The effect of sexual counseling based on the Ex-PLISSIT model on sexual quality of life and sexual satisfaction in women with stoma: a randomized controlled trial

Women with stomas often face body image issues, anxiety, and shame, which can lead to sexual problems and avoidance of intimacy, negatively affecting their quality of life and showing the need for supportive interventions. This study aimed to evaluate the effectiveness of sexual counseling based on the Ex-PLISSIT model in improving sexual quality of life, sexual satisfaction, and marital relationship satisfaction in women with permanent stomas. A prospective, single-center, randomized controlled trial was conducted between September 2023 and April 2024. The CONSORT statement was used to report the findings. Thirty-two women with permanent stomas were randomized to the counseling group (n = 16) or the control group (n = 16). One participant from the counseling group was lost to follow-up after baseline, and 31 participants were included in the final analysis. The counseling group received 3 structured sessions of sexual counseling based on the Ex-PLISSIT model. Data were collected at baseline, 1 month, and 3 months using the Sexual Quality of Life-Female (SQoL-F) questionnaire, Visual Analog Scale-Sexual Satisfaction (VAS-SS), and Visual Analog Scale-Marital Relationship Satisfaction (VAS-MRS). The outcomes included SQoL-F, VAS-SS, and VAS-MRS scores measured at baseline, 1 month, and 3 months. At baseline, no significant differences were observed between the groups. At 1 and 3 months, the counseling group had significantly higher SQoL-F scores (from 27.50 ± 18.94 to 99.30 ± 3.02) and VAS-SS scores (from 2.25 ± 2.09 to 8.39 ± 1.24) than the control group (P < .001). Visual Analog Scale-Marital Relationship Satisfaction scores showed no significant differences between groups; however, the interaction effect approached significance (P = .053). Sexual counseling based on the Ex-PLISSIT model can be effectively integrated into routine stoma care to support improvements in sexual and relational well-being, and it is recommended that nurses, physicians, and sex therapists prioritize this component within clinical practice. The study provides valuable insights into addressing sexual health in women with stomas. Limitations include the single-center design, small sample size, and lack of an active control group. Further research with larger samples is recommended. The Ex-PLISSIT-based counseling intervention significantly improved sexual quality of life and satisfaction, may contribute to marital relationship satisfaction, and is recommended as an important component of clinical care for individuals with stomas by nurses, physicians, and sex therapists.