Document Type : Original Article
Authors
1 Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
2 Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
BACKGROUND: The World Health Organization recommendation requires the development and use
of effective, brief, clear, and evidence‑based education packages to improve health‑care outcomes.
No comprehensive sexual health improvement package exists for the pregnancy period in the Iranian
health system. This study aimed to develop a package to promote sexual health in pregnancy.
MATERIALS AND METHODS: The present study is a qualitative study, which was conducted
in 2019 in Tehran, Iran. Sexual health package during pregnancy was developed based on the
National Institute for Health and Clinical Excellence (NICE) steps. The first step included reviewing of
international guidelines, strategies, handbooks, education packages, and articles in this regard. The
package was developed in the second step. In the third step, quality assessment was performed using
expert opinion with the Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE
II) tool, and validation was performed using Delphi method.
RESULTS: Package content was designed in two sections: for midwives and health‑care providers
and for pregnant mothers in three sessions (in each trimester of pregnancy). The quality assessment
using the AGREE II guidelines revealed excellent quality (>89%). The package was validated based
on expert opinion (>95%).
CONCLUSION: The sexual health promotion package during pregnancy was designed with high
quality and validity based on NICE steps. It is recommended, midwives be performed this designed
and validated package in routine pregnancy care to promote the couple’s sexual health.
Keywords
1. Giovanni C, Lior L, Natalio C, Fabrizio P, Beatrice C, Francesca T,
John D, Hartmut P, Ilan G, et al. The ESSM Manual of Sexual
Medicine. Amsterdam: The European Society for Sexual
Medicine (ESSM); 2015.
2. Johnson CE. Sexual health during pregnancy and the postpartum.
J Sex Med 2011;8:1267‑84.
3. DeJong J, Jawad R, Mortagy I, Shepard B. The sexual and
reproductive health of young people in the Arab countries and
Iran. Reprod Health Matters. 2005 May; 13(25):49‑59. doi: 10.1016/
s0968‑8080 (05) 25181‑9. PMID: 16035597.
4. Masoumi SZ, Kheirollahi N, Rahimi A, Beyrami Haghgu M,
Ahmadvand S and Hosseini SN. Effect of a sex education program
on females’ sexual satisfaction during pregnancy: A randomized
clinical trial. Iran J Psychiatry Behav Sci 2018;12(1):e6105.
5. Rogers RG, Borders N, Leeman LM, Albers LL. Does spontaneous
genital tract trauma impact postpartum sexual function.
J Midwifery Womens Health 2009; 54(2):98‑103.
6. Lamont J, Bajzak K, Bouchard C, Burnett M, Byers S, Cohen T,
Fisher W, Holzapfel S and Senikas V. Female sexual health
consensus clinical guidelines. J Obstet Gynaecol Can 2012;
34(8):769‑75.
7. Guidelines for Comprehensive Sexuality Education; 2004.
Available from: http://sexedu.org.tw/guideline.pdf. [Last
accessed on 2021 Feb 14].
8. “Women and Sexual and Reproductive Health” Australian
Women’s Health Network; 2012. Available from: http://
awhn.org.au/wp‑content/uploads/2015/03/94_
AWHNWomenSexualReproductiveHealthPositionPaper2012.
pdf. [Last accessed on 2021 Feb 21].
9. A Framework for Sexual Health Improvement in England; 2013.
Available from: https://www.gov.uk/government/uploads/
system/uploads/attachment_data/file/142592/9287‑2900714TSO-SexualHealthPolicyNW_ACCESSIBLE.pdf. [Last accessed
on2021 Feb 14].
10. Rafaei SK, Chinichian M, Eftekhar AH, Pourreza AG and
Ramezan KA. Need assessment: Sexual health education in family
planning centers, Tehran. Iran J Payesh 2010;9:251‑60.
11. Khoshnazar TA, Rassouli M, Akbari ME. Developing Palliative
Care Sever Package for Women with Breast Cancer. 2017, Nursing
and Midwifery Shahid Beheshti University of Medical Sciences
Tehran Iran. Available from: http://dlib.sbmu.ac.ir/site/
catalogue/167998. [Last accessed on 2021 Feb 14].
