Skip to main content

The effect of a tele-educational intervention on modifying dysfunctional sexual beliefs of pregnant women: a randomized controlled trial


Background & aim

Some cultural scenarios in pregnancy and childbirth reinforce dysfunctional sexual beliefs that reverse changes in the couple's sexual life. The present study aimed to investigate the effect of education by sending text messages on modifying dysfunctional sexual beliefs in pregnant women.

Methods & materials

This study is a randomized clinical trial, and 82 eligible pregnant women referred to educational-medical centers to receive prenatal care were randomly assigned to intervention or control group. The intervention group received 24 text messages during eight weeks (three text messages per week), and the control group received only routine care. Data was collected through a demographic questionnaire, reproductive profile, Spinner's Dyadic Adjustment Scale (DAS), and dysfunctional sexual beliefs questionnaire. Both groups completed the questionnaires before and one week after the intervention. Independent t-test, paired t-test, and analysis of covariance was used to analyze the data.


The findings revealed no statistically significant difference in the baseline Dyadic Adjustment mean scores of control (132.4 ± 11.01) and intervention (130.10 ± 10.66) groups. Paired t-test analysis showed that the mean score of dysfunctional sexual beliefs was significantly decreased from (29 ± 7.61) at baseline compared to one week after intervention (10.54 ± 6.97) (p < 0.001). Analysis of covariance test to compare the scores of dysfunctional sexual beliefs in the intervention group (10.54 ± 6.97) and control group (26.80 ± 7.80) showed a statistically significant difference (p < 0.01) with an effect size of 0.67.


This study showed that sending text messages to mobile phones of pregnant women has corrected their dysfunctional sexual beliefs. Therefore, this approach can be used in pregnancy care to promote women's sexual health.

Trial registration

Clinical trial registry: IRCT20161230031662N9.

Peer Review reports


Pregnancy is one of the most sensitive periods in women's lives that can affect sexual relationships by creating physical and psychological changes [1, 2]. Sexual behavior is well defined by a biopsychosocial model [3] and is closely related to a woman's beliefs [4]. During pregnancy, sexual behaviors and attitudes are influenced by sexual value systems, indigenous culture, and traditional or religious beliefs [5]. Studies suggested changes in sexual behavior of pregnant women that are not related to sexual functioning but are associated with sexual distress [6]. Pregnant women's sexual behaviors alter due to many reasons such as; the fear of harm to the fetus, pain, miscarriage, discomfort, the belief that sex in pregnancy is a sin, fatigue, enlarged abdomen, nausea, and vomiting [7].

In addition, spouses of pregnant women sometimes come up with a decrease in their sexual desire and activity due to fear of harm to the fetus, the belief that sexual activity is immoral during pregnancy, and the stress of fatherhood [1]. While there are no restrictions on sexual activity in normal pregnant women [8], most couples are unaware of how to have sex during pregnancy. Despite the need for education on sexual issues during pregnancy, this is often ignored [9, 10]. Despite the high prevalence of sexual dysfunction and sexual beliefs about pregnancy [10, 11], few are consulted and treated [12]. Dysfunctional sexual beliefs endanger a couple's sexual life and influence their sexual function [13]. In many cases, the individual is so influenced by dysfunctional beliefs in sexual practice that clarifying and reconstructing them is an essential step toward creating desirable sexual relations between couples [6].

Despite the need for educational counseling interventions, there are gaps in the reproductive health system [12]. Studies have shown that face-to-face sex education can improve dysfunctional sexual beliefs and, consequently, the quality of sexual life, sexual satisfaction, and marital relationship of pregnant women [14, 15]. Still, it is not clear whether tele-education can have such an effect.

Telehealth is beneficial for easier access to health care [16], and some methods, such as text messaging, are considered effective and acceptable interventions for promoting health behaviors [17]. Delivering SMS text messages is a cost-effective strategy to provide maternal health care [18, 19]. It is associated with improvement in obstetric outcomes, perinatal smoking cessation, breastfeeding [20], self-care of pregnant women [21], and doctor-patient communication [22]. Moreover, mobile phone text-based interventions have received more attention in reproductive and sexual health studies worldwide [23, 24].

