, Olcer and Oskay (2021) observed higher scores on the body image subscale of the EORTC Quality of Life Questionnaire\u0026rsquo;s functional scale among women in the intervention group. However, when they examined the mean scores of the \u0026ldquo;Body Contribution Scale,\u0026rdquo; no statistically significant differences were found between the two groups. In another study, Shahin et al. (2021) provided counseling to women through four phases (introduction, explanation, discussion, and timing) based on the BETTER Model, and the intervention was shown to improve body image. Similarly, Farnam et al. (2021) reported that, in a counseling intervention using the GES model, women\u0026rsquo;s mean body image scores were higher in the intervention group than in the control group.\u003c/p\u003e\n\u003cp\u003eDeveloped by Metz and McCarthy, the Good Enough Sex (GES) model aims to reduce sexual problems. It was adapted for couples experiencing sexual issues and is built upon two central concepts: (1) engaging in mutual sexual relations to enjoy intimacy and (2) achieving maximum pleasure within an individual\u0026rsquo;s capacity when coping with sexual dysfunction, focusing on closeness and mutual admiration. Overall, the model emphasizes developing intimacy and establishing a strong sexual bond rather than focusing solely on intercourse. In the GES Model, each partner is responsible for their own sexuality, working together as a cohesive and intimate team to create a comfortable and functional sexual style (McCarthy \u0026amp; Metz, 2008; Jamalianfar et al., 2021).\u003c/p\u003e\n\u003cp\u003eBreast cancer is the most commonly diagnosed type of cancer in women (Taylan \u0026nbsp;\u0026amp; Kola\u0026ccedil;, 2021) Surgical intervention is the most prevalent treatment for breast cancer (American Cancer Society. 2023) and such procedures can profoundly affect women\u0026rsquo;s body image. Because breasts are widely viewed as symbolic of femininity, sexuality, and attractiveness, surgical treatment for breast cancer may be perceived as a threat to body image, maternal identity, and sexual appeal (Taylan \u0026nbsp;\u0026amp; Kola\u0026ccedil;, 2021); these surgeries can negatively influence patients\u0026rsquo; perceptions of their bodies, and changes in physical appearance often complicate their psychological well-being (Archangelo et al., 2019; Sel \u0026amp; Beydağ, 2022). Indeed, various studies have confirmed that women who undergo breast surgery experience detrimental effects on their body image (Taylan \u0026nbsp; \u0026amp; Kola\u0026ccedil;, 2021; Archangelo et al., 2019; Lundberg. \u0026amp; Phoosuwan, 2022; Bodur \u0026amp; Katran, 2024). Research further indicates that body image concerns in breast cancer patients are associated with depression, anxiety, and changes in social relationships, ultimately affecting the overall quality of life (Taylan \u0026nbsp;\u0026amp; Kola\u0026ccedil;, 2021; Ahn \u0026amp; Suh, 2023). This study found that interventions using sexual counseling models contributed positively to body image; however, much of the literature on model-based counseling interventions has focused primarily on sexual health, demonstrating limited research specifically addressing body image.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment-Related Side Effects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to Saboula et al. (2015), applying the PLISSIT model to women yielded improvements in all the reported side effects. A statistically significant relationship was identified between pre- and post-intervention side effects, including nausea/vomiting, diarrhea, and pain. Globally, the number of women diagnosed with breast cancer continues to rise, and many must cope with the physical, emotional, and social challenges arising from both the disease and its treatment (Başkaya \u0026amp; Rizalar, 2024). The present study also revealed that sexual counseling positively influenced treatment side effects. This outcome may stem from counseling interventions\u0026mdash;grounded in sexual counseling models\u0026mdash;enhancing psychosocial well-being, including body image, couple harmony, and marital adaptation. Indeed, in a systematic review of 35 articles, D\u0026rsquo;egidio et al. (2017) noted that various counseling interventions helped achieve social and psychological rehabilitation in women with breast cancer, suggesting that enhanced social and psychological well-being could ameliorate treatment side effects (D\u0026rsquo;egidio et al., 2017). Nonetheless, the limited number of studies on this topic highlights a gap in the current literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCouple Satisfaction, Sexual Harmony, and Marital Adjustment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the study by Saboula, N. and El-Sayed, S. (2015), it was shown that couple satisfaction increased among participating women following the application of the PLISSIT counseling model. There were statistically significant differences in couple satisfaction before and after implementing the PLISSIT model. The total couple satisfaction scores post-PLISSIT counseling improved from 31.90% to 220.0%. Several studies included in this review similarly found that sexual counseling models enhance couple harmony and marital adjustment (Shahin et al., 2021;\u0026nbsp;Saboula \u0026amp; El-Sayed, 2015). Breast cancer and its subsequent treatment may lead to functional changes within the family. Because a woman may be intensely focused on her illness during this period, her capacity to fulfill her spousal role could diminish (Gao et al., 2024).Breast cancer diagnosis may also upset the family\u0026rsquo;s usual balance, preventing the healthy partner from meeting certain familial and societal expectations (Daniel et al., 2022; Adejoh et al., 2021). Studies have shown that avoidance-focused and self-blaming coping strategies in couples with breast cancer negatively affect overall well-being (Valente et al., 2021).Women with breast cancer may develop concerns over their body image and appearance, which, coupled with confronting a life-threatening disease and significant role changes, can lead to psychological distress (Oers \u0026amp; Schlebusch, 2020). Moreover, hormonal therapy and psychological well-being significantly influence sexual function; therefore, disruptions in these areas can reduce marital adjustment (Favez et al., 2016; Di Mattei et al., 2021). A decline in marital adjustment, role changes, body image concerns, and sexual dysfunction can also detrimentally affect couples\u0026rsquo; harmony.