Sexual counselling for sexual problems in patients with cardiovascular disease

Investigating the impact of couple counseling based on the CHARMS model on sexual quality of life and marital satisfaction of wives of men suffering from myocardial infarction: a study protocol

INTRODUCTION

Cardiovascular diseases are a common chronic illness in adults, with implications for health and psychological well-being. These implications not only affect the patients themselves but also impact family members, especially the spouses of patients. One significant issue and consequence of this disease is its impact on marital relationships and sexual satisfaction, which can also influence other dimensions of quality of life. The aim of the current study is to determine the effect of couple counseling based on the CHARMS model on sexual quality of life and marital satisfaction of wives of men suffering from myocardial infarction.

METHOD

This study is a clinical randomized controlled trial. Sampling will be done on a convenience basis. Participants will be randomly allocated into two groups: control (50 couples) and intervention (50 couples). Couples in 6 groups of 8 members each will attend counseling sessions based con the CHARMS model, with sessions held weekly and lasting for 60 min. Data collection tools will include Demographic information questionnaire, Women's Sexual Quality of Life Questionnaire, Enrich Marital Satisfaction Questionnaire, Sexual Compatibility Questionnaire and Perceived Quality of Relationship Dimensions Questionnaire, which will be completed by women in both groups before and after the intervention. Data will be analyzed using appropriate statistical tests and SPSS software.

DISCUSSION

This trial will evaluate whether a counseling intervention based on the CHARMS model can enhance sexual quality of life and marital satisfaction of wives of men with myocardial infarction in Urmia city.

TRIAL REGISTRATION

IRCT code: IRCT20240218061046N1.

Effectiveness of Online Versus Telephone Counseling of Rational-Emotional-Behavioral Therapy on Sexual Function of Women Undergoing Cardiac Rehabilitation: A Randomized Clinical Trial:

Background:Sexual function in patients with cardiovascular disease (CVDs) is often associated with anxiety and irrational beliefs. Moreover, 60-78% of patients with CVDs report sexual problems. Some studies suggest that sexual counseling is necessary for these patients but is not usually provided for them. Online or telephone counseling may be helpful during the covid-19 pandemic, but studies on its application to sexual function appear to be limited. This study aimed to investigate the effectiveness of online vs. telephone counseling of rational-emotional-behavioral therapy (REBT) on the sexual function of women undergoing cardiac rehabilitation. Materials and Methods: In this randomized clinical trial study, 46 women diagnosed with CVDs under rehabilitation were assigned into online and telephone groups. Overall, eight 60-min intervention sessions were held (once a week). The Female's Sexual Function Index (FSFI) questionnaire was completed by the women at baseline, week 8th, and follow-up week 12th (main outcome). Results: FSFI scores between the two groups at baseline (online: 13.28±2, telephone: 12.68±1.52, P=0.254) compared to week 12th (online 28.86±2.44, telephone, 26.6±2.10, P=0.002) were significantly different. As for within-group comparison in baseline compared to week 12th statistically significant difference was observed in all subscales of FSFI (P=0.05). Conclusion: Online and telephone REBT counseling can improve the sexual function of women undergoing cardiac rehabilitation, but online counseling appears to be more effective. Thus, this method is recommended to improve the sexual function of these women during the covid-19 pandemic. [GMJ.2022;11:e2396].

The effect of sexual counseling on depression, anxiety, stress, sexual knowledge and sexual quality of life in men who have undergone invasive coronary interventions: An RCT

Background

Sexual dysfunctions are common in men with ischemic heart disease, especially in men undergoing therapeutic interventions.

Objective

This study intended to assess the effect of counseling on depression, anxiety, stress, sexual knowledge and sexual quality of life in men after invasive coronary interventions in the post catheterization department of Kashan Shahid Beheshti Hospital during 2018.

Materials and Methods

The study population consisted of 54 male participants who had undergone an invasive coronary intervention. The intervention group received counseling and the control group underwent the standard ward routine. Data were collected using the depression anxiety stress scales, Abraham's sexual quality of life, and the Yi-Hung Sexual Knowledge questionnaires before discharge and also two months later.

