Feasibility of an Online Mindfulness-Based Intervention for Women with Sexual Interest/Arousal Disorder

A randomized controlled trial of online mindfulness and cognitive-behavioral interventions for sexual interest/arousal disorder in women: eSense

OBJECTIVE

Sexual interest/arousal disorder (SIAD) is a common and distressing sexual dysfunction in women. Although efficacious psychological treatments for SIAD exist, they are generally underutilized and inaccessible. eSense is a feasible and useable online intervention containing Cognitive-Behavioral Therapy (CBT) and Mindfulness-Based Therapy (MBT) programs. Our goal was to test the efficacy of the CBT and MBT arms of eSense relative to a waitlist control condition.

METHOD

Women with SIAD were randomized to eSense-CBT (n = 43), eSense-MBT (n = 43), or a waitlist (n = 43). Both interventions consisted of 8 modules with a recommended completion time of 8-12 weeks. Participants also met remotely with non-expert "navigators" for up to 12 weeks. Participants completed validated self-report measures of primary outcomes (sexual desire/arousal and distress) and secondary outcomes (sexual satisfaction, dissatisfaction, and overall sexual function) at baseline, mid-treatment, posttreatment, and 6-month posttreatment.

RESULTS AND CONCLUSIONS

Compared to waitlist, both active treatment groups reported significant improvements in primary outcomes at post-treatment (desire/arousal d > .90; sexual distress d < -0.62) and these improvements were generally maintained at follow-up. The two active treatments did not differ in terms of primary outcomes. Effects on sexual satisfaction were also significant (d = 0.70-0.81) and MBT resulted in slightly greater improvements. There was no effect on sexual dissatisfaction. For overall sexual function, the effect was large (d = 1.20 to 1.23) with no between-arm differences. Future steps to improve engagement and increase access are discussed.

Feasibility of a Cognitive-Behavioral Couple Therapy Intervention for Sexual Interest/Arousal Disorder

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.

Psychological and interpersonal dimensions of sexual function and dysfunction: recommendations from the fifth international consultation on sexual medicine (ICSM 2024)

INTRODUCTION

Sexual health concerns are common and significantly impact quality of life, but many people do not seek treatment due to embarrassment and other barriers. A biopsychosocial model of assessment and treatment acknowledges the biological, psychological, and social contributors to sexual difficulties and suggests that all these domains should be evaluated.

OBJECTIVES

This paper provides an overview of the major psychological factors contributing to sexual difficulties and offer an evidence-based approach for primary care clinicians to assess and treat these issues.

METHODS

A comprehensive literature review was undertaken focusing on articles published since the last consultation in 2016. The study findings were synthesized, critiqued, authors assigned a Grading of Recommendation as Weak or Strong following a year-long process of discussions among the committee. When a particular well-established psychological practice was not evaluated in the literature, we assigned an expert opinion recommendation.

RESULTS

Since the 2015 ICSM, there have been a number of high-quality trials of psychological treatments addressing sexual dysfunctions, as well as meta-analyses and systematic reviews. In some domains, there is strong evidence of psychological treatment, and primary care providers should be aware of such approaches and refer when appropriate.

CONCLUSIONS

This paper offers a practical guide for primary care clinicians to understand the psychological factors underlying sexual dysfunction and outlining what approaches may be appropriate for this clinician, and when the patient should be referred to a specialist. We emphasize an evidence-based approach to managing sexual dysfunctions in primary care, allowing for timely interventions. A comprehensive evaluation of biopsychosocial factors is recommended to personalize psychological interventions to overall context, including chronic diseases, mental health issues, and relationship conflicts. The initial assessment is key to developing an individualized intervention plan, which may include psychoeducation, referral for cognitive-behavioral therapy, mindfulness, or couple therapy, and consideration of medical or digital health interventions.

Evaluating a Digital Health Tool Designed to Improve Low Sexual Desire in Women: Mixed-Methods Implementation Science Study

BACKGROUND

Sexual health difficulties affect up to 30% of women, with desire and arousal problems being the most prevalent. While cognitive behavioral therapy and mindfulness-based therapy are effective treatments, access is limited by barriers such as specialist shortages, cost, and embarrassment. Web-based interventions offer a potential solution by providing self-paced, cost-effective treatments. eSense, a digital health program, offers cognitive behavioral therapy and mindfulness-based therapy skills targeted to women with low sexual desire, and previous trials find eSense to be highly feasible and efficacious.