12. Ministry of Health Medical Education. National Guide to
Obstetrics and Gynecology. 3rd ed. Tehran, Iran: Ministry of
Health, Medical Education, Family and Population Health Office,
Maternal Health Office; 2017. Available from: http://www.
naigo.ir/midwifery_content/media/article/Rahnamaye%20
keshvari‑3_0.pdf. [Last accessed on 2021 Feb 14].
13. Ministry of Health Medical Education. Safe Motherhood
National Program: Integrated Care for Maternal Health.
Vol. 2016. Tehran, Iran: Ministry of Health, Medical Education, Family and Population Health Office, Maternal Health
Office; 2016. Available from: http://vch.qums.ac.ir/Portal/
home/?news/98839/465906/750690 [Last accessed on
2021 May 23].
14. Baradaran‑Akbarzadeh N, Tafazoli M, Mojahedi M, Mazlom SR.
The effect of educational package on sexual function in cold
temperament women of reproductive age. J Educ Health Promot
2018;7:65.
15. Rahimi F, Goli S, Eslami F. The effect of educational classes
during pregnancy on the level of sexual satisfaction after delivery
in nulliparous women. J Edu Health Promot 2020;9:253.
16. Schulz MS, Cowan CP, Cowan PA. Promoting healthy
beginnings: A randomized controlled trial of a preventive
intervention to preserve marital quality during the transition to
parenthood. J Consult Clin Psychol 2006;74(1):20‑31.
17. Masoumi SZ, Kazemi F, Nejati B, Parsa P, Karami M. Effect
of sexual counseling on marital satisfaction of pregnant
women referring to health centers in Malayer (Iran): An
educational randomized experimental study. Electron Physician
2017;9:3598‑604.
18. National Institute for Health Care Excellence. Developing NICE
Guidelines: The Manual. NICE Process Methods Guides. London:
National Institute for Health Care Excellence; 2015.
19. Habibi A, Sarafrazi A, Izadyar S. Delphi technique theoretical
framework in qualitative research. Int J Eng Sci 2014;3:8‑13.
20. Landeta, J, Current validity of the Delphi method in social
sciences. Technol Forecast Soc Change 2006;73:467‑82.
21. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F,
Feder G, et al. AGREE II: Advancing guideline development,
reporting and evaluation in health care. CMAJ 2010;182:E839‑42.
22. Brouwers MC, Kerkvliet K, Spithoff K. AGREE Next Steps
Consortium. The AGREE Reporting Checklist: A tool to improve
reporting of clinical practice guidelines. BMJ 2016;352:i1152.
23. Polit DF, Beck CT. Essentials of Nursing Research: Appraising
Evidence for Nursing Practice. Philadelphia, Pennsylvania,
United States: Lippincott Williams and Wilkins; 2009.
24. Department of Health, Clinical Practice Guidelines: Pregnancy
Care Canberra; 2019. Available from: https://www.health.gov.
au/sites/default/files/pregnancy‑care‑guidelines_0.pdf. [Last
accessed on 2021 Feb 15].
25. Australian Health Ministers’ Advisory Council. Clinical Practice
Guidelines: Antenatal Care – Module 1. Australian Government
Department of Health and Ageing Canberra; 2012. Available
from: https://consultations.health.gov.au/phd‑tobacco/
clinical‑practice‑guidelines‑antenatal‑care‑module/supporting_
documents/ANC_Guidelines_Mod1FINAL%20D13871243.
PDF. [Last accessed on 2021 Feb 15].
26. Homer C, Oats J. Clinical Practice Guidelines Antenatal
Care – Module II. Canberra: Australian Government Department
of Health; 2014. Available from: http://amare.org.au/wordpress/
wp‑content/uploads/2016/09/Antenatal‑care‑module2_
Clinical‑Practice‑Guidelines.pdf. [Lastaccessed on 2021 Feb 15].
27. Department of Health Western Australia. Clinical Practice
Guideline: Antenatal Care Schedule. 7th ed. Australia, Government
of Western Australia North Metropolitan Health Service Women
and Newborn Health Service; 2016. Available from: https://
www.kemh.health.wa.gov.au/~/media/Files/Hospitals/
WNHS/For%20health%20professionals/56%20WNHS%20
0062%20Antenatal%20Shared%20care%20guidelines%20for%20
GPs.pdf. [Last accessed on 2021 Feb 15].
