PLISSIT/EX-PLISSIT-Based Sexual Counseling in Women with Gynecologic Cancer or Surgery: A Systematic Review and Meta-Analysis.

Abstract

This study examined the effectiveness of sexual counseling interventions based on the PLISSIT/EX-PLISSIT models in women with gynecologic cancer or undergoing gynecologic surgery. A comprehensive literature search was conducted across eight databases, including PubMed, Cochrane Library, Embase, Web of Science, PsycINFO, Scopus, EBSCO, and TR Dizin, between January 7 and February 7, 2025. Of the 6,437 records identified, seven randomized controlled trials involving 467 participants met the eligibility criteria. The certainty of evidence was assessed using the GRADE approach and was rated as low for the primary outcomes. Meta-analysis results indicated that PLISSIT/EX-PLISSIT-based sexual counseling was associated with improved overall sexual function compared with control groups (MD: 7.38, 95% CI: 4.04-10.72, p < .001), with the greatest improvements observed in the pain and lubrication domains. Sexual quality of life was also higher among women receiving sexual counseling interventions (MD: 3.73, 95% CI: 0.99-6.47, p = .008). Overall, these findings suggest that PLISSIT/EX-PLISSIT-based counseling may offer potential benefits for addressing sexual health challenges following gynecologic surgery or gynecologic cancer treatment. However, given the low certainty of evidence according to GRADE, the results should be interpreted cautiously, and further high-quality randomized controlled trials are needed to strengthen the evidence base.