OBJECTIVE

The goal of the present implementation science study was to use the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance of Implementation) framework to assess the integration of eSense into several sexual health clinics. We chose the RE-AIM framework because it addresses both dissemination (eg, reach) and implementation of an intervention.

METHODS

A total of 14 specialty clinics participated, and we report on the reported experiences of those clinics in implementing eSense. We also examined responses from 12 women on waitlists to receive sex therapy or sexual medicine care.

RESULTS

Per clinic outcomes, all aspects of implementation (reach, effectiveness, adoption, implementation, and maintenance) were in the moderate to high range for clinics, reporting that offering eSense helped them overcome negative feelings associated with their long clinic waitlists. The majority expressed a need for eSense and could see how it overcame the limitations of traditional therapy. Nearly all expressed a wish to continue offering eSense to patients after the implementation study was complete. One caveat was that half of the clinics noted cost as a key issue for future implementation, and one-third noted that the administrative burden of implementing eSense as a standard of care may be challenging. For individual users, the majority expressed an interest in knowing more about eSense and a desire to use eSense, though most of these did not complete the program in its entirety. Users experienced a significant improvement in sex-related distress with no clinically meaningful change in other outcomes and a high level of satisfaction with eSense. Most also reported doing things differently in their sexual lives after participating in eSense.

CONCLUSIONS

We found that eSense demonstrates potential as a digital intervention for sexual difficulties for women, particularly concerning its moderate implementation outcomes and also because of its ability to reduce sexual distress. Future studies should address the barriers identified for broader adoption of eSense in clinical settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05168371; https://clinicaltrials.gov/study/NCT05168371.

Predictors of Sexual Dysfunction, Associated Distress, and Sexual Satisfaction Among Male and Female Patients Living with Anxiety Disorders in Denmark

Although previous studies have established links between anxiety disorders, sexual dysfunctions, and sexual satisfaction, there is relatively little research on the specific factors associated with living with an anxiety disorder that might contribute to these sexual health disparities. This study assessed the associations between anxiety, cognitive distractions, biased expectancies, and 1) sexual dysfunction (DSM-5 diagnostic criteria) 2) associated distress, and 3) sexual satisfaction while considering the role of pharmacological treatment-related sexual side effects and comorbid depressive symptoms. A large clinical population (N = 207) of people with anxiety diagnoses seeking treatment at 11 outpatient anxiety clinics in Denmark participated. Higher cognitive distraction levels were linked with a greater risk of sexual dysfunction, more sexual dysfunction-associated distress, and lower sexual satisfaction. Higher sexuality and anxiety biased expectancies were associated with an increased risk of sexual dysfunctions and associated distress and decreased sexual satisfaction. Higher anxiety symptom severity was only associated with lower sexual satisfaction among female respondents. Higher anxiety sensitivity was linked to a higher risk of sexual dysfunction, associated distress, and lower sexual satisfaction among female participants only.

A Preliminary Investigation into the Use of Cannabis Suppositories and Online Mindful Compassion for Improving Sexual Function Among Women Following Gynaecological Cancer Treatment

