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Sexual health is not merely about sexual dysfunction, but a complex, diverse, and multifaceted natural process encompassing a wide range of aspects of human life, extending from childhood to old age. Quality of sexual life refers to an individual's satisfaction with their sexual life. Due to increased life expectancy, women spend more than a third of their lives in the postmenopausal period. Contrary to expectations, sexuality becomes increasingly important for women in the postmenopausal period. The postmenopausal period, following menopause, brings about vasomotor, psychological, and urogenital changes and complaints, as well as various health problems. These changes and complaints can impair sexual function, sexual satisfaction, and marital harmony, negatively impacting the quality of sexual life. The literature indicates that sexual satisfaction is one of the most important factors affecting marital harmony, and that sexual dissatisfaction diminishes positive emotions and intimacy within marriage. The postmenopausal period has a significant impact not only on life expectancy but also on couples' sexual health and marital harmony. However, the assessment of this issue by healthcare personnel is often neglected. Assessing patients' sexual health and concerns about sexuality is an important part of the professional nursing role and holistic care. For this purpose, it is stated that participation in special training programs aimed at assessing patient sexuality and the use of models that will provide guidance can be beneficial . The use of professional sexual diagnostic models by nurses in assessing patient sexuality will lead to a healthier and more effective questioning and evaluation of sexuality. The PLISSIT and EX-PLISSIT models are commonly used by nurses in primary care to address sexual health needs and concerns. The PLISSIT model consists of four therapeutic stages: Permission, Limited Information (LI), Specific Suggestions (SS), and Intensive Therapy (IT). As the intervention stages of the PLISSIT model progress, more comprehensive knowledge, training, and skills are required. Ex-PLISSIT is an expanded version of the PLISSIT model, with the permission stage being central. One cannot proceed to the next stage without completing the permission stage
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| control group | No Intervention | The control group will not receive any intervention. They will only be given educational brochures. | |
| experimental group | Experimental | The group that received sexual education based on the EX PLISSIT model |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Group receiving sexual counseling based on the EX PLISSIT model. | Other | Appointments will be scheduled for the women in the intervention group to meet at a convenient time and in a suitable environment at the hospital. Sexual counseling within the intervention group will be planned and implemented according to the 4 stages of the EX-PLISSIT model, focusing on the patients' sexual health. Counseling sessions will be conducted by a nurse specializing in sexuality (first author) with a sexual counseling certificate, under the direct supervision of a faculty member specializing in obstetrics and gynecology nursing (second author). The intervention consisted of 4 counseling sessions, each lasting 60-90 minutes, once a week for four weeks. All sessions will be conducted face-to-face and individually in a private room. |
| Measure | Description | Time Frame |
|---|---|---|
| Measuring the impact of sexual counseling based on the EX PLISSIT model | After sexual counseling based on the EX PLISSIT model, the Female Sexual Function Index (FSFI) scale were administered to women in the experimental and control groups via face-to-face interviews. The administration time for each scale varied between 15 and 20 minutes. Changes in the Female Sexual Function Index (FSFI) scale were measured two months after sexual counseling based on the EX PLISSIT model. Female Sexual Function Index (FSFI) This is a 19-item multidimensional scale for evaluating female sexual function. The scale includes six subheadings, desire, arousal, lubrication, orgasm, satisfaction, and pain. Each title was scored between 0 or 1 and six. The lowest and highest scores are 2 and 36, respectively. Higher scores indicated better sexual function. The cut-off value of the scale was 26.55. A total FSFI score of ≤26.55, it indicates sexual dysfunction | two months |
| Measure | Description | Time Frame |
|---|---|---|
| Measuring the impact of sexual counseling based on the EX PLISSIT model | After sexual counseling based on the EX PLISSIT model, the Sexual Quality of Life-Female (SQoL-F) scale were administered to women in the experimental and control groups via face-to-face interviews. The administration time for each scale varied between 15 and 20 minutes. Changes in the Female Sexual Quality of Life (SQoL-F) scales were measured two months after sexual counseling based on the EX PLISSIT model. Sexual Quality of Life-Female (SQoL-F): It is a 6-point Likert-type scale consisting of 18 items. Respondents consider their sexual life over the past four weeks. Scores range from 18 to 108. Higher scores indicate better sexual quality of life. |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Selcuk University | Konya | Konya | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Zahan, A., Sharma, N. K., Islam, M. N., Sen, S., & Bhowmik, K. R. (2025). Menopausal Symptoms and Coping Strategies among Women of 40-60 Years Age-Group: A Tertiary Care Hospital Experience from Bangladesh. Community Based Medical Journal, 14(1), 54-60. | ||
| Background | World Health Organization. (2017). Sexual health and its linkages to reproductive health: An operational approach. Accessed 02. 05. 2020, https://www.who.int/publications/i/item/97892415 49998. | ||
| Background | Üstgörül, S., Yanıkkerem, E., & Göker, A. (2025). Investigation of the Effect of Counseling Given to Postpartum Women with the EX-PLISSIT Model on Sexual. The Family Journal, 10664807241312203. | ||
| 17165482 | Background | Taylor B, Davis S. Using the extended PLISSIT model to address sexual healthcare needs. Nurs Stand. 2006 Nov 22-28;21(11):35-40. doi: 10.7748/ns2006.11.21.11.35.c6382. |
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The PLISSIT and EX-PLISSIT models are commonly used by nurses in primary care to address sexual health needs and concerns. The PLISSIT model consists of four therapeutic stages: Permission, Limited Information (LI), Specific Suggestions (SS), and Intensive Therapy (IT). As the intervention stages of the PLISSIT model progress, more comprehensive knowledge, training, and skills are required. Ex-PLISSIT is an expanded version of the PLISSIT model, with the permission stage being central. One cannot proceed to the next stage without completing the permission stage.