28. Health, T.D.O. The Pregnancy Book. Your Complete Guide To:
A Healthy Pregnancy, Labour and Childbirth, The First Weeks
with your New Baby. NHC; 2017. Available from: https://
yedd.me/wp‑content/uploads/2017/11/The‑Pregnancy‑Book.
pdf. [Lastaccessed on 2021 Feb 12].
29. National Collaborating Centre for, W.S. and H. Children’s,
National Institute for Health and Clinical Excellence: Guidance,
in Antenatal Care: Routine Care for the Healthy Pregnant Woman.
London: RCOG Press National Collaborating Centre for Women’s
and Children’s Health; 2008.
30. National Institute for Health Care Excellence. Antenatal Care for
Uncomplicated Pregnancies. United Kingdom: National Institute
for Health and Clinical Excellence; 2008. Available from: https://
www.nice.org.uk/guidance/cg62. [Last accessed on 2021Feb 15].
31. NHS. Sex in Pregnancy; 2018. Available from: http://www.nhs.
uk/conditions/pregnancy‑and‑baby/pages/sex‑in‑pregnancy.
aspx#close. [Last accessed on 2021 Feb 15].
32. Guidelines, F.S.H.C.C. Sexuality across the lifespan. J Obstet
Gynaecol Can 2012;34:S8‑14.
33. The Province of British Columbia, Ministry for Children and
Families Baby’s Best Chance: Parents’ Handbook of Pregnancy
and Baby Care. John Wiley and Sons Canada,: Government of
British Columbia; 2005.
34. Healthy Families BC, Healthy Sex during Pregnancy; 2013.
Available from: https://www.healthyfamiliesbc.ca/home/
articles/healthy‑sex‑during‑pregnancy. [Last accessed on
2021 Feb 15].
35. The Mothers Program. Sex during Pregnancy; 2018. Available
from: http://www.themothersprogram.ca/during‑pregnancy/
whats‑safe‑whats‑not/sex. [Last accessed on 2021 Feb 12].
36. Care, Women‑Centred, Perinatal Services BC Provincial
Perinatal Guidelines Population and Public Health Prenatal Care
Pathway; 2014. Available from: http://www.perinatalservicesbc.
ca/Documents/Guidelines‑Standards/HealthPromotion/
PrenatalCarePathway.pdf. [Last accessed on 2021 Feb 15].
37. American Academy of Pediatrics, Guidelines for Perinatal Care.
7th edit. Washington, D.C: American Academy of Pediatrics; 2012.
38. Sheryl A. Kingsberg, Cheryl B. Igesia, Sisa Kellogg, Michael L.
Krychman. Handbook on Female Sexual Health and Wellness.
the Health Resources and Services Administration (HRSA) of the
U.S.: Association of Reporductive Health Professions; 2011.
39. Mayo Foundation for Medical Education and Research. Sex
during Pregnancy: What’s OK, What’s Not; 2018. Available
from: https://www.mayoclinic.org/healthy‑lifestyle/
pregnancy‑week‑by‑week/in‑depth/sex‑during‑pregnancy/
art‑20045318?pg=2. [Last accessed on 2021 Feb 15]
40. Holan S, Mathiesen M, Petersen K. A National Clinical Guideline
for Antenatal Care Short Version – Recommendations. Norwegia:
Directorate for Health Social Affairs; 2005.
41. Department of Women’s Health and Reproductive Health,
Prenatal Care Management Guideline. Republic of Turkey
Ministry of Health, Public Health Agency of Turkey, Department
of Women’s Health and Reproductive Health. Ankara: Ministry
of Health Publication; 2014.
42. World Health Organization. Counselling for Maternal and
Newborn Health Care: A Handbook for Building Skills. Geneva:
World Health Organization; 2013.
43. World Health Organization, Intimate Partner Violence during
Pregnancy, Information Sheet; 2011. Available from: http://
apps.who.int/iris/bitstream/handle/10665/70764/WHO_
RHR_11.35_eng.pdf?sequence=1. [Last accessed on 2021 Feb 12]
44. World Health Organization, WHO Recommendations on
Antenatal Care for a Positive Pregnancy Experience; 2016. Available
from: http://www.who.int/reproductivehealth/publications/
maternal_perinatal_health/anc‑positive‑pregnancy‑experience/
en/.[Last accessed on 2021 Feb 12]
45. Cavallucci D, Fulbright YK. Your Orgasmic Pregnancy: Little
Sex Secrets Every Hot Mama Should Know. Hunter House. U.S.:
Hunter House Incorporated Publishers; 2008.
