Archives of Sexual Behavior

, Volume 42, Issue 6, pp 915–933 | Cite as

Efficacy of Psychological Interventions for Sexual Dysfunction: A Systematic Review and Meta-Analysis

  • Sarah Frühauf
  • Heike Gerger
  • Hannah Maren Schmidt
  • Thomas Munder
  • Jürgen Barth
Original Paper

Abstract

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.

Keywords

Sexual dysfunction Treatment Psychological Meta-analysis Review 

References

  1. Al-Sughayir, M. (2005). Vaginismus treatment: Hypnotherapy versus behavior therapy. Neurosciences, 10, 163–167.PubMedGoogle Scholar
  2. Althof, S. E., Leiblum, S. R., Chevret-Measson, M., Hartmann, U., Levine, S. B., McCabe, M., et al. (2005). Psychological and interpersonal dimensions of sexual function and dysfunction. Journal of Sexual Medicine, 2, 793–800. doi:10.1111/j.1743-6109.2005.00145.x.PubMedCrossRefGoogle Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  4. Andersen, B. L. (1981). A comparison of systematic desensitization and directed masturbation in the treatment of primary orgasmic dysfunction in females. Journal of Consulting and Clinical Psychology, 49, 568–570. doi:10.1037/0022-006X.49.4.568.PubMedCrossRefGoogle Scholar
  5. 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
  6. 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
  7. Becker, J. V., Skinner, L. J., Abel, G. G., & Cichon, J. (1984). Time limited therapy with sexually dysfunctional sexually assaulted women. Journal of Social Work and Human Sexuality, 3(1), 97–115. doi:10.1300/J291v03n01_08.Google Scholar
  8. 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
  9. Binik, Y., & Meana, M. (2009). The future of sex therapy: Specialization or marginalization. Archives of Sexual Behavior, 38, 1016–1027. doi:10.1007/s10508-099-9475-9.PubMedCrossRefGoogle Scholar
  10. Bitzer, J., & Brandenburg, U. (2009). Psychotherapeutic interventions for female sexual dysfunction. Maturitas, 63, 160–163. doi:10.1016/j.maturitas.2009.02.2012.PubMedCrossRefGoogle Scholar
  11. Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological grinterventions: Controversies and evidence. Annual Review of Psychology, 52, 685–716. doi:10.1146/annurev.psych.52.1.685.PubMedCrossRefGoogle Scholar
  12. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
  13. 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
  14. de Carufel, F., & Trudel, G. (2006). Effects of a new functional-sexological treatment for premature ejaculation. Journal of Sex and Marital Therapy, 32, 97–114. doi:10.1080/00926230500442292.PubMedCrossRefGoogle Scholar
  15. DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7, 177–188. doi:10.1016/0197-2456(86)90046-2.PubMedCrossRefGoogle Scholar
  16. Dodge, L. J., Glasgow, R. E., & O’Neill, H. K. (1982). Bibliotherapy in the treatment of female orgasmic dysfunction. Journal of Consulting and Clinical Psychology, 50, 442–443. doi:10.1037/0022-006X.50.3.442.PubMedCrossRefGoogle Scholar
  17. Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal, 315, 629–634.PubMedCrossRefGoogle Scholar
  18. Everaerd, W., & Dekker, J. (1981). A comparison of sex therapy and communication therapy: Couples complaining of orgasmic dysfunction. Journal of Sex and Marital Therapy, 7, 278–289. doi:10.1080/00926238108405429.PubMedCrossRefGoogle Scholar
  19. Everaerd, W., & Dekker, J. (1982). Treatment of secondary orgasmic dysfunction: A comparison of systematic desensitization and sex therapy. Behaviour Research and Therapy, 20, 269–274. doi:10.1016/0005-7967(82)90145-0.PubMedCrossRefGoogle Scholar
  20. Foa, E. B., & Meadows, E. A. (1997). Psychosocial treatments for posttraumatic stress disorder: A critical review. Annual Review of Psychology, 48, 449–480. doi:10.1146/annurev.psych.48.1.449.PubMedCrossRefGoogle Scholar
  21. Google. (2011). Google translate. Retrieved from http://translate.google.com/.
  22. 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.