Interventions to promote the sexual health of pregnant women and modify their beliefs about sexuality in pregnancy need an effective model that could increase access to psycho-education materials. Delivering text message-based psycho-education can overcome some common barriers such as specialist availability, cost, and geographic access for people [25] and also help provide an effective intervention to increase individuals' mental and physical health [26]. A pilot study based on a 12-week intervention of text messaging could significantly affect decreasing depression symptoms [25]. Even in the critical era of the COVID-19 pandemic, tele-health education could help pregnant women lessen their pregnancy-related stress and anxiety [27]. The present study aimed to determine the effect of tele-education on modifying the dysfunctional sexual beliefs of pregnant women.

Materials and methods


This study is a randomized clinical controlled trial conducted from July to November 2019 on 82 pregnant women aged 18–45 with 14 to 31 weeks gestational age based on LMP or ultrasound records. Samples of the study were expectant mothers referred to Kamali and Imam Ali educational medical centers for receiving prenatal care. These two centers are specialized academic hospitals of Alborz University of Medical Sciences, including an active gynecology clinic and access to research samples. The participants were recruited by convenience sampling and then randomly assigned to the intervention or control group. Block randomization was done by the online randomization site "Sealed envelope website" using the block size of four. A colleague out of the study conducted randomization and concealment. Both groups completed the demographic questionnaire, reproductive profile, dysfunctional sexual beliefs scale, and Spinner's Dyadic Adjustment Scale (DAS). Individuals who obtained scores less than 100 from DAS questionnaire were excluded from the study. Then, one week after the intervention, both groups completed a dysfunctional sexual belief questionnaire. The intervention group was asked an item about satisfaction with a 5-point Likert scale from "completely satisfied" to "completely dissatisfied". At the end of the intervention, an educational face-to-face session was presented for the control group.


The participants fulfilled the inclusion criteria, including the age range of 18 to 45 years, gestational age of 14–31 weeks, Iranian nationality, intended pregnancy, monogamous relationships, being physically healthy, single pregnancy, no addiction in couples, having a personal cell phone, and marital adjustment. The study exclusion criteria were: self-reported mental illness, sexual dysfunction or any known psychiatric disorder in the couples, high-risk pregnancy such as vaginal bleeding, placenta previa, assisted reproductive techniques, threatened abortion, chronic medical conditions, previous history of miscarriage or intrauterine death of the fetus.


During three months, 200 pregnant mothers were registered and evaluated in the prenatal clinic by attending the centers every other week and interviewing mothers. First of all, the participants were explained the aim of the study and then included in the study after taking the informed written consent if they met the inclusion criteria. The participants referred to the prenatal clinics of two educational hospitals were recruited by convenience sampling. Forty-one participants were allocated to each group by block randomization. The first researcher prepared 21 opaque envelopes (to obscure the envelope's contents), and each random sequence created was recorded on a card and placed inside the envelope. They were then placed in a larger envelope. One of the colleagues outside the research team was asked to keep the envelopes. Finally, 82 mothers were included in the intervention. Figure 1 presents the flowchart of the study.

figure 1

2010 CONSORT flow diagram

The number of samples using G * Power software version 3.1.2 was estimated to be 34 in each group according to α = 0.05, effect size = 0.7, and β = 0.20. The attrition rate was considered equal to 20 percent, and then the total sample size was 82 (41 in each group). This study was registered in Alborz University of Medical Sciences with the code of ethics IR.ABZUMS.REC.1398.024 and registered in the Iranian Clinical Trial database with the code IRCT20161230031662N9. The first registration was done on 15/07/2019.