46. Stephanie Buehler, PsyD, CST‑S. Counseling Couples Before,
During, and After Pregnancy: Sexuality and Intimacy Issues.
New York, United States, Springer Publishing Company; 2018.
47. Ozgoli G, Riazi H, Alizadeh S. Sexual Health Promotion Package
for Pregnancy Period. Tehran, Iran: Shahid Beheshti University of Medical Science; 2019.
48. Riazi H, Banoo Zs, Moghim Ba, Amini L. The Effect Of Sexual
Health Education On Sexual Function During Pregnancy. Payesh
2013.12(4): 367‑74.
49. AfsharM, Mohammad‑Alizadeh‑Charandabi S, Merghti‑KhoeiES,
Yavarikia P. The effect of sex education on the sexual function of
women in the first half of pregnancy: a randomized controlled
trial. J Caring Sci. 2012 Nov 22;1(4):173‑81.
50. Bahadoran P, Mohammadi Mahdiabadzade M, Nasiri H,
GholamiDehaghi A. The effect of face‑to‑face or group education
during pregnancy on sexual function of couples in Isfahan. Iran
J Nurs Midwifery Res. 2015 Sep‑Oct; 20(5):582‑7.
51. Rostamkhani F, Moghadam R, Merghati Khoei E A, Jafari F,
Ozgoli G. The effect of Counseling using the PLISSIT
Model on Sexual Function of Pregnant Women. PCNM.
2016; 6 (1):18‑28. URL: http://zums.ac.ir/nmcjournal
/article‑1‑295‑en.html.
52. Alizadeh S, Riazi H, Majd HA, OzgoliG. The effect of sexual health
education on sexual activity, sexual quality of life, and sexual
violence in pregnancy: a prospective randomized controlled trial.
BMC Pregnancy Childbirth. 2021 Apr 26;21(1):334.
53. Patel S, Ngunjiri A, Sandhu H, Griffiths F, Thistlewaite J,
Brown S, et al. Design and development of a decision support
package for low back pain. Arthritis Care Res (Hoboken) 2014;
66(6):925‑33.
54. Zheng YW, Jiang LL, Hu JL, Yang WY, Ruan H. Construction
of perioperative oral care program for elderly patients with oral
cancer based on Delphi method. Shanghai Kou Qiang Yi Xue
2020; 29(2):192‑201.
55. Astrand R, Rosenlund C, Unden J. Scandinavian guidelines
for initial management of minor and moderate head trauma in
children. BMC Med 2016;14:33‑52.
56. Hoedl M, Schoberer D, Halfens RJ, Lohrmann C. Adaptation
of evidence‑based guideline recommendations to address
urinary incontinence in nursing home residents according to the
ADAPTE‑process. J Clin Nurs 2018; 27(15‑16):2974‑83.
John D, Hartmut P, Ilan G, et al. The ESSM Manual of Sexual
Medicine. Amsterdam: The European Society for Sexual
Medicine (ESSM); 2015.
2. Johnson CE. Sexual health during pregnancy and the postpartum.
J Sex Med 2011;8:1267‑84.
3. DeJong J, Jawad R, Mortagy I, Shepard B. The sexual and
reproductive health of young people in the Arab countries and
Iran. Reprod Health Matters. 2005 May; 13(25):49‑59. doi: 10.1016/
s0968‑8080 (05) 25181‑9. PMID: 16035597.
4. Masoumi SZ, Kheirollahi N, Rahimi A, Beyrami Haghgu M,
Ahmadvand S and Hosseini SN. Effect of a sex education program
on females’ sexual satisfaction during pregnancy: A randomized
clinical trial. Iran J Psychiatry Behav Sci 2018;12(1):e6105.
5. Rogers RG, Borders N, Leeman LM, Albers LL. Does spontaneous
genital tract trauma impact postpartum sexual function.
J Midwifery Womens Health 2009; 54(2):98‑103.
6. Lamont J, Bajzak K, Bouchard C, Burnett M, Byers S, Cohen T,
Fisher W, Holzapfel S and Senikas V. Female sexual health
consensus clinical guidelines. J Obstet Gynaecol Can 2012;
34(8):769‑75.
