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Brotto LA, Altas M. New management approaches for female sexual dysfunction. Curr Opin Obstet Gynecol 2024; 36:372-377. [PMID: 39109594 DOI: 10.1097/gco.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
PURPOSE OF REVIEW The goal of this paper is to review the most recent studies evaluating treatments for female sexual dysfunction (FSD), including distressing symptoms of desire, arousal, and orgasm disorder. We divide the sections into psychological and pharmacological. RECENT FINDINGS There is excellent evidence in favour of mindfulness, cognitive behavioural therapy, and psychoeducation for improving low sexual desire in women, and less evidence in support of these approaches to address other sexual dysfunctions in women. There are two US Food and Drug Administration (FDA) approved pharmacological treatments for low desire in premenopausal women that have modest benefits above placebo, and a significant proportion of users will experience side effects. Evidence also supports the use of transdermal testosterone for low desire in postmenopausal women. SUMMARY Sexual dysfunction in women is common and distressing, and there are a variety of psychological and pharmacological treatments. More research is needed to better understand the predictors of a positive treatment response in order to deliver more personalized care.
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia
| | - Melanie Altas
- BC Centre for Vulvar Health, Vancouver, British Columbia, Canada
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Xue A, Makarenko B, Brotto LA. A Brief Online Mindfulness Intervention for Women's Sexual Desire: The BROWSE Study. JOURNAL OF SEX & MARITAL THERAPY 2024; 50:607-626. [PMID: 38650453 DOI: 10.1080/0092623x.2024.2343286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
With growing interest in developing digital health tools for treating sexual dysfunction, this pilot study aimed to determine feasibility and gather preliminary efficacy data of a self-led online mindfulness intervention in comparison to an online psychoeducational intervention for women's low sexual desire in a community sample (N = 57). After a four-week intervention, participants showed overall improvements on sexual functioning, orgasm, sexual self-pleasure, sexual self-image, and sexual distress, in both treatment arms. Majority completed assigned homework and felt the intervention enhanced their sexual well-being. This study supports the feasibility of a self-led online mindfulness intervention that could help inform future programs.
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Affiliation(s)
- Adrianna Xue
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Brett Makarenko
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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Bouchard KN, Bergeron S, Rosen NO. Feasibility of a Cognitive-Behavioral Couple Therapy Intervention for Sexual Interest/Arousal Disorder. JOURNAL OF SEX RESEARCH 2024:1-11. [PMID: 38593203 DOI: 10.1080/00224499.2024.2333477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Female sexual interest/arousal disorder (SIAD) is strongly influenced by interpersonal factors; however, there are no empirically-supported, couple-based sex therapy interventions for this disorder. This pre-registered study tested the feasibility of a cognitive-behavioral couple therapy (CBCT) intervention for SIAD. A sample of 19 couples in which a female partner was diagnosed with SIAD completed a 16-session CBCT intervention delivered online by therapists with PhD-level training in clinical psychology. Women with SIAD (Mage = 43.47, SD = 12.76) and their partners (Mage = 43.74, SD = 11.68) were in long-term relationships (M = 13.86, SD = 9.15). The CBCT sessions were video recorded and independently coded for treatment manual adherence and therapists reported on the completion of in-session and homework exercises. Participants completed measures of treatment satisfaction following the intervention as well as dyadic sexual desire (women with SIAD only) and sexual distress prior to treatment, post-treatment, and at 6 months follow-up. The therapists exhibited a high level of adherence to the treatment manual and couples had high rates of homework completion. Moreover, couples had low dropout rates, high attendance rates, and reported moderately high global treatment satisfaction and high satisfaction with virtual care. Women with SIAD reported large improvements in dyadic sexual desire and sexual distress from pre-treatment to post-treatment and pre-treatment to 6-month follow-up. Partners reported moderate and small improvements in sexual distress for post-treatment and 6-month follow-up, respectively. Results support the feasibility of an evidence-based CBCT intervention for SIAD and the need for a randomized clinical trial of the intervention.
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Affiliation(s)
| | | | - Natalie O Rosen
- Department of Psychology and Neuroscience, Dalhousie University
- Department of Psychology and Neuroscience and Department of Obstetrics and Gynaecology, Dalhousie University
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Stephenson KR, Latimer SRE, Zippan NL, Brotto LA. History of Sexual Assault as a Predictor of Response to a Self-Guided Online Program for Sexual Desire and Arousal Difficulties in Women. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3379-3391. [PMID: 37697093 DOI: 10.1007/s10508-023-02685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 09/13/2023]
Abstract
Sexual Interest/Arousal Disorder (distressing, long-lasting impairments in sexual desire and/or arousal) is common in women, but few have access to efficacious psychotherapies, including cognitive-behavioral therapy (CBT) and mindfulness-based therapy (MBT). eSense, an online program meant to maximize treatment access, has been shown to be a feasible, satisfactory, and potentially efficacious intervention. However, subpopulations such as sexual assault survivors may find the program less usable or efficacious. The current study compared women with and without a history of sexual assault (SA) regarding their ability to use and benefit from eSense. Forty-four women (22 with a history of SA; M age = 34.20 years) used eSense (CBT or MBT) and completed validated self-report scales of sexual function, sexual distress, treatment satisfaction, and homework compliance. A history of SA did not predict differences in attrition or changes in clinical outcomes. Exploratory analyses suggested that women with a history of SA reported slightly higher difficulty completing homework assignments, but also slightly higher treatment satisfaction. These preliminary results suggest that eSense may be usable and helpful for women with a history of SA. We discuss ways to maximize the acceptability and efficacy of online programs for women with a history of SA.