Results

Within two months, the intervention group's mean score of sexual knowledge significantly increased, compared with the control group, from 12.37 to 14.81 (p ≤ 0.001). The intervention group's mean score of sexual quality of life also significantly increased, compared with the control group, from 48.2 to 60.7 (p ≤ 0.001). Moreover, the mean anxiety score changed in the intervention group from 11.18 to 5.25, again a significant difference compared with the control group (p = 0.01). But, the differences in the depression and stress scores were not significant.

Conclusion

Our findings suggest that sexual counseling may improve sexual knowledge, sexual quality of life and anxiety in men following invasive coronary intervention, but might not reduce their stress or depression. Further studies are needed to confirm these findings.

Acceptability of Health Professionals' Address of Sexuality and Erectile Dysfunction - A Qualitative Interview Study with Men in Cardiac Rehabilitation

INTRODUCTION

In the developing phase of the complex health intervention: Physical Activity to reduce Vascular Erectile Dysfunction (PAVED), it is crucial to explore whether men can accept the communicative component regarding information that regular aerobe Physical Activity can reduce Erectile Dysfunction (i-PAVED). This information is provided by health professionals (HPs) in cardiac rehabilitation, where sexuality issues such as erectile dysfunction (ED) are otherwise rarely addressed.

AIM

To explore how acceptance of cardiac HPs' address of sexuality, ED, and i-PAVED can be identified in men's narratives.

METHODS

In this descriptive qualitative study, we conducted semi-structured individual interviews with 20 men (range 48-78 years of age) attending municipal cardiac secondary prevention and rehabilitation programmes on their acceptance of HPs' address of sexuality, ED, and i-PAVED. The Theoretical Framework of Acceptability components (affective attitude, burden, ethicality, intervention coherence, perceived effectiveness, opportunity costs and self-efficacy) and three temporal perspectives (retrospective, concurrent and prospective) were used in the concept-driven first step of a content analysis, which was followed by a thematically data-driven second step.

MAIN OUTCOME MEASURES

Men anticipated and experiential acceptance was identified in six out of seven components of Theoretical Framework of Acceptability.

RESULTS

Men acceptance was identified as "expression of interest," "addressing sexuality," "attitudes and values," "understandable and meaningful," "insights" and "motivation," whereas no narratives were identified in relation to the component of opportunity costs.

CONCLUSION

As an aspect of the development of the complex cardiovascular health care intervention PAVED, this qualitative study showed that men attending cardiac secondary prevention and rehabilitation seemed to prospectively accept the communicative component of PAVED being HPs' address of sexuality, ED, and i-PAVED, if the HPs are professional, educated and competent in the field of sexual health. Gerbild H, Areskoug-Josefsson K, Larsen CM, et al. Acceptability of Health Professionals' Address of Sexuality and Erectile Dysfunction - A Qualitative Interview Study with Men in Cardiac Rehabilitation. Sex Med 2021;9:100369.

Confusion at the beginning of sexual intercourse, the challenge of patients after coronary artery bypass graft surgery in Iran: A qualitative study

BACKGROUND:

Many patients suffer from sexual dysfunction after coronary artery bypass graft surgery, but they refuse to propose and follow up on the problem due to the cultural structures prevailing in Iranian society. Untreated sexual dysfunction will disturb the quality of life of these patients. This study was performed to explain the experiences of male patients from sexual problems after coronary artery bypass graft surgery.

MATERIALS AND METHODS:

This qualitative study was performed with the approach of conventional content analysis in Tehran in 2020. The data were collected through semi-structured interviews with 12 men after coronary artery bypass graft surgery at the hospital's cardiac surgery clinic, as well as the surgeon's clinic. Participants were selected by the targeted sampling method. After obtaining informed consent, the collected data were written word by word, and the content analysis approach was used to name the data, create analytical codes, and determine subcategories and categories. The data were analyzed by MAXQDA 10 software.

RESULTS:

The findings of this study show that the dimensions of confusion in patients’ sexual intercourse after coronary artery bypass graft surgery in four subcategories of challenges of the first intercourse after surgery, ambiguity in how to obtain information, the ambiguity of sexual issues after surgery, and spouse are concerned about having sexual intercourse.

