The Effectiveness of Group Problem-Solving Therapy on Sexual Function and Satisfaction in Women After Mastectomy | BMC Women’s Health

Design and tuning

The present research was a semi-experimental study, with a pre-test, a post-test and a follow-up period of one month. Written informed consent was obtained from all participants. The patients were contacted on the basis of the list available at the institute and according to the admission criteria. Samples were selected based on inclusion criteria by reviewing existing records. Breast cancer patients can choose this institution to seek treatment and use its services. Out of 40 patients referred to Tehran Breast Cancer Institute between August and December 2020, 32 were invited to participate in the study according to the inclusion and exclusion criteria. The sample size formula was (({varvec{N}} = frac{{2user2{*}left( {{varvec{Z}}_{{left( {1 – frac{ propto }{2}} right)}} + {varvec{Z}}_{{(1 – {varvec{beta}})}} } right)^{2} user2{*p*q}}}{{ ({varvec{p}}_{0} – {varvec{p}}_{1} )^{2} }}) or ({varvec{p}} = frac{{{varvec{p}}_{0} – {varvec{p}}_{1} }}{2}), ({varvec{q}} = 1 – {varvec{p}}), with %95 confidence interval, %5 alpha and %15 chance of falling). The students were assured that the results of the study were confidential and would be published without names. They could leave the search at any time.

Eligibility criteria

The inclusion criteria were as follows: cancer stages between I and III, 1 to 5 years after breast surgery, Iranian nationality, residence in Tehran, 30 to 59 years old, ability to read and write, mastectomy, being married, having a single partner, not attending any other counseling classes and having completed chemotherapy.

Exclusion criteria were lumpectomy surgery, cancer recurrence, history of significant physical and mental illnesses such as schizophrenia and major depression, and substance abuse.


Research instruments included a demographic characteristics questionnaire, the Female Sexual Function Index Questionnaire (FSFI) [21]and the Larson Sexual Satisfaction Questionnaire [22]. The demographic characteristics questionnaire included age, education, marital status, contraceptive method, breast cancer grading, type of surgery, chemotherapy, and radiation therapy records.

The Female Sexual Function Index (FSFI) consists of 19 questions, each with four response options. This standard questionnaire measures six dimensions of sexual function (sexual desire (two items), sexual arousal (four items), lubrication (four items), orgasm (three items), sexual satisfaction (three items) and pain (three items) on the past four weeks. Measurements were taken in accordance with the questionnaire to determine each person’s score in each section and determine the overall score. The lowest score of 2 is the maximum of 36. The cut score to determine disorders is 26 or less the total score obtained is calculated in different domains (the total score is obtained by adding six sections (Brown, 2000). The questionnaire has been validated by Fakhri et al. The general coefficients of test-retest reliability were acceptable for each domain of the questionnaire (from 0.73 to 0.86) and the internal consistencies (from 0.72 to 0.90) [24].

The Sexual Satisfaction Questionnaire is the Iranian version of the Sexual Satisfaction Questionnaire consisting of 25 questions with 5 answers. Questionnaire items are scored on a one-to-five Likert scale, where “never” receives 1, “rarely” receives 2, “sometimes” receives 3, “most of the time” receives 4, and “always” receives 5. A total score of 25-75 equals low sexual satisfaction, 76-100 average sexual satisfaction, and 101-125 high sexual satisfaction. Reliability was determined using Cronbach’s alpha (0.8 for the positive question and 0.77 for the negative) and intraclass correlation coefficients (ICC = 0.8) (23, 24).


This study was conducted in the fall and winter of 2020. After obtaining informed consent, participants provided their phone numbers and addresses to participate in the study. The time, date and place of the counseling sessions were announced by telephone. A counseling program based on a problem-solving approach, comprising eight 90-minute counseling sessions per week, was designed for the participants based on a review of the texts and the opinions of the research team. The participants formed four groups, each consisting of eight people in an appropriate location at the breast cancer institute. A summary of the content of the sessions is presented in Table 1. The questionnaires were completed by the participants before the intervention (baseline), immediately after the intervention and one month later (follow-up).

Table 1 Topics discussed at each counseling session

Ethical considerations

The study was performed within the framework of the Declaration of Helsinki and approved by the Ethics Committee of the Research Assistant of the Shahid Sadoughi University of Medical Sciences (code: IR.SSU.MEDICINE.REC. 1397.176).

After explaining the study objectives to the participants, written informed consent was obtained from all participants. Confidentiality was assured.

Data analysis

Data were analyzed using descriptive statistics and inferential statistics via SPSS 21 software (SPSS, Inc., Chicago, IL, USA). A significant value was considered less than 0.05. As the distributions of the variables studied were normal, parametric statistical tests, such as the analysis of variance used, repeated measures and Bonferroni’s post hoc test, were carried out.

The training of the five problem-solving skills began based on the problem-solving steps of Dezorella and Goldfried. The steps included defining and planning the problem, analyzing the problem, determining the actual goals, producing a solution, deciding and choosing the best solution, predicting the possible consequences of each action, l paying attention to the usefulness of these consequences, implementing the chosen solution, and reviewing and evaluating the steps in problem-solving skills.

Examples of homework:

  • A list of symptoms and treatment complications has been prepared and shared at the next consultation

  • Prepare a list of ways to deal with negative thoughts and reinforce positive thoughts, review solutions

  • Practice problem-solving skills (reducing intimacy and fear of having sex) and practicing strategies and suggestions in the next counseling session

  • Practice anger management strategies, reduce negative emotions, practice active listening and share the results in the next counseling session

  • Devote time and space to yourself, practice relaxation techniques, practice sensory exercises, breathing training, practice joint massage and Kegel exercise and share it with your spouse

Due to the magnitude of the problem in counseling sessions, problem-solving and cognitive-behavioral methods have become a component.

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