The effects of psychological interventions on sexual function of women: A systematic review and meta-analysis
Abstract
Background & Aim: Despite expand using psychological interventions, there is no obvious evidence about the effects of them on sexual function. The study aimed to determine the effect of psychological interventions based on different approaches to the sexual function of women.
Methods & Materials: Pubmed, ISI, SCOPUS, EMBASE, Cochrane reviews, Science direct, SID, and Magiran were searched up to May 2019. Eligible studies were randomized controlled trials in which the effect of psychological interventions on the sexual function of women was assessed using the Female Sexual Function Index without any limitations based on age, ethnicity, language, and nationality. Two of the authors screened the titles/abstracts and obtained all full text of the candidate studies, independently. The quality of studies was assessed using the Cochrane checklist risk of bias. Meta-analysis performed via standardized mean differences with a random-effects model using Review Manager Software (RevMan) version 5.3.
Results: Twenty-one studies with 1460 participants were included. The most effective psychological intervention was individual and group type (SMD=3.82; 95% CI, 2.56, 5.08; P<0.001) with cognitive approach (SMD=2.50; 95% CI, 1.06, 3.95; P<0.001), especially in women with no specific condition (SMD=2.17; 95% CI, 1.20-3.15; P<0.001). The effect of psychological interventions on sexual function increased from 1.48 in one month to 2.30 and 3.78 in two and three months after the intervention; however, it decreased to 1.43 in six months or more follows ups (all Ps<0.001). There was a significant change in all FSFI domains (all Ps<0.01).
Conclusion: Based on the results, individual and group psychological interventions using the cognitive approach and multidimensional therapies with long term follow-ups are suggested for the treatment of sexual dysfunction.
1. Bae H, Park H. Sexual function, depression, and quality of life in patients with cervical cancer. Supportive care in cancer. 2016 Mar 1;24(3):1277-83.
2. American Psychological Association. Diagnostic and Statistical Manual of Mental Disorder (DSM-V). 5 th ed. Washington, DC, USA: American Psychiatric Publishing; 2013.
3. McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD, Laumann E, Lee SW, Segraves RT. Incidence and prevalence of sexual dysfunction in women and men: a consensus statement from the Fourth International Consultation on Sexual Medicine 2015. The journal of sexual medicine. 2016 Feb 1;13(2):144-52.
4. Mishra VV, Nanda S, Vyas B, Aggarwal R, Choudhary S, Saini SR. Prevalence of female sexual dysfunction among Indian fertile females. Journal of mid-life health. 2016 Oct;7(4):154-58.
5. Çayan S, Yaman Ö, Orhan İ, Usta M, Başar M, Resim S, Aşcı R, Gümüş B, Kadıoğlu A. Prevalence of sexual dysfunction and urinary incontinence and associated risk factors in Turkish women. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2016 Aug 1;203:303-8.
6. Zhang H, Fan S, Yip P. The Association between female sexual dysfunction and the husband's erectile dysfunction: evidence from married couples in Hong Kong. Journal of sex & marital therapy. 2016 Apr 2;42(3):214-22.
7. Mitchell KR, Mercer CH, Ploubidis GB, Jones KG, Datta J, Field N, Copas AJ, Tanton C, Erens B, Sonnenberg P, Clifton S. Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). The Lancet. 2013 Nov 30;382(9907):1817-29.
8. Maiorino MI, Chiodini P, Bellastella G, Giugliano D, Esposito K. Sexual dysfunction in women with cancer: a systematic review with meta-analysis of studies using the Female Sexual Function Index. Endocrine. 2016;54(2): 329-41.
9. Boutari C, Imprialos K.P, Stavropoulos K, Kokkinos P, Pittaras A, Faselis C, Petidis K, Deligkaris P, Stavropoulos N, Athyros V, Karagiannis A, Doumas M. Prevalence of sexual dysfunction in females with resistant hypertension, Journal of Hypertension. 2016 Sep: 34: e259.
