Skip to main content
Springer Nature Link
Log in

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

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

References

  • Al-Sughayir, M. (2005). Vaginismus treatment: Hypnotherapy versus behavior therapy. Neurosciences, 10, 163–167.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  • 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.

    Article  PubMed  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.

    Article  PubMed  Google 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.

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Bitzer, J., & Brandenburg, U. (2009). Psychotherapeutic interventions for female sexual dysfunction. Maturitas, 63, 160–163. doi:10.1016/j.maturitas.2009.02.2012.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7, 177–188. doi:10.1016/0197-2456(86)90046-2.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google 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.

  • 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.

    Article  PubMed  Google Scholar 

  • Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. London: Academic Press.

    Google Scholar 

  • Heiman, J. R., & Meston, C. M. (1997). Empirically validated treatment for sexual dysfunction. Annual Review of Sex Research, 8, 148–194.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Kockott, G. (2007). Psychotherapie sexueller Funktions- und Erlebensstörungen. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz, 50, 11–18. doi:10.1007/s00103-007-0112-2.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. New York: Bantam Books.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • McGuire, H., & Hawton, K. (2003). Interventions for vaginismus. Cochrane Database of Systematic Reviews (2), CD001760. doi:10.1002/14651858.CD001760.

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • The Epidata Association. (2011). Epi Data Version 3.1 [Computer software]. Retrieved from http://www.epidata.dk/. Accessed 06 Jan 2011.

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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 

  • 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.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

  1. Division of Social and Behavioural Health Research, Institute of Social and Preventive Medicine (ISPM), Niesenweg 6, 3012, Bern, Switzerland

    Sarah Frühauf, Heike Gerger, Hannah Maren Schmidt, Thomas Munder & Jürgen Barth

Authors
  1. Sarah Frühauf
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Heike Gerger
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Hannah Maren Schmidt
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Thomas Munder
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Jürgen Barth
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Jürgen Barth.

Additional information

Sarah Frühauf and Heike Gerger contributed equally.

Appendix

Appendix

Fig. 4
figure 4

Funnel plots of symptom severity and sexual satisfaction from studies of psychological interventions for sexual dysfunction

Full size image

Rights and permissions

Reprints and permissions

About this article

Cite this article

Frühauf, S., Gerger, H., Schmidt, H.M. et al. Efficacy of Psychological Interventions for Sexual Dysfunction: A Systematic Review and Meta-Analysis. Arch Sex Behav 42, 915–933 (2013). https://doi.org/10.1007/s10508-012-0062-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-012-0062-0

Keywords

Profiles

  1. Heike Gerger View author profile
  2. Jürgen Barth View author profile