Development of strategies to promote healthy sexuality based on Iranian girls perspective about the role of virginity in the construction of their sexuality: an explanatory sequential mixed method study protocol
Authors: Naghizadeh Somayyeh , Maasoumi Raziyeh , Khalajabadi-Farahani Farideh , Mirghafourvand Mojgan 
Published: February 2022

Abstract
Background
The modern Iran is a blend of tradition and modernity, but its dominant culture is still traditional and takes pride in female virginity. On the other hand, the influential factors such as modernity, education, social networks, global communication, influence from advanced Western societies, have obviously led to the emergence of a freer sexual attitude associated with less significance of virginity. Since the traditional, cultural and religious significance of virginity among Iranian girls can shape their sexual behaviors, therefore, the aim of the present study is development of strategies to promote healthy sexuality based on Iranian girls perspective about the role of virginity in the construction of their sexuality.

Methods/design
This is a two-stage study; an explanatory sequential mixed-methods follow-up design will be employed in the first stage, which consists of two quantitative and qualitative phases. The first phase is the cross-sectional survey that will be conducted on 700 single girls born in the 1970s, 1980s and 1990s. The sample will be selected using the cluster sampling method in the health centers of Tabriz-Iran. The determined sample size will be divided among the selected health centers based on the quota criterion, and eligible households will be selected randomly from the said centers using the SIB website (sib.tbzmed.ac.ir). To collect the required data in the quantitative phase, we will use a researcher-made questionnaire to evaluate the girls’ views about virginity and its influential factors, designed based on the theory of “social construction of sexuality”. After quantitative data collection and analysis, the findings inform qualitative data collection and analysis. The qualitative phase of the study will be conducted on girls living in Tabriz using in-depth and semi-structured individual interviews and purposive sampling method to collect the required qualitative data. The collected data will be analyzed using the conventional content analysis approach. The findings of two phase will be integrated for further explanation and interpretation to be used in the second stage. In the second phase of this study, a nominal group meeting will be held with the participation of reproductive and sexual health experts. The strategies extracted from the results of the first phase and review the texts in this meeting will be provided to experts and after receiving the opinions and ideas of the relevant group of experts and prioritizing them, appropriate strategies to improve and promote the healthy sexuality of Iranian girls will be presented.

Discussion
This study is one of the few studies conducted in the field of sexual health and culture in Iran, that using a “mixed-methods” approach to determine and explain the role of virginity in the construction of the sexuality from the Iranian girls perspective. We hope that this study can present evidence-based documents from the latest physical, psychological and social developments in young Iranian girls’ sexuality and that the presented healthy sexuality promotion strategies, which will be based on Iranian socio-cultural developments, can provide the basic information required for policy-making and planning for young girls’ sexual health. It is also hoped that the findings of this study will be useful in culture-based sexuality education and support for reproductive and sexual health care for the young Iranian generation.