\u003c/p\u003e\n\u003cp\u003eSimilarly, breast cancer and its treatment have a negative effect on women\u0026rsquo;s sexual harmony. Indeed, existing research has discovered that the disease and its treatments influence women\u0026rsquo;s psychological health and marital adaptation, thereby decreasing sexual harmony (Başkaya \u0026amp;Rizalar, 2024; Arıkan et al., 2020). Consistent with the results of this study, G\u0026uuml;dek and Yılmaz (2024) examined the effectiveness of a PLISSIT-based counseling intervention for the sexual problems of women with breast cancer and found that the approach improved women\u0026rsquo;s sexual harmony. Sexual harmony, couple satisfaction, and marital cohesion are interrelated concepts, and difficulties in one area can adversely affect others. Consequently, improving sexual harmony is expected to enhance marital harmony or couple satisfaction. This study showed that model-based interventions positively affected couple satisfaction, sexual harmony, and marital adjustment. In line with the current findings, an investigation of an EX-PLISSIT-based counseling approach in postpartum women demonstrated that model-based interventions heightened marital satisfaction (Dangesaraki et al., 2019).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and Recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSexual counseling involves providing information about sexual concerns and facilitating a safe return to normal sexual activities with psychosexual assessment and support as integral components ( Mangolian et al., 2021).Healthcare professionals should routinely screen patients for body image and sexual health issues, ensure they feel comfortable discussing such topics, and be prepared to offer information and resources (Wilson et al., 2022). Although numerous sexual counseling models are available, few have been rigorously studied in women with breast cancer. The limited research to date suggests that model-based interventions not only alleviate sexual dysfunction but also positively influence side effects, marital adjustment, and body image.\u003c/p\u003e\n\u003cp\u003eHowever, existing studies have predominantly focused on sexual outcomes, and other domains remain underexplored. Midwives, nurses, and other health professionals who provide primary care for women with breast cancer are strongly encouraged to integrate model-based sexual counseling into routine practice. Further research is essential to clarify the broader impact of counseling, particularly on body image, treatment-related side effects, and partner relationships. By incorporating diverse models and designs, healthcare professionals can address the complex needs of women with breast cancer more comprehensively and significantly improve their quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a systematic review; all data have already been published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e The authors declare that they have no financial conflict of interest with any institution, organization or person related to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Support\u003c/strong\u003e: The authors declare that the study has not received financial support from any person, institution or organization\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eStudy design: BD, Mİ, MK, ZTData collection: BD, MİData analysis: BD, Mİ, MKStudy supervision: BD, Mİ, MKManuscript writing: BD,MİCritical revisions for important intellectual content: BD, ZT\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdejoh S.O., Olorunlana A., Adejayan A. (2021). Patients\u0026apos; experiences of family members\u0026apos; reactions to diagnosis of breast cancer and support in the management of breast cancer in Lagos, Nigeria. Palliat Support Care, 19(5):592\u0026ndash;597. doi: 10.1017/S147895152000070X.\u003c/li\u003e\n\u003cli\u003eAhmed K, Marchand E, Williams V, Coscarelli A, \u0026amp; Ganz PA (2016). Development and pilot testing of a psychosocial intervention program for young breast cancer survivors. PMC, 99(3), 414\u0026ndash;420.\u003c/li\u003e\n\u003cli\u003eAhn, J., \u0026amp; Suh, E. E. (2023). Body image alteration in women with breast cancer: A concept analysis using an evolutionary method. Asia-Pacific Journal of Oncology Nursing, 10, 2-8. https://doi.org/10.1016/j.apjon.2023.100214.\u003c/li\u003e\n\u003cli\u003eAkcan, K., Turhan, İ. (2022). Sexual counseling models. Gevher Nesibe Journal of Medical and Health Sciences, 7(17), 50-56, https://doi.org/10.46648/gnj.382.\u003c/li\u003e\n\u003cli\u003eAlmeida, N. G., Knobf, T. M., de Oliveira, M. R., d Salvetti, M., Ori\u0026aacute;, M. O., \u0026amp; Fialho, A. V. (2020). A pilot intervention study to improve sexuality outcomes in breast cancer survivors. \u003cem\u003eAsia-Pacific Journal of Oncology Nursing\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(2), 161-166.\u003c/li\u003e\n\u003cli\u003eAmerican Cancer Society. (2023). Mastectomy. https://www.cancer.org/cancer/types/breastcancer/treatment/surgery-for-breast-cancer/mastectomy.html\u003c/li\u003e\n\u003cli\u003eAnnon, J. (1975). A proposed conceptual scheme for behavioral treatment of sexual problems. \u003cem\u003eJ Sex Educ Ther\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e, 1-15.\u003c/li\u003e\n\u003cli\u003eAnnon JS.(2013) The PLISSIT model: a proposed conceptual. General procedures: handbook of behavior therapy with sexual problems.;1:70.\u003c/li\u003e\n\u003cli\u003eArchangelo, S. D. C. V., Sabino, M., Veiga, D. F., Garcia, E. B., \u0026amp; Ferreira, L. M. (2019). Sexuality, depression and body image after breast reconstruction. Clinics, 74, e883. https://doi.org/10.6061/clinics/2019/e883.