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Affiliation(s)
- Kyle R Stephenson
- School of Psychology, Xavier University, 3800 Victory Parkway, Cincinnati, OH, 45207, USA.
| | | | - Natasha L Zippan
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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Vowels LM, Sever Z. Are Digital Interventions the Next Frontier in Sex Therapy? A Mixed Methods Study Examining Attitudes toward Digital Sex Therapy. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:1043-1061. [PMID: 37553901 DOI: 10.1080/0092623x.2023.2243266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Digital health interventions can address governments' aims of providing better care, better outcomes, and lower costs. No previous research has examined attitudes toward digital sex therapy to understand what might facilitate, or hinder, the uptake of these interventions. This sequential mixed-methods study with qualitative structured interviews (n = 27) followed by a quantitative survey (n = 334) aimed to understand participants' expectations and attitudes toward digital sex therapy interventions. Participants reported a mixture of positive and negative attitudes to digital sex therapy. More positive attitudes, higher education level, and previous engagement in therapy predicted greater openness to using these interventions.
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Affiliation(s)
- Laura M Vowels
- FAmily and DevelOpment research center (FADO), Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Zoe Sever
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Velten J, Margraf J. Exploring barriers and facilitators to women's intention and behavior to seek treatment for distressing sexual problems. PLoS One 2023; 18:e0288205. [PMID: 37463132 DOI: 10.1371/journal.pone.0288205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
Many women experience distressing problems with sexual functioning, most commonly in the form of low sexual desire or arousal, difficulties reaching orgasm, or genito-pelvic pain with sexual activity. Although effective treatments are available, more than half of the women who experience distressing sexual problems do not seek professional help. Understanding help-seeking patterns, experiences with treatment providers, and barriers to treatment is crucial to address this underutilization. Examining the role of personal characteristics, sexual problem symptoms, and cognitive factors in explaining the intention to seek treatment can help identify individuals who are most reluctant to seek help. Psychological online interventions are a promising resource to increase the availability of effective treatments. Knowledge about the predictors of women's intention to use internet-delivered treatments, as well as information about personal preferences regarding their scope, can help tailor them to women's needs. To address these research questions, cross-sectional data of 800 women (Mage = 30.49, range = 18-73) were analyzed. While many women considered clinical psychologists to be the most qualified treatment providers, gynecologists were cited as the most likely first point of contact. Among women not utilizing any treatments, many reported a preference for dealing with a sexual problem on their own as a reason not to seek help. Higher help-seeking intention was related to living in a larger city, experiencing higher sexual distress, experiencing pain or difficulties with vaginal penetration, higher self-stigma. and lower sexual assertiveness. Women who were convinced of the effectiveness of psychological online interventions and who appreciated the benefits of anonymity indicated that they were more likely to use them. Understanding what factors influence women's decisions about whether or not to seek professional help for distressing sexual problems is key to reducing the underutilization of available resources and developing treatments that meet their needs and preferences.
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Affiliation(s)
- Julia Velten
- Mental Health Research and Treatment Center, Ruhr University Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr University Bochum, Germany
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Effectiveness of an Unguided Online Intervention for Sexual Pleasure in Women: A Randomized Controlled Pilot Study. SEXES 2023. [DOI: 10.3390/sexes4010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The importance of sexual pleasure as a factor promoting sexual and public health is increasingly recognized. Nevertheless, hardly any theory-based and empirically tested interventions exist for fostering sexual pleasure. Consequently, we developed an unguided online intervention called PleaSure to promote sexual pleasure in women. In a randomized controlled pilot trial with a mixed-method design, we evaluated the effectiveness of PleaSure by comparing the intervention group to a waitlist control group in pre–post measurements over 4 weeks. With 657 participants (Mage = 31.46, SDage = 8.78), we evaluated an index of sexual pleasure and five facets: sensual pleasure, pleasure-related mastery, pleasure-related validation, interaction pleasure, and bonding pleasure. The results show that the online intervention primarily strengthened the intrapersonal domain of sexual pleasure by increasing pleasure-related mastery. Neither the other facets nor the index was significantly influenced by the intervention. Although the effects of the quantitative data are small, the qualitative data support overall positive effects on participants’ sexual experience. We discuss the content of the intervention and the methods used. Our pilot study suggests that sexual pleasure can be promoted but that major improvements are needed to the intervention’s content and design to do so effectively. Therefore, future studies are encouraged to further develop and implement such resource-efficient interventions in clinical and non-clinical samples to better understand the importance of sexual pleasure to sexual health.