The SMS content in this study was designed based on a literature review. Training messages were sent to pregnant women at the gestational age of 14 to 31 weeks in the intervention group for eight weeks; one message every other day, at 10 AM. The educational messages were related to the anatomy of the female reproductive system, uterus, fetus, and amniotic sac. Moreover, it was clarified that there is no relation between intercourse and miscarriage or rupture of the amniotic sac or the onset of childbirth pains in normal pregnancies. We have also provided educational messages regarding appropriate sexual positions during pregnancy, the use of condoms to prevent the transfer of infection, physiological changes during pregnancy, body image of the pregnant women to strengthen the mother's self-confidence, and modifying beliefs about guilt and immorality of sex during pregnancy.

The participants were suggested to write the received messages in a separate notebook and review them repeatedly with their spouses. A multiple-choice test was sent to participants in the middle of the training course to ensure they noticed the messages. An in-person training session was held for the control group at the end of the study.

Before delivering any message, we asked a question. Samples of questions and messages were: "Can the sexual intercourse during pregnancy be considered a "sin" according to Sharia?" Then the message was:

"The pregnant mother should know that having sex during pregnancy is completely normal, and she does not commit any sin or mistake. The goal is to reach a point of peace of mind and meet the couple's emotional needs. Sex and sexual intercourse do not only mean satisfying sexual desire but also hugging, kissing, and expressing love causes more intimacy and maintains family unity."

"Or another question and message were: "Does sex during pregnancy cause a ruptured amniotic sac?" Then the message was: "During sexual intercourse, the penis enters the vagina but has no contact with the amniotic sac around the fetus, so if sex is not very deep in the last trimester, it has no significant association with premature rupture of the sac."


This study's data collection tools include demographic and individual characteristics, a fertility profile questionnaire, the Sexual Dysfunctional Beliefs Questionnaire, and Dyadic Adjustment Scale (DAS). Also, one question about satisfaction with the training was formulated on a five-point Likert scale, from completely satisfied to completely dissatisfied, which was asked at the end of the intervention using SMS by the intervention group. The primary variable was dysfunctional sexual beliefs.

Demographic and individual characteristics

Demographic and individual characteristics: included variables such as age, education, occupation of the couple, and age of marriage.

Fertility profile questionnaire: Number of pregnancies, number of abortions, number of live children, gestational age, intercourse method, and number of intercourses per week and month were assessed in this questionnaire.

Questionnaire of dysfunctional sexual beliefs

The questionnaire on dysfunctional sexual beliefs in pregnant women, with an extensive literature review and based on the study of Sosa et al. [28,29,30], was designed by the research team, and the validity and reliability were evaluated. The final form of this questionnaire has 13 questions, and the scoring method is based on a five-point Likert scale, from "strongly disagree" to "strongly agree," and the scores were from 0 to 4. A higher score indicates more dysfunctional beliefs.

Qualitative and quantitative content validity methods assessed the validity of this questionnaire. The initial questionnaire consisting of 21 items was reviewed by ten specialists in reproductive health, obstetrics, psychology, sex therapy, and health education and was studied based on corrective opinions. Quantitative content validity was assessed by two indicators, CVR and CVI. In examining the content validity ratio, the standard index for ten experts was 0.62 based on the Lawshe table [31]. Accordingly, eight items were removed, and 13 out of 21 remained. The reliability of the dysfunctional sexual beliefs questionnaire was confirmed with Cronbach's alpha = 0.89.

Dyadic Adjustment Scale (DAS)

Dyadic adjustment scale (DAS) has 32 items and four dimensions: marital satisfaction, marital cohesion, marital agreement, and expression of love. The score range of this questionnaire is from zero to 150, and a higher score is a sign of more adjustment. On this scale, a score of 100 or more means adjustment of individuals, and scores less than 100 tell marital problems. Scoring is based on a 5-point Likert scale. High scores indicate higher marital quality. The validity and reliability of this scale have been approved in Iran [32]. In the present study, the reliability of this scale was determined to be 0.91 based on Cronbach's alpha.