10. Wincze JP, Weisberg RB. Sexual dysfunction: A guide for assessment and treatment. Guilford Publications; 2015 May 18.
11. Frühauf S, Gerger H, Schmidt HM, Munder T, Barth J. Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis. Archives of Sexual Behavior. 2013 Aug 1;42(6):915-33.
12. Günzler C, Berner MM. Efficacy of psychosocial interventions in men and women with sexual dysfunctions—a systematic review of controlled clinical trials. The journal of sexual medicine. 2012 Dec 1;9(12):3108-25.
13. Stephenson KR, Kerth J. Effects of mindfulness-based therapies for female sexual dysfunction: A meta-analytic review. The Journal of Sex Research. 2017 Sep 2;54(7):832-49.
14. Uman LS. Systematic reviews and meta-analyses. Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2011 Feb;20(1):57-9.
15. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JA. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj. 2011 Oct 18;343:d5928.
16. Cohen J. Statistical power analysis for the behavioral sciences. Erlbaum Associates, Hillsdale; 1988.
17. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I² index?. Psychological methods. 2006 Jun;11(2):193-206.
18. Afshar M, Mohammad-Alizadeh-Charandabi S, Merghti-Khoei ES, Yavarikia P. The effect of sex education on the sexual function of women in the first half of pregnancy: a randomized controlled trial. Journal of caring sciences. 2012 Dec;1(4):173-81.
19. Hezbiiyan Z, Khodakarami B, Parsa P, Faradmal MJ. The effect of postnatal counseling on sexual function in women referred to health centers in Hamedan in 1392. Avicenna Journal of Nursing and Midwifery Care. 2016 Dec 10;24(4):272-80.
20. Hosseini N, Amini A, Alamdari A, Shams M, Vossoughi M, Bazarganipour F. Application of the PRECEDE model to improve sexual function among women with hysterectomy. International Journal of Gynecology & Obstetrics. 2016 Feb 1;132(2):229-33.
21. Jones LM, McCabe MP. The effectiveness of an internet‐based psychological treatment program for female sexual dysfunction. The Journal of Sexual Medicine. 2011 Oct 1;8(10):2781-92.
22. Khakbazan Z, Daneshfar F, Behboodi-Moghadam Z, Nabavi SM, Ghasemzadeh S, Mehran A. The effectiveness of the Permission, Limited Information, Specific suggestions, Intensive Therapy (PLISSIT) model based sexual counseling on the sexual function of women with Multiple Sclerosis who are sexually active. Multiple sclerosis and related disorders. 2016 Jul 1;8:113-9.
23. Moradi M, Geranmayeh M, Mirmohammadali M, Mehran A. The effect of sexual counseling on sexual function in women with type 2 diabetes mellitus. Journal of hayat. 2016 Jul 15;22(2):148-58.
24. Masheb RM, Kerns RD, Lozano C, Minkin MJ, Richman S. A randomized clinical trial for women with vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy. PAIN®. 2009 Jan 1;141(1-2):31-40.
25. Rostamkhani F, Ozgoli G, Khoei EM, Jafari F, Majd HA. Effectiveness of the PLISSIT-based Counseling on sexual function of women. Journal of Shahid Beheshti School of Nursing & Midwifery. 2012;22(76): 1-9.
26. Soltani A, Rezaei F, Razavi V. The Effectiveness of Barlow's cognitive-affective counseling on Female Sexual Frigidity Treatment in Isfahan. JSR. 2017 Feb 15;17(3):81-9.
27. Tork Zahrani SH, Azad M, Ozgoli G, Banaei M, Mahmoudikohani F. The effectiveness of consultation based on plissit model on sexual function of lactating women. The J Urmia Nurs Midwifery Fac. 2016;14(7):639-47.
28. Ziaee P, Sepehri Shamlou Z, Mashhadi A. The effectiveness of sexual education focused on cognitive schemas, on the improvement of sexual functioning among female married students. Evidence Based Care. 2014 Jul 1;4(2):73-82.