  23. Hartman, L. M., & Daly, E. M. (1983). Relationship factors in the treatment of sexual dysfunction. Behaviour Research and Therapy, 21, 153–160. doi:10.1016/0005-7967(83)90161-4.PubMedCrossRefGoogle Scholar
  24. Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. London: Academic Press.Google Scholar
  25. Heiman, J. R., & Meston, C. M. (1997). Empirically validated treatment for sexual dysfunction. Annual Review of Sex Research, 8, 148–194.PubMedGoogle Scholar
  26. Higgins, J., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. British Medical Journal, 327, 557. doi:10.1136/bmj.327.7414.557.PubMedCrossRefGoogle Scholar
  27. Hurlbert, D. F. (1993). A comparative study using orgasm consistency training in the treatment of women reporting hypoactive sexual desire. Journal of Sex and Marital Therapy, 19, 41–55. doi:10.1080/00926239308404887.PubMedCrossRefGoogle Scholar
  28. 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
  29. Jüni, P., Altman, D. G., & Egger, M. (2001). Assessing the quality of controlled clinical trials. British Medical Journal, 323, 42–46. doi:10.1136/bmj.323.7303.42.PubMedCrossRefGoogle Scholar
  30. Kilmann, P. R., Milan, R. J., Boland, J. P., Nankin, H. R., Davidson, E., West, M. O., et al. (1987). Group treatment of secondary erectile dysfunction. Journal of Sex and Marital Therapy, 13, 168–182. doi:10.1080/00926238708403890.PubMedCrossRefGoogle Scholar
  31. Kilmann, P. R., Mills, K. H., Caid, C., Davidson, E., Bella, B., Milan, R. J., et al. (1986). Treatment of secondary orgasmic dysfunction: An outcome study. Archives of Sexual Behavior, 15, 211–229. doi:10.1007/BF01542413.PubMedCrossRefGoogle Scholar
  32. Kockott, G. (2007). Psychotherapie sexueller Funktions- und Erlebensstörungen. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz, 50, 11–18. doi:10.1007/s00103-007-0112-2.
  33. Kröger, C. (2007). Welche Auswirkungen hat Ehe- und Paarberatung auf die Sexualität und die sexuelle Zufriedenheit? Zeitschrift für klinische Psychologie und Psychotherapie, 36(2), 121. doi:10.1026/1616-3443.36.2.121.CrossRefGoogle Scholar
  34. Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States: Prevalence and predictors. Journal of the American Medical Association, 281, 537–544. doi:10.1001/jama.281.6.537.PubMedCrossRefGoogle Scholar
  35. 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
  36. Libman, E., Fichten, C. S., Rothenberg, P., Creti, L., Weinstein, N., Amsel, R., et al. (1991). Prostatectomy and inguinal hernia repair: A comparison of the sexual consequences. Journal of Sex and Marital Therapy, 17, 27–34. doi:10.1080/00926239108405466.PubMedCrossRefGoogle Scholar
  37. MacPhee, D. C., Johnson, S. M., & van der Veer, M. M. (1995). Low sexual desire in women: The effects of marital therapy. Journal of Sex and Marital Therapy, 21, 159–182. doi:10.1080/00926239508404396.PubMedCrossRefGoogle Scholar
  38. Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. New York: Bantam Books.Google Scholar
  39. McCabe, M., Price, E., Piterman, L., & Lording, D. (2008). Evaluation of an internet-based psychological intervention for the treatment of erectile dysfunction. International Journal of Impotence Research, 20, 324–330. doi:10.1038/ijir.2008.3.PubMedCrossRefGoogle Scholar
  40. McGuire, H., & Hawton, K. (2003). Interventions for vaginismus. Cochrane Database of Systematic Reviews (2), CD001760. doi:10.1002/14651858.CD001760.
  41. Munjack, D. J., Schlaks, A., Sanchez, V. C., Usigli, R., Zulueta, A., & Leonard, M. (1984). Rational-emotive therapy in the treatment of erectile failure: An initial study. Journal of Sex and Marital Therapy, 10, 170–175. doi:10.1080/00926238408405942.PubMedCrossRefGoogle Scholar
  42. Obler, M. (1982). A comparison of hypnoanalytic/behavior modification technique and a cotherapist-type treatment with primary orgasmic dysfunction females: Some preliminary results. Journal of Sex Research, 18, 331–345. doi:10.1080/00224498209551159.CrossRefGoogle Scholar
