Efficacy of Psychological Interventions for Sexual Dysfunction: A Systematic Review and Meta-Analysis
- 4.3k Downloads
Sexual dysfunction is highly prevalent in the general population and associated with psychological distress and impaired sexual satisfaction. Psychological interventions are promising treatment options, as sexual dysfunction is frequently caused by and deteriorates because of psychological factors. However, research into the efficacy of psychological interventions is rather scarce and an up-to-date review of outcome studies is currently lacking. Therefore, we conducted a systematic review and meta-analysis of all available studies from 1980 to 2009 to examine the efficacy of psychological interventions for patients with sexual dysfunction. A total of 20 randomized controlled studies comparing a psychological intervention with a wait-list were included in the meta-analysis. The overall post-treatment effect size for symptom severity was d = 0.58 (95 % CI: 0.40 to 0.77) and for sexual satisfaction d = 0.47 (95 % CI: 0.27 to 0.70). Psychological interventions were shown to especially improve symptom severity for women with Hypoactive Sexual Desire Disorder and orgasmic disorder. Our systematic review of 14 studies comparing at least two active interventions head-to-head revealed that very few comparative studies are available with large variability in effect sizes across studies (d between −0.69 and 2.29 for symptom severity and −0.56 and 14.02 for sexual satisfaction). In conclusion, psychological interventions are effective treatment options for sexual dysfunction. However, evidence varies considerably across single disorders. Good evidence exists to date for female hypoactive sexual desire disorder and female orgasmic disorder. Further research is needed on psychological interventions for other sexual dysfunctions, their long-term and comparative effects.
KeywordsSexual dysfunction Treatment Psychological Meta-analysis Review
Jürgen Barth received a grant (no. 105314-118312/1) from the Swiss National Science Foundation. We thank the Associate Editor, Dr. Lori Brotto, for her important suggestions to improve our article.
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
- Aubin, S., Heiman, J. R., Berger, R. E., Murallo, A. V., & Yung Wen, L. (2009). Comparing Sildenafil alone vs. Sildenafil plus brief couple sex therapy on erectile dysfunction and couples’ sexual and marital quality of life: A pilot study. Journal of Sex and Marital Therapy, 35, 122–143. doi: 10.1080/00926230802712319.PubMedCrossRefGoogle Scholar
- Banner, L. L. (2001). The effects of collaborative care in the treatment of erectile dysfunction (ED): An integrative treatment protocol (ITP). Unpublished doctoral dissertation, The Fielding Institute.Google Scholar
- Bergeron, S., Binik, Y., Khalife, S., Pagidas, K., Glazer, H., Meana, M., et al. (2001). A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain, 91, 297–306. doi: 10.1016/S0304-3959(00)00449-8.PubMedCrossRefGoogle Scholar
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
- Cuijpers, P., van Straten, A., Bohlmeijer, E., Hollon, S. D., & Andersson, G. (2010). The effects of psychotherapy for adult depression are overestimated: A meta-analysis of study quality and effect size. Psychological Medicine, 40, 211–223. doi: 10.1017/s0033291709006114.PubMedCrossRefGoogle Scholar
- Google. (2011). Google translate. Retrieved from http://translate.google.com/.
- Harris, R., Bradburn, M., Deeks, J., Harbord, R., Altman, D., Steichen, T., & Sterne, J. (2006). METAN: Stata module for fixed and random effects meta-analysis. Retrieved from http://ideas.repec.org/c/boc/bocode/s456798.html.
- Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. London: Academic Press.Google Scholar
- Hurlbert, D., White, L., Powell, R., & Apt, C. (1993). Orgasm consistency training in the treatment of women reporting hypoactive sexual desire: An outcome comparison of women-only groups and couples-only groups. Journal of Behavior Therapy and Experimental Psychiatry, 24, 3–13. doi: 10.1016/0005-7916(93)90003-F.PubMedCrossRefGoogle Scholar
- Kockott, G. (2007). Psychotherapie sexueller Funktions- und Erlebensstörungen. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz, 50, 11–18. doi: 10.1007/s00103-007-0112-2.
