Discussion
thyroid disorders, illness behaviors, anxiety, obsessive compulsive disorder, vaginismus, Amiri, chronic diseases, pain, sexual dysfunction, psychiatric, chronic physical illness, hypothyroidism, sexual desire, diabetes
THYROID DISORDERS, DISORDER, CHRONIC ILLNESSES, VAGINISMUS, CHRONIC DISEASES, DISORDERS, MALE SEXUAL DYSFUNCTION, HYPOTHYROIDISM, DIABETES
The present study was carried out to evaluate the effect of CBT on sexual function in women with hypothyroidism. According to the findings, CBT improved the six dimensions of female sexual function including desire, arousal, lubrication, orgasm, satisfaction, and pain, as well as the total sexual function score in women with hypothyroidism immediately and 4 weeks after completion of cognitive-behavioral therapy program.According to Romero-Gómez et al. (2020), compared with controls, the prevalence of sexual dysfunction was higher in women with hypothyroidism despite levothyroxine treatment. Based on their results, hypothyroidism increased the risk of sexual dysfunction, with the most affected domains being desire, orgasm, and pain [Amiri et al. (2015) reported that in patients with hypothyroidism, the level of anxiety and stress is undesirable, which can be due to hypothyroidism. Therefore, they concluded that in addition to alternative treatment with levothyroxine, treatment of associated psychological problems is essential in these patients [Mestre-Bach et al. (2022) conducted a review study. They focused on “the psychotherapeutic approaches used in the treatment of female sexual dysfunction disorders” and reported cognitive-behavioral counseling as a successful treatment [Since at the time of writing this manuscript, we found no study on the application of cognitive-behavioral therapy aimed at the treatment of sexual dysfunction in reproductive-aged women with hypothyroidism, we tried to compare the results of the present study with those of studies examining the effect of cognitive-behavioral therapy in individuals with sexual dysfunction without underlying disorders or in patients with other chronic diseases.The results of Nezamnia et al. (2020) and Ahi et al. (2018) showed that cognitive-behavioral counseling can improve sexual desire in women and lead to increased sexual desire and sexual attraction in them [By the same token, Sabetnejad et al. (2016) found that the cognitive-behavioral counseling program together with fluoxetine significantly increases sexual performance in women with obsessive compulsive disorder [Ziaee et al. (2014) also reported the effect of cognitive-behavioral counseling on vaginal lubrication in women [Hamid et al. (2012) found that CBT led to increased sexual function in women with vaginismus [The hypothyroidism has been shown to be associated with an increased incidence of sexual dysfunction even when normalized with levothyroxine and thyroid stimulating hormone (TSH) [As mentioned earlier, due to the insufficient studies conducted on this topic, the effect of cognitive-behavioral therapy on improving sexual function and its mechanisms in chronic diseases such as thyroid disorders have not been studied thoroughly yet. Factors such as psychiatric disorders associated with chronic illnesses including health anxiety, coping problems, and difficulty in compliance with treatment, as well as problems with illness behaviors may play a role in the development of sexual dysfunction in patients with chronic diseases CBT has been proposed as a very effective and possibly cost-effective treatment for managing anxiety caused by health problems [Lukkahatai et al. (2019) also pointed to the role of cognitive-behavioral therapy in managing chronic diseases, controlling the symptoms, and improving the quality of life [Cognitive-behavioral therapy is used to treat psychiatric disorders not only in patients with chronic physical illness, but also in those who do not have a psychiatric disorder but have problems with illness-related beliefs, illness behaviors, or illness adaptation [Cognitive-behavioral therapy has been shown to be effective in improving sexual dysfunction in women with diabetes [Therefore, given the results of studies on the effects of chronic diseases on sexual dysfunction on the one hand and the effect of CBT on the improvement of these disorders on the other, and considering the results of this study, it can be argued that the use of this treatment along with standard treatments can play an important role in promoting sexual function in these patients.The most important strength of the present study was the novelty of its topic, and it was the first study to investigate the effectiveness of using cognitive-behavioral counseling along with pharmacotherapy to treat sexual dysfunction in women with hypothyroidism. Conducting the treatment sessions under the supervision of an experienced psychiatrist is another strength of this study.Nevertheless, a limitation that should be taken into account is that this study was conducted during the Covid-19 pandemic, which caused anxiety and stress among the participants for attending the sessions. This problem was minimized by reducing the number of people attending the sessions, providing a completely appropriate space for them, and observing hygienic protocols.