Open Journal of Urology, 2013, 3, 261-268 http://dx.doi.org/10.4236/oju.2013.36049 Published Online October 2013 (http://www.scirp.org/journal/oju) Psycho-Physiological Combined Therapy on the Sexual Desire* Roohallah Bay1#, Shaiful Bahari Ismail2, Fatemeh Bay3 1Sexual and Family Therapy Group, Departmen t of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia (USM), Kelantan, Malaysia 2Department of Family Medicine, Uni ve r si ti Sains Malaysia (USM), Kelantan, Malaysia 3Department of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran Email: #ir_psychology@yahoo.com Received August 7, 2013; revised September 7, 2013; accepted September 15, 2013 Copyright © 2013 Roohallah Bay et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Objective: Hypoactive Sexual Desire is characterized as a lack or absence of sexual fantasies and desire for sexual ac- tivity. The current study ex amines the effects of psycho- physiological th erapy (stretch therapy combined with breath ing exercise) on the sexual desire among heterosexual men. Methods: We used “convenience sampling” for this research; 80 people were recruited. For collection of data, we used an identical quasi-experimental design called “nonequivalent control group.” Ther apy sessions each lasting (20) 90 to 120 min were carried out on 3 alternate days of week. The vo- lunteers have been selected from heterosexual men with stable relationship, those who married minimum of 6 months, within 20 to 55 years old, who attended to HUSM Family Clinic. Pre-tests, post-tests, and follow-up tests were con- ducted in a HUSM clinic (Malaysia). For assessment we used Hurlbert Index of Sexual Desire (HISD). Results: The psycho-physiological group had better post-test scores compared to the control group. Also follow-up test scores were marginally better compared to the control group, but this difference did not reach statistical significance. Also age and education level of participants didn’t have any significant effect on this intervention. Conclusion: Psycho-physiolog ical combined therapy including stretching and breathing exercise appears to result in better improvement in sexual desire compared to control group but this improvement is not great. It increases sexual desire of heterosexual men, whenever people follow the therapy. Keywords: Combined Therapy; Sex; Desire 1. Introduction Hypoactive sexual desire is considered as a sexual dys- function and is listed under the Sexual and Gender Iden- tity Disorders of the DSM-IV. It is characterized as a lack or absence of sexual fantasies and desire for sexual activity for some period of time [1]. During the last few de cades, marital tensio ns and stresses have influenced various dimensions of life. Studies done on married persons compatible with marital life show that they live largely with healthy food, body and nutrition and thus suffered less from psychological difficulties [2]. At the root of a couple’s argument over a day to day, mundane matter is often the need for intimate contact. This is not to say that sexual intercourse is a panacea for all problems couples encountering in life. However, the desire of the need for intimate contact inclusive of some form of physical contact is fundamental to personal he alth and in fact fundamental to human nature. Sex is an indi- vidual psychological event, and the attitudes of the indi- vidual. His/her earlier experience, anxiety, tiredness and overwork can all have a major dama ging effect on sex [3]. It is evident that in direction to confront these difficu l- ties, prevention and training and reform are very impor- tant in order to increase knowledge & power of people in correct & suitable reaction with life events. At present, paying attention to current relationship in marital and family life & its sexual relationship in order to overco me this problem is among the most important steps. There are clear evidences that from the first of 1980, psychotherapy has grown very fast towards integration. This movement puts the best approach together to make a better & more complete treatment model [4]. *This study was supported by USM SHORT TERM GRANT from the Universiti Sains Malaysia from the Health Campus, School of Medical Sciences. #Corresponding author. C opyright © 2013 SciRes. OJU
R. BAY ET AL. 262 Within this way, psycho-physiological sex-therapy is one of the new alterative and complementary therapies in order to keep saving marriage and increasing society welfare. Sex therapy is the result of relatively recent scientific attention to human sexual function and dysfunction. In- creased knowledge of physiology and psychology of hu- man sexual behavior brought a new professional appre- ciation for human sexual response. At a time in our soci- ety, when sexuality is being more openly discussed, we are beginning to realize how uninformed, many people, really are about this important personal topic. Sex ther- apy can be helpful for individuals and couples depending on the issue being addressed. Some issues can be dealt with on an individual basis, while others are best treated in the context