CONCLUSION:

The results of this study show that male patients who have undergone coronary artery bypass graft surgery have many ambiguities in the process of sexual intercourse, which passes the beginning of sexual intercourse with fear and avoidance of intercourse. Postoperative patients do not propose these problems with the medical staff when they suffer from sexual dysfunction or ambiguity due to the taboo of talking about sexual intercourse. Eventually, the patient and his or her partner become confused about sexual intercourse after surgery. Therefore, it is recommended that policymakers in the field of health create the culture and planning for solving the ambiguities created in the path of sexual intercourse of these patients.

Sexual Activity After Myocardial Revascularization Surgery

After a cardiovascular event, patients and their families often face numerous changes in their lives. Poorly addressing physical and psychological challenges can lead to an impaired quality of life. Sexuality is an important quality of life aspect to many patients and couples who can be negatively affected by a cardiovascular event. Sexual health requires a positive and respectful approach to sexuality and sexual relationships. Time to resume sexual activity after myocardial revascularization surgery is a gap in cardiologic practice. We know from literature that coronary patients have decreased sexual activity. There are barriers from the medical environment such as lack of knowledge, confidence and training, and many others that arise from the patient's perspective, which do not allow generating a space to address sexual problems. This review aims to familiarize and update cardiologists, providing knowledge and resources to face the impact of myocardial revascularization surgery on the quality of sexual life, promoting multidisciplinary management among doctors and other health professionals.

Interventions for sexual dysfunction following stroke

BACKGROUND

Sexual dysfunction following stroke is common but often is poorly managed. As awareness of sexual dysfunction following stroke increases as an important issue, a clearer evidence base for interventions for sexual dysfunction is needed to optimise management.

OBJECTIVES

To evaluate the effectiveness of interventions to reduce sexual dysfunction following stroke, and to assess adverse events associated with interventions for sexual dysfunction following stroke.

SEARCH METHODS

We conducted the search on 27 November 2019. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; from June 2014), in the Cochrane Library; MEDLINE (from 1950); Embase (from 1980); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1982); the Allied and Complementary Medicine Database (AMED; from 1985); PsycINFO (from 1806); the Physiotherapy Evidence Database (PEDro; from 1999); and 10 additional bibliographic databases and ongoing trial registers.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that compared pharmacological treatments, mechanical devices, or complementary medicine interventions versus placebo. We also included other non-pharmacological interventions (such as education or therapy), which were compared against usual care or different forms of intervention (such as different intensities) for treating sexual dysfunction in stroke survivors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected eligible studies, extracted data, and assessed study quality. We determined the risk of bias for each study and performed a 'best evidence' synthesis using the GRADE approach.

MAIN RESULTS

We identified three RCTs with a total of 212 participants. We noted significant heterogeneity in interventions (one pharmacological, one physiotherapy-based, and one psycho-educational), and all RCTs were small and of 'low' or 'very low' quality. Based on these RCTs, data are insufficient to provide any reliable indication of benefit or risk to guide clinical practice in terms of the use of sertraline, specific pelvic floor muscle training, or individualised sexual rehabilitation.

AUTHORS' CONCLUSIONS

Use of sertraline to treat premature ejaculation needs to be tested in further RCTs. The lack of benefit with structured sexual rehabilitation and pelvic floor physiotherapy should not be interpreted as proof of ineffectiveness. Well-designed, randomised, double-blinded, placebo-controlled trials of long-term duration are needed to determine the effectiveness of various types of interventions for sexual dysfunction. It should be noted, however, that it may not be possible to double-blind trials of complex interventions.

Patients' Experiences of Living with Atrial Fibrillation: A Mixed Methods Study

INTRODUCTION

Awareness of epidemiological and clinical consequences of atrial fibrillation (AF) has increased, as have disease-related costs. Less attention has been paid to patient-related issues, such as understanding how symptoms, different therapies, and lifestyle adjustments affect daily life. We aimed to describe patients' experiences of living with AF.

