“Does sex therapy work? How can we know?” Measuring outcomes in sex therapy

The Sexual Function Evaluation Questionnaire (SFEQ) to Evaluate Effectiveness of Treatment for Sexual Difficulties: Development and Validation in a Clinical Sample

Progress toward establishing the effectiveness of biopsychosocial treatment for patients with sexual problems is limited by the lack of brief measurement tools assessing change across various domains of the treatment model. We developed and psychometrically validated a new clinical evaluation tool, the Sexual Function Evaluation Questionnaire (SFEQ) to meet this gap. The SFEQ combines into a single scale the best performing items from two instruments that were piloted in a UK sexual problems clinic (n = 486): the Natsal-SF Clinical Version and the National Sexual Outcomes Group 1 measure. Internal construct validity evidence from exploratory and confirmatory factor analyses supported a 16-item measure consisting of one overarching dimension of overall sexual function distributed along four subscales: problem distress, partner relationship, sex life, and sexual confidence. The measure had satisfactory configural, metric, and scalar invariance over time and across groups based on gender, ethnicity, and age. Correlations with patient depression and anxiety demonstrated external validity. Change in scores over the course of therapy varied as predicted, with greater improvement in younger patients and in areas more amenable to change via therapy (sexual confidence and problem distress). The SFEQ is a brief clinical tool with the potential to assess sexual function and evaluate the effectiveness of biopsychosocial treatment programs.

A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM)

INTRODUCTION

Although erectile dysfunction (ED) involves an interaction between physiological and psychological pathways, the psychosocial aspects of ED have received considerably less attention so far.

AIM

To review the available evidence on the psychosocial aspects of ED in order to develop a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine (ESSM).

METHOD

A comprehensive, narrative review of the literature was performed.

MAIN OUTCOME MEASURES

Specific statements and recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria were provided.

RESULTS

A multidisciplinary treatment, in which medical treatment is combined with a psychological approach, is preferred over unimodal treatment. There is increasing evidence that psychological treatments of ED can improve medical treatments, the patient's adherence to treatment, and the quality of the sexual relationship. The main components of psychological treatment of ED involve cognitive and behavioral techniques aimed at reducing anxiety, challenging dysfunctional beliefs, increasing sexual stimulation, disrupting sexual avoidance, and increasing intimacy and communication skills in a relational context. When applicable and possible, it is strongly recommended to include the partner in the assessment and treatment of ED and to actively work on interpartner agreement and shared decision-making regarding possible treatment options. To ensure a better integration of the biopsychosocial model into clinical practice, developing concrete treatment protocols and training programs are desirable.

CONCLUSION

Because the psychosocial approach to ED has been underexposed so far, this position statement provides valuable information for clinicians treating ED. Psychological interventions on ED are based on existing theoretical models that are grounded in empirical evidence. However, the quality of available studies is low, which calls for further research. The sexual medicine field would benefit from pursuing more diversity, inclusivity, and integration when setting up treatments and evaluating their effect. Dewitte M, Bettocchi C, Carvalho J, et al. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med 2021;9:100434.

Predictors of Sexual Satisfaction in Women: A Systematic Review

INTRODUCTION

The increasing research interest in sexual satisfaction corresponds to a large amount of studies which focus on different singular determinants without establishing a common model for its explanation.

OBJECTIVES

The purpose of this review is to systematically identify and evaluate the structure and results of the current research about sexual satisfaction in heterosexual women in a long-term relationship.

METHODS

A systematic literature search using Web of Knowledge, ProQuest and PSYNDEX was conducted from January 2004 to October 2019. In total, 1,649 studies published in the last 15 years were extracted from the databases with a systematic keyword search. Through a multistage evaluation process 204 studies met the inclusion criteria and described findings about sexual satisfaction as dependent variable.

RESULTS

Research interest in sexual satisfaction increased notably in the last 5 years. Empirical analyses were predominantly based on data from North America whereas a considerably smaller share of research analyzed samples from Europe or Asia. Relationship variables were the most frequently analyzed predictors and included in more than half of the identified studies. Sexual behavior was most often analyzed in the form of frequency of sexual interactions. Contrariwise, sexual practices, communication about sexuality and sexual desire, and sexual thoughts received limited attention. Demographics were considered in one third of all studies. The inclusion of control variables was rare. Some important studies considered variables closely related to sexual satisfaction such as sexual dysfunction.

CONCLUSION

Relationship satisfaction and the frequency of sexual interactions are identified as the most frequently confirmed predictors of sexual satisfaction across all evaluated studies. Results about the effects of pornography consumption, religion, and relationship duration showed the greatest inconsistency. In general, identified effects were often believed to result from mediator variables like sexual desire or distracting thoughts. Rausch D, Rettenberger M. Predictors of Sexual Satisfaction in Women: A Systematic Review. Sex Med Rev 2021;9:365-380.