Sex Therapy – does it work? A systematic review

This was done by two people independently and using published checklists. 50 articles filled the inclusion criteria, with 15 systematic reviews and 35 articles, covering more than 600 scientific publications. 9 systematic reviews and 34 randomized, controlled trials on the treatment of sexual dysfunctions and 6 systematic reviews and one RCT on sexual offender treatment: We performed the first meta-analysis of the effects of sexual therapies for these conditions. In addition to published systematic reviews for sexological interventions in men we found four randomized, controlled trials, and in addition to four systematic reviews we found 12 randomised controlled trials on the effects of sexological interventions in women. Many of the included studies were of moderate methodological quality. For many comparisons it was not possible to pool the results and we could only report from single studies. We have pooled results in meta-analysis.

For female sexual dysfunction 7 studies on orgastic dysfunction (OD) showed an overall treatment effect on coital orgasmic frequency (odds ratio) of 3,66 (1,76–7.64). The findings were significant for primary OD, and near significant for sendary OD. Directed mastubation improved female orgastic dysfunction (Odds Ratio 2,7 (1,55–4,69). Three articles on hypoactive sexual desire disorder were included, with significant improvement. One article was included on sexual arousal disorder. Four studies on treating vaginismus were pooled, but did not reach statistical significance.

For male sexual dysfunctions there have been published Cochrane reviews on Erectile dysfunction and premature ejaculation. Latency time is improved with behavioral therapy and sex therapy gives additional effect to medication, improves adherence and provides statistically better outcome for erectile dysfunction (Risk ratio for persistent erectile dysfunction 0,40 (0,17–0,98)). Three studies of 242 couples indicate that couples therapy with communication training and confiictsolving supplemented with sex therapy have positive effects on several outcome measures.

There is a modest, but significant effect of bibliotherapy. Most of the self-help literature studied in 2 systematic reviews was on female orgastic disorder and premature ejaculation. There is an overall positive effect across interventions and populations. This is shown for a broad spectrum of populations and sexual problems. However, we cannot rule out a possible publication bias in the material. There is a large variation of outcome measures in the literature. Interventions in the research literature do not appear to be entirely representative for the array of treatment methods that are offered for sexual problems and dysfunctions in men and women.