Background and Objectives: The impact of gynaecological cancer and its treatments on sexual intimacy can be profound on female sexuality. However, very few registered clinical trials have addressed sexual intimacy among this cohort. Materials and Methods: This preliminary randomised control trial (RCT) and content analysis assessed the effectiveness of a brief online mindful compassion group intervention adjunct with cannabis suppositories. Eighty-three participants aged between 18 and 50+ years who were at least six months post-cancer treatment were randomly allocated to one of four groups, depending on whether they were already using cannabis suppositories. These included a cannabis-only group (CO), a mindful-compassion group (MC), a combined mindful-compassion and cannabis suppositories group (COCM) and a care-as-usual group (CAU). Measurements of sexual function, sexual self-efficacy, mindful compassion, well-being and quality of life were taken at weeks 0, 4 and 12. Results: Sexual function, including arousal, lubrication and orgasms, improved for both the MC p = 0.002 and COCM p ≤ 0.001 groups; in addition, sexual pain was reduced in the COCM p = 0.008 and CO p ≤ 0.001 groups compared to the CAU and MC groups, where p ≥ 0.05. Feedback suggested that cannabis mediated the effects of mindful compassion and supported well-being, sexual self-efficacy, and quality of life. Participants also voiced a preference for cannabis suppositories when using dilators as part of their treatment and the use of sex toys instead of dilators, suggesting that dilators had negatively impacted their sexuality. Conclusions: These preliminary and exploratory outcomes look promising and provide a foundation for future research to develop varied healthcare options to improve mental health service delivery and quality of life for this cohort.

Homework adherence in mindfulness-based cognitive interventions for female sexual dysfunction: a scoping review

BACKGROUND

Mindfulness-based cognitive therapy (MBCT) includes regular home practice of mindfulness exercises as a key means of cultivating mindfulness. Although there are instruments available for measuring homework adherence following cognitive behavioral therapy (CBT), little is known about measuring homework practice in MBCT studies for sexual dysfunction.

AIM

In this review we sought to investigate which items and instruments are the most used for the assessment of homework adherence in studies evaluating MBCT for the treatment of female sexual dysfunction (FSD). We also investigated the types of homework used in these interventions.

METHODS

Five databases (PubMed, Scopus, PsycINFO, Embase, and Web of Science) were searched and a total of 30 articles were included in this review.

OUTCOMES

Our main findings revealed that there was no gold standard instrument used to assess homework adherence in patients using MBCT interventions for FSD, and that most of the reported studies did not provide information on how they assess homework adherence.

RESULTS

Six of the 9 studies for which the articles reported how homework was assessed used only ad hoc measures. Only 3 studies used psychometrically validated instruments. We also found that mindfulness, psychoeducation, and CBT exercises were the most prescribed homework.

STRENGTHS AND LIMITATIONS

This review uniquely integrates homework adherence measures with studies on FSD that evaluate mindfulness, finding no gold standard for assessing adherence. However, limitations including both MBCT and CBT interventions, limiting generalization to MBCT alone, the predominance of Western-based studies, and the lack of reporting on instruments used to assess adherence, indicating a gap in the field.

CONCLUSION

Further studies should consider adapting existing instruments that assess homework adherence in studies of CBT for other psychopathologies or seek to develop new psychometrically validated instruments for MBCT interventions that assess homework adherence.

New management approaches for female sexual dysfunction

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.

History of Sexual Assault as a Predictor of Response to a Self-Guided Online Program for Sexual Desire and Arousal Difficulties in Women

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.

Investigating the effect of mindfulness counselling on sexual functioning of women with premenstrual syndrome

Mindfulness exercises can improve a wide range of the psychological and interpersonal consequences of premenstrual syndrome. Nevertheless, there is sparse information about the effect of mindfulness counselling on sexual dysfunction in women with this condition. This study aimed to determine the effect of mindfulness counselling on the sexual functioning of women with premenstrual syndrome. In this controlled randomized study, 112 women diagnosed with premenstrual syndrome referred to selected urban healthcare centers in Isfahan, Iran, were randomly allocated to two groups (intervention and control), each with 56 participants. The intervention group underwent mindfulness counselling in eight 60-minute sessions online via Google Meet. The control group did not receive any kind of intervention. The principal measure was score on the Rosen Female Sexual Functioning Index (FSFI) before, immediately, and one month after the intervention. The data were analyzed by SPSS 23, through descriptive and analytical statistical tests (chi-square, Mann-Whitney, independent t-test, ANOVA, and repeated measure) with a significance level of 0.05. There was no statistically significant difference in the mean FSFI score (or the subscores) between the intervention and control groups (p greater than 0.05) at baseline. In the intervention group, there were significant increases (relative to both baseline and in comparison with the control group) in the mean subscores for sexual desire (P < 0.0001), orgasm (P = 0.01), satisfaction (P = 0.0001), sexual pain (P = 0.003), and general sexual functioning (P < 0.0001) immediately after and one month after the intervention, but the score for sexual arousal was significantly greater only at the one-month evaluation (P < 0.0001) and there were no differences in the scores for vaginal lubrication. On the other hand. Mindfulness counselling was effective in improving the sexual functioning of women suffering from premenstrual syndrome, and should be used for this purpose in healthcare centers.

