March 15, 2017
2 min read

Internet-based cognitive behavioral therapy may improve sexual dysfunction in breast cancer survivors

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Internet-based cognitive behavioral therapy improved sexual dysfunction in breast cancer survivors, according to results of a randomized control study.

“Our findings indicate that internet-based cognitive behavioral therapy has a salutary effect on the sexual functioning, body image and sex-related menopausal symptoms of breast cancer survivors with a Diagnostic and Statistical Manual of Mental Disorders Version IV diagnosis of a sexual dysfunction,” Neil K. Aaronson, PhD, from the division of psychosocial research and epidemiology at Netherlands Cancer Institute in Amsterdam, and colleagues wrote.

Aaronson and colleagues randomly assigned 169 women (mean age, 51.1 years) — from 10 hospitals in the Netherlands — who were breast cancer survivors and had a diagnosis of sexual dysfunction to either Internet-based cognitive behavioral therapy (n =84) or a wait-list control group (n = 85).

Survivors in the wait-list group received an information book about sexuality issues after breast cancer therapy 6 weeks after assignment, whereas patients assigned cognitive behavioral therapy participated in weekly therapist-guided sessions online, with a maximum duration of 24 weeks. Both groups completed self-report questionnaires at baseline, midtherapy and post-therapy.

Researchers measured sexual functioning using the Female Sexual Function Index and the Sexual Activity Questionnaire, and sexual distress with the Female Sexual Distress Scale—Revised.

Most of the patients (94.7%) had a significant other.

More than half of the survivors underwent breast-conserving treatment (56.2%), and 83.4% underwent chemotherapy, 81.1% underwent radiotherapy and 81.7% underwent endocrine therapy.

A majority of women were diagnosed with two sexual dysfunctions (56.2%), and many reported first having experienced sexual problems during treatment for breast cancer (65.7%). The most prevalent sexual dysfunction was hypoactive sexual desire disorder (82.2%), followed by sexual arousal disorder (39.6%) and dyspareunia (32.5%).

Cognitive behavioral therapy was successfully completed by 61.9% of women (mean duration of therapy, 22.1 weeks; standard deviation [SD], 4.5). Behavioral therapy ended prematurely for 31% of patients (mean duration of therapy, 9.6 weeks; SD, 5.8) and was never initiated for 7.1% of patients.

Women who underwent cognitive behavioral therapy showed an improvement over time in overall sexual functioning by posttreatment (effect size [ES], .43; P = .031). This was evident from an increase in sexual desire (ES during therapy, .48; ES posttherapy, .72; P < .001), sexual arousal (ES posttherapy, .5; P = .008) and vaginal lubrication (ES posttherapy = .46; P = .013).

The intervention group also reported more improvement over time in sexual pleasure (ES midtherapy, .32; ES posttherapy, .62; P = .001), less discomfort during sex (ES midtherapy, .49; ES posttherapy, .66; P = .001) and less sexual distress (ES posttherapy, .59; P = .002) compared with the control group.


Further, the intervention group reported greater improvement in body image (ES posttherapy, .45; P = .009) and less menopausal symptoms (ES midtherapy, .39; P = .007).

The reliable change index for the Female Sexual Function Index total score showed that 63.2% of patients in the intervention group experienced a clinically significant change in sexual functioning compared with 32% of patients in the control group. Patients in the intervention group had 3.66 times higher odds of improvement than the control group (P < .001).

Researchers did not observe a significant effect of cognitive behavioral therapy on orgasmic function, sexual satisfaction, intercourse frequency, relationship intimacy, marital functioning, psychological distress or health-related quality of life.

“A next step would be to investigate which elements of the cognitive behavioral therapy contribute most to the efficacy of the intervention and whether comparable outcomes can be achieved with a less intensive or briefer Internet-based intervention,” the researchers wrote. – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.