rel at i onship of a couple [5]. Now considering the above-mentioned, this research is going to investigate the effectiveness of psycho-physio- logi cal combined th erapy (Stretch Th erapy combined Brea- thing Exercise) on the Sexual desire in Hete rosexual Men. Currently, stretch therapy is increasing in the United States, where 10 - 15 million people participate in stretching classes [6]. In 1997, more than 40% of people living in the United States had practiced at least one type of complementary or alternative therapy; psycho-physio- logical stretch therapy is one of the modalities included in this term [7]. Finally, 65% of people receiving mental health services eng age in one type o f modality of alterna- tive or adjunctiv e therapy [8]. The findings have described possible benefits of s tre tch- ing to protect mental health. Specifically the literature suggests that some style of them such as yoga may be related to an increase in coping skills, and self-esteem, and a decrease stress, anxiety, and depression [9-12]. Research has shown that some kinds of breathing ex- ercises such as Bhasrika help in treatment. They affect mind, brain and nervous system and increase oxygen lev- els and reduce carbon dioxide levels in the blood. In these breathing styles, the abdominal muscles and dia- phragm are used which put pressure on the internal or- gans. Also, Regular practice of breathing exercises will ensure proper oxygenation of all parts of the body and cure many diseases. Proper oxygenation helps purify the blood and removal of toxins and carbon dioxide from the body [13]. Stretching and the improvement of flexibility have been an important goal bo th in the recreational and th erapeutic field in the belief that it is beneficial in promoting good physical and mental function [14-17]. It is claimed that stretching can reduce injury risk, relax hypertonic mus- cles, lengthen shortened tissue [18,19], and help improve faulty posture [15,20,21]. In spite of its constant use and clinically observable results, the research remains some- what con trovers ial in d etermin ing how eff ective stretch- ing is, and indeed how stretching achieves its effects. Utilizing various movement philosophies, for example Proprioceptive Neuromuscular Facilitation (PNF) [22], Feldenkrais1 [23], Pilates [24], and Tai Chi [25], can help restore or improve flex ibility, decrease pain and im- prove coordination, thereby improve overall function. The following article and ensu ing articles by different autho rs will attempt to review and explain some basic facts, phi- losophies and observations regarding flexibility and how and why it is of such clinical importance. The purpose of this study was to address 1 main hy- pothesis and 2 minor hypotheses. The main hypotheses of this research are to evaluate if psycho-physiological combined therapy (Stretch Therapy combined Breathing Exercise) has an effect on the Sexual desire among Het- erosexual Men and if a difference exists between the ef- fects of psycho-physiological combined therapy (Stretch Therapy combined Breathing Exercise) and those of con- trol group on the Sexual desire. The minor hypotheses are to test if differences exist between the effects of psy- cho-physio logical co mbined th erapy (Stre tch Therapy c o m- bined Breathing Exercise) and control group on the Sex- ual desire among Heterosexual Men when (1) age, and (2) education level, are considered either individually or as a whole. 2. Material and Methods In this research, the independent variable is ps ych o - p h ys i o- logical combined therapy (Stretch Therapy combined Breathing Exercise), and the dependent variable is the sexual desire of heterosexu al men. The therapy schedu le, gender (only Male), Co morbidities (Stable, No n-Cardiac and without Prostatic Disease), social, economic and cultural factors, the location and the environment of ther- apy, and the therapist are control variables. Moderator variables are education level and age (we would study the subjects in 2 part of age: 20 - 35 and 36 - 55 ). 3. Intervention Therapy Methods Psycho-Physiological Combine d Therapy: For this research, we used Static Stretching and Brea th- ing Exercise techniques to make an integration therapy. Static stretching involves a muscle that is slowly and passively stretched to full range, continued tension is then maintained for an extended period of time e.g. 2 ± 15 min, to further increase its length. For maximum gains, it is important that the person stretching waits until the muscles relax in the assumed pos ition. Each one of treatment session will start with 10 minute warming up and rhythmic breathing (10 Sec inhales, 25 Sec blocking the breath, 15 Sec exhales, and 10 Sec blocking the breath) techniques. Then, we will continue with Stretch Therapy. Each muscle would be stretched Copyright © 2013 SciRes. OJU