\u003c/li\u003e\n\u003cli\u003eArıkan F, K\u0026ouml;r\u0026uuml;k\u0026ccedil;\u0026uuml; \u0026Ouml;, K\u0026uuml;\u0026ccedil;\u0026uuml;k\u0026ccedil;akal A, Coşkun HŞ.(2020). Determination of Self-Efficacy, Body Image and Sexual Adjustment of Women with Breast Cancer. Eur J Breast Health, 30;16(4):282-289. doi: 10.5152/ejbh.2020.5188. PMID: 33062970; PMCID: PMC7535985.\u003c/li\u003e\n\u003cli\u003eBober, S. L., Michaud, A. L., \u0026amp; Recklitis, C. J. (2019). Finding sexual health aids after cancer: are cancer centers supporting survivors\u0026rsquo; needs?. \u003cem\u003eJournal of Cancer Survivorship\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, 224-230.\u003c/li\u003e\n\u003cli\u003eBobrie A, Jarlier M, Moussion A, Jacot W, D\u0026apos;Hondt V. (2022).Sexual quality of life assessment in young women with breast cancer during adjuvant endocrine therapy and patient-reported supportive measures. Support Care Cancer. 30(4):3633-3641. doi: 10.1007/s00520-022-06810-3. \u003c/li\u003e\n\u003cli\u003eBodur, B. Y., \u0026amp; Katran, H. B. (2024). Changes in Body Image Perceptions of Patients Who Underwent Surgery Due to Breast Cancer. Fenerbahce University Journal of Health Sciences, 4(2), 315-324.\u003c/li\u003e\n\u003cli\u003eBagheri, M., \u0026amp; Mazaheri, M. (2015). Body image and quality of life in female patients with breast cancer and healthy women. \u003cem\u003eJournal of Midwifery and Reproductive Health\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(1), 285-292.\u003c/li\u003e\n\u003cli\u003eBaşkaya, K., \u0026amp; Rizalar, S. (2024). Determination of body image and sexual adjustment in women with breast cancer after surgery. \u003cem\u003eHealth Care for Women International\u003c/em\u003e, 45(12), 1367-1383.\u003c/li\u003e\n\u003cli\u003eBokaie, M., Hejazi, N. S., Jafari, M., \u0026amp; Shabani, M. (2023). Effect of online solution-focused counseling on the sexual quality of life of women with a history of breast cancer: a clinical trial. \u003cem\u003eBMC Women\u0026apos;s Health\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(1), 326.\u003c/li\u003e\n\u003cli\u003eBouya S, Koochakzai M, Rafiemanesh H, Balouchi A, Taheri S, Badakhsh M.(2018).Health-related quality of life of Iranian breast cancer patients: a meta-analysis and systematic review. Breast Cancer Res Treat. 70(2):205\u0026ndash;212. doi: 10.1007/s10549-018-4750-x.\u003c/li\u003e\n\u003cli\u003eCobo-Cuenca, A. I., Mart\u0026iacute;n-Espinosa, N. M., Sampietro-Crespo, A., Rodr\u0026iacute;guez-Borrego, M. A., \u0026amp; Carmona-Torres, J. M. (2018). Sexual dysfunction in Spanish women with breast cancer. \u003cem\u003ePloS one\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(8), e0203151.\u003c/li\u003e\n\u003cli\u003e\u0026Ccedil;ınar, N. (2021). How to write a good systematic review?. Online Turkish Journal of Health Sciences, 6(2), 310-314.\u003c/li\u003e\n\u003cli\u003eCicek Ozdemir S, Dogan Gangal A, Senturk Erenel A. (2024).The Effect of Sexual Counseling Based on PLISSIT and EX-PLISSIT Models on Sexual Function, Satisfaction, and Quality of Life: A Systematic Review and Meta-Analysis. \u003cem\u003eArch Sex Behav\u003c/em\u003e, 53(9):3485-3513. doi: 10.1007/s10508-024-02898-2. Epub 2024 Jun 18.\u003c/li\u003e\n\u003cli\u003eDaniel S., Venkateswaran C., Singh C., Hutchinson A., Johnson M.J.(2022). \u0026ldquo;So, when a woman becomes ill, the total structure of the family is affected, they can\u0026apos;t do anything\u0026hellip;\u0026rdquo; Voices from the community on women with breast cancer in India: a qualitative focus group study. \u003cem\u003eSupport Care Cancer\u003c/em\u003e, 30(1):951\u0026ndash;963. doi: 10.1007/s00520-021-06475-4.\u003c/li\u003e\n\u003cli\u003eDangesaraki, M. M., Maasoumi, R., Hamzehgardeshi, Z., \u0026amp; Kharaghani, R. (2019). Effect of the EX-PLISSIT model on sexual function and sexual quality of life among women after hysterectomy: a randomised controlled trial. \u003cem\u003eSexual health\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(3), 225-232.\u003c/li\u003e\n\u003cli\u003eD\u0026rsquo;egidio, V., Sestili, C., Mancino, M., Sciarra, I., Cocchiara, R., Backhaus, I., ... \u0026amp; Return To Breast Collaborative group Francesca Di Murro Vanessa Palmeri Lorenza Lia Giulia Paradiso Valerio Aceti Annarita Libia. (2017). Counseling interventions delivered in women with breast cancer to improve health-related quality of life: a systematic review. Quality of Life Research, 26, 2573-2592.\u003c/li\u003e\n\u003cli\u003eDi Mattei VE, Perego G, Taranto P, Mazzetti M, Marotta E, Candiani M, Salvatore S.(2021) The Long-Term Effects of Cancer Treatment on Sexuality and Couple Relationships. Fam Process. ;60(3):853-865. doi: 10.1111/famp.12604. Epub 2020 Oct 8. PMID: 33030242.)\u003c/li\u003e\n\u003cli\u003eEsmkhani, M., Kharaghani, R., Shakibazadeh, E., Faghihzadeh, S., Korte, J. E., \u0026amp; Merghati-Khoei, E. (2021). Comparison of the effects of the PLISSIT model versus the sexual health model on quality of life among women with breast cancer. \u003cem\u003eSexuality and Disability\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e, 85-96.\u003c/li\u003e\n\u003cli\u003eFavez N, Cairo Notari S, Charvoz L, Notari L, Ghisletta P, Panes Ruedin B, Delaloye JF. (2016).Distress and body image disturbances in women with breast cancer in the immediate postsurgical period: The influence of attachment insecurity. J Health Psychol, 21(12):2994-3003. doi: 10.1177/1359105315589802.\u003c/li\u003e\n\u003cli\u003eFarnam, F., Khakbazan, Z., Nedjat, S., Dizaji, S. R., \u0026amp; Barjasteh, S. (2021). The effect of good enough sex (GES) model-based sexual counseling intervention on the body image in women surviving breast cancer: a randomized clinical trial. \u003cem\u003eAsian Pacific Journal of Cancer Prevention: APJCP\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(7), 2303.