The demographic characteristics of the participants are given in Table 1. There were 39 subjects in each intervention and control group. There was no statistically significant difference between the intervention and control groups regarding demographic variables. The mean and standard deviation of the scores of the marital adjustment for the control and intervention groups before the intervention show that the mean scores of marital adjustment in the control and intervention groups were 132.41 and 130.10, respectively, and according to t = -0.940, at 95% confidence level, marital adjustment was not significantly different.

Table 1 Statistical description of demographic and fertility information by the control and intervention groups

Paired t-test showed that the difference between the mean scores of the dysfunctional sexual beliefs in the control group was not significant (P = 0.096). Still, it was significant in the intervention group (P < 0.01). (Table 2).

Table 2 Dysfunctional sexual beliefs scores in the two groups before and after the intervention

The homogeneity analysis of the regression line slope as a default covariance analysis showed that the significance level of the mutual effect line of the group before the intervention (p = 0.177) was greater than 0.05. Therefore, the regression homogeneity hypothesis is accepted.

The significance level of Levene test was sig = 0.76, which indicates the equality of variances between the two groups (Table 3). Therefore, it can be concluded that there is a significant difference between the mean scores of the post-test variable of dysfunctional sexual beliefs in the intervention and control groups.

Table 3 The difference between the mean scores of dysfunctional sexual beliefs in the intervention and control groups after the intervention

The results of analysis of covariance to compare the scores of dysfunctional sexual beliefs in the intervention and control groups after the intervention showed that the value of F is equal to 152.52, and its significance level is less than 0.01 (p < 0.01) (Table 4). Based on this and considering the lower average scores of the intervention group after the intervention, it can be concluded that text messages have been effective and could correct the sexual beliefs of pregnant women. The effect of text messages on correcting sexual beliefs was 67%.

Table 4 Results of analysis of covariance to compare dysfunctional sexual beliefs in the intervention and the control groups


This study showed that text messages effectively corrected the sexual beliefs of pregnant women. Education by text message on sex in pregnant women is being studied for the first time in Iran. Today, mobile phones can help improve and strengthen preventive health care in low-income and middle-income countries. The use of text messages, even only as a reminder, will still promote health.

The prevalence of mobile phones, especially in Iran, has reached about 90%. This issue leads to all people receiving the messages despite their busy schedules. For this reason, we could expect changes through text messages in pregnant women [33]. Using mobile phones in educational programs through text messages for pregnant women improves access to education, reduces social costs, promotes justice in education, and optimizes time [18, 19].

Due to misconceptions and changes in pregnant woman's body image, reduced feeling of attractiveness to the husband, fear of harm to the fetus, and risk of abortion [34], many studies have shown that health behaviors of pregnant women can be modified and corrected through tele-education [14, 33, 35]. Text messaging can increase a large population's reproductive health knowledge and reduce the risks of unwanted pregnancies in female adolescents [36]. It seems that integrating this mode of education in primary health services is necessary. Tele-education can reduce the dysfunctional beliefs of pregnant women remotely and without the need for physical presence, which can be a practical approach to achieving sexual health. A large part of the feeling of guilt may originate from this belief that coitus may be harmful to the fetus.

Alizadeh et al. showed that more than half of pregnant women had been worried about the possibility of harm to the fetus during sexual activity before the educational intervention. After a one-hour one-on-one individual session, this rate was reduced to 3.3% in the intervention group and remained at 50% in the control group [29]. It shows the effectiveness and necessity of training to correct sexual beliefs, aligning with the present study results.

A study showed a significant decrease in the score of dysfunctional sexual beliefs related to the harms of intercourse to the fetus, such as abortion, infection, rupture of the sac, premature delivery, etc., which is in line with the present study. But the score of a woman's guilt feelings about sex during pregnancy and the perception that they are unattractive to their husbands and that sex was immoral during this period did not change significantly from their and their husbands' point of view [30]. The guilty feelings about the intercourse are started from early pregnancy, and they may need a longer time to be relieved. One difference between our study and the above-mentioned study was that our intervention was done over a more extended time, emphasizing re-reading the messages together with the spouse, which caused a significant reduction in scores of all 13 dysfunctional sexual beliefs items. In the present study, the belief in guilt caused by sexual intercourse in pregnancy was sharply reduced with training in the intervention group. Still, the control group, who did not receive SMS, increased significantly with gestational age. This finding was contrary to the results of a study that could not change the mother's guilt [29].

