Counseling Training Boosts Midwives’ Skills Talking About Sex With Postmenopausal Women

A new randomized, single-blind clinical trial from Kerman, Iran, reports that a structured counseling education program measurably improved both the clinical skills and the willingness of midwives to talk about sex with postmenopausal women.

The research team, led by Fatemeh Adabiyeh and colleagues, set out to test whether education in sexual counseling based on the PLISSIT model — Permission, Limited Information, Specific Suggestions and Intensive Therapy — could raise midwives’ competence in this sensitive area.

The trial enrolled 232 midwives who met the inclusion criteria, selected randomly from the membership of the Kerman medical council. Participants were randomly divided into two groups in this pretest-posttest design with a control group. Before any training began, everyone completed questionnaires measuring clinical skills and sexual dialogue — the practice of openly discussing sexual matters with patients. The two groups were homogeneous in demographic variables and, importantly, showed no significant difference in clinical skills or sexual dialogue scores at baseline, meaning any later gap could be attributed to the intervention rather than pre-existing differences.

The intervention itself was compact but intensive. Midwives in the intervention group received two sex counseling sessions based on the PLISSIT model, each lasting five hours — a total of ten hours of structured education. At the end of the last session, both groups completed the same questionnaires again, allowing the researchers to compare changes within and between the groups. Data were analyzed using SPSS 22.

The results were striking. After the intervention, the mean clinical skills score in the intervention group was 154.33 (standard deviation 11.21), compared with 129.68 (standard deviation 10.44) in the control group. Sexual dialogue scores showed a similar pattern: 161.03 (standard deviation 7.46) in the trained group versus 144.36 (standard deviation 4.88) among controls. Both differences were reported as statistically significant, with the authors reporting p > 0.0001.

What makes this trial notable is its focus on the provider rather than the patient. This study flips the lens: it treats the midwife as the target of the intervention, on the premise that the high prevalence of sexual problems in menopausal women is partly due to insufficient skills, knowledge and wrong attitudes among health care providers about sexual issues. By equipping midwives with a concrete framework for raising and managing these conversations, the intervention aimed to remove a barrier that sits upstream of patient care.

The authors conclude that this PLISSIT-based counseling education can be used as an effective intervention to promote the clinical skills and sexual dialogue of midwives with postmenopausal women, and that it may ultimately contribute to improving the quality of life of postmenopausal women themselves. That final link — from provider training to patient wellbeing — remains an inference at this stage; the trial measured outcomes in the midwives, not in their patients, so any downstream benefit to women’s quality of life would need to be demonstrated in future studies.

The trial was approved by the Ethics Committee of Kerman University of Medical Sciences (ethics code IR.KMU.REC.1398.681) and registered as a randomized controlled clinical trial (IRCT20170624034722N2), with first registration on 24 December 2023.

Subject of Research: A randomized trial testing whether PLISSIT-based sexual counseling education improves midwives' clinical skills and dialogue with postmenopausal women.

Article Title: Education of counseling has improved sexual dialogue and clinical skills of midwives with postmenopausal women: a randomized single blind clinical trial

Article References: Adabiyeh, F., Ahmadi, A., Mirzaee, M., Ghazanfarpour, M., & Mirzaee, F. (2026). Education of counseling has improved sexual dialogue and clinical skills of midwives with postmenopausal women: a randomized single blind clinical trial. BMC Women's Health. https://doi.org/10.1186/s12905-026-05020-x

Image Credits: AI Generated

DOI: 10.1186/s12905-026-05020-x

Keywords: midwives, postmenopausal women, sexual health, PLISSIT model, counseling education, randomized controlled trial, clinical skills, sexual dialogue, Iran, nursing education, menopause, continuing education