The effectiveness of interactive digital interventions for sexual problems in adults: a systematic review

Abstract

BackgroundThere is a high prevalence of people with sexual problems (eg, erectile problems or reduced sexual desire) within general practice and sexual health services, and many more people have sexual problems but do not seek help for them. Barriers to seeking help include discomfort and embarrassment discussing sexual problems with health professionals, geographic barriers, and time constraints due to work or childcare commitments, or both. A way to overcome some of these barriers might be to offer help and support via the internet. This systematic review aimed to assess the effectiveness of interactive digital interventions (IDIs) for sexual problems in adults, with the primary outcomes of interest being sexual function, satisfaction, and level of distress. Methods16 databases were searched for randomised controlled trials of IDIs for sexual problems, including CINAHL, CENTRAL, Embase, ERIC, IBSS, Medline, PsycINFO, and Web of Science. Hand searching, reference and citation tracking, and consultation with experts were also used to identify further studies. Relevant authors were contacted for missing information. Searching took place between September, 2012, and January, 2013, with no language or date restrictions. Selection criteria were randomised controlled trials of IDIs for sexual problems, affecting adults aged 18 years or older, irrespective of sex, sexuality, ethnicity, nationality, and type of sexual problem. Two review authors independently screened titles and abstracts, applied eligibility criteria, and extracted full text data. Study quality was assessed with the Cochrane risk of bias assessment method. Separate meta-analyses were done by type of comparator (minimal intervention, face-to-face intervention, different design of IDI) and type of outcome (sexual function, relationship satisfaction, emotional states, quality of life). FindingsNine studies met the inclusion criteria for the review, providing a total sample size of 575 participants with available outcome data. All interventions were cognitive–behavioural in approach. Study investigators reported significant positive effects on sexual and relational outcomes (but not emotional states) in all studies with low risk of bias. The results of meta-analyses comparing IDIs to waitlist controls showed IDIs to have a moderate effect on sexual function (standardised mean difference 0·60, 95% CI 0·03 to 1·17) and a non-significant effect on relationship satisfaction (0·35, −0·34 to 1·04). There were insufficient data available to run meta-analyses on emotional state and quality of life outcomes. There were only two studies that compared IDIs to face-to-face therapy, but one study was deemed high risk in terms of bias and therefore could not be entered into a meta-analysis. We are awaiting further information from authors before running the meta-analyses comparing IDIs to other forms of IDI. InterpretationThe evidence suggests that users can benefit from IDIs for sexual problems. However, well-designed studies with larger numbers of participants are needed to be certain of effects. We also need to understand the effects of different types of digital interventions on a broader range of sexual problems. FundingNIHR SPCR PhD studentship.