About a third of sexually active women experience either no or very low levels of sexual interest, desire, and arousal which can sometimes be a source of unhappiness and distress. Psychological treatments for low sexual desire include cognitive behavioral approaches (CBT) to challenge negative thoughts that can interfere with sexual arousal, and mindfulness-based approaches (MBI) to help focus on pleasurable sensations without distraction from interfering thoughts.

Both treatments have been shown to be more effective than no-treatment controls. Internet-based CBT and MBI for low sexual desire have the potential to make treatment more affordable and accessible.  

Velten et al. [Journal of Clinical and Consulting Psychology] tested the relative efficacy of internet-based CBT and MBI approaches vs. a waitlist control on symptoms of low sexual desire and sexual distress among women with low sexual desire.

The researchers randomly assigned 266 German women (average age=36 years) who met the diagnostic criteria for both hyposexual desire dysfunction (ICD-11 diagnosis) and sexual interest and arousal disorder (DSM-5 diagnosis) to an internet-based CBT, an internet-based MBI, or a waitlist control. Both active treatments consisted of eight online individual treatment modules, with participants instructed to complete one module per week. CBT and MBI included didactic presentations, guided exercises, and standard elements of sex education and therapy. 

Participants were assessed on sexual desire (primary outcome) and sexual distress (secondary outcome) with online self-report questionnaires at baseline, 5 weeks, and 3-, 6-, and 12-month follow-ups. The intent-to-treat analytic results showed that both treatment groups had significant large-sized increases (d=1.14 and 1.11) in sexual desire at 5 weeks and moderate-sized increases (d=0.75 and 0.74) in sexual desire at 3 months compared to the control group.

There were also significant, large-sized decreases in sexual distress (d=-1.14 and -0.98) at 5 weeks, which were sustained at 3 months (d=-1.18 and -1.00). All shorter-term improvements were maintained at 6- and 12-month follow-up. 

However, not all participants improved in the treatment groups based on a predetermined objective score set by the researchers. At 12-month follow-up, only 20-24% of the women showed clinically meaningful improvement in sexual desire, and only 37-42% had showed clinically meaningful improvement in sexual distress. Indeed, 35-45% of the women showed no improvement in sexual desire, and 12-16% showed no improvement in sexual distress.

The study reveals that internet-based CBT and MBI treatments show equal benefit in increasing sexual desire and decreasing sexual distress among women with low sexual desire, though most participants do not achieve clinically meaningful improvement.

The study is limited by a high dropout rate that was similar across all groups, a common problem in internet-based treatment studies, with only 46% of participants completing the 3-month follow-up and 31% completing the 12-month follow-up.

Reference:

Velten, J., Hirschfeld, G., Meyers, M., & Margraf, J. (2024). Results of a randomized waitlist-controlled trial of online cognitive behavioral sex therapy and online mindfulness-based sex therapy for hypoactive sexual desire dysfunction in women. Journal of Consulting and Clinical Psychology.

Link to study