\u003c/li\u003e\n\u003cli\u003eFaghani, S., \u0026amp; Ghaffari, F. (2016). Effects of sexual rehabilitation using the PLISSIT model on quality of sexual life and sexual functioning in post-mastectomy breast cancer survivors. \u003cem\u003eAsian Pacific journal of cancer prevention: APJCP\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(11), 4845.\u003c/li\u003e\n\u003cli\u003eGao W, Zhang Q, Wang D, Li X, Zhang L, Xu M, Han J.(2024). The role expectations of young women as wives after breast cancer treatment: A qualitative study. Int J Nurs Sci, 29;11(3):366-373. doi: 10.1016/j.ijnss.2024.05.001. PMID: 39156686; PMCID: PMC11329045.\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;dek, G., \u0026amp; Yılmaz, S. (2024). Effectiveness of sexual education given in line with the PLISSIT model for sexual problems of women with breast cancer. \u003cem\u003eAndrology Bullettin)\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(2).\u003c/li\u003e\n\u003cli\u003eGray, J. R., Grove, S. K., \u0026amp; Sutherland, S. (2016). Burns and grove\u0026apos;s the practice of nursing research-E-book: Appraisal, synthesis, and generation of evidence. Elsevier Health Sciences.\u003c/li\u003e\n\u003cli\u003eHanley, T., \u0026amp; Cutts, L. (2013). What is a systematic review?. \u003cem\u003eCounselling Psychology Review\u003c/em\u003e, \u003cem\u003e28\u003c/em\u003e(4), 3-6.\u003c/li\u003e\n\u003cli\u003eHiggins, J. P., Altman, D. G., G\u0026oslash;tzsche, P. C., J\u0026uuml;ni, P., Moher, D., Oxman, A. D., ... \u0026amp; Sterne, J. A. (2011). The Cochrane Collaboration\u0026rsquo;s tool for assessing risk of bias in randomised trials. \u003cem\u003eBmj\u003c/em\u003e, \u003cem\u003e343\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eHummel, S. B., van Lankveld, J. J., Oldenburg, H. S., Hahn, D. E., Kieffer, J. M., Gerritsma, M. A., ... \u0026amp; Aaronson, N. K. (2019). Sexual functioning and relationship satisfaction of partners of breast cancer survivors who receive internet-based sex therapy. \u003cem\u003eJournal of sex \u0026amp; marital therapy\u003c/em\u003e, \u003cem\u003e45\u003c/em\u003e(2), 91-102.\u003c/li\u003e\n\u003cli\u003eHo PJ, Gernaat SAM, Hartman M, Verkooijen HM.(2017). Health-related quality of life in Asian patients with breast cancer: a systematic review. BMJ Open. 2018;8:e020512. doi: 10.1136/bmjopen-2017-020512.\u003c/li\u003e\n\u003cli\u003eIşık, I. (2014). Psychosocial problems developing in breast cancer patients in the post-treatment period and supportive nursing interventions. Education and Research in Nursing, 11(3), 58-64.\u003c/li\u003e\n\u003cli\u003eJamalianfar, F., Riazi, H., Firoozi, A., Nasiri, M., \u0026amp; Montazeri, A. (2021). The Effectiveness of \u0026lsquo;Good-Enough Sex Model\u0026rsquo;on Sexual Satisfaction and Sexual Intimacy in Women with Multiple Sclerosis: A Randomized Trail. \u003cem\u003eSexuality and Disability\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e(3), 507-519.\u003c/li\u003e\n\u003cli\u003eKarakas, S., \u0026amp; Aslan, E. (2019). Sexual counseling in women with primary infertility and sexual dysfunction: Use of the BETTER model. \u003cem\u003eJournal of sex \u0026amp; marital therapy\u003c/em\u003e, \u003cem\u003e45\u003c/em\u003e(1), 21-30.\u003c/li\u003e\n\u003cli\u003eKarimi, F., Babazadeh, R., Roudsari, R. L., Asgharipour, N., \u0026amp; Esmaily, H. (2021). Comparing the effectiveness of sexual counseling based on PLISSITand BETTER models on sexual selfdisclosure in women with sexual problems after childbirth: A randomized trial. \u003cem\u003eIranian Journal of Nursing and Midwifery Research\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(1), 68-74.\u003c/li\u003e\n\u003cli\u003eKeshavarz, Z., Karimi, E., Golezar, S., Ozgoli, G., \u0026amp; Nasiri, M. (2021). 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\u0026ndash;posttest trial. \u003cem\u003eBMC women\u0026apos;s health\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e, 1-8.\u003c/li\u003e\n\u003cli\u003eKhoei, E. M., Kharaghani, R., Shakibazadeh, E., Faghihzadeh, S., Aghajani, N., Korte, J. E., \u0026amp; Esmkhani, M. (2022). Sexual health outcomes of PLISSIT-based counseling versus grouped sexuality education among Iranian women with breast cancer: A randomized clinical trial. \u003cem\u003eSexual and Relationship Therapy\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(4), 557-568\u003c/li\u003e\n\u003cli\u003eKorkutan, F., \u0026amp; Taylan, S. (2024). Effects of PLISSIT-based sexual counselling on the sexual lives of women with breast cancer: meta-analysis study. \u003cem\u003eCurrent Psychology\u003c/em\u003e, \u003cem\u003e43\u003c/em\u003e(44), 33844-33855.\u003c/li\u003e\n\u003cli\u003eLiberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., G\u0026oslash;tzsche, P. C., Ioannidis, J. P., ... \u0026amp; Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. \u003cem\u003eAnnals of internal medicine\u003c/em\u003e, \u003cem\u003e151\u003c/em\u003e(4), W-65.\u003c/li\u003e\n\u003cli\u003eLundberg, P. C. \u0026amp; Phoosuwan, N. (2022). Life situations of Swedish women undergoing mastectomy for breast cancer: A qualitative study. \u003cem\u003eEuropean Journal of Oncology Nursing\u003c/em\u003e , 57 , 102116. https://doi.org/10.1016/j.ejon.2022.102116.\u003c/li\u003e\n\u003cli\u003eMangolian Shahrbabaki, P, Mehdipour-Rabori, R, Gazestani, T, Forouzi, M.A. (2021). Iraniannurses\u0026apos; perspective of barrierstosexualcounseling for patientswithmyocardialinfarction. \u003cem\u003eBMC nursing\u003c/em\u003e, 20(1), 196.\u003c/li\u003e\n\u003cli\u003eMick, J., Hughes, M., Cohen, M. Z., \u0026amp; Brant, J. M. (2004). Using the BETTER Model to assess sexuality. \u003cem\u003eClinical journal of oncology nursing\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(1).\u003c/li\u003e\n\u003cli\u003eMcCarthy, B. W., \u0026amp; Metz, M. E. (2008). The \u0026ldquo;Good-Enough Sex\u0026rdquo; model: a case illustration. \u003cem\u003eSexual and Relationship Therapy\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(3), 227-234.\u003c/li\u003e\n\u003cli\u003eMoola, S., Munn, Z., Tufanaru, C., Aromataris, E., Sears, K., Sfetcu, R., et al. (2017). Checklist for analytical crosssectional studies. Joanna Briggs Inst. 2017; Rev. Man. 6. AvaiableFrom: https://doi.org/10.17221/96/2009-CJGPB.