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| two months |
| 37168977 | Background | Shami M, Montazeri A, Faezi ST, Behboodi Moghadam Z. The Effect of Sexual Counseling Based on EX-PLISSIT Model on Improving the Sexual Function of Married Women with Systemic Lupus Erythematosus: A Randomized Controlled Trial. Sex Disabil. 2023;41(2):451-466. doi: 10.1007/s11195-023-09776-0. Epub 2023 Feb 27. |
| 10782451 | Background | Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D'Agostino R Jr. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000 Apr-Jun;26(2):191-208. doi: 10.1080/009262300278597. |
| Background | Nazari, S., Keramatkar, M., Moghdehipanah, H., & Olfati, F. (2023). The effect of ex-PLISSIT model on sexual satisfaction in women with multiple sclerosis. Sexuality and Disability, 41(2), 467-477. |
| 35997810 | Background | Mohammadi Z, Maasoumi R, Vosoughi N, Eftekhar T, Soleimani M, Montazeri A. The effect of the EX-PLISSIT model-based psychosexual counseling on improving sexual function and sexual quality of life in gynecologic cancer survivors: a randomized controlled clinical trial. Support Care Cancer. 2022 Nov;30(11):9117-9126. doi: 10.1007/s00520-022-07332-8. Epub 2022 Aug 23. |
| 31064641 | Background | Mahmoodi Dangesaraki M, Maasoumi R, Hamzehgardeshi Z, Kharaghani R. Effect of the EX-PLISSIT model on sexual function and sexual quality of life among women after hysterectomy: a randomised controlled trial. Sex Health. 2019 Jun;16(3):225-232. doi: 10.1071/SH18107. |
| Background | Koçak, V., Koçak, A. T., Arslan, S., & Uca, A. U. (2026). Enhancing Sexual Health in Multiple Sclerosis: A Randomized Controlled Trial of EX-PLISSIT Counseling. Sexuality and Disability, 44(1), 4. |
| 20233278 | Background | Herbenick D, Reece M. Development and validation of the female genital self-image scale. J Sex Med. 2010 May;7(5):1822-30. doi: 10.1111/j.1743-6109.2010.01728.x. Epub 2010 Mar 3. |
| 28580495 | Background | Gazibara T, Nurkovic S, Kovacevic N, Kurtagic I, Rancic B, Radovanovic S, Milosevic B, Terzic M, Dotlic J. Factors associated with sexual quality of life among midlife women in Serbia. Qual Life Res. 2017 Oct;26(10):2793-2804. doi: 10.1007/s11136-017-1608-3. Epub 2017 Jun 3. |
| Background | Fattahi, M., Masoumi, S. Z., Kazemi, F., & Ahmadpanah, M. (2023). The effect of couple-centered counseling based on EX-PLISSIT model on the sexual function of couples during pregnancy: a randomized controlled trial. Nurs Midwifery Stud, 12(4), 213-220. |
| 42098181 | Background | Dalvand R, Otogara M, Shayan A, Kazemi F, Haghighi M. The impact of couple-focused counseling based on the Ex-PLISSIT model on the sexual self-concept of infertile couples: a randomized trial. Sci Rep. 2026 May 7;16(1):21034. doi: 10.1038/s41598-026-43203-6. |
| Background | Annon, J.S. (1976). The PLISSIT model: a proposed conceptual scheme for the behavioral treatment of sexual problems. Journal of Sex Education, 4(6), 81-88. |
| Background | Altunbaş, N., & Gölbaşı, Z. (2024). The effect of sex education and counseling based on the ex-plissit model on sexual life in primigravidas. Clinical and Experimental Health Sciences, 14(2), 367-376. |
| ID | Term |
|---|---|
| D003075 | Coitus |
| D019529 | Sexuality |
| ID | Term |
|---|---|
| D012725 | Sexual Behavior |
| D001519 | Behavior |
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