{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T07:40:21Z","timestamp":1792395621977,"version":"4.4.0"},"reference-count":55,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Infertility profoundly affects women's sexual health and psychological well\u2010being, 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This parallel\u2010group, single\u2010blind 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\u201335 years) were recruited via convenience sampling and then randomly allocated to either a 6\u2010week WhatsApp\u2010based Good Enough Sex (GES) counseling program (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200950) or a routine care control group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200950). Outcomes included infertility\u2010related stress (Newton Infertility Stress Questionnaire) and sexual satisfaction (Larson's Sexual Satisfaction Questionnaire), assessed at baseline, post\u2010intervention, and 1\u2010month follow\u2010up. Data were analyzed using repeated\u2010measures ANOVA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The intervention group showed significant improvements in sexual satisfaction (mean increase: 41.92 points) and significant reductions in infertility\u2010related stress (mean reduction: 108.90 points) immediately post\u2010intervention, with effects largely sustained at 1\u2010month follow\u2010up (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 for all). Effect sizes were large (partial \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.52 for sexual satisfaction; partial \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.82 for infertility stress). The control group showed no significant changes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among this sample of infertile Iranian women, WhatsApp\u2010based GES counseling was associated with reduced infertility\u2010related 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\u2010month follow\u2010up, these findings should be considered promising preliminary evidence. Larger multicenter randomized trials with more diverse populations and longer follow\u2010up 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Policy Implications<\/jats:title>\n                    <jats:p>In conservative societies where sexual health discussions are stigmatized, infertility clinics may consider integrating WhatsApp\u2010based 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\u2010based education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>IRCT20210926052593N1, The date of registration: 13\u201010\u20102021.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73340","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:13:13Z","timestamp":1791439993000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cSilent Suffering\u201d: Affirming Iranian Women's Right to Sexual Health Through a Whatsapp\u2010Based \u201cGood Enough Sex\u201d Counseling Program: A Parallel\u2010Group Randomized Controlled Trial"],"prefix":"10.1002","volume":"9","author":[{"given":"Emdadi\u2010Babanazr","family":"Shahla","sequence":"first","affiliation":[{"name":"School of Nursing and Midwifery Urmia University of Medical Sciences Urmia Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5273-7264","authenticated-orcid":false,"given":"Moghaddam\u2010Tabrizi","family":"Fatemeh","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery Urmia University of Medical Sciences Urmia Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haghighi","family":"Mahmonir","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine Razi Hospital Urmia University of Medical Sciences Urmia Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gharaaghaji Asl","family":"Rasool","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, School of Medicine Urmia University of Medical Sciences Urmia Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_2_21_2_1","doi-asserted-by":"crossref","unstructured":"Organization WH. 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