The rationale behind the work is demographic as much as medical. The world’s older population is growing rapidly, and the authors point out that societal attitudes toward sexuality influence older adults more strongly than any other age group. Older adults also tend to absorb their vulnerability more deeply, largely because of negative perceptions of themselves, a dynamic that can erode confidence, intimacy, and the willingness to seek help. Sexual health, in the framework the researchers adopt, is not merely the absence of dysfunction; it is a state of physical, emotional, mental, and social well-being in relation to sexuality that requires a positive and respectful approach to sexual relationships, along with the possibility of pleasurable and safe experiences. For older couples, chronic disease, medication effects, hormonal changes, loss of partners, and social taboos all interact to shape that state, often in ways that standard geriatric services never address.

What makes this protocol technically interesting is its refusal to treat sexual health as a purely clinical problem. Instead, the team borrows the logic of strategic planning, the same framework used by health systems and organizations to set missions, visions, and priorities. The authors argue that devising a strategic plan is preferable to any other approach precisely because sexual health is so heavily shaped by social attitudes, culture, and context. A plan built this way can be adapted by any center that provides health services to older adults, rather than remaining locked inside a single clinic or a single country’s norms. The study was supported and ethically approved by Isfahan University of Medical Sciences, with the protocol reviewed under ethics code IR.MUI.NUREMA.REC 1403.026 and protocol ID 3403467, and it forms part of a reproductive health Ph.D. thesis.

The first stage of the research is qualitative, designed to identify the actual needs of sexual health from the ground up. Participants include two distinct groups: older couples themselves, whose personal experiences reveal what intimacy, communication, and sexual well-being look like in real later life, and sexual health actors, the healthcare providers, counselors, and other professionals who encounter these needs professionally. Listening to both groups matters because the gap between what older adults experience and what providers assume is often where sexual health quietly fails. Qualitative work of this kind typically uses in-depth interviews and thematic analysis to surface needs that older adults may never voice in a routine appointment, from the effects of chronic illness on desire to the shame that keeps couples from asking questions.

The second stage is a structured literature review, a systematic sweep of existing research to identify sexual health needs documented across studies worldwide. This step provides the technical counterweight to the interviews: it grounds the emerging plan in peer-reviewed evidence about prevalence, interventions, and barriers, ensuring that the final strategies are not limited to the memories and opinions of a single participant group. By triangulating the qualitative findings with the published literature, the researchers can distinguish needs that are universal from those that are specific to their cultural and social setting, a distinction the authors explicitly value since the resulting plan is intended to be based on cultural and social factors.

The third stage is where strategic management takes over. A focus group discussion will be used to integrate the needs identified in the qualitative stage with the findings of the literature review, and from that integration the team will establish the goals, mission, and vision of the plan. Then comes the analytical core: strategies will be devised based on needs after focusing on internal factors, meaning strengths and weaknesses, and external factors, meaning opportunities and threats, and on the balance between them. This is the classic SWOT logic of strategic planning, and in this protocol it is applied to something rarely subjected to such analysis, the sexual well-being of older couples. Internal strengths might include the resilience and experience of long-married couples or the presence of dedicated geriatric services, while internal weaknesses could involve provider discomfort, lack of training, and the internalized stigma older adults carry. External opportunities might include growing policy attention to aging populations, while external threats include taboos, misinformation, and resource constraints.

Once candidate strategies exist, the stakeholders themselves will select and prioritize them during focused group discussion sessions using matrix tables. These tables, a standard tool of strategic planning, allow participants to score strategies against criteria such as feasibility, impact, and resource demands, turning a diffuse conversation into a ranked, defensible set of priorities. The use of stakeholders, including the providers and actors who will eventually implement the plan, is a deliberate design choice: strategies imposed from above tend to collapse in practice, while strategies chosen by the people responsible for delivery are far more likely to survive contact with real clinics, real budgets, and real cultural resistance.

The final safeguard is consensus testing. The complete plan will be devised and then evaluated by the stakeholders using the modified Delphi technique, a structured consensus method in which expert panels score statements across repeated rounds, with feedback between rounds allowing views to converge. In this protocol, the Delphi process acts as a quality filter, ensuring that every element of the final strategic plan, from its mission statement to its prioritized strategies, commands genuine expert agreement rather than reflecting the preferences of a single research team. Modified Delphi designs are widely used in health services research precisely because they combine the judgment of diverse experts with a transparent, reproducible scoring procedure, making the resulting consensus difficult to dismiss.

The authors conclude that the strategic sexual health plan produced by this study will consider the sexual experiences of older couples and healthcare providers, and will therefore be rooted in cultural and social factors rather than imported clinical templates. That orientation is what could make the work travel: because the plan is built from needs identified locally and validated through structured consensus, centers providing health services to older adults can adopt and adapt it to their own populations. The protocol is open access, published in BMC Geriatrics with the DOI 10.1186/s12877-026-08402-w, and its authors declare no competing interests. As a protocol, it describes what will be done rather than reporting results, but its architecture is already a statement in itself, insisting that the sexual health of older couples is a system-level challenge that can be planned for, prioritized, and preserved with the same rigor applied to any other pillar of geriatric care.

Subject of Research: Preserving sexual health of older couples: a protocol for a strategic plan

Article Title: Preserving sexual health of older couples: a protocol for a strategic plan

Article References: Rahimi, M., Noroozi, M., Ghorbanian, A., & Beigi, M. (2026). Preserving sexual health of older couples: a protocol for a strategic plan. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08402-w

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08402-w

Keywords: Preserving, sexual, health, older, couples, protocol, strategic, plan, scientific research