The importance of correcting sexual beliefs in pregnant women is the effect that incorrect sexual beliefs have on the quality of sexual life and other aspects of sexuality. Studies have shown the association between women's sex knowledge and sexual behaviors at childbearing age [29]. Fear of harm to the fetus, fear of miscarriage or premature birth, and fear of infection are present in more than half of women [29, 30]. More than 65% of the partners of pregnant women do not have the desire to have intercourse in pregnancy because they fear harm to the fetus [12]. The present study also showed that among the study participants, the highest score of dysfunctional belief in the pre-test of the intervention group was 43.6%. The pre-test of the control group was 38.5%, which was related to the husband's fear of harming the fetus during intercourse, which decreased by 10.3% in the post-test intervention group but increased by 46.6% in the control group.

Using questionnaires has limitations, including that individuals may not reflect the truth about questions for various reasons. However, the authors did proper communication and tried to justify the importance of accurate data. Therefore, the accuracy of the participants' statements was trusted. Only female participants and pregnant women at the 14 to 31 weeks of pregnancy were recruited for this study, which is a limitation. Although we tried to control some confounding variables, psychological variables and the mental health of individuals who may influence sexual beliefs have not been examined in this study. Still, we have controlled dyadic adjustment of the couples, which may be considered a strength of this study.


Tele-education effectively modifies dysfunctional sexual beliefs of pregnant women in the second trimester of pregnancy. To promote pregnant women's sexual health, designing and applying this approach in routine prenatal care can play an essential role.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.


  1. Fernández-Carrasco FJ, Rodríguez-Díaz L, González-Mey U, Vázquez-Lara JM, Gómez-Salgado J, Parrón-Carreño T. Changes in sexual desire in women and their partners during pregnancy. J Clin Med. 2020;9(2):526.

    Article  Google Scholar 

  2. Bogren LY. Changes in sexuality in women and men during pregnancy. Arch Sex Behav. 1991;20(1):35–45.

    Article  CAS  Google Scholar 

  3. Afshar M, Mohammad-Alizadeh-Charandabi S, Merghti-Khoei ES, 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;1(4):173–81.

    PubMed  PubMed Central  Google Scholar 

  4. Bourdeau B, Grube JW, Bersamin MM, Fisher DA. The role of beliefs in sexual behavior of adolescents: development and validation of an Adolescent Sexual Expectancies Scale (ASEXS). J Res Adolesc 2011, 21(3):

  5. Rahimian M, Nassiri S, Saffarieh E. Pregnant women’s attitude towards sexual desire and its relationship with quality of life and rumination in the last trimester of pregnancy. J Obstet Gynecol Cancer Res. 2019;4(1):16–23.

    Article  Google Scholar 

  6. Beveridge JK, Vannier SA, Rosen NO. Fear-based reasons for not engaging in sexual activity during pregnancy: associations with sexual and relationship well-being. J Psychosom Obstet Gynaecol. 2018;39(2):138–45.

    Article  Google Scholar 

  7. Jones C, Chan C, Farine D. Sex in pregnancy. CMAJ. 2011;183(7):815–8.

    Article  Google Scholar 

  8. Williams JW, Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS. Williams obstetrics. 25th ed. New York: McGrow-Hill; 2018.

    Google Scholar 

  9. Al Bustan MA, El Tomi NF, Faiwalla MF, Manav V. Maternal sexuality during pregnancy and after childbirth in muslim Kuwaiti women. Arch Sex Behav. 1995;24(2):207–15.

