The Effect of Self-Compassion Training on Sexual Life Quality and Marital Adjustment in Women With Sexual Dysfunction

Sexual function in the postpartum period, the gateway to newness and change, can be affected by problems such as caring for a new baby, breastfeeding, fatigue, anxiety about pain during sexual intercourse, postpartum depression, pelvic floor dysfunction, urinary symptoms and body image. Changes in sexual function are common in the postpartum period. Pregnancy and childbirth is a period in a woman's life that causes hormonal and physical changes and has an impact on the parents' quality of life.

Postpartum sexual function is an important issue for couples, as the first sexual intercourse after childbirth is an important step for couples to establish intimate relationships. Many factors affect postpartum sexual dysfunction, including number of births, breastfeeding, mode of delivery, episiotomy, physical and psychological dysfunction, including fatigue and postpartum depression. Without adequate information and counseling on sexual life by health professionals in the postpartum period, most women may remain silent about their sexual concerns and anxieties, preferring instead to share their problems with friends. More holistic and multidisciplinary approaches are needed to treat female sexual dysfunctions. The use of mindfulness-based therapies has recently become widespread in the treatment of women diagnosed with sexual dysfunction.Thanks to mindfulness practices, it has been observed that women perceive stimuli better and are able to notice clues that they did not notice before. The Compassion Focused Therapy program is one of these practices. It is known to integrate well with existing approaches to therapy and offers some useful ways of reducing sexual problems to provide a coherent rationale for treatment strategies.

The postpartum period is a 6-12-week period that starts with the delivery of the placenta and continues with the disappearance of the physiologic and anatomic changes that occurred during pregnancy . Spousal and family support is very important for a healthy and harmonious passage of this period. With the realization of delivery, the mode of delivery, body image changes, hormonal changes, lactation and breast problems, fatigue, vaginal bleeding, problems related to the baby, sexual reluctance and the relationship between spouses affect the sexual life of women. Although the time to start postpartum sexual intercourse varies from person to person and culture to culture, this period is traditionally 6 weeks. As a result of the studies, it is reported that the time to start postpartum sexual intercourse is between 5-8 weeks. Couples are concerned about starting sexual intercourse when there is bleeding, laceration or episiotomy in the woman in the postpartum period. Physiologic changes that occur during pregnancy and delivery affect sexual intercourse in the postpartum period, and perineal pain and dyspareunia due to episiotomy and laceration are observed in women. However, according to studies, sexual function problems encountered by women in this period include dyspareunia, pelvic floor dysfunction, vaginal dryness, sexual desire / intercourse. satisfaction as a decrease in sexual satisfaction. In a study conducted by Lagaert et al. with 109 women in the postpartum period; women who had spontaneous vaginal delivery and women who had interventional delivery were compared and women who had interventional delivery stated that they experienced more painful sexual intercourse . In the postpartum period, reasons such as episiotomy, perineal pain, vaginal bleeding and discharge, fatigue, pelvic floor dysfunction, feeling less attractive due to physical changes lead to a decrease in sexual desire and consequently to withdrawal from sexuality.

During the first year after birth, new parents face many personal and interpersonal changes, including changes in their sexual relationships. In particular, it has been found that most new parents experience sexual concerns specific to the postpartum period, wondering when to restart sexual intercourse after birth, pain during sexual intercourse, and the impact of body image concerns on sexual activity. Lorenz et al. found that couples generally experienced a decrease in the frequency of sexual activity in the postpartum phase . In a study conducted with 1507 women in the postpartum period, 89% of women were reported to have sexual health problems. In the postpartum 3rd month, the most common complaints were loss of sexual desire, pain during sexual intercourse, and vaginal dryness. Although traditional and complementary treatment practices are utilized in the treatment of sexual dysfunctions, the effectiveness of very few of them has been shown in studies with high level of evidence. Traditional and Complementary Medicine practices used in sexual dysfunctions include natural products (plants, vitamins, minerals and probiotics etc.), mind and body practices such as yoga, mindfulness-based intervention, acupuncture and other methods. The use of mindfulness-based therapies has recently become widespread in the treatment methods of women diagnosed with sexual dysfunction. With these therapies, it has been observed that there is a significant improvement in general sexual function level, arousal and sexual problems. Through mindfulness practices, it has been observed that women perceive stimuli better and are able to recognize clues that they did not notice before. Compassionate mindfulness program is one of these practices. CFT (Compassion Focused Therapy) is known to integrate well with existing approaches to psychosexual therapy and offers some useful ways to reduce sexual problems to provide a coherent rationale for treatment strategies .Self-compassion proceeds in parallel with the individual's self-knowledge, acceptance, positive perspective towards life, social activities, consciousness, character structure open to development and subjectivity. There is an inverse relationship with anxiety disorder, mental depression and the negativities provided by negative situations.

In order to develop compassionate involvement in therapy, the therapist's non-judgmental, warm and encouraging stance when talking about sexual intercourse, as well as detailed information about sexual difficulties, can be a starting point for the client to cope with the difficulties they experience. The therapist can then use a normalizing and non-shaming CFT (Compassion Focused Therapy) formulation to help the client turn towards the difficulties they are experiencing and look at them with understanding. In this sense, the place of midwives who are in constant one-to-one communication with women in the protection and development of sexual health is very important. Determining the sexual needs of women in any period of women's life, eliminating sexual problems, explaining behaviors and attitudes related to sexual life, providing education and guidance are among the roles of midwifery. Midwives have the responsibilities of taking anamnesis, identifying sexual problems and providing education and counseling for these problems in order to maintain and increase the sexual health of pregnant women during pregnancy. It is important for midwives to communicate as a very good listener, to take into account the concerns of the woman, to ask effective questions, to speak by reassuring and stating that privacy will be ensured, to identify the sexual problems of the woman and to provide effective counseling.

Eligibility Criteria:
Inclusion Criteria:

* Erbal communicator and no literacy disability,
* Living with his wife,
* Beginning postpartum sexual intercourse, menstrual cycle has not started
* Between 2-6 months postpartum,
* Having a healthy baby
* Menstrual cycle has not started
* Women diagnosed with sexual dysfunction (total score ≥19) according to the Arizona
* Sexual Experiences Scale will be included in the study.

Exclusion Criteria:

* Having undergone gynecological surgery during the study,
* Have been or are currently diagnosed with a psychiatric illness,
* Having attended any awareness-based training at least 6 months ago