29. Tutuncu B, Yildiz H. The influence on women’s sexual functions of education given according to the PLISSIT model after hysterectomy. Procedia Soc Behav Sci. 2012 Jan 1;47:2000-4.
30. Behboodi Moghadam Z, Rezaei E, Yalegonbadi K, Montazeri A, Arzaqi SM, Tavakol Z, Yari F. The effect of sexual health education program on women sexual function in Iran. Journal of research in health sciences. 2015;15(2):124-28.
31. Chun N. Effectiveness of PLISSIT model sexual program on female sexual function for women with gynecologic cancer. Journal of Korean Academy of Nursing. 2011 Aug 1;41(4):471-80.
32. Nho JH. Effect of PLISSIT Model Sexual Health Enhancement Program for Women with Gynecologic Cancer and Their Husbands. Journal of Korean Academy of Nursing. 2013 Oct 1;43(5).
33. Alimohammadi L, Mirghafourvand M, Zarei F, Pirzeh R. The effectiveness of group counseling based on Bandura's self-efficacy theory on sexual function and sexual satisfaction in Iranian newlywed women: A randomized controlled trial. Applied Nursing Research. 2018 Aug 1;42:62-9.
34. Faghani S, Ghaffari F. Effects of sexual rehabilitation using the PLISSIT model on quality of sexual life and sexual functioning in post-mastectomy breast cancer survivors. Asian Pacific journal of cancer prevention: APJCP. 2016;17(11):4845-51.
35. Fatehi S, Maasoumi R, Atashsokhan G, Hamidzadeh A, Janbabaei G, Mirrezaie SM. The effects of psychosexual counseling on sexual quality of life and function in Iranian breast cancer survivors: a randomized controlled trial. Breast cancer research and treatment. 2019 May 15;175(1):171-9.
36. Golbabaei F, Jamshidimanesh M, Ranjbar H, Azin SA, Moradi S. Efficacy of Sexual Counseling based on PLISSIT Model on Sexual Functioning in Women with Polycystic Ovarian Syndrome. Journal of Mazandaran University of Medical Sciences. 2019 May 15;29(172):43-52.
37. Nejati B, Kazemi F, Masoumi SZ, Parsa P, Karami M, Mortazavi A. Efficacy of sexual consultation based on PLISSIT model (Permission, Limited Information, Specific Suggestions, Intensive Therapy) on sexual function among pregnant women: a randomized controlled clinical trial. Journal of Isfahan Medical School. 2017;35(435):739-48.
38. Khoei M. The effect of Counseling using the PLISSIT Model on Sexual Function of Pregnant Women. Preventive Care in Nursing & Midwifery Journal. 2016 Jun 10;6(1):18-28.
39. Feltham C, Hanley T, Winter LA, editors. The SAGE handbook of counselling and psychotherapy. Sage; 2017 Sep 20.
40. Gabbard GO. Long-term psychodynamic psychotherapy: A basic text. American Psychiatric Pub; 2017 Feb 13.
41. Woolfe R, Dryden W, Strawbridge S, editors. Handbook of counselling psychology. Sage; 2003 Apr 3.
42. Assalian P. Psychological and interpersonal dimensions of sexual function and dysfunction. Arab journal of urology. 2013 Sep 1;11(3):217-21.
43. Mohammadi SD, Mohammadkhani P, Dolatshahi B, Dadkhah A. Effectiveness of cognitive behavioral therapy on the signs, symptoms and clinical consequences of premature ejaculation. Japanese Psychological Research. 2013 Oct;55(4):350-7.
44. Avagianou PA. Cognitive behavioral therapy in sexual dysfunction. InErectile Dysfunction in Hypertension and Cardiovascular Disease 2015 (pp. 205-211). Springer, Cham.
