Comparison of the effects of two sexual counseling models, GES (Good Enough Sex) and PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy), on sexual dysfunction in postmenopausal women: a randomized controlled trial

OBJECTIVES: To evaluate and compare the impacts of GES (Good Enough Sex) and PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy) sexual counseling models on sexual intimacy, sexual quality of life, and sexual satisfaction relative to standard care. METHODS: This randomized controlled trial included 108 postmenopausal women aged 45-60 years, recruited from comprehensive health centers in Urmia, Iran, between June 2023 and December 2024. Participants were randomly assigned to three groups of 36 individuals each: the GES, PLISSIT, and control groups. Data were collected using validated questionnaires that assessed sexual intimacy, sexual quality of life, and sexual satisfaction at baseline and 2 months postintervention. The GES group participated in weekly group counseling sessions, while the PLISSIT group received individual counseling over a 4-week period. The control group received standard care without any specialized counseling interventions. Sample characteristics were summarized using descriptive statistics (means and SDs). Inferential tests (χ2, Fisher exact, paired t tests, ANOVA, Kruskal-Wallis, and Tukey) were used for group comparisons and change analysis, with P < 0.05 considered significant. RESULTS: Both the GES and PLISSIT groups demonstrated significant improvements in sexual intimacy, sexual quality of life, and sexual satisfaction, compared with the control group (P < 0.001). The intervention demonstrated a substantial improvement compared with the control group. The standardized mean difference (SMD) for overall outcomes was 1.83 (95% CI: 1.27-2.38). Within-group analysis showed a large positive effect in the PLISSIT group (SMD = 1.48; 95% CI: 0.98-1.97) and the GES group (SMD = 1.83; 95% CI: 1.27-2.38), whereas the control group showed no meaningful change (SMD = -0.26; 95% CI: -0.60 to 0.08). CONCLUSIONS: Both the GES and PLISSIT models effectively enhance sexual intimacy, sexual quality of life, and sexual satisfaction in postmenopausal women. Incorporating structured sexual counseling into health care strategies can significantly improve their quality of life, emphasizing the importance of tailored, accessible interventions.