R. BAY ET AL. 263 separately. And all of the surfaces muscles would be stretched. Patient should exhale, when muscle would be stretched, and patients should inhale, when it would be released. And ultimately, we would finish each session with rhythmic breathing techniques and 5 minute warm- ing down. In this research program, we consider twenty (20) 90 - 120 minutes session. 4. Materials and Research Methodology Our samplegroups of 80 heterosexual men were selected from volunteers who were registered at who visited HUSM clinic of Kotabharu (Kelantan, Malaysia). We used “Convenience Sampling” about this point. The vol- unteers have selected from heterosexual men with stable relationship, those who married minimum of 6 months, within 20 to 55 years old, who attended to HUSM Family Clinic. For data collection, we used quasi-experimental designs called “non-equivalent control group.” Pre-tests were done on both groups before intervention began, post-tests were done after intervention had been com- pleted, and follow-up tests were done 1 month after the last session. For the setting, we used a hall at Men’s Health clinic at HUSM. For the experimental group, we conducted ten (20) 90 to 120 minute meetings on 3 alternate days of week, while for the control group, we left the m to follow own ordinary life. We conducted this program for 20 sessions and had 3intervention session every week. To measure the effects of intervention, we used pre- tests, post-tests and follow-up tests. Also Cardiac Pa- tients, Uncontrolled Types 1 and 2 Diabetic Patients, HbA1c < 8.5%, Patient with Prostatic Disease, Major Uncontrolled Psychiatric Disorders, Chronic arthritis, His to r y o f a l cohol or drug abuse and Clinically significant baseline laboratory abnormality have been as Subject Exclusion Criteria; And Signed informed Consent, Het- erosexual Married Men minimum of 6 months and aged > 20 and <50 years as Subject Inclusion Criteria. 5. Statistical Methods Data entry and statistical analyses were done using SPSS version 19. In descriptive statistics, we used the mean and standard deviation (SD), as well as tables and charts. In inferential statistics, in order to compare the data, we used Repeated Measure ANOVA. For assumption checks, we examine the residuals for normality and equality of variances. On examination of histogram of residuals, all of them are normally distrib- uted. Extend of spread of error variances by each level looked similar, so assumption of equal variances met. Further, the Levene’s test was not significant, so assu mp- tion of equ al variances assumed. 6. Procedure We announced this research at hospital and clinics of Universiti Sains Malaysia (Kelantan). Then, the volun- teers for this research were asked to complete forms to get information about the volunteers’ ages, genders, dru gs used, education levels, other illnesses that they suffered, etc. This information was necessary both to form similar groups to prevent obstructive variable effects and to man - age the control and the moderator variables, as well as the obstructive factors. Initially, we had 150 volunteer heterosexual men. The n, by paying attention to the control and moderator vari- ables and trying to decrease obstructive variables, we invited them for interviews and checkups. We, the time of the interviews, researcher obtained information on the patients’ backgrounds, durations of disease, kinds of med i- cines used, and nutrition with lists of daily meals, and etc. Then, according to the research design (unequal control groups), we made an experimental group and one control group. Ultimately, from the 100 patients, we placed 80 people in both groups randomly. The duration for all therap y sessions was around 90 to 120 minutes, and we conducted 20 therapy sessions for each of the volunteers in the experimental group. It is i m- portant to note that before starting the therapy sessions, all of the volunteers (both the placebo and the experi- mental groups) went to the HUSM clinic to medical checkup. Then before starting the therapy sessions, we made pre-test on all of the volunteers (both the control and the experimental groups). For the experimental group’s patients, we conducted psychophysiological combined therapy (stretching ther- apy combined with breathing exercise) during each ses- sion on 3 alternate days per week. At the end of ther apy, for both the experimental and control group’s we made post-test. Then, we left the experimental group to get back ordinary life too. Around one month after finishing the therapy sessions, on a specified day, we made follow-up test on all patients of both groups, to get how long the effect of therapy would remain. 7. Assessment In order to assessment of sexual desire, we used Hurlbert Index of Sexual Desire (HISD) [26 ] . 8. Results Data shown P value Mauchly’s Test is less than 0.05 (0.000) and Epsilon Greenhouse-Geisser is more than 0.75 (0.830); so we have to read Greenhouse-Geisser from within subject effect table. As you see in Table 1, the time P value is 0.122. it means some changes have happened with passing time Copyright © 2013 SciRes. OJU