\u003c/li\u003e\n\u003cli\u003eMohammadi Z, Maasoumi R, Vosoughi N, Eftekhar T, Soleimani M, Montazeri A. (2022). Effect of psychosexual counseling based on the PLISSIT model in improving sexual function and quality of sexual life in gynecologic cancer survivors: a randomized controlled clinical trial. \u003cem\u003eSupportive Care Cancer\u003c/em\u003e, 30(11):9117\u0026ndash;9126. doi: 10.1007/s00520-022-07332-8.\u003c/li\u003e\n\u003cli\u003eMomeni ES, Danesh M, Moosazadeh M, Hamidi F, Shahhosseini Z.(2023). Sexual Quality of Life of Breast Cancer Survivors: A Cross-Sectional Study. Asian Pac J Cancer Prev. 1;24(5):1621-1627. doi: 10.31557/APJCP.2023.24.5.1621\u003c/li\u003e\n\u003cli\u003eNazarzadeh, S., Moghaddam-Tabrizi, F., Haghighi, M., \u0026amp; Gharaaghaji-Asl, R. (2024). Effect of WhatsApp-based BETTER model sexual counselling on sexual function and sexual quality of life in breast cancer survivors: a randomized control trial. \u003cem\u003eBMC women\u0026apos;s health\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(1), 452.\u003c/li\u003e\n\u003cli\u003eOlcer, Z. O., \u0026amp; Oskay, U. (2022). Effects of the better model based counseling on sexuality of women with breast cancer. \u003cem\u003eInternational Journal of Sexual Health\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(1), 41-54.\u003c/li\u003e\n\u003cli\u003eOers, H., \u0026amp; Schlebusch, L. (2020). Indicators of psychological distress and body image disorders in female patients with breast cancer. Journal of Mind and Medical Sciences, 7(2), 179-187. https://doi.org/10.22543/7674.72.P179187.\u003c/li\u003e\n\u003cli\u003eSaboula, N., \u0026amp; El-Sayed, S. (2015). Effectiveness of application of PLISSIT counseling model on sexuality for breast cancer\u0026rsquo;s women undergoing treatment. \u003cem\u003eAm J Nurs Sci\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(4), 218-30.\u003c/li\u003e\n\u003cli\u003eSel, Z., \u0026amp; Beydağ, K. D. (2022). Relationship between body perception, sexual quality of life and marital adjustment in women who underwent surgery for breast cancer. Bandırma Onyedi Eyl\u0026uuml;l University Journal of Health Sciences and Research, 4(2), 119-127.\u003c/li\u003e\n\u003cli\u003eShalamzari, K. H., Asgharipour, N., Jamali, J., Kermani, A. T., \u0026amp; Babazadeh, R. (2024). Comparing the effect of sexual counseling based on BETTER and PLISSIT models on sexual assertiveness in women with breast cancer after mastectomy. \u003cem\u003eJournal of Education and Health Promotion\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(1), 55.\u003c/li\u003e\n\u003cli\u003eShamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., \u0026amp; Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. \u003cem\u003eBmj\u003c/em\u003e, \u003cem\u003e349\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eShahin, MA., Amin Ali Gaafar, H., \u0026amp; Lotfi Afifi Alqersh, D. (2021). Effect of nursing counseling guided by BETTER model on sexuality, marital satisfaction and psychological status among breast cancer women. \u003cem\u003eEgyptian Journal of Health Care\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(2), 75-95.\u003c/li\u003e\n\u003cli\u003eShalamzari, K. H., Asgharipour, N., Jamali, J., Kermani, A. T., \u0026amp; Babazadeh, R. (2022). The Effect of Sexual Counseling Based on BETTER and PLISSIT Model on Quality of Sexual Life in Women with Breast Cancer after Mastectomy. \u003cem\u003eJournal of Midwifery \u0026amp; Reproductive Health\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(4).\u003c/li\u003e\n\u003cli\u003eTaylan, S., \u0026amp; Kola\u0026ccedil;, N. (2021). Body image and sexual adjustment of women who underwent breast cancer surgery. Andrology Bulletin, 23(3), 163-169.\u003c/li\u003e\n\u003cli\u003eTurhan, İ., \u0026amp; Akcan, K. (2022). Current Diagnosis and Treatments for Female Sexual Dysfunction. Gevher Nesibe Journal of Medical and Health Sciences, 7(17), 57-63.\u003c/li\u003e\n\u003cli\u003eValente M, Chirico I, Ottoboni G, Chattat R.(2021). Relationship Dynamics among Couples Dealing with Breast Cancer: A Systematic Review. Int J Environ Res Public Health. 7;18(14):7288. doi: 10.3390/ijerph18147288. PMID: 34299738; PMCID: PMC8303482.\u003c/li\u003e\n\u003cli\u003eWilson, C. M., Gee, A., \u0026amp; Mooney, K. (2022). Clinician and patient communication about body image, sexuality, and sexual function in gynecologic cancer patients: An integrative review. \u003cem\u003eSexuality and Disability\u003c/em\u003e, 40 (2), 363\u0026ndash;379. https://doi.org/10.1007/s11195-022-09736-0.\u003c/li\u003e\n\u003cli\u003eZangeneh, S., Savabi-Esfahani, M., Taleghani, F., Sharbafchi, M. R., \u0026amp; Salehi, M. (2023). Effectiveness of online sexual education based on the extended PLISSIT model on sexual function and sexual satisfaction in women undergoing breast cancer treatment. \u003cem\u003eJournal of education and health promotion\u003c/em\u003e, (1), 311.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003e\u003cstrong\u003eTable I. Characteristics of the Studies Evaluated in the Study\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"866\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eAuthor/Year/Country\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eType of Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eArticle Title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePurpose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eSample\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eMeasurement Tools\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eFindings-Results\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eKeshavarz Z. (2021) / Iran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003ePretest-Posttest, Single-Group Quasi-Experimental\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eThe effect of PLISSIT based counseling model on sexual function, quality of life, and sexual distress in women surviving breast cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eAimed to determine the effect of PLISSIT-based counseling on sexual function, sexual distress, and QoL in women surviving breast cancer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e65 women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFSFI\u003c/p\u003e\n \u003cp\u003eBDI-II,\u003c/p\u003e\n \u003cp\u003eSTAI\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWHOQOL-BREF \u0026nbsp; \u0026nbsp; FSDS-R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eSexual function and various dimensions of quality of life scores increased significantly, while sexual distress scores decreased after the intervention.