"Silent Suffering": Affirming Iranian Women's Right to Sexual Health Through a Whatsapp-Based "Good Enough Sex"...

Infertility profoundly affects women's sexual health and psychological well-being, particularly in cultures where childbearing defines female identity and sexuality remains a taboo subject. In Iran, no randomized controlled trial has evaluated a culturally adapted digital psychosexual intervention for infertile women.

This parallel-group, single-blind randomized controlled trial was conducted from September 2021 to April 2022 at two major infertility centers in Urmia, Iran. A total of 100 infertile women (aged 25-35 years) were recruited via convenience sampling and then randomly allocated to either a 6-week WhatsApp-based Good Enough Sex (GES) counseling program (n = 50) or a routine care control group (n = 50). Outcomes included infertility-related stress (Newton Infertility Stress Questionnaire) and sexual satisfaction (Larson's Sexual Satisfaction Questionnaire), assessed at baseline, post-intervention, and 1-month follow-up. Data were analyzed using repeated-measures ANOVA.

The intervention group showed significant improvements in sexual satisfaction (mean increase: 41.92 points) and significant reductions in infertility-related stress (mean reduction: 108.90 points) immediately post-intervention, with effects largely sustained at 1-month follow-up (p < 0.001 for all). Effect sizes were large (partial η² = 0.52 for sexual satisfaction; partial η² = 0.82 for infertility stress). The control group showed no significant changes.

Among this sample of infertile Iranian women, WhatsApp-based GES counseling was associated with reduced infertility-related stress and improved sexual satisfaction. Because the sample was recruited by convenience sampling from two referral centers, was relatively small, used restrictive eligibility criteria, and had only 1-month follow-up, these findings should be considered promising preliminary evidence. Larger multicenter randomized trials with more diverse populations and longer follow-up are needed before conclusions about generalizability can be drawn. If confirmed, this approach may offer a useful adjunct to infertility care in culturally conservative settings.

In conservative societies where sexual health discussions are stigmatized, infertility clinics may consider integrating WhatsApp-based GES counseling into routine care. Policymakers could support training providers in this model and digital ethics, and health authorities can leverage this approach to replace online misinformation with evidence-based education.

IRCT20210926052593N1, The date of registration: 13-10-2021.