R. BAY ET AL. 264 Table 1. Tests of within subjects effec ts. Source df F Sig. Time Greenhouse-Geisser 1.660 2.2220.122 Time*Group Greenhouse-Geisser 1.660 8.0770.001 Time*Group*Age Greenhouse-Geisser 1.660 1.9990.148 Time*Group*Education Greenhouse-Geisser 1.660 0.2190.763 but statistically it is not sign ificant. The time and group P value is significant (0.001). It means some change hap- pened in groups with passing time. Also as you see in Table 2, the group P value is 0.434. There is no difference between the groups regardless of time. In order to g et the quantity of changing, we should g et the details from Estimate Marginal Mean data. As you see in Table 3, experimental group Estimate Marginal Mean data shows pretest sexual desire has been 54.637 and in posttest it increased to 63.216 and ulti- mately in follow-up test it change to 63.444. Simultaneously control group Estimate Marginal Mean data shows pretest sexual desire has been 65.467 and in posttest it decreased to 62.933 and ultimately in fol- low-up test it change to 62.583. If you compare posttest and follow-up test mean score of experimental group (63.216 and 63.444) with pretest lower to upper b ound range (48.305 - 60.969) you would find the experimental group changing in posttest is sig- nificant. But you couldn’t find same situation in control group. It means experimental group got improvement within combined psycho-physiological therapy. As you see in Table 1, the time, group and age P value is 0.148. It means the age has had some effects on groups with passing Time but statistically the effect differentia- tion is not significant. Also as you see in Tabl e 2, the group and ag e P-value (between groups) is not significant (0.478). It mean we can say regardless to time, statistically age has had no effect on groups. In order to g et the quantity of changing, we should g et the details from Estimate Marginal Mean data. As you see in Table 4, experimental group Estimate Marginal Mean data shows age group 1 (20 - 35) pretest sexual desire has been 52.417 and in posttest it increased to 66.194 and ultimately in follow-up test it change to 67.889. And Estimate Marginal Mean data shows age group 2 (36 - 55) pretest sexual desires have been 56.857 and in posttest it increased to 60.238 and ultimately in follow- up test it change to 59.000. Simultaneously control group Estimate Marginal Mean data shows age group 1 (20 - 35) pretest sexual desire has been 64.000 and in posttest it decreased to 61.900 and ultimately in follow-u p test it change to 61.500. Table 2. Tests of between subjects effects. Source df F Sig. Group 1 0.619 0.434 Group*Age 1 0.509 0.478 Group*Education 1 0.213 0.646 Table 3. Group*time. 95% Confidence Interval Group Time Mean Std. Error Lower Bound Upper Bound 154.6373.173 48.305 60.969 263.2162.784 57.661 68.772 Experimental 363.4443.206 57.047 69.842 165.4673.450 58.583 72.350 262.9333.027 56.893 68.973 Control 362.5833.486 55.628 69.539 And Estimate Marginal Mean data shows age group 2 (36 - 55) pretest sexual desire has been 66.933 and in posttest, it decreased to 63.967 and ultimately in follow- up test it change to 63.667. As you see in Table 1, the time, group and education P value is 0.763. It mean the education level have had some effects on groups with passing Time but statically the effect differentiation is not significant. Also as you see in Table 2, the group and Education P value (between groups) is not significant (0.646). It means we can say regardless to time, statically education has had no effect on groups. In order to g et the quantity of changing, we should g et the details from Estimate Marginal Mean data. As you see in Table 5, experimental group Estimate Marginal Mean data shows educatio n group 1 (primary-secondary) pretest sexual desire has been 55.940 and in posttest it increased to 65.488 and ultimately in follow-up test it changed to 64.667. And Estimate Marginal Mean data shows education group 2 (tertiary) pretest sexual desires has been 53.333 and in posttest it increased to 60.944 and ultimately in follow-up test it change to 62.222 . Simultaneously control group Estimate Marginal Mean data shows education group 1 (primary-secondary) pre- test sexual desire has been 69.100 and in posttest it de- creased to 65.867 and ultimately in follow-up test it change to 66.500. And Estimate Marginal Mean data shows education group 2 (tertiary) pretest sexual desire has been 61.833 and in posttest, it decreased to 60.000 and ultimately in follow-up test it change to 58.667 . 9. Discussion Approximately 35% of all family medicine departments Copyright © 2013 SciRes. OJU
