Introduction
Humans have many desires that make their identity and personality. Their timely and adequate satisfaction has a significant effect on their physical and mental health. One of these desires is sexual desire. The basis of the family is based on sexual desire. This desire is a good feeling that drives men and women towards marriage and building families. By sexual satisfaction, a person can reach peace in mind, in addition to meeting physical needs [1, 2]. Mindfulness is usually defined as a state of awareness and attention to what is happening in the present moment [6]. Researchers have shown that high mindfulness is related to various health outcomes such as reduced pain, anxiety, depression, unhealthy eating behaviors, and stress [6, 7]. Mindfulness can help free people from automatic thoughts, unhealthy habits and behavioral patterns, and thus plays an important role in regulating behavioral processes [1, 6].
According to some reports from clinical studies, the important role of attention and concentration in women’s arousal and orgasm cycles, can emphasize the effectiveness of therapeutic methods based on mindfulness in reducing sexual dysfunctions and improving the quality of orgasm. Some evidence suggests that mindfulness skills reduce women’s sexual anxiety, and women probably experience orgasm more consciously in such conditions, which may lead to its qualitative improvement [2, 7]. On the other hand, since mindfulness interventions are usually performed in group, it seems that they can lead to reduced treatment costs and better time efficiency [6, 7]. The present study aims to investigate the effectiveness of sexual therapy based on mindfulness on indicators of orgasm quality and sexual function in women with orgasmic disorder. This method was designed using mindfulness-based stress reduction method and Masters and Johnson’s model of sex therapy.

Methods
This is a clinical trial. The study population consists of Iranian married women referred to the clinics of family therapy, sex therapy, and psychiatry in Tehran, Iran. After obtaining informed consent, 25 participants were interviewed and completed the Symptom Checklist-90 (SCL90) where items are rated on a scale from 0 to 4. The total score should not be less than the cut-off point. Then, the sexual function questionnaire and a researcher-made questionnaire on orgasm quality were completed by all participants. The sexual function questionnaire with 19 questions measures women’s sexual function in 6 areas of sexual desire, arousal, moisture, orgasm, satisfaction and sexual pain. We used its Persian version whose validity has already been approved in other study. The researcher-made orgasm quality questionnaire measures the frequency of sexual intercourse in the past month, the frequency of orgasm in the past month in relation to the number of sexual intercourses, and self-assessment of orgasm quality. Demographic information, general health conditions, and relationship-related information were obtained through self-report. Then, they received education about the structure of sexual system and sexual response processes. After that, the mindfulness-based sex therapy protocol was presented at 8 sessions. The questionnaires were completed again immediately after and three months after the treatment program.

Results
The mean age of 25 participants was 39.48±6.40 years. Their mean years of education was 17.08±1.14 years. Fifteen women (60%) were employed, all of them had master’s degree or higher. The mean scores of participants are presented in Table 1.


In comparing sexual function, orgasm quality, symptoms of female orgasmic disorder, and number of sexual intercourses per month (Table 2), the results showed an increase in sexual function and indicators of orgasm quality immediately after and three months after the intervention.


Compared to the results recorded before the intervention, the mindfulness-based intervention increased the scores, and the interaction effect of treatment and time showed was significant. Multivariate analysis of variance showed a significant difference in sexual function (Wilks’ Lambda=0.05, F(2, 22)=195.95, P<0.0001, η2=0.947), symptoms of female orgasmic disorder (Wilks’ Lambda=0.31, F(2,22)=330.97, P<0.0001, η2=0.969), orgasm experience quality (Wilks’ Lambda=0.29, F(2, 22)=352.28, P<0.0001, η2=0.971) and number of sexual intercourses per month (Wilks’ Lambda=0.05, F(2, 22)=183.15, P<0.0001, η2=0.946) over time. The pairwise comparison of times showed that the difference in the study variables between the times “immediately after the intervention” and “three months after the intervention” was statistically significant, compared to the pre-intervention period (P<0.05).

Discussion
It seems that mindfulness-based sex therapy is effective in improving sexual function and orgasm quality in women with orgasmic disorder. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1399.1018) and was registered by Iranian Registry of Clinical Trials (ID: IRCT20180310039024N2).

Funding
This study was extracted from the doctoral thesis of the first author in clinical psychology approved by Islamic Azad University of Shiraz branch. This study was not funded by any organizations.

Authors contributions
The authors contributed equally to preparing this paper.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank the participants for their cooperation.

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