7. Guidelines for Comprehensive Sexuality Education; 2004.
Available from: http://sexedu.org.tw/guideline.pdf. [Last
accessed on 2021 Feb 14].
8. “Women and Sexual and Reproductive Health” Australian
Women’s Health Network; 2012. Available from: http://
awhn.org.au/wp‑content/uploads/2015/03/94_
AWHNWomenSexualReproductiveHealthPositionPaper2012.
pdf. [Last accessed on 2021 Feb 21].
9. A Framework for Sexual Health Improvement in England; 2013.
Available from: https://www.gov.uk/government/uploads/
system/uploads/attachment_data/file/142592/9287‑2900714TSO-SexualHealthPolicyNW_ACCESSIBLE.pdf. [Last accessed
on2021 Feb 14].
10. Rafaei SK, Chinichian M, Eftekhar AH, Pourreza AG and
Ramezan KA. Need assessment: Sexual health education in family
planning centers, Tehran. Iran J Payesh 2010;9:251‑60.
11. Khoshnazar TA, Rassouli M, Akbari ME. Developing Palliative
Care Sever Package for Women with Breast Cancer. 2017, Nursing
and Midwifery Shahid Beheshti University of Medical Sciences
Tehran Iran. Available from: http://dlib.sbmu.ac.ir/site/
catalogue/167998. [Last accessed on 2021 Feb 14].
12. Ministry of Health Medical Education. National Guide to
Obstetrics and Gynecology. 3rd ed. Tehran, Iran: Ministry of
Health, Medical Education, Family and Population Health Office,
Maternal Health Office; 2017. Available from: http://www.
naigo.ir/midwifery_content/media/article/Rahnamaye%20
keshvari‑3_0.pdf. [Last accessed on 2021 Feb 14].
13. Ministry of Health Medical Education. Safe Motherhood
National Program: Integrated Care for Maternal Health.
Vol. 2016. Tehran, Iran: Ministry of Health, Medical Education, Family and Population Health Office, Maternal Health
Office; 2016. Available from: http://vch.qums.ac.ir/Portal/
home/?news/98839/465906/750690 [Last accessed on
2021 May 23].
14. Baradaran‑Akbarzadeh N, Tafazoli M, Mojahedi M, Mazlom SR.
The effect of educational package on sexual function in cold
temperament women of reproductive age. J Educ Health Promot
2018;7:65.
15. Rahimi F, Goli S, Eslami F. The effect of educational classes
during pregnancy on the level of sexual satisfaction after delivery
in nulliparous women. J Edu Health Promot 2020;9:253.
16. Schulz MS, Cowan CP, Cowan PA. Promoting healthy
beginnings: A randomized controlled trial of a preventive
intervention to preserve marital quality during the transition to
parenthood. J Consult Clin Psychol 2006;74(1):20‑31.
17. Masoumi SZ, Kazemi F, Nejati B, Parsa P, Karami M. Effect
of sexual counseling on marital satisfaction of pregnant
women referring to health centers in Malayer (Iran): An
educational randomized experimental study. Electron Physician
2017;9:3598‑604.
18. National Institute for Health Care Excellence. Developing NICE
Guidelines: The Manual. NICE Process Methods Guides. London:
National Institute for Health Care Excellence; 2015.
19. Habibi A, Sarafrazi A, Izadyar S. Delphi technique theoretical
framework in qualitative research. Int J Eng Sci 2014;3:8‑13.
20. Landeta, J, Current validity of the Delphi method in social
sciences. Technol Forecast Soc Change 2006;73:467‑82.
21. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F,
Feder G, et al. AGREE II: Advancing guideline development,
reporting and evaluation in health care. CMAJ 2010;182:E839‑42.
22. Brouwers MC, Kerkvliet K, Spithoff K. AGREE Next Steps
Consortium. The AGREE Reporting Checklist: A tool to improve
reporting of clinical practice guidelines. BMJ 2016;352:i1152.
23. Polit DF, Beck CT. Essentials of Nursing Research: Appraising
Evidence for Nursing Practice. Philadelphia, Pennsylvania,
United States: Lippincott Williams and Wilkins; 2009.
24. Department of Health, Clinical Practice Guidelines: Pregnancy
Care Canberra; 2019. Available from: https://www.health.gov.
au/sites/default/files/pregnancy‑care‑guidelines_0.pdf. [Last
accessed on 2021 Feb 15].