45. Ninivaggio C, Rogers RG, Leeman L, Migliaccio L, Teaf D, Qualls C. Sexual function changes during pregnancy. International urogynecology journal. 2017 Jun 1;28(6):923-9.
46. Adelman MR, Sharp HT. Ovarian conservation vs removal at the time of benign hysterectomy. American journal of obstetrics and gynecology. 2018 Mar 1;218(3):269-79.
47. Cornell LF, Mussallem DM, Gibson TC, Diehl NN, Bagaria SP, McLaughlin SA. Trends in sexual function after breast cancer surgery. Annals of surgical oncology. 2017 Sep 1;24(9):2526-38.
48. Hertlein KM, Gambescia N, Weeks GR, editors. Systemic sex therapy. Routledge; 2015 Feb 20.
2. American Psychological Association. Diagnostic and Statistical Manual of Mental Disorder (DSM-V). 5 th ed. Washington, DC, USA: American Psychiatric Publishing; 2013.
3. McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD, Laumann E, Lee SW, Segraves RT. Incidence and prevalence of sexual dysfunction in women and men: a consensus statement from the Fourth International Consultation on Sexual Medicine 2015. The journal of sexual medicine. 2016 Feb 1;13(2):144-52.
4. Mishra VV, Nanda S, Vyas B, Aggarwal R, Choudhary S, Saini SR. Prevalence of female sexual dysfunction among Indian fertile females. Journal of mid-life health. 2016 Oct;7(4):154-58.
5. Çayan S, Yaman Ö, Orhan İ, Usta M, Başar M, Resim S, Aşcı R, Gümüş B, Kadıoğlu A. Prevalence of sexual dysfunction and urinary incontinence and associated risk factors in Turkish women. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2016 Aug 1;203:303-8.
6. Zhang H, Fan S, Yip P. The Association between female sexual dysfunction and the husband's erectile dysfunction: evidence from married couples in Hong Kong. Journal of sex & marital therapy. 2016 Apr 2;42(3):214-22.
7. Mitchell KR, Mercer CH, Ploubidis GB, Jones KG, Datta J, Field N, Copas AJ, Tanton C, Erens B, Sonnenberg P, Clifton S. Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). The Lancet. 2013 Nov 30;382(9907):1817-29.
8. Maiorino MI, Chiodini P, Bellastella G, Giugliano D, Esposito K. Sexual dysfunction in women with cancer: a systematic review with meta-analysis of studies using the Female Sexual Function Index. Endocrine. 2016;54(2): 329-41.
9. Boutari C, Imprialos K.P, Stavropoulos K, Kokkinos P, Pittaras A, Faselis C, Petidis K, Deligkaris P, Stavropoulos N, Athyros V, Karagiannis A, Doumas M. Prevalence of sexual dysfunction in females with resistant hypertension, Journal of Hypertension. 2016 Sep: 34: e259.
10. Wincze JP, Weisberg RB. Sexual dysfunction: A guide for assessment and treatment. Guilford Publications; 2015 May 18.
11. Frühauf S, Gerger H, Schmidt HM, Munder T, Barth J. Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis. Archives of Sexual Behavior. 2013 Aug 1;42(6):915-33.
12. Günzler C, Berner MM. Efficacy of psychosocial interventions in men and women with sexual dysfunctions—a systematic review of controlled clinical trials. The journal of sexual medicine. 2012 Dec 1;9(12):3108-25.
13. Stephenson KR, Kerth J. Effects of mindfulness-based therapies for female sexual dysfunction: A meta-analytic review. The Journal of Sex Research. 2017 Sep 2;54(7):832-49.
14. Uman LS. Systematic reviews and meta-analyses. Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2011 Feb;20(1):57-9.
15. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JA. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj. 2011 Oct 18;343:d5928.
16. Cohen J. Statistical power analysis for the behavioral sciences. Erlbaum Associates, Hillsdale; 1988.
17. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I² index?. Psychological methods. 2006 Jun;11(2):193-206.