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eKorkutan F. (2024) / Global\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eMeta-Analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eEffects of PLISSIT-based sexual counselling on the sexual lives of women with breast cancer: meta-analysis study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eTo evaluate the effects of PLISSIT-based sexual counseling on the sexual lives of women with breast cancer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e325 women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003ch4\u003eComprehensive Meta-Analysis (CMA) software version 3\u003c/h4\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eShows that PLISSIT-based sexual counseling improves the sexual lives of breast cancer patients in their postoperative treatment period. Both sexual life and sexual function outcomes were significantly better in the PLISSIT-based counseling group than in the routine counseling group.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eNazarzadeh S. (2024) / Iran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eEffect of WhatsApp-based BETTER model sexual counselling on sexual function and sexual quality of life in breast cancer survivors: a randomized control trial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eInvestigates the effect of WhatsApp-based BETTER model sexual counseling on sexual function and sexual quality of life in breast cancer survivors.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003ewomen:45\u003c/p\u003e\n \u003cp\u003emen: 45\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSQOL-F\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFSFI-BC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eFound successful improvement in women\u0026rsquo;s sexual quality of life and sexual function among breast cancer patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eG\u0026uuml;dek, G., \u0026amp; Yılmaz, S. (2024) / Turkey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eThe effectiveness of sexual education provided in line with PLISSIT model for sexual problems of women with breast cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eTo determine the effectiveness of PLISSIT-model-based sexual education for addressing the sexual problems of women diagnosed with breast cancer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003ewomen:34\u003c/p\u003e\n \u003cp\u003emen:32\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eASEX\u003c/p\u003e\n \u003cp\u003eFSFI\u003c/p\u003e\n \u003cp\u003eSABIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eThe study concluded that, after PLISSIT-model-based sexual education, women in the intervention group had higher FSFI scores; the CUBİ\u0026Ouml; subscale scores for sexual function were improved, and subsequent body image results were better.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eOlcer Z.O., Oskay U. (2021) / Turkey\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eExperimental and Control Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eEffects of the Better Model Based Counseling on Sexuality of Women with Breast Cancer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eTo determine the impact of a BETTER Model\u0026ndash;based counseling program on the sexual problems of women with breast cancer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003ewomen:30\u003c/p\u003e\n \u003cp\u003emen:30\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eEORTC Quality of Life Questionnaire-BR23\u003c/p\u003e\n \u003cp\u003eFSFI\u003c/p\u003e\n \u003cp\u003eBCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eAfter the \u0026ldquo;Better Model\u0026rdquo; counseling program, lubrication, orgasm, pain subscale scores, and total FSFI scores were higher in the intervention group. Women in the intervention group also scored higher on the body image subscale of the functional section of the quality of life questionnaire.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eFaghani S, Ghaffari F (2016) / Iran\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eQuasi-Experimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eEffects of Sexual Rehabilitation Using the PLISSIT Model on Quality of Sexual Life and Sexual Functioning in Post-Mastectomy Breast Cancer Survivors.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eConducted to determine the effect of sexual rehabilitation using the PLISSIT model on post-mastectomy breast cancer survivors.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003ewomen:50\u003c/p\u003e\n \u003cp\u003emen:50\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSQOL-F\u003c/p\u003e\n \u003cp\u003eFSFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eIndicates that nurses can use the PLISSIT model alongside chemotherapy and radiotherapy to teach women with breast cancer coping and problem-solving skills, encouraging them to participate in group programs to express their feelings and attitudes about their current sexual life, thereby helping improve sexual quality of life and sexual function.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eSaboula, N., \u0026amp; El-Sayed, S. (2015) / Egypt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eQuasi-Experimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eEffectiveness of Application of PLISSIT Counseling Model on Sexuality for Breast Cancer\u0026rsquo;s Women Undergoing Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eExamines the effectiveness of the PLISSIT Counseling Model on female sexuality, body image, and couple satisfaction among women undergoing breast cancer treatment.