R. BAY ET AL. Copyright © 2013 SciRes. OJU 265 Table 4. Group*age*time. 95% Confidence Interval Group Age Time Mean Std. ErrorLower Bound Upper Bound 1 52.417 2.905 46.619 58.214 2 66.194 2.549 61.108 71.281 20-35 3 67.889 2.936 62.031 73.747 1 56.857 5.642 45.599 68.115 2 60.238 4.950 50.360 70.116 Experimental 36-55 3 59.000 5.701 47.624 70.376 1 64.000 6.038 51.951 76.049 2 61.900 5.298 51.328 72.472 20-35 3 61.500 6.101 49.325 73.675 1 66.933 3.338 60.273 73.594 2 63.967 2.929 58.123 69.811 Control 36-55 3 63.667 3.373 56.937 70.397 Table 5. Group*education*time. 95% Confidence Interval Group Education Time Mean Std. ErrorLower Bound Upper Bound 1 55.940 2.552 50.849 61.032 2 65.488 2.239 61.021 69.956 primary_secondary 3 64.667 2.578 59.522 69.812 1 53.333 5.810 41.739 64.928 2 60.944 5.098 50.772 71.117 Experimental tertiary 3 62.222 5.871 50.507 73.938 1 69.100 2.663 63.787 74.413 2 65.867 2.336 61.205 70.528 primary_secondary 3 66.500 2.690 61.131 71.869 1 61.833 6.365 49.132 74.534 2 60.000 5.585 48.856 71.144 Control tertiary 3 58.667 6.431 45.833 71.500 offer some kind of instruction in alternative therapies. According to Bricklin, approximately 40% of the US population is found to be using alternative therapies [27]. As popular interest in alternative medicine has in creased, so has advanced practical nurse involvement, research attention and the likelihood of insurance reimbursement. Research interest in alternative therapies at the National Institute of Health is growing. The Organization of Al- ternative Medicine (OAM) has recently f unded a study of alternative therapies at several academic centers, includ- ing, among others, Harvard, Stanford and Columbia medi- cal schools. Meanwhile, managed care organizations and insurance companies, including Mutual of Omaha, Blue Cross/Blue Shield of Washington and Alaska, and U.S. Health Care, are offering special health plan s that include alternative therapies [27]. We hypothesized that combined psycho-physiological therapy (Stretch therapy combined breathing exercise) have effect in self-reported sexual desire compared to control group. Consistent with our hypotheses, psycho- physiological group achieved greater improvements in sexual desire compared to participants in control group. We observed a trend towards greater improvements in sexual desire for psycho-physiological therapy group com- pared to participants in control group, but this difference did not reach statistical significance. Overall, these find- ings provide support for the beneficial effects of com- bined psycho-physiological therapy (Stretch therapy com- bined breathing exercise) on sexual desire for 20 - 55 years old heterosexual men. Also the data had shown that age and education doesn’t have any significant effect in the psycho-physiological intervention. Several studies suggest that higher levels of physical activity are associated with improved sexual function [28-30]. In a 2006 meta-analysis, Ch eng et al. o bse rved a dose-response relationship between levels of physical activity and ED, with higher levels of activity predicting lower risk of ED and vice versa [31]. In a cross-sectional
R. BAY ET AL. 266 study of 1506 men in Hong Kong, Ch eng and Ng (2007) determined that greater self-reported physical activity (expressed as energy expenditure per month) was associ- ated with lower levels of self-reported ED, particularly among men who were overweight. Esposito et al. (2004) randomly assigned 110 obese men with ED either to a two-year diet and physical activity gr oup intervention, or to an education control group. After two years, the inter- vention group reported better erectile function compared to the control group. Furthermore, increased physical ac- tivity was associated with improvements in ED, inde- pendent of weight loss. Relationships between physical activity and sexual dysfunction have not been studied as thoroughly in women. One study by Wilbur et al. exam- ined the effects of a 24-week moderate intensity walking program on menopausal symptoms, including uro-genital symptoms of vaginal dryness, irritation, decreased sexual desire, and pain during intercourse. This study did not show significant improvements in uro-genital symptoms in the walking group as compared to the control group. However, adherence was low in the walking group [32]. Shapiro & Cline [33] also ev aluated the eff ect of st r e t c h - ing and breathing exercise on mood. Participants were eight women and three men, ages 23 to 59. There was no control group. Results indicated significant changes for 9 out of the 15 moods including a decrease in anxiety, fr us- tration, stress, and fatigu e and an increase in feeling con- tent, happy, optimistic, and relaxed. Arpita suggested that stretch and breathing exercise such as yoga may lead to physiological balance, a de- crease in psychological distress, and an increase in self- esteem. Vahia, Vinekar, and Donngaji (1966) studied 30 hospital patients with a range of diagnoses including de- pression, peptic ulcer, schizophrenia, and anxiety reac- tion disorder. Treatment consisted of stretching postures, philosophy, breathing techniques, and meditation for an average of four to six weeks. Patients attended classes six days a week for one-half hour to an hour. Results indi- cated that patients suffering from anxiety and depressive disorders showed a decrease in symptoms [34]. Our study supports a link between alternative healing therapies and increase in mean sexual desire. This creates a need for structured programs teaching lifestyle change, non-pharmacologic interventions and alternative thera- pies in conjunctio n with conventional treatment. Alterna- tive therapies can be extremely useful adjuncts to con- ventional care, and they sometimes