- Li, P., Zhu, G.-S., Xu, P., Sun, L.-H., & Wang, P. (2006). Interventional effect of behaviour psychotherapy on patients with premature ejaculation. Zhong Hua Nan Ke Xue, 12, 717–719.Google Scholar
- Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. New York: Bantam Books.Google Scholar
- McGuire, H., & Hawton, K. (2003). Interventions for vaginismus. Cochrane Database of Systematic Reviews (2), CD001760. doi: 10.1002/14651858.CD001760.
- Ravart, M., Trudel, G., Marchand, A., Turgeon, L., & Aubin, S. (1996). The efficacy of a cognitive behavioural treatment model for hypoactive sexual desire disorder: An outcome study. Canadian Journal of Human Sexuality, 5, 279–293.Google Scholar
- Schnyder, U., Schnyder-Luthi, C., Ballinari, P., & Blaser, A. (1998). Therapy for vaginismus: In vivo versus in vitro desensitization. Canadian Journal of Psychiatry, 43, 941–944.Google Scholar
- Shao, X., & Li, J. (2008). Clinical study on treatment of premature ejaculation with Paroxetine and behavior-therapy. Chinese Journal of Andrology, 1, 18–20.Google Scholar
- ter Kuile, M. M., van Lankveld, J. J. D. M., de Groot, E., Melles, R., Neffs, J., & Zandbergen, M. (2007). Cognitive-behavioral therapy for women with lifelong vaginismus: Process and prognostic factors. Behaviour Research and Therapy, 45, 359–373. doi: 10.1016/j.brat.2006.03.013.PubMedCrossRefGoogle Scholar
- The Epidata Association. (2011). Epi Data Version 3.1 [Computer software]. Retrieved from http://www.epidata.dk/. Accessed 06 Jan 2011.
- van Lankveld, J. J. D. M., Everaerd, W., & Grotjohann, Y. (2001). Cognitive-behavioral bibliotherapy for sexual dysfunctions in heterosexual couples: A randomized waiting-list controlled clinical trial in the Netherlands. Journal of Sex Research, 38, 51–67. doi: 10.2307/3813262.CrossRefGoogle Scholar
- van Lankveld, J. J. D. M., Leusink, P., van Diest, S., Gijs, L., & Slob, A. K. (2009). Internet-based brief sex therapy for heterosexual men with sexual dysfunctions: A randomized controlled pilot trial. Journal of Sexual Medicine, 6, 2224–2236. doi: 10.1111/j.1743-6109.2009.01321.x.PubMedCrossRefGoogle Scholar
- van Lankveld, J. J. D. M., ter Kuile, M. M., de Groot, H. E., Melles, R., Nefs, J., & Zandbergen, M. (2006). Cognitive-behavioral therapy for women with lifelong vaginismus: A randomized waiting-list controlled trial of efficacy. Journal of Consulting and Clinical Psychology, 74, 168–178. doi: 10.1037/0022-006X.74.1.168.PubMedCrossRefGoogle Scholar
- Wilson, D. B. (2001). Effect size determination program [Computer software]. Retrieved from http://mason.gmu.edu/~dwilsonb/ma.html.
- World Health Organization. (2004). International statistical classification of diseases and health-related problems. Geneva: Author.Google Scholar
- Yuan, P., Dai, J., Yang, Y., Guo, J., & Liang, R. (2008). A comparative study on treatment for premature ejaculation: Citalopram used in combination with behavioral therapy versus either Citalopram or behavioral therapy alone. Chinese Journal of Andrology, 5, 35–38.Google Scholar
- Zhang, J.-G., Wang, Y.-L., Li, J., & Zhou, S.-W. (2005). Chronic prostatitis related sexual dysfunction and its psychologic treatment. Zhong Hua Nan Ke Xue, 11, 658–660.Google Scholar