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e66 women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFSDI\u003c/p\u003e\n \u003cp\u003eBody Image Scale\u003c/p\u003e\n \u003cp\u003eRDAS\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eThe application of the PLISSIT model was effective in improving sexual function, body image, and couple satisfaction for women undergoing treatment for breast cancer.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eAlmeida, N. G. D., Britto, D. F. (2019) / Brazil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eCase Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003ePLISSIT model: sexual counseling for breast cancer survivors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eReports on the experience of using the PLISSIT model as a tool in nursing care for breast cancer patients with sexual dysfunction.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e15 women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;FSFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eWith counseling based on the PLISSIT Model, women\u0026rsquo;s FSFI scores increased by 36.79%.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eZangeneh S. et al. (2023) / Iran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eQuasi-Experimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eEffectiveness of online sexual education based on the extended PLISSIT model on sexual function and sexual satisfaction in women undergoing breast cancer treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eAims to determine the effect of online sexual education based on the Ex-PLISSIT model on sexual function and satisfaction in women undergoing breast cancer treatment.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003ewomen:40\u003c/p\u003e\n \u003cp\u003emen:40\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFSFI\u003c/p\u003e\n \u003cp\u003eLarson\u0026rsquo;s Sexual Satisfaction Questionnaire\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eThe study demonstrated a significant increase in the mean scores for sexual satisfaction and function in the intervention group after the intervention.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eShalamzari K.H. (2024) / Iran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eQuasi-Experimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eComparing the effect of sexual counseling based on BETTER and PLISSIT models on sexual assertiveness in women with breast cancer after mastectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eConducted to compare the effects of sexual counseling based on two models\u0026mdash;PLISSIT (Permission, Limited Information, Specific Suggestion, Intensive Therapy) and BETTER (Bringing up, Explaining, Telling, Timing, Educating, Recording)\u0026mdash;on sexual assertiveness in post-mastectomy women.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e78 women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eHISA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eThe study showed that BETTER sexual counseling was more effective than PLISSIT counseling in increasing sexual assertiveness among women who had undergone mastectomy.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eKhoei (2022) / Iran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eSexual health outcomes of PLISSIT-based counseling versus grouped sexuality education among Iranian women with breast cancer: A randomized clinical trial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eThe aim of this study is to compare the impact of individual therapy (PLISSIT) vs. group therapy (Sexual Health model) on sexual behavior scores in Iranian women with breast cancer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e75 women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eThe study showed that the PLISSIT model was effective in improving women\u0026rsquo;s sexual behavior scores.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eEsmkhani M. (2021) / Iran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eComparison of\u0026nbsp;the\u0026nbsp;Effects of\u0026nbsp;the\u0026nbsp;PLISSIT Model Versus the\u0026nbsp;Sexual Health Model on\u0026nbsp;Quality of\u0026nbsp;Life Among Women with\u0026nbsp;Breast Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eAims to assess the effect of individual therapy (PLISSIT Model) vs. group therapy (Sexual Health Model) on the quality of life in Iranian women with breast cancer.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e75 women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eEORTC QLQ-C30V.3\u003c/p\u003e\n \u003cp\u003eSexual Distress Questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eThe study showed that the PLISSIT Model was effective in improving women\u0026rsquo;s quality of life.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eShalamzari, K. H. (2022) / Iran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eQuasi-Experimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eThe Effect of Sexual Counseling Based on BETTER and PLISSIT Model on Quality of Sexual Life in Women with Breast Cancer after Mastectomy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eConducted to compare the effect of counseling based on two models, PLISSIT and BETTER, on sexual quality of life in women with breast cancer after mastectomy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e78 women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSQOL-F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eBETTER-model-based sexual counseling is more effective than the PLISSIT model in improving sexual quality of life.