BACKGROUND: Pregnancy may change sex life, this period may be associated with decreased sex, and this is due to fear of miscarriage, nausea and vomiting, fear of harm to the fetus, fatigue, and fear of ruptured membranes. Midwives could help them to improve their sexual life during this period. One of the important approaches to improving sexual life during pregnancy is cognitive-behavioral therapy (CBT). This nonmedical approach could improve misconceptions about sex during pregnancy. The aim of this study was the effect of sexual health counseling based on CBT on sexual satisfaction and inefficient sexual beliefs of primigravida women. MATERIALS AND METHODS: This was a randomized clinical trial study, the research population being 52 pregnant women who were randomly divided into groups, the experimental (26) and the control (26). Before the sexual health counseling based on CBT, the Sexual Satisfaction Questionnaire and the Inefficient Sexual Beliefs Questionnaire were filled by both the groups. These standard questionnaires were completed three times (before, immediately, and 4 weeks after intervention). After pretest, eight sexual health counseling sessions (90 min) were performed for the experimental group. The control group received routine care. Data analysis was performed by using descriptive statistics tests, ANOVA, and post hoc tests by Bonferroni method in SPSS version 22. P < 0.05 was considered statistically significant. RESULTS: The mean score of inefficient sexual beliefs in the interventional group before intervention, immediately after the intervention, and 1 month later was obtained 22.85 ± 9.57, 12.92 ± 7.25, and 7.86 ± 13.88, respectively (P < 0.001). The mean score of sexual satisfaction before the study, immediately after the intervention, and 1 month later was 88.77 ± 11.89, 95.62 ± 9.27, and 94.65 ± 8.28, respectively, in the experimental group (P < 0.001). CONCLUSION: Sexual health counseling based on CBT could reduce inefficient sexual beliefs and increase the sexual satisfaction of the primigravida women during pregnancy, but most participants preferred fewer sessions.