METHODS

The study design used a parallel convergent mixed methods approach. Patients with AF were included in the SMURF study and referred for catheter ablation. Patients completed questionnaires on symptoms, health-related quality of life, depression, anxiety, and perceived control and were interviewed. The datasets were analysed separately using inductive content analysis and descriptive statistics. Data were merged to obtain a final interpretation.

RESULTS

Nineteen patients were interviewed and 18 completed questionnaires. Twelve of the patients were male, mean age 60 years (45-75 years). Inductive qualitative analysis revealed three categories: (i) symptoms and concerns limiting life, (ii) dimensions of worries, and (iii) strategies for management. The most common symptoms were tiredness, weakness/fatigue, and breathlessness during activities, and the most pronounced negative impacts on health-related quality of life (HRQOL) were physically related, shown in the ASTA questionnaire. The most negative SF-36 scores were found in role limitations due to physical health problems and vitality. HADS revealed five patients with some degree of anxiety and four with some degree of depression. Patients had lower scores on perceived control than perceived helplessness in CAS. Patients' perceived control was higher than their families', and families experienced more helplessness.

CONCLUSIONS

The mixed methods design deepens our understanding of challenges faced by patients. Patients experienced a limited ability to perform activities of daily living due to AF which created different kinds of worries that encouraged the use of various strategies to manage their lives. Healthcare providers need to be aware that relationships between patients and their relatives can change, and therefore they need to be supported and integrated into the care system.

Development of standardised programme content for phase II cardiac rehabilitation programmes in Australia using a modified Delphi process

OBJECTIVE

To develop standardised programme content for Australian phase II cardiac rehabilitation (CR) programme.

DESIGN

Using the RAND/UCLA appropriateness method (RAM), a two-phase process including a comprehensive literature review and a two round modified Delphi process was undertaken to develop and validate content of a standardised CR programmes.

PARTICIPANTS

An invited multidisciplinary expert advisory group (EAG; n=16), including CR health professionals (nurses, allied health professionals, cardiologist), academics, policy makers, representation from the Australian Cardiovascular Health and Rehabilitation Association and consumers, provided oversight of the literature review and assisted with development of best practice statements. Twelve members of the EAG went onto participate in the modified Delphi process rating the necessity of statements in two rounds on a scale of 1 (not necessary) to 9 (essential).

MAIN OUTCOME MEASURE

Best practice statements that achieved a median score of ≥8 on a nine-point scale were categorised as 'essential'; statements that achieved a median score of ≥6 were categorised as 'desirable' and statements with a median score of <6 were omitted.

RESULTS

49 best practice statements were developed from the literature across ten areas of care within four module domains (CR foundations, developing heart health knowledge, psychosocial health and life beyond CR). At the end of a two-round validation process a total of 47 best practice statements were finalised; 29 statements were rated as essential, 18 as desirable and 2 statements were omitted.

CONCLUSIONS

For the first time in Australia, an evidence-based and consensus-led standardised programme content for phase II CR has been developed that can be provided to CR coordinators.

Participants' Experiences of a Sexual Counseling Intervention During Cardiac Rehabilitation: A Nested Qualitative Study Within the CHARMS Pilot Randomized Controlled Trial

Background:

International guidelines recommend sexual assessment and counseling be offered to all patients with cardiovascular disease during cardiac rehabilitation. However, sexual problems are infrequently addressed. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention is a complex, multilevel intervention designed to increase the provision of sexual counseling in cardiac rehabilitation. It was piloted in 2 cardiac rehabilitation centers to assess the acceptability and feasibility of the intervention and to inform and refine a definitive cluster randomized controlled trial protocol.

Objectives:

The aim of this study was to explore the experiences, perceptions, and opinions of patients, partners, and cardiac rehabilitation staff who participated in the CHARMS staff-led patient education class.

Methods:

A qualitative, descriptive study using semistructured interviews to collect the data. Cardiac rehabilitation staff (n = 8) were interviewed when the intervention commenced in their center and 3 months later (n = 6). Patients (n = 19) and partners (n = 2) were interviewed after delivery of the class; 7 were interviewed again 3 months postintervention to explore temporal changes in opinions.