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eFarnam, F. (2021) / Iran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eThe Effect of Good Enough Sex (GES) Model-Based Sexual Counseling Intervention on the Body Image in Women Surviving Breast Cancer: A Randomized Clinical Trial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eThe objective of this study is to determine the effect of a counseling intervention based on the Good Enough Sex (GES) model on body image in women who have survived breast cancer.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003ewomen:50\u003c/p\u003e\n \u003cp\u003emen:50\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eDisease-related information\u003c/p\u003e\n \u003cp\u003eBody Image Scale (BIS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eResults showed a statistically significant difference in average body image scores between the intervention and control groups. The GES model\u0026ndash;based counseling intervention improved body image in women.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eA. Shahin (2021) / Egypt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eQuasi-Experimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eEffect of Nursing Counseling Guided by BETTER Model on Sexuality, Marital Satisfaction, and Psychological Status among Breast Cancer Women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eEvaluates the effect of nursing counseling guided by the BETTER model on sexuality, marital satisfaction, and psychological status among women with breast cancer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e87 women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFSFI\u003c/p\u003e\n \u003cp\u003eBody Image Scale\u003c/p\u003e\n \u003cp\u003eENRICH\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMarital Satisfaction Scale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eThe Arabic version of the Tylor Anxiety Scale\u003c/p\u003e\n \u003cp\u003ePSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eDemonstrated a highly significant difference in marital satisfaction, sexual orientation, and psychological well-being among study participants before and after implementing BETTER-model-based nursing counseling.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"sexuality-and-disability","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sedi","sideBox":"Learn more about [Sexuality and Disability](http://link.springer.com/journal/11195)","snPcode":"11195","submissionUrl":"https://submission.springernature.com/new-submission/11195/3","title":"Sexuality and Disability","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Sexual counseling models, breast cancer, midwifery, systematic review","lastPublishedDoi":"10.21203/rs.3.rs-7813921/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7813921/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study aimed to determine the effects of model-based sexual counseling on the health of women diagnosed with breast cancer and those who have survived breast cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A comprehensive literature review was conducted using six databases, Google Scholar, Cochrane Library, PubMed, Web of Science, ScienceDirect, and Medline, covering all quantitative studies published up to December 15, 2024, that met the inclusion criteria. The keywords used were breast cancer, counseling models, ALLOW, PLISSIT, EX-PLISSIT, BETTER, GES, IMB, and ALARM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Fifteen studies published between 2015 and 2024 were included, with a combined sample size of 1,350 participants. Sixteen distinct outcomes were reported regarding the positive impact of sexual counseling models on women’s health, including sexual desire, arousal, lubrication, orgasm, satisfaction, dyspareunia, anxiety levels, overall quality of life, sexual distress, sexual quality of life, sexual functioning, sexual compatibility, body image, couple satisfaction, and treatment-related side effects. This systematic review concluded that sexual counseling using established models can effectively improve women’s health in those diagnosed with or surviving breast cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and Recommendations:\u003c/strong\u003eThis review shows that interventions based on sexual counselling models not only improve sexual problems but also address a range of issues including side effects, marital adjustment and body image. Midwives, nurses and all health professionals providing primary care to women with breast cancer are advised to use appropriate sexual counselling models in their practice. Further research is needed to clarify the broader impact of model-based sexual counselling on women’s overall health.\u003c/p\u003e","manuscriptTitle":"Sexual Counseling and Breast Cancer: A Systematic Analysis of the Predictive Effect on Women's Health Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-27 20:39:52","doi":"10.21203/rs.3.rs-7813921/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-17T01:19:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-16T04:26:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156171538840573679918372326397616631284","date":"2025-10-21T04:56:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-14T01:45:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-10T07:43:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-10T07:39:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sexuality and Disability","date":"2025-10-09T06:51:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sexuality-and-disability","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sedi","sideBox":"Learn more about [Sexuality and Disability](http://link.springer.com/journal/11195)","snPcode":"11195","submissionUrl":"https://submission.springernature.com/new-submission/11195/3","title":"Sexuality and Disability","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a6830a32-3824-4a06-9bbd-b44a76d2295f","owner":[],"postedDate":"October 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T01:53:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-27 20:39:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7813921","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7813921","identity":"rs-7813921","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}