    Article  CAS  Google Scholar 

  10. Banaei M, Azizi M, Moridi A, Dashti S, Yabandeh AP, Roozbeh N. Sexual dysfunction and related factors in pregnancy and postpartum: a systematic review and meta-analysis protocol. Syst Rev. 2019;8(1):161–161.

    Article  Google Scholar 

  11. Khalesi ZB, Bokaie M, Attari SM. Effect of pregnancy on sexual function of couples. Afr Health Sci. 2018;18(2):227–34.

    Article  Google Scholar 

  12. Heidari M, Amin Shokravi F, Zayeri F, Azin SA, Merghati-Khoei E. sexual life during pregnancy: effect of an educational intervention on the sexuality of iranian couples: a quasiexperimental study. J Sex Marital Ther. 2018;44(1):45–55.

    Article  Google Scholar 

  13. Bayrami R, Sattarzadeh N, Ranjbar Koochaksariie R, Pezeshki M. Sexual dysfunction in couples and its related factors during pregnancy. J Reprod Infertil. 2008;9(3):271–83.

    Google Scholar 

  14. Navidian A, Navabi Rigi S, Imani M, Soltani P. The effect of sex education on the marital relationship quality of pregnant women. HAYAT. 2016;22(2):115–27.

    Google Scholar 

  15. Masoumi SZ, Kheirollahi N, Rahimi A, Beyrami Haghgu M, Ahmadvand S, 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.

    Article  Google Scholar 

  16. McFarland S, Coufopolous A, Lycett D. The effect of telehealth versus usual care for home-care patients with long-term conditions: a systematic review, meta-analysis and qualitative synthesis. J Telemed Telecare. 2021;27(2):69–87.

    Article  Google Scholar 

  17. Wei J, Hollin I, Kachnowski S. A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions. J Telemed Telecare. 2011;17(1):41–8.

    Article  Google Scholar 

  18. LeFevre A, Cabrera-Escobar MA, Mohan D, Eriksen J, Rogers D, Neo Parsons A, Barre I, Jo Y, Labrique A, Coleman J. Forecasting the value for money of mobile maternal health information messages on improving utilization of maternal and child health services in Gauteng, South Africa: cost-effectiveness analysis. JMIR Mhealth Uhealth. 2018;6(7):e153.

    Article  Google Scholar 

  19. Khorshid MR, Afshari P, Abedi P. The effect of SMS messaging on the compliance with iron supplementation among pregnant women in Iran: a randomized controlled trial. J Telemed Telecare. 2014;20(4):201–6.

    Article  Google Scholar 

  20. DeNicola N, Grossman D, Marko K, Sonalkar S, Butler Tobah YS, Ganju N, Witkop CT, Henderson JT, Butler JL, Lowery C. Telehealth interventions to improve obstetric and gynecologic health outcomes: a systematic review. Obstet Gynecol. 2020;135(2):371–82.

    Article  Google Scholar 

  21. Abbaspoor Z, Amani A, Afshari P, Jafarirad S. The effect of education through mobile phone short message service on promoting self-care in pre-diabetic pregnant women: a randomized controlled trial. J Telemed Telecare. 2020;26(4):200–6.

    Article  Google Scholar 

  22. Kashgary A, Alsolaimani R, Mosli M, Faraj S. The role of mobile devices in doctor-patient communication: a systematic review and meta-analysis. J Telemed Telecare. 2017;23(8):693–700.

    Article  Google Scholar 

  23. Willoughby JF, L’Engle KL, Jackson K, Brickman J. Using text message surveys to evaluate a mobile sexual health question-and-answer service. Health Promot Pract. 2018;19(1):103–9.

    Article  Google Scholar 

  24. Chung IY, Kang E, Yom CK, Kim D, Sun Y, Hwang Y, Jang JY, Kim SW. Effect of short message service as a reminder on breast self-examination in breast cancer patients: a randomized controlled trial. J Telemed Telecare. 2015;21(3):144–50.