Are Digital Interventions the Next Frontier in Sex Therapy? A Mixed Methods Study Examining Attitudes toward Digital Sex Therapy

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.

Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia Using an Integrative Approach

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by persistent, unwanted physiological genital arousal (i.e., sensitivity, fullness, and/or swelling) in the absence of sexual excitement or desire which can persist for hours to days and causes significant impairment in psychosocial well-being (e.g., distress) and daily functioning. The etiology and course of PGAD/GPD is still relatively unknown and, unsurprisingly, there are not yet clear evidence-based treatment recommendations for those suffering from PGAD/GPD. We present the case of a 58-year-old woman with acquired persistent genital arousal disorder, which began in March 2020; she believed she developed PGAD/GPD due to a period of significant distress and anxiety related to the COVID-19 pandemic. After seeking medical diagnosis and treatment from multiple healthcare providers and trying a combination of pharmacological and medical treatment modalities, she presented for psychological treatment. An integrative therapy approach (3 assessment sessions, 11 treatment sessions), which included cognitive behavior therapy, distress tolerance and emotion regulation skills from dialectical behavior therapy, and mindfulness practice, was utilized. The patient reported improvements anecdotally (e.g., decreased impact on occupational and social functioning, greater self-compassion, less frequent and shorter duration of PGAD/GPD flare-ups, improved ability to cope with PGAD/GPD symptoms, and decreased need for sleeping medication) and on self-report measures (e.g., lower PGAD/GPD catastrophizing, lower anxiety and depression, and greater overall quality of life).We report the use of an integrative (i.e., psychoeducational, cognitive behavioral, dialectical behavioral, and mindfulness-based) intervention, which may be an effective psychological treatment for PGAD/GPD.

A Systematic Review on Psychological Interventions for Sexual Health in Older Age

Objectives

The present review aims to identify the existing evidence on outcome-treatment studies of psychological sexual health interventions in older age.

Methods

A systematic search was conducted for studies published until October 2022. Data search was conducted on EBSCO, MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials databases.

Results

From 30,840 screened records, 12 reports were selected. Results were grouped into four categories according to the intervention that was implemented.

Conclusions

Despite results presenting some bias concerns, this review suggests that educational and cognitive-behavioral approaches seem to be effective for promoting sexual health in older age.

Repetitive Negative Thinking and Sexual Functioning in Portuguese Men and Women: A Cross-Sectional Study

Objective: Repetitive negative thinking (RNT) is a transdiagnostic process involved in the development and maintenance of emotional disorders that negatively affect sexual functioning. However, empirical evidence for the role of RNT on sexual functioning is still lacking. The current study aimed to investigate the role of RNT on sexual functioning in men and women by examining differences in RNT between men and women and between individuals with and without subclinical sexual difficulties. It also aimed to investigate the predictive role of RNT on sexual function indices in men and women. Methods: A total of 424 participants (270 women) completed online a sociodemographic questionnaire and Portuguese versions of the Persistent and Intrusive Negative Thoughts Scale, the Female Sexual Functioning Index, and the International Index of Erectile Function. Results: The main findings showed that women scored significantly higher than men on the RNT. Similarly, individuals with subclinical sexual difficulties scored significantly higher on the RNT compared with individuals without sexual difficulties. RNT was a statistically significant and negative predictor of sexual functioning in women and men. The role of RNT on sexual functioning in women and men was found, with men and women with subclinical sexual difficulties more likely to express persistent and intrusive negative thoughts compared with men and women without sexual difficulties. Conclusions: In summary, RNT appears to be a negative predictor of sexual functioning in both women and men, suggesting that individuals with more intrusive and negative persistent thoughts also have more difficulty in their sexual response.