  43. O’Donohue, W. T., Swingen, D. N., Dopke, C. A., & Regev, L. G. (1999). Psychotherapy for male sexual dysfunction: A review. Clinical Psychology Review, 19, 591–630. doi:10.1016/S0272-7358(98)00063-4.PubMedCrossRefGoogle Scholar
  44. Price, S. C., Reynolds, B. S., Cohen, B. D., Anderson, A. J., & Schochet, B. V. (1981). Group treatment of erectile dysfunction for men without partners: A controlled evaluation. Archives of Sexual Behavior, 10, 253–268. doi:10.1007/BF01543078.PubMedCrossRefGoogle Scholar
  45. 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
  46. Read, S., King, M., & Watson, J. (1997). Sexual dysfunction in primary medical care: Prevalence, characteristics and detection by the general practitioner. Journal of Public Health, 19, 387–391.CrossRefGoogle Scholar
  47. 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
  48. 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
  49. Simons, J. S., & Carey, M. P. (2001). Prevalence of sexual dysfunctions: Results from a decade of research. Archives of Sexual Behavior, 30, 177–219. doi:10.1023/A:1002729318254.PubMedCrossRefGoogle Scholar
  50. Spence, S. H. (1985). Group versus individual treatment of primary and secondary female orgasmic dysfunction. Behaviour Research and Therapy, 23, 539–548. doi:10.1016/0005-7967(85)90101-9.PubMedCrossRefGoogle Scholar
  51. Stravynski, A., Gaudette, G., Lesage, A., Arbel, N., Petit, P., Clerc, D., et al. (1997). The treatment of sexually dysfunctional men without partners: A controlled study of three behavioural group approaches. British Journal of Psychiatry, 17, 338. doi:10.1192/bjp.170.4.338.CrossRefGoogle Scholar
  52. ter Kuile, M. M., Brauer, M., & Laan, E. (2006). The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS): Psychometric properties within a Dutch population. Journal of Sex and Marital Therapy, 32, 289–304. doi:10.1080/00926230600666261.PubMedCrossRefGoogle Scholar
  53. 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
  54. ter Kuile, M. M., van Lankveld, J. J. D. M., Kalkhoven, P., & van Egmond, M. (1999). The Golombok Rust Inventory of Sexual Satisfaction (GRISS): Psychometric properties within a Dutch population. Journal of Sex and Marital Therapy, 25, 59–71. doi:10.1080/00926239908403977.PubMedGoogle Scholar
  55. The Epidata Association. (2011). Epi Data Version 3.1 [Computer software]. Retrieved from http://www.epidata.dk/. Accessed 06 Jan 2011.
  56. Trudel, G., & Laurin, F. (1988). The effects of bibliotherapy on orgasmic dysfunction and couple interactions: An experimental study. Sexual and Marital Therapy, 3, 223–228. doi:10.1080/02674658808407713.Google Scholar
  57. Trudel, G., Marchand, A., Ravart, M., Aubin, S., Turgeon, L., & Fortier, P. (2001). The effect of a cognitive-behavioral group treatment program on hypoactive sexual desire in women. Sexual and Relationship Therapy, 16, 145–164. doi:10.1080/14681990120040078.CrossRefGoogle Scholar
  58. 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
  59. 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
  60. 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
  61. Wilson, D. B. (2001). Effect size determination program [Computer software]. Retrieved from http://mason.gmu.edu/~dwilsonb/ma.html.
  62. World Health Organization. (2004). International statistical classification of diseases and health-related problems. Geneva: Author.Google Scholar
  63. 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
  64. 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
  65. Zimmer, D. (1987). Does marital therapy enhance the effectiveness of treatment for sexual dysfunction? Journal of Sex and Marital Therapy, 13, 193–209. doi:10.1080/00926238708403892.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sarah Frühauf
    • 1
  • Heike Gerger
    • 1
  • Hannah Maren Schmidt
    • 1
  • Thomas Munder
    • 1
  • Jürgen Barth
    • 1
  1. 1.Division of Social and Behavioural Health ResearchInstitute of Social and Preventive Medicine (ISPM)BernSwitzerland

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