provide the most ap- propriate treatment for treat conditions, such as sexual desire, erection disorder and sexual satisfaction. The psychological role has always been one of pa- tients’ advocates. If lifestyle changes and alternative heal - ing, such as stretch therapy combined breathing exercise, are taught to patients, the risk of sexual problems and its other side effects on family life will decrease. Pharma- cologic treatment is an area of expertise that requires special attention in family problems population. However, there can be adverse side effects with medication. By implementing holistic healing classes, the therapist can give patients the found atio n to redu ce stress in their liv es, thereby reducing the need for conventional medical treat- ment. Therapist can also experience both the benefits and the limitations of these approaches and find ways to use them with their patients. By embarking on these extended courses of study, the clinical results may justify the in- vestment of time and energy [35]. The findings of our study have implications for ad- vanced psycho-physiological practice, education and health care of low sexual desire patients and for others who suffer from sexual problems. The implementation of psycho-physiological therapy (stretch therapy combined breathing exercise) classes taught by a psycho-physio- logist in the outpatient clinic should be considered at the patient’s first clinic visit. A shift in emphasis from treat- ing to teaching highlights the psychological function as a guide and teacher and makes patient care a more fulfill- ing partnership. All psychologists should have know- ledge of holistic healing and implementation of psycho- physiological therapy (stretch therapy combined breath- ing exercise) as classes in schools of psychology will introduce the concept of alternative healing therapies [36]. Our study has raised questions and has impacted other areas. Alternative and combined therapies suggest a wi der vision of what medicine can and should be through ap- preciation of the interconnectedness of mind and body, emphasis on enhancing the body’s own capacity for heal- ing and the use of the entire world’s healing traditions. Alternative therapies can be used as an adj unct to treat all disease states of the mind and body. It is entirely possible that in less than a generation, the approach and tech- niques currently called “alternative” will be an integral part of the practice of all family and sex therapist, psy- cho-physiology and neuro-psychology practitioners . Our study established combined psycho-physiological therapy (stretch therapy combined breathing exercise) as important to the family and sexual problem patient popu- lations as it provides the patient with the power to de- crease stress and to enhance the body’s own capacity for healing. Integration of stretch therapy and breathing ex- ercise in treatment plans allows a collaborative and de- mocratic relationship between the advanced psycho- physiological practition er, other health providers, and the patient, who then reaps the psychological and physio- logical rewards of feeling more in control of their own lives. 10. Limitations These results are unique to this trial, and will need to be Copyright © 2013 SciRes. OJU
R. BAY ET AL. 267 replicated in future research. In this research, the sample size may not be representative, as samples would only be from Kota Bharu (Kelantan-Malaysia) and within limited time frame, so future researchers are encouraged to ex- tend these results to other popu lations, and to continu e to pursue research on sexual dysfunction and marital satis- faction. In this research, we had to get the sample from volun- taries who would like to attend for this intervention, and then we placed these people in groups randomly. But after analyzing we got the group base lines, which ha- ven’t been completely the same. It seems experimental group voluntaries, who had more motivation to attend in experimental group, already have had some more diffi- cult situations or they were feeling to have more prob- lems in comparing voluntaries of control group. That’s why we can find clear differences among scores and tests of groups but because of mentioned cause, these differ- ences statistically are not significant, although it is clear that the intervention has had good effect on experimental group, if you check th e resu lts and mean scores of groups. So it is suggested that following future and similar re- searches should pay attention to motivation of voluntar- ies and try to use other methods of sampling. Also, additional research is needed for mechan isms by which psycho-physiological exercise and treatment im- prove family and sexual functioning, with an emphasis on other populations and women. 11. Acknowledgements This study was supported by USM SHORT TERM GRANT from the University Sains Malaysia from the Health Campus, School of Medical Sciences. REFERENCES [1] J. Waite-Linda, “Why Marriage Matters,” Strengthening Marriage Round Table, Washington DC, 1997. 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