Pregnancy is one of the most sensitive and important periods in a woman's life [1]. The biological, psychological, and social changes created during this period can lead to changes in sexual function and emotional relationships [2]. As a result, sexual dysfunction is common in pregnant women [3, 4], and studies have reported the prevalence of these disorders about 57–93% [1, 4]. In one study, more than 60% of women and more than 40% of their husbands reported decreased desire and sexual function during pregnancy [5].
Factors affecting women's sexual function in pregnancy can be divided into biological, psychological, and interpersonal factors [3, 6]. During pregnancy, hormonal and physical changes, abdominal enlargement and breast tenderness, fatigue, and back pain can affect women's sexual desire [7]. Psychological factors such as women's self-concept of losing attractiveness to their husbands, feelings of shame and guilt about sex and negative attitudes about sex during this period, fear of miscarriage, fetal harm, and preterm delivery are all among the factors that reduce sexual desire and reduce emotional and loving relationship from the spouse and cause anxiety and lack of self-confidence in the mother [8].
Sexual behaviors and attitudes of individuals during pregnancy are influenced by tradition, cultural values, society, wanted or unwanted pregnancy, the type of relationship with the spouse, religious beliefs, and medical conditions [1, 7]. Studies show that men experience their first extramarital sex during their wives' pregnancy, which may be due to the fact that their sexual and emotional needs are not met [7, 9]. This causes conflict in couples' relationships, and just when they need more than ever to be close to each other, they become cold and quarrelsome [10].
Sexual intimacy as an important factor in marital relationships is the need to share, contribute and express sexual thoughts, feelings, and fantasies with the spouse [11, 12]. Intimacy in sexual relationships is directly related to satisfaction and quality of married life [13, 14]. Therefore, sexual problem in pregnancy is one of the most important issues for counselors and therapists in the field of sexual health, and different approaches are used in this field.
Sexual dysfunction is successfully treated with various methods such as sex therapy, psychological education, couple therapy, and Cognitive-behavioral Therapy (CBT) [3, 15]. Today, the most common methods used to treat sexual dysfunction are CBT [16]. CBT includes identifying and correcting thought patterns, teaching communication skills, teaching distorted thoughts, dealing with sexual problems, as well as conflict resolution methods that lead to intimacy between couples [17, 18]. Cognitive-behavioral techniques for the treatment of female sexual dysfunction include increasing sexual awareness, training sexual fantasies and helping individual concentration and attention to pleasurable sexual stimuli, reducing anxiety about sexual activity through a combination of methods of sensate focus exercises, attention concentration skills, exposure, and cognitive reconstruction and problem-solving ability [18–20].
Cognitive-behavioral counseling is an effective treatment for managing dyspareunia, improved sexual function, marital and psychosocial adjustment [21]. The effectiveness of CBT was demonstrated in various studies [22, 23]. However, in a study in Iran, sexual counseling with a cognitive-behavioral approach could not improve the sexual function of pregnant women [24]. In another study, it was reported that the sexual function of pregnant women in the group which received education did not show a satisfactory difference compared to the control group [25].
Nowadays, the Internet plays a significant role in exchanging information in our daily lives. Electronic information is shared in various ways, including audio and video activities, the Internet, multimedia, virtual meetings, and video conferencing [26].
The benefits of virtual counseling include: saving time and money, easy access, increased speed of learning, taking advantage of teamwork, independence of time and place, up-to-date information, elimination of unnecessary traffic, easier self-disclosure of patients, privacy, being more attractive to learners, the ability to browse content, videos, and images [27, 28]. In some mental disorders, due to the high effectiveness and efficiency of Internet-based CBT, this method is in the first place compared to face-to-face CBT [29]. Internet-based CBT can help people deal with their problems and relapses [30].
Besides, crises such as COVID-19, which may coexist with the world for years, can affect on sexual behavior of pregnant women [31]. Standard public health measures, including quarantine, and social distancing to control the disease, have changed the relationship between therapists and patients. COVID-19 has changed social lifestyles, and the growing need for virtual counseling using distance health education seems essential [32]. Therefore, this study aimed to assess the effects of virtual sexual counseling based on CBT approach on sexual function and intimacy of pregnant women.