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Meyers M, Margraf J, Velten J. A Qualitative Study of Women's Experiences with Cognitive-Behavioral and Mindfulness-Based Online Interventions for Low Sexual Desire. JOURNAL OF SEX RESEARCH 2022; 59:1082-1091. [PMID: 35435791 DOI: 10.1080/00224499.2022.2056565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cognitive-behavioral (CBT) and mindfulness-based therapy (MBT) are among the most researched types of psychological interventions for low sexual desire in women. While both have been found effective in improving women's sexual desire, little is known about how women personally experience these treatments. To closely examine both approaches from a participant's perspective, semi-structured telephone-based interviews were conducted with 51 cis-women (Mage = 39, SD = 11, range = 22 to 69) who participated in a randomized controlled study comparing internet-based CBT and MBT for low sexual desire with a waitlist. Interview data were analyzed using thematic and content analysis. Most women (n = 44, 86.3%) evaluated their respective treatment (i.e., CBT or MBT) as helpful in improving their sexual desire. CBT-techniques, such as cognitive restructuring, were mentioned as being helpful for challenging maladaptive thinking patterns, while formal mindfulness-exercises allowed women to disengage from negative sexuality-related thoughts. Elements of sex therapy, including self-stimulation exercises and sensate focus, were perceived as crucial for getting women in touch with their sexual desires and preferences. Strengths of the online format included anonymity, flexibility, and convenient access. Overall, women's personal accounts supported feasibility, acceptability, and clinical usefulness of CBT- and MBT-based internet interventions targeting low sexual desire.
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Affiliation(s)
- Milena Meyers
- Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Faculty of Psychology, Ruhr University Bochum
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Faculty of Psychology, Ruhr University Bochum
| | - Julia Velten
- Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Faculty of Psychology, Ruhr University Bochum
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Online and Mobile Psychotherapeutic Treatments for Female Sexual Difficulties: a Review of Recent Empirical Literature. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saleh DA. Efficacy of Online Psychoeducation and Cognitive Behavior Therapy on Female Sexual Interest/Arousal Disorder: Single Case Design. JOURNAL OF PSYCHOSEXUAL HEALTH 2022. [DOI: 10.1177/26318318221108336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This case report of brief research communication utilized single case design aimed at studying the efficacy of online psychoeducation and cognitive behavior therapy (CBT) on female sexual interest/arousal disorder. Arizona Sexual Experience Scale (ASEX) was used for data collection. Findings of the study showed that client’s pretest and posttest results significantly differ after online psychoeducation and CBT; sexual arousal, sex drive (desire), vaginal lubrication, orgasm, and orgasm satisfaction significantly improved. Furthermore, significant improvement in the frequency of sexual relationship was found. Outcome of this study should guide clinical psychologists in the area of intervention for sexual disorder, especially among women. It should also serve as a reference material for women suffering with sexual dysfunction and serve as an encouragement not to die in silence but seek for professional help.
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Feasibility of an Online Mindfulness-Based Intervention for Women with Sexual Interest/Arousal Disorder. Mindfulness (N Y) 2022; 13:647-659. [PMID: 35035598 PMCID: PMC8750367 DOI: 10.1007/s12671-021-01820-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 12/16/2022]
Abstract
Objectives Difficulties with sexual desire impact up to a third of women and most do not seek or receive appropriate care for these complaints, in part due to stigma, embarrassment, and limited availability of treatment. In-person mindfulness-based interventions have lasting benefits to sexual desire and sex-related distress in controlled clinical trials but are difficult to access. Online cognitive-behavioral interventions for sexual concerns have shown promising findings, but online mindfulness interventions have received little testing. The current study assessed the feasibility of an online program (called eSense-Mindfulness) adapted from an effective face-to-face intervention for women with Sexual Interest/Arousal Disorder. Methods Thirty cisgender women (M age = 35.3) with Sexual Interest/Arousal Disorder consented and completed at least one of the eight modules of eSense-Mindfulness while providing weekly feedback regarding their experience. Feasibility was assessed via attrition rates and participant self-report regarding challenges of using the program. Limited efficacy testing was based on effect sizes for changes in sexual response and sex-related distress. Results Participants (n = 25 who completed all testing) reported high levels of usability and ease of understanding content and reported the mindfulness exercises as well as the information on partner communication to be the most relevant. Limited efficacy testing showed large effect sizes for reductions in sex-related distress, and improvements in sexual desire, arousal, and satisfaction whereas there were smaller effect sizes for improvements in lubrication, orgasm, and vaginal pain. Conclusions The findings suggest that efficacious face-to-face mindfulness interventions for sexual dysfunction in women show excellent evidence of feasibility when delivered online without personalized guidance.
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