Psychosexual counseling intervention to improve women's genital self-image: Study protocol for a randomized controlled trial based on a multistage mixed method design.

Background: Genital self-image (GSI) is a major barrier to reproductive and sexual health for women. This practical randomized trial aims to evaluate the effect of psychosexual counseling based on a cognitive-behavioral approach to promoting GSI for reproductive-age married Iranian women.

Methods: Married women aged 15-49 years under the coverage of health centers will be invited to join the study. The study will be conducted using a multistage mixed method design in three phases. In the first phase, semi-structured interviews with women and key informants will be conducted to understand better the GSI concept, the factors influencing it, and the interventions promoting it. Simultaneously, a literature review will be conducted by searching electronic databases to find the factors influencing GSI and the interventions to enhance it.In the second phase, the GSI-related factors, sexual and reproductive health outcomes correlated with GSI, and intervention programs for promoting GSI in women will be extracted from the integration of qualitative study and literature review. Then, based on the expert panel's priority, a suitable program will be prepared.In the third phase, at first, a cross-sectional study will be conducted to identify women with poor GSI and the factors relating to GSI, and then psychosexual counseling intervention will be performed. For the randomized controlled trial study, participants will be randomly allocated into two groups: (1) the intervention group and (2) the control group. Data will be collected using the Female Genital Self-Image Scale and sexual and reproductive health outcomes correlated with GSI at baseline, immediate, and 2-month follow-up assessments. The impact of the intervention on the promotion of GSI will be evaluated.

Discussion: This study provides a counseling program for promoting GSI. If this interventional program is successful, it has practical potential to be generalized for Iranian Women with poor GSI.