Table 1 Contents of counseling sessions based on the CHARMS method

First

With a focus on establishing communication and building trust and collaboration between couples, evaluating the mental, emotional, and physical health of individuals, identifying their sexual problems, informing couples about the session structure and setting goals, educating on the sexual cycle, and familiarizing them with sexual performance and the internal and external organs of men and women. Defining sexual desire, arousal, lubrication, and orgasm, as well as familiarizing them with the sexual response pattern and explaining the physiological changes in men and women during sexual activity, including sexual positions.

Group

Second

Counseling and providing information about cardiovascular diseases and symptoms, general and sexual consequences on the individual and their impact on the life of patients.

Group

Third

Counseling and providing information on the impact of cardiovascular disease on reducing sexual desire, lack of sufficient communication skills in sexual relationships, misconceptions about sexual relationships, providing information and education on coping with shame and deciding to resolve it, providing information on sexual aspects of life and training strategies to enhance marital satisfaction, providing necessary information and education on sensory focus techniques. Providing information on expressing feelings and beliefs about sexual behaviors and teaching problems-solving skills.

Group

Fourth

Consultation and provision of information on identifying the root causes of decreased sexual desire, offering solutions, strengthening empathetic communication, sexual discourse with a partner, explaining the secrets of sexual attraction, assisting in maintaining verbal and emotional relationship with a spouse, emphasizing the importance of lovemaking and romance, warning signs of heart disease during or after intimacy.

Group

The fifth

Collaborative contract writing technique to articulate needs and expectations in sexual relationships, clarifying expectations, correcting misconceptions and myths about sexual relationships, guidance on creating a structured timeline for noting thoughts and mindset during desirable and unpleasant sexual experiences, aversion, muscle tension, and emotional pressures. Household responsibilities, addressing potential inquiries.

Group

The sixth

Review of previous materials and nutritional recommendations, sleep hygiene education, performing stretching exercises and sports, recommending daily walks, bedroom environment, teaching alternative positive thinking and stopping negative thoughts.

Group