Results:

Most cardiac rehabilitation staff were comfortable delivering the CHARMS intervention but would prefer a less structured format. Some staff perceived discomfort among patients. Few patients reported discomfort. Most patients and partners considered that the intervention was a welcome and acceptable part of a cardiac rehabilitation program.

Conclusion:

Incorporating sexual counseling into cardiac rehabilitation programs is feasible. Although the views of the patients and staff diverged on a number of issues including the perceived comfort of patients, its inclusion was welcomed by patients and was acceptable overall to both staff and patients.

The Effect of Cognitive Behavioral Therapy on Marital Quality among Women

Background

Marital quality reflects the individual's overall evaluation of marital relationship. The aim of study was examine the effect of cognitive behavioral counseling on marital quality among women.

MATERIALS AND METHODS

The experimental study was a randomized clinical trial with two groups, on 198 qualified women who referred to selected health care centers in Hamadan, Iran in 2016. The intervention participants attended four 90-minute sessions of cognitive behavioral counseling. Demographic information questionnaire and marital quality scale [Revised Dyadic Adjustment Scale (RDAS)] were completed by the two groups before and after the intervention. To perform the comparisons, t test, Chi-square test and Fisher's test, Logistic Regression and covariance analysis were used. Covariance analysis or change analysis were employed. Statistical analysis was done using SPSS Software, version 21.0. The significance level was set at 5% (P<0.05).

RESULTS

According to the results of the present study, the mean age in the control group and the intervention group was 23.58 ± 7.54 and 35.04 ± 7.91 years old, respectively. Covariance analysis was utilized to examine the marital quality scores. In this analysis, after modification of the variables of age, marital quality score of agreement and satisfaction before the intervention, and income status, the total marital quality score experienced a significant change in all dimensions (P<0.05) and the mean scores increased remarkably. Moreover, according to the cut-off point of the dimensions, the scores of all dimensions increased remarkably and the proportion of individuals with high marital quality before and after the intervention changed significantly (P<0.05).

CONCLUSION

Due to the role of sexual relations in stabilizing marriage, cognitive behavioral consultation was effective in improving marital quality especially after agreement and can be used in health care centers in order to improve the relationship between couples and reduce divorce rates (Registration number: IRCT201610209014N125).

Another Chance at Life: Jordanian Patients' Experience of Going Through a Myocardial Infarction

BACKGROUND AND PURPOSE

Myocardial infarction (MI) is a life-threatening health condition that has physical, spiritual, emotional, and social changes. Understanding feelings and thoughts of patients who suffered MI attacks is essential to recovery. Among Jordanian patients who suffered an acute attack of MI, the aim of the study was to describe the experiences and the varied meanings that they assign to their experiences.

METHODS

A qualitative hermeneutic phenomenological research design was used. Five participants were engaged in in-depth semistructured interviews. The participants were identified using a purposeful sampling technique, after being admitted at a coronary care unit in a university hospital located in Amman, the capital city of Jordan. The hospital provides a full range of cardiovascular medical and surgical care for patients admitted from different socioeconomic levels. Transcribed data were analyzed following inductive qualitative content analysis method.

RESULTS

The experience of MI was a traumatizing event characterized by life-threatening symptoms, and participants feared they would not come back home. However, cultural values and religiosity among the Jordanian patients played a major role in facilitating their positive coping during and after the MI attack. The participants' recount of their experience was summed-up into 5 major themes: frightening experience, needed support, religiosity, experiencing changes, and lifestyle modifications. After the MI attack, most of the participants felt that they had given another chance to live, showing a pressing need to make healthier lifestyle modifications to avoid another MI attack.

IMPLICATIONS FOR PRACTICE

Health care workers should need not only pay attention on physical and physiological caring aspects but should also consider other patients' needs, while supporting the patients and their family members.