18. Afshar M, Mohammad-Alizadeh-Charandabi S, Merghti-Khoei ES, Yavarikia P. The effect of sex education on the sexual function of women in the first half of pregnancy: a randomized controlled trial. Journal of caring sciences. 2012 Dec;1(4):173-81.
19. Hezbiiyan Z, Khodakarami B, Parsa P, Faradmal MJ. The effect of postnatal counseling on sexual function in women referred to health centers in Hamedan in 1392. Avicenna Journal of Nursing and Midwifery Care. 2016 Dec 10;24(4):272-80.
20. Hosseini N, Amini A, Alamdari A, Shams M, Vossoughi M, Bazarganipour F. Application of the PRECEDE model to improve sexual function among women with hysterectomy. International Journal of Gynecology & Obstetrics. 2016 Feb 1;132(2):229-33.
21. Jones LM, McCabe MP. The effectiveness of an internet‐based psychological treatment program for female sexual dysfunction. The Journal of Sexual Medicine. 2011 Oct 1;8(10):2781-92.
22. Khakbazan Z, Daneshfar F, Behboodi-Moghadam Z, Nabavi SM, Ghasemzadeh S, Mehran A. The effectiveness of the Permission, Limited Information, Specific suggestions, Intensive Therapy (PLISSIT) model based sexual counseling on the sexual function of women with Multiple Sclerosis who are sexually active. Multiple sclerosis and related disorders. 2016 Jul 1;8:113-9.
23. Moradi M, Geranmayeh M, Mirmohammadali M, Mehran A. The effect of sexual counseling on sexual function in women with type 2 diabetes mellitus. Journal of hayat. 2016 Jul 15;22(2):148-58.
24. Masheb RM, Kerns RD, Lozano C, Minkin MJ, Richman S. A randomized clinical trial for women with vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy. PAIN®. 2009 Jan 1;141(1-2):31-40.
25. Rostamkhani F, Ozgoli G, Khoei EM, Jafari F, Majd HA. Effectiveness of the PLISSIT-based Counseling on sexual function of women. Journal of Shahid Beheshti School of Nursing & Midwifery. 2012;22(76): 1-9.
26. Soltani A, Rezaei F, Razavi V. The Effectiveness of Barlow's cognitive-affective counseling on Female Sexual Frigidity Treatment in Isfahan. JSR. 2017 Feb 15;17(3):81-9.
27. Tork Zahrani SH, Azad M, Ozgoli G, Banaei M, Mahmoudikohani F. The effectiveness of consultation based on plissit model on sexual function of lactating women. The J Urmia Nurs Midwifery Fac. 2016;14(7):639-47.
28. Ziaee P, Sepehri Shamlou Z, Mashhadi A. The effectiveness of sexual education focused on cognitive schemas, on the improvement of sexual functioning among female married students. Evidence Based Care. 2014 Jul 1;4(2):73-82.
29. Tutuncu B, Yildiz H. The influence on women’s sexual functions of education given according to the PLISSIT model after hysterectomy. Procedia Soc Behav Sci. 2012 Jan 1;47:2000-4.
30. Behboodi Moghadam Z, Rezaei E, Yalegonbadi K, Montazeri A, Arzaqi SM, Tavakol Z, Yari F. The effect of sexual health education program on women sexual function in Iran. Journal of research in health sciences. 2015;15(2):124-28.
31. Chun N. Effectiveness of PLISSIT model sexual program on female sexual function for women with gynecologic cancer. Journal of Korean Academy of Nursing. 2011 Aug 1;41(4):471-80.
32. Nho JH. Effect of PLISSIT Model Sexual Health Enhancement Program for Women with Gynecologic Cancer and Their Husbands. Journal of Korean Academy of Nursing. 2013 Oct 1;43(5).
33. Alimohammadi L, Mirghafourvand M, Zarei F, Pirzeh R. The effectiveness of group counseling based on Bandura's self-efficacy theory on sexual function and sexual satisfaction in Iranian newlywed women: A randomized controlled trial. Applied Nursing Research. 2018 Aug 1;42:62-9.
