THE EFFECT OF WHATSAPP-BASED EX-PLISSIT MODEL SEXUAL COUNSELING ON SEXUAL FUNCTION AND SEXUAL DISTRESS IN BREAST CANCER SURVIVORS

May 30, 2026 updated by: Serap Kırıcı, Karamanoğlu Mehmetbey University

THE EFFECT OF WHATSAPP-BASED EX-PLISSIT MODEL SEXUAL COUNSELING ON SEXUAL FUNCTION AND SEXUAL DISTRESS IN BREAST CANCER SURVIVORS: A RANDOMIZED CONTROLLED STUDY

Cancer is a significant health problem negatively impacting human health due to population growth, aging, and lifestyle changes known to cause cancer. According to World Health Organization sources, the number of newly diagnosed cancer patients, which was 19.3 million in 2020, is projected to reach 30.2 million in 2040. Breast cancer, the most frequently diagnosed type of cancer in the female population worldwide, has an incidence of 47.8 per 100,000 globally and 47.7 per 100,000 in Turkey, according to 2020 GLOBOCAN data. Surgical treatment, chemotherapy, radiotherapy, and hormonal therapies used in the treatment of breast cancer, which has a high incidence worldwide and causes significant loss of workforce, have become important in altering the course of the disease. However, long-term treatments and related complications negatively affect the sexual functions of individuals. Women and men of reproductive age diagnosed with cancer; Even if they have survived cancer and benefited from curative treatments, they face sexual problems caused by the treatment. Individuals diagnosed with and treated for breast cancer experience difficulties in accessing counseling on issues related to their sexuality.Studies have shown that patients are hesitant to discuss sexual matters, need information about sexual problems during and after cancer treatment, but sexual counseling is not included in oncology care, and healthcare professionals focus more on medical issues. In this context, healthcare professionals can utilize many models for sexual counseling. The use of models in assessing sexual health guides healthcare professionals, facilitates the history-taking process, and helps in identifying sexual problems. The International Society for Research on Women's Sexual Health (ISSWSH) aims to establish a basic methodological strategy for identifying sexual problems in women and considering biological, psychological, sociocultural, and related factors that may cause sexual problems. The use of professional sexual assessment models by nurses in questioning and evaluating patient sexuality will be healthier and more effective. PLISSIT and EX-PLISSIT models are widely used by nurses working in primary care settings to address sexual health needs and concerns.

The PLISSIT model consists of four levels: P - Permission, LI - Limited Information, SS - Specific Suggestions, and IT - Intensive Therapy. As the intervention stages of the PLISSIT model progress, more comprehensive knowledge, training, and skills are required. The Ex-PLISSIT model has been developed as an extension of the PLISSIT model. Ex-PLISSIT is a more expanded version of the PLISSIT model, with the permission stage at its center. One cannot proceed to the next stage without obtaining permission.

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

86

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Women diagnosed with breast cancer, stage 0, I, or II,
  • Having undergone mastectomy, and at least 6 months having passed since the completion of radiotherapy and chemotherapy treatment,
  • Aged 18-49, not pregnant, not breastfeeding, not menopausal,
  • Women with sexual dysfunction (FSFI score 26.55 or lower), sexually active, married and living with their spouse.

Exclusion Criteria:

  • Women with chronic, psychological, and physical illnesses,
  • Those with alcohol and substance abuse,
  • Those who have previously received education or counseling for sexual dysfunction,
  • Women diagnosed with cancer other than breast cancer

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: control group
Experimental: experimental group
Sexual Counseling Based on the EX-PLISSIT Model
Behavioral: Sexual counseling group based on the EX-PLISSIT Model
Sexual counseling in the intervention group will be conducted according to the 4-stage EX-PLISSIT model. The EX-PLISSIT model will be implemented by the first author (SK), a specialist nurse who completed a PhD in obstetrics and gynecology nursing with a focus on sexuality. Furthermore, the first author (SK) attended a 120-hour Sexual Therapy Training Certificate Program prior to the study. This will be conducted both individually and in a group setting online. Appropriate training packages in the form of video clips, images, and audio recordings will be created by the research team and then shared via WhatsApp. The intervention consists of four counseling sessions, each lasting 30 to 60 minutes, once a week for four weeks. The control group will receive only routine care without any intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Measuring the effect of sexual counseling on sexual function based on the BETTER model.
Time Frame: one month

After sexual counseling based on the EX-PLISSIT model, the Female Sexual Function Index (FSFI) scale were administered to women in the experimental and control groups via face-to-face interviews. The administration time for each scale varied between 15 and 20 minutes.

Changes in the Female Sexual Function Index (FSFI) scale were measured two months after sexual counseling based on the BETTER model.

Female Sexual Function Index (FSFI) It was developed by Rosen et al. as a multidimensional scale comprising 19 items to evaluate female sexual function. The scale includes six subheadings, desire, arousal, lubrication, orgasm, satisfaction, and pain. Each title was scored between 0 or 1 and six. The lowest and highest scores are 2 and 36, respectively. Higher scores indicated better sexual function. The cut-off value of the scale was 26.55. A total FSFI score of ≤26.55, it indicates sexual dysfunction
one month

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Measuring the effect of sexual counseling on sexual distress based on the BETTER model
Time Frame: one month

After sexual counseling based on the EX-PLISSIT model, the Female Sexual Distress Scale-Revised (FSDS-R) scale were administered to women in the experimental and control groups via face-to-face interviews. The administration time for each scale varied between 15 and 20 minutes.

Changes in the Female Sexual Distress Scale-Revised (FSDS-R) scale were measured one months after sexual counseling based on the BETTER model.

Female Sexual Distress Scale-Revised (FSDS-R) Developed by Derogatis et al. (2008) to measure personal distress related to sexuality in women. The FSDS-R is a 13-item, 5-point Likert-type scale where items are scored on a 0-4 scale. The minimum score that can be obtained from the FSDS-R is "0", and the maximum score is "52". A higher score indicates a higher level of sexual distress. The cutoff point of the scale is 11.5. A score of 11.5 ≥ indicates the presence of sexual distress.
one month

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Karamanoğlu Mehmetbey University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 1, 2026

Primary Completion (Estimated)

June 1, 2026

Study Completion (Estimated)

August 1, 2026

Study Registration Dates

First Submitted

May 30, 2026

First Submitted That Met QC Criteria

May 30, 2026

First Posted (Actual)

June 4, 2026

Study Record Updates

Last Update Posted (Actual)

June 4, 2026

Last Update Submitted That Met QC Criteria

May 30, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • DECISION 02-2026/44

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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