Erectile Dysfunction in Young Myocardial Infarction Survivors: Evaluation, Follow Up

Erectile dysfunction significantly affects quality of life in young men. Authors have evaluated erectile function in men with coronary artery disease (CAD) and the relationship between the degree of erectile dysfunction (ED) and the age of their first acute myocardial infarction (AMI). The incidence of erectile dysfunction in three groups of patients of AMI survivors was investigated: AMI survivors younger than 45 years, AMI survivors older than 65 years, and normal male population aged between 30 and 60 years. Erectile function was assessed by the International Index of Erectile Function (IIEF-5) questionnaire. In post-AMI male patients younger than 45 years (n = 76), mild ED occurred in 26% and severe in 7%. In the older AMI group, mild ED occurred in 52% and severe in 38%. In the control group age matched to younger survivors, 96% denied ED and only one control patient had a score of 20 on the IIEF-5. A paradoxical result was observed in patients using beta blockers (BB), who had better scores than the group without BB. Statin treatment had a positive influence on the score in questionnaires. Those on statins had an average score of 21.0 ± 4.9 vs. without statin 17.7 ± 5.7, p = .03. The current findings identified that the prevalence of ED is relatively high in young patients with CAD and is related to treatment of the CAD. The overall increase in ED presence suggests that the background of their coronary event is not due to destabilization of single focused atheroma but may reflect a generalized atherosclerotic process.

Attitudes and Performance of Cardiologists Toward Sexual Issues in Cardiovascular Patients

Introduction

The aim of the present study was to evaluate the attitudes and performance of cardiologists regarding sexual issues in patients with cardiovascular diseases.

Methods

A nationwide survey was conducted in a sample of cardiologists, representative of Iranian cardiologists, in 2015.

Main Outcome Measures

Appropriate questionnaires were developed and used to ask participants about their attitudes, performance, and barriers regarding discussing sexual issues with patients with cardiovascular disease.

Results

The study population consisted of 202 cardiologists (138 men and 63 women) with a mean age of 44.25 years (SD = 8.45). Overall, 93.15% of cardiologists agreed with the importance of discussing sexual issues with their patients with cardiovascular diseases. Almost 76.7% of cardiologists agreed they had a responsibility to deal with patients' sexual problems, and 79.9% of them were aware of the association of cardiovascular disease with sexual problems of cardiac patients, but only 33% of them were confident in their knowledge and skills in this regard. Only 10.6% of cardiologists reported they frequently or always assessed sexual problems with their patients, but 51.50% of them stated they were responding to patients' questions about sexual problems. There was a significant association between performance and responsibility.

Conclusion

The results of this study indicate a gap between cardiologist's attitudes and their actual performance and that their professional responsibility to address patients' sexual issues is a significant parameter for better performance.

Implementing international sexual counselling guidelines in hospital cardiac rehabilitation: development of the CHARMS intervention using the Behaviour Change Wheel

BACKGROUND

Decreased sexual activity and sexual problems are common among people with cardiovascular disease, negatively impacting relationship satisfaction and quality of life. International guidelines recommend routine delivery of sexual counselling to cardiac patients. The Cardiac Health and Relationship Management and Sexuality (CHARMS) baseline study in Ireland found, similar to international findings, limited implementation of sexual counselling guidelines in practice. The aim of the current study was to develop the CHARMS multi-level intervention to increase delivery of sexual counselling by healthcare professionals. We describe the methods used to develop the CHARMS intervention following the three phases of the Behaviour Change Wheel approach: understand the behaviour, identify intervention options, and identify content and implementation options. Survey (n = 60) and focus group (n = 14) data from two previous studies exploring why sexual counselling is not currently being delivered were coded by two members of the research team to understand staff's capability, opportunity, and motivation to engage in the behaviour. All potentially relevant intervention functions to change behaviour were identified and the APEASE (affordability, practicability, effectiveness, acceptability, side effects and equity) criteria were used to select the most appropriate. The APEASE criteria were then used to choose between all behaviour change techniques (BCTs) potentially relevant to the identified functions, and these BCTs were translated into intervention content. The Template for Intervention Description and Replication (TIDieR) checklist was used to specify details of the intervention including the who, what, how and where of proposed intervention delivery.

RESULTS

Providing sexual counselling group sessions by cardiac rehabilitation staff to patients during phase III cardiac rehabilitation was identified as the target behaviour. Education, enablement, modelling, persuasion and training were selected as appropriate intervention functions. Twelve BCTs, linked to intervention functions, were identified for inclusion and translated into CHARMS intervention content.