25. Australian Health Ministers’ Advisory Council. Clinical Practice
Guidelines: Antenatal Care – Module 1. Australian Government
Department of Health and Ageing Canberra; 2012. Available
from: https://consultations.health.gov.au/phd‑tobacco/
clinical‑practice‑guidelines‑antenatal‑care‑module/supporting_
documents/ANC_Guidelines_Mod1FINAL%20D13871243.
PDF. [Last accessed on 2021 Feb 15].
26. Homer C, Oats J. Clinical Practice Guidelines Antenatal
Care – Module II. Canberra: Australian Government Department
of Health; 2014. Available from: http://amare.org.au/wordpress/
wp‑content/uploads/2016/09/Antenatal‑care‑module2_
Clinical‑Practice‑Guidelines.pdf. [Lastaccessed on 2021 Feb 15].
27. Department of Health Western Australia. Clinical Practice
Guideline: Antenatal Care Schedule. 7th ed. Australia, Government
of Western Australia North Metropolitan Health Service Women
and Newborn Health Service; 2016. Available from: https://
www.kemh.health.wa.gov.au/~/media/Files/Hospitals/
WNHS/For%20health%20professionals/56%20WNHS%20
0062%20Antenatal%20Shared%20care%20guidelines%20for%20
GPs.pdf. [Last accessed on 2021 Feb 15].
28. Health, T.D.O. The Pregnancy Book. Your Complete Guide To:
A Healthy Pregnancy, Labour and Childbirth, The First Weeks
with your New Baby. NHC; 2017. Available from: https://
yedd.me/wp‑content/uploads/2017/11/The‑Pregnancy‑Book.
pdf. [Lastaccessed on 2021 Feb 12].
29. National Collaborating Centre for, W.S. and H. Children’s,
National Institute for Health and Clinical Excellence: Guidance,
in Antenatal Care: Routine Care for the Healthy Pregnant Woman.
London: RCOG Press National Collaborating Centre for Women’s
and Children’s Health; 2008.
30. National Institute for Health Care Excellence. Antenatal Care for
Uncomplicated Pregnancies. United Kingdom: National Institute
for Health and Clinical Excellence; 2008. Available from: https://
www.nice.org.uk/guidance/cg62. [Last accessed on 2021Feb 15].
31. NHS. Sex in Pregnancy; 2018. Available from: http://www.nhs.
uk/conditions/pregnancy‑and‑baby/pages/sex‑in‑pregnancy.
aspx#close. [Last accessed on 2021 Feb 15].
32. Guidelines, F.S.H.C.C. Sexuality across the lifespan. J Obstet
Gynaecol Can 2012;34:S8‑14.
33. The Province of British Columbia, Ministry for Children and
Families Baby’s Best Chance: Parents’ Handbook of Pregnancy
and Baby Care. John Wiley and Sons Canada,: Government of
British Columbia; 2005.
34. Healthy Families BC, Healthy Sex during Pregnancy; 2013.
Available from: https://www.healthyfamiliesbc.ca/home/
articles/healthy‑sex‑during‑pregnancy. [Last accessed on
2021 Feb 15].
35. The Mothers Program. Sex during Pregnancy; 2018. Available
from: http://www.themothersprogram.ca/during‑pregnancy/
whats‑safe‑whats‑not/sex. [Last accessed on 2021 Feb 12].
36. Care, Women‑Centred, Perinatal Services BC Provincial
Perinatal Guidelines Population and Public Health Prenatal Care
Pathway; 2014. Available from: http://www.perinatalservicesbc.
ca/Documents/Guidelines‑Standards/HealthPromotion/
PrenatalCarePathway.pdf. [Last accessed on 2021 Feb 15].
37. American Academy of Pediatrics, Guidelines for Perinatal Care.
7th edit. Washington, D.C: American Academy of Pediatrics; 2012.
38. Sheryl A. Kingsberg, Cheryl B. Igesia, Sisa Kellogg, Michael L.
Krychman. Handbook on Female Sexual Health and Wellness.
the Health Resources and Services Administration (HRSA) of the
U.S.: Association of Reporductive Health Professions; 2011.
