Effect of the EX-PLISSIT model on sexual function and sexual quality of life among women after hysterectomy: a randomised controlled trial Marieh Mahmoodi Dangesaraki A , Raziyeh Maasoumi B,C , Zeinab Hamzehgardeshi D and Roghieh Kharaghani A,E A Department of Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran. B Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. C Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. D Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran. E Corresponding author. Email: r.kharaghani@zums.ac.ir Abstract. Background: After hysterectomy, most patients experience psychological problems and sexual dysfunction that can affect their sexual quality of life (QOL). This study determined the effects of counselling based on the Extended Permission-Limited Information-Specific Suggestion-Intensive Therapy (EX-PLISSIT) model on sexual function and sexual QOL after hysterectomy among women attending hospitals in Sari, northern Iran. Methods: A randomised controlled trial was conducted between 2016 and 2017. Of 354 women undergoing hysterectomy, 80 women without anxiety, stress or depression who showed signs of sexual dysfunction were selected and, using blocked randomisation, were assigned to the intervention and control groups. The intervention group received two 1-h counselling sessions each week based on the EX-PLISSIT model. The control group received no counselling. Mood and sexual function and quality of life were measured using established tools (i.e. Depression, Anxiety and Stress Scale, Female Sexual Function Index (FSFI), and the Sexual Quality of Life – Female (SQOL-F)). Eight weeks after completion of counselling, outcomes were compared between the intervention and control groups using independent t-tests and Chi-squared, Mann–Whitney U, Wilcoxon, and Fisher tests. Results: There were no significant differences between the two groups in terms of demographics and most other outcome variables. However, there were significant differences between the intervention and control groups in terms of sexual functioning (median (interquartile range (IQR) FSFI score 32.45 (28.47–33.52) vs 23.85 (20.52–26.45) respectively) and sexual quality of life (median (IQR) SQOL-F score 107.50 (91–108) vs 87 (62.75–96.25), respectively) at the 8-week follow-up (P < 0.001 for both). Conclusion: Use of the EX-PLISSIT model is recommended to sexual health care professionals. Additional keywords: gynaecologic surgeries, Iran, sex education, sexual counselling. Received 1 June 2018, accepted 1 January 2019, published online 8 May 2019 Introduction Hysterectomy is the extraction of the uterus and cervix without removing the adnexa. 1 This is the most common gynaecological surgery in the world, and the highest levels of hysterectomy occur in the US, where 27.4 in 100000 women undergo hysterectomy. 2,3 In Iran, hysterectomy accounts for 3.8% of the total number of surgeries overall. 4 The most important indications for hysterectomy include fibroids, abnormal uterine bleeding, adenomyosis, endometriosis and cervical, uterine or ovarian malignancies, as well as severe haemorrhage postpartum, in which case the hysterectomy is performed as an emergency surgery. 1,3 Hysterectomy is performed in various ways, and most women who undergo hysterectomy experience psychological problems and sexual dysfunction. 5 Sexual function is associated with sexual arousal and activities, including intercourse and a sense of satisfaction and pleasure in the couple. In desired sexual function, there is no guilt or anxiety, and coercion plays no role in forming this relationship. 6 In sexual dysfunction, sexual pleasure or the relationship degenerates with no satisfaction, and this can affect the sexual quality of life (QOL). 7 Sexual QOL is a feeling of sexual attraction, interest and participation in the sexual activity and understanding the sexual functioning, which is related to the general QOL and satisfaction. 8 Reduced libido, CSIRO PUBLISHING Sexual Health, 2019, 16, 225–232 https://doi.org/10.1071/SH18107 Journal compilation Ó CSIRO 2019 www.publish.csiro.au/journals/sh