34. Faghani S, Ghaffari F. Effects of sexual rehabilitation using the PLISSIT model on quality of sexual life and sexual functioning in post-mastectomy breast cancer survivors. Asian Pacific journal of cancer prevention: APJCP. 2016;17(11):4845-51.
35. Fatehi S, Maasoumi R, Atashsokhan G, Hamidzadeh A, Janbabaei G, Mirrezaie SM. The effects of psychosexual counseling on sexual quality of life and function in Iranian breast cancer survivors: a randomized controlled trial. Breast cancer research and treatment. 2019 May 15;175(1):171-9.
36. Golbabaei F, Jamshidimanesh M, Ranjbar H, Azin SA, Moradi S. Efficacy of Sexual Counseling based on PLISSIT Model on Sexual Functioning in Women with Polycystic Ovarian Syndrome. Journal of Mazandaran University of Medical Sciences. 2019 May 15;29(172):43-52.
37. Nejati B, Kazemi F, Masoumi SZ, Parsa P, Karami M, Mortazavi A. Efficacy of sexual consultation based on PLISSIT model (Permission, Limited Information, Specific Suggestions, Intensive Therapy) on sexual function among pregnant women: a randomized controlled clinical trial. Journal of Isfahan Medical School. 2017;35(435):739-48.
38. Khoei M. The effect of Counseling using the PLISSIT Model on Sexual Function of Pregnant Women. Preventive Care in Nursing & Midwifery Journal. 2016 Jun 10;6(1):18-28.
39. Feltham C, Hanley T, Winter LA, editors. The SAGE handbook of counselling and psychotherapy. Sage; 2017 Sep 20.
40. Gabbard GO. Long-term psychodynamic psychotherapy: A basic text. American Psychiatric Pub; 2017 Feb 13.
41. Woolfe R, Dryden W, Strawbridge S, editors. Handbook of counselling psychology. Sage; 2003 Apr 3.
42. Assalian P. Psychological and interpersonal dimensions of sexual function and dysfunction. Arab journal of urology. 2013 Sep 1;11(3):217-21.
43. Mohammadi SD, Mohammadkhani P, Dolatshahi B, Dadkhah A. Effectiveness of cognitive behavioral therapy on the signs, symptoms and clinical consequences of premature ejaculation. Japanese Psychological Research. 2013 Oct;55(4):350-7.
44. Avagianou PA. Cognitive behavioral therapy in sexual dysfunction. InErectile Dysfunction in Hypertension and Cardiovascular Disease 2015 (pp. 205-211). Springer, Cham.
45. Ninivaggio C, Rogers RG, Leeman L, Migliaccio L, Teaf D, Qualls C. Sexual function changes during pregnancy. International urogynecology journal. 2017 Jun 1;28(6):923-9.
46. Adelman MR, Sharp HT. Ovarian conservation vs removal at the time of benign hysterectomy. American journal of obstetrics and gynecology. 2018 Mar 1;218(3):269-79.
47. Cornell LF, Mussallem DM, Gibson TC, Diehl NN, Bagaria SP, McLaughlin SA. Trends in sexual function after breast cancer surgery. Annals of surgical oncology. 2017 Sep 1;24(9):2526-38.
48. Hertlein KM, Gambescia N, Weeks GR, editors. Systemic sex therapy. Routledge; 2015 Feb 20.
| Files | ||
| Issue | Vol 7 No 3 (2020): Summer | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/npt.v7i3.3345 | |
| Keywords | ||
| psychological techniques; sexual dysfunction; women; meta-analysis; randomized controlled trial | ||
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How to Cite
1.
Kharaghani R, Esm Khani M, Mahmoodi Dangesaraki M, Damghanian M. The effects of psychological interventions on sexual function of women: A systematic review and meta-analysis. NPT. 2020;7(3):169-182.