39. Mayo Foundation for Medical Education and Research. Sex
during Pregnancy: What’s OK, What’s Not; 2018. Available
from: https://www.mayoclinic.org/healthy‑lifestyle/
pregnancy‑week‑by‑week/in‑depth/sex‑during‑pregnancy/
art‑20045318?pg=2. [Last accessed on 2021 Feb 15]
40. Holan S, Mathiesen M, Petersen K. A National Clinical Guideline
for Antenatal Care Short Version – Recommendations. Norwegia:
Directorate for Health Social Affairs; 2005.
41. Department of Women’s Health and Reproductive Health,
Prenatal Care Management Guideline. Republic of Turkey
Ministry of Health, Public Health Agency of Turkey, Department
of Women’s Health and Reproductive Health. Ankara: Ministry
of Health Publication; 2014.
42. World Health Organization. Counselling for Maternal and
Newborn Health Care: A Handbook for Building Skills. Geneva:
World Health Organization; 2013.
43. World Health Organization, Intimate Partner Violence during
Pregnancy, Information Sheet; 2011. Available from: http://
apps.who.int/iris/bitstream/handle/10665/70764/WHO_
RHR_11.35_eng.pdf?sequence=1. [Last accessed on 2021 Feb 12]
44. World Health Organization, WHO Recommendations on
Antenatal Care for a Positive Pregnancy Experience; 2016. Available
from: http://www.who.int/reproductivehealth/publications/
maternal_perinatal_health/anc‑positive‑pregnancy‑experience/
en/.[Last accessed on 2021 Feb 12]
45. Cavallucci D, Fulbright YK. Your Orgasmic Pregnancy: Little
Sex Secrets Every Hot Mama Should Know. Hunter House. U.S.:
Hunter House Incorporated Publishers; 2008.
46. Stephanie Buehler, PsyD, CST‑S. Counseling Couples Before,
During, and After Pregnancy: Sexuality and Intimacy Issues.
New York, United States, Springer Publishing Company; 2018.
47. Ozgoli G, Riazi H, Alizadeh S. Sexual Health Promotion Package
for Pregnancy Period. Tehran, Iran: Shahid Beheshti University of Medical Science; 2019.
48. Riazi H, Banoo Zs, Moghim Ba, Amini L. The Effect Of Sexual
Health Education On Sexual Function During Pregnancy. Payesh
2013.12(4): 367‑74.
49. AfsharM, Mohammad‑Alizadeh‑Charandabi S, Merghti‑KhoeiES,
Yavarikia P. The effect of sex education on the sexual function of
women in the first half of pregnancy: a randomized controlled
trial. J Caring Sci. 2012 Nov 22;1(4):173‑81.
50. Bahadoran P, Mohammadi Mahdiabadzade M, Nasiri H,
GholamiDehaghi A. The effect of face‑to‑face or group education
during pregnancy on sexual function of couples in Isfahan. Iran
J Nurs Midwifery Res. 2015 Sep‑Oct; 20(5):582‑7.
51. Rostamkhani F, Moghadam R, Merghati Khoei E A, Jafari F,
Ozgoli G. The effect of Counseling using the PLISSIT
Model on Sexual Function of Pregnant Women. PCNM.
2016; 6 (1):18‑28. URL: http://zums.ac.ir/nmcjournal
/article‑1‑295‑en.html.
52. Alizadeh S, Riazi H, Majd HA, OzgoliG. The effect of sexual health
education on sexual activity, sexual quality of life, and sexual
violence in pregnancy: a prospective randomized controlled trial.
BMC Pregnancy Childbirth. 2021 Apr 26;21(1):334.
53. Patel S, Ngunjiri A, Sandhu H, Griffiths F, Thistlewaite J,
Brown S, et al. Design and development of a decision support
package for low back pain. Arthritis Care Res (Hoboken) 2014;
66(6):925‑33.
54. Zheng YW, Jiang LL, Hu JL, Yang WY, Ruan H. Construction
of perioperative oral care program for elderly patients with oral
cancer based on Delphi method. Shanghai Kou Qiang Yi Xue
2020; 29(2):192‑201.
55. Astrand R, Rosenlund C, Unden J. Scandinavian guidelines
for initial management of minor and moderate head trauma in
children. BMC Med 2016;14:33‑52.
56. Hoedl M, Schoberer D, Halfens RJ, Lohrmann C. Adaptation
of evidence‑based guideline recommendations to address
urinary incontinence in nursing home residents according to the
ADAPTE‑process. J Clin Nurs 2018; 27(15‑16):2974‑83.
)