CONCLUSIONS

This paper details the use of Behaviour Change Wheel approach to develop an implementation intervention in an under-researched area of healthcare provision. The systematic and transparent development of the CHARMS intervention will facilitate the evaluation of intervention effectiveness and future replication and contribute to the advancement of a cumulative science of implementation intervention design.

Sexual counselling for sexual problems in patients with cardiovascular disease

BACKGROUND

Sexual problems are common among people with cardiovascular disease. Although clinical guidelines recommend sexual counselling for patients and their partners, there is little evidence on its effectiveness.

OBJECTIVES

To evaluate the effectiveness of sexual counselling interventions (in comparison to usual care) on sexuality-related outcomes in patients with cardiovascular disease and their partners.

SEARCH METHODS

We searched CENTRAL, MEDLINE, EMBASE, and three other databases up to 2 March 2015 and two trials registers up to 3 February 2016.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs, including individual and cluster RCTs. We included studies that compared any intervention to counsel adult cardiac patients about sexual problems with usual care.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included three trials with 381 participants. We were unable to pool the data from the included studies due to the differences in interventions used; therefore we synthesised the trial findings narratively.Two trials were conducted in the USA and one was undertaken in Israel. All trials included participants who were admitted to hospital with myocardial infarction (MI), and one trial also included participants who had undergone coronary artery bypass grafting. All trials followed up participants for a minimum of three months post-intervention; the longest follow-up timepoint was five months.One trial (N = 92) tested an intensive (total five hours) psychotherapeutic sexual counselling intervention delivered by a sexual therapist. One trial (N = 115) used a 15-minute educational video plus written material on resuming sexual activity following a MI. One trial (N = 174) tested the addition of a component that focused on resumption of sexual activity following a MI within a hospital cardiac rehabilitation programme.The quality of the evidence for all outcomes was very low.None of the included studies reported any outcomes from partners.Two trials reported sexual function. One trial compared intervention and control groups on 12 separate sexual function subscales and used a repeated measures analysis of variance (ANOVA) test. They reported statistically significant differences in favour of the intervention. One trial compared intervention and control groups using a repeated measures analysis of covariance (ANCOVA), and concluded: "There were no significant differences between the two groups [for sexual function] at any of the time points".Two trials reported sexual satisfaction. In one trial, the authors compared sexual satisfaction between intervention and control and used a repeated measured ANOVA; they reported "differences were reported in favour of the intervention". One trial compared intervention and control with a repeated measures ANCOVA and reported: "There were no significant differences between the two groups [for sexual satisfaction] at any of the timepoints".All three included trials reported the number of patients returning to sexual activity following MI. One trial found some evidence of an effect of sexual counselling on reported rate of return to sexual activity (yes/no) at four months after completion of the intervention (relative risk (RR) 1.71, 95% confidence interval (CI) 1.26 to 2.32; one trial, 92 participants, very low quality of evidence). Two trials found no evidence of an effect of sexual counselling on rate of return to sexual activity at 12 week (RR 1.01, 95% CI 0.94 to 1.09; one trial, 127 participants, very low quality of evidence) and three month follow-up (RR 0.98, 95% CI 0.88 to 1.10; one trial, 115 participants, very low quality of evidence).Two trials reported psychological well-being. In one trial, no scores were reported, but the trial authors stated: "No treatment effects were observed on state anxiety as measured in three points in time". In the other trial no scores were reported but, based on results of a repeated measures ANCOVA to compare intervention and control groups, the trial authors stated: "The experimental group had significantly greater anxiety at one month post MI". They also reported: "There were no significant differences between the two groups [for anxiety] at any other time points".One trial reporting relationship satisfaction and one trial reporting quality of life found no differences between intervention and control.No trial reported on satisfaction in how sexual issues were addressed in cardiac rehabilitation services.

AUTHORS' CONCLUSIONS

We found no high quality evidence to support the effectiveness of sexual counselling for sexual problems in patients with cardiovascular disease. There is a clear need for robust, methodologically rigorous, adequately powered RCTs to test the effectiveness of sexual counselling interventions for people with cardiovascular disease and their partners.