    Article  Google Scholar 

  25. Pfeiffer P, Henry J, Ganoczy D, Piette J. Pilot study of psychotherapeutic text messaging for depression. J Telemed Telecare. 2017;23:665–72.

    Article  Google Scholar 

  26. Rathbone AL, Prescott J. The use of mobile apps and SMS messaging as physical and mental health interventions: systematic review. J Med Internet Res. 2017;19(8):e295.

    Article  Google Scholar 

  27. AksoyDerya Y, Altiparmak S, AkÇa E, GÖkbulut N, Yilmaz AN. Pregnancy and birth planning during COVID-19: the effects of tele-education offered to pregnant women on prenatal distress and pregnancy-related anxiety. Midwifery. 2021;92:102877–102877.

    Article  Google Scholar 

  28. Sossah L. Sexual behavior during pregnancy: a descriptive correlational study among pregnant women. Euro J Res Med Sci. 2014;2(1):16–27.

    Google Scholar 

  29. Alizadeh S, Riazi H, Majd HA, Ozgoli G. 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;21(1):334.

    Article  Google Scholar 

  30. Mohamadi S, Ozgoli G, Alizadeh S, Borumandnia N, Abbas A. The effect of modification of dysfunctional sexual beliefs on promotion of quality of pregnant women sexual life in Besat hospital. Pejouhesh dar Pezeshki (Res Med). 2017;41(3):166–74.

    Google Scholar 

  31. Lawshe CH. A quantitative approach to content validity. Pers Psychol. 1975;28(4):563–75.

    Article  Google Scholar 

  32. Torkan H, Molavi H. An investigation on the psychometric features of Dyadic Adjustment Scale (DAS). J Psychol. 2010;13:445–67.

    Google Scholar 

  33. Haghani F, Shahidi S, Manoochehri F, Kalantari B, Ghasemi G. The effect of distance learning via sms on knowledge & satisfaction of pregnant women. Iran J Med Educ. 2016;16:43–52.

    Google Scholar 

  34. Balali Dehkordi N, Sadat Rouholamini M. The role of body image and obsessive believes in prediction of sexual function among pregnant women. Iran J Obstet Gynecol Infertil. 2016;19(16):7–16.

    Google Scholar 

  35. Eskandari Z, Alipoor A, Mohammadi NK, Ramezankhani A. The effect of mobile based education on knowledge and behavior of pregnant mothers regarding risk factors signs in pregnancy. J Health Field. 2019;6(4):20–7.

    Google Scholar 

  36. Brinkley DY, Ackerman RA, Ehrenreich SE, Underwood MK. Sending and receiving text messages with sexual content: relations with early sexual activity and borderline personality features in late adolescence. Comput Hum Behav. 2017;70:119–30.

    Article  Google Scholar 

Download references


The authors would like to thank the individuals who willingly participated and shared their time to make this study possible. Also, we would like to acknowledge special thanks to Ms. Nastaran Salehifar for the professional English language editing of the manuscript. This study was conducted in partial fulfillment of an MSc. degree in Midwifery Counseling at Alborz University of Medical Sciences.


There was no funding for this project.

Author information

Authors and Affiliations



All authors contributed to the design of the study. ShKh and RL conducted data collection and analysis and drafted the manuscript. KK and EMKh assisted with data analysis. All authors read and approved the final paper.

Corresponding author

Correspondence to Razieh Lotfi.

Ethics declarations

Ethics approval and consent to participate

The ethics committee of Alborz University of Medical Sciences approved this study with the code of IR.ABZUMS.REC.1398.024. All participants provided informed written consent. All methods were performed in accordance with the relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khoddam, S., Lotfi, R., Kabir, K. et al. The effect of a tele-educational intervention on modifying dysfunctional sexual beliefs of pregnant women: a randomized controlled trial. BMC Pregnancy Childbirth 22, 495 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Pregnancy
  • Sexuality
  • Tele-education
  • Text message
  • Dysfunctional sexual beliefs