“Silent Suffering”: Affirming Iranian Women's Right to Sexual Health Through a Whatsapp‐Based “Good Enough Sex” Counseling Program: A Parallel‐Group Randomized Controlled Trial

ABSTRACT Introduction Infertility profoundly affects women's sexual health and psychological well‐being, particularly in cultures where childbearing defines female identity and sexuality remains a taboo subject. In Iran, no randomized controlled trial has evaluated a culturally adapted digital psychosexual intervention for infertile women. Methods This parallel‐group, single‐blind randomized controlled trial was conducted from September 2021 to April 2022 at two major infertility centers in Urmia, Iran. A total of 100 infertile women (aged 25–35 years) were recruited via convenience sampling and then randomly allocated to either a 6‐week WhatsApp‐based Good Enough Sex (GES) counseling program (n = 50) or a routine care control group (n = 50). Outcomes included infertility‐related stress (Newton Infertility Stress Questionnaire) and sexual satisfaction (Larson's Sexual Satisfaction Questionnaire), assessed at baseline, post‐intervention, and 1‐month follow‐up. Data were analyzed using repeated‐measures ANOVA. Results The intervention group showed significant improvements in sexual satisfaction (mean increase: 41.92 points) and significant reductions in infertility‐related stress (mean reduction: 108.90 points) immediately post‐intervention, with effects largely sustained at 1‐month follow‐up (p < 0.001 for all). Effect sizes were large (partial η2 = 0.52 for sexual satisfaction; partial η2 = 0.82 for infertility stress). The control group showed no significant changes. Conclusions Among this sample of infertile Iranian women, WhatsApp‐based GES counseling was associated with reduced infertility‐related stress and improved sexual satisfaction. Because the sample was recruited by convenience sampling from two referral centers, was relatively small, used restrictive eligibility criteria, and had only 1‐month follow‐up, these findings should be considered promising preliminary evidence. Larger multicenter randomized trials with more diverse populations and longer follow‐up are needed before conclusions about generalizability can be drawn. If confirmed, this approach may offer a useful adjunct to infertility care in culturally conservative settings. Policy Implications In conservative societies where sexual health discussions are stigmatized, infertility clinics may consider integrating WhatsApp‐based GES counseling into routine care. Policymakers could support training providers in this model and digital ethics, and health authorities can leverage this approach to replace online misinformation with evidence‐based education. Trial Registration IRCT20210926052593N1, The date of registration: 13‐10‐2021.