CBT Improved Sex Life For Peri-Menopausal Women

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Cognitive behavioral therapy tied to better satisfaction and desire

by
Sophie Putka, Enterprise & Investigative Writer, MedPage Today
September 17, 2024

CHICAGO — Peri- and post-menopausal women who had cognitive behavioral therapy (CBT) for sexual concerns reported improvements in a range of symptoms after four sessions, according to a small trial.

Results included a significant change in overall score on the Female Sexual Function Index (FSFI; Cohen’s d 0.87, P<0.001), a questionnaire that included desire, arousal, lubrication, orgasm, satisfaction, and pain domains, Sheryl Green, PhD, of McMaster University in Ontario, Canada, reported at the annual meeting of the Menopause Society.

Treatment had moderate to large effect sizes on most of the 11 scales used to measure symptoms, she reported.

“We saw significant improvement on all of these subscales by post-treatment,” Green said during her presentation. “On a couple of measures that are related to sexual concerns — so body image and couples satisfaction — we saw significant improvements there, and we all actually did see that trickle-down effect that CBT does have on other symptoms that we don’t directly target in treatments, including depression, hot flashes, anxiety, and overall self-reported health.”

With the loss of estrogen during menopause, women can experience a range of sexual concerns, including vaginal dryness, reduced sexual desire and sensitivity, and discomfort or pain during sex. Hormone therapy is an effective treatment for these issues, but not all women are good candidates due to contraindications or personal preference.

“Not everyone wants to take medication for sexual concerns. And … a lot of people who are on hormone therapy and other medications are still experiencing significant clinical distress and dysfunction related to sexual concerns in spite of taking the medication,” Green said. “So there is a need for a nonpharmacological treatment option as an alternative or complementary form of treatment.”

Previous studies have found CBT effective in reducing hot flashes, depression, anxiety, and sleep difficulties, but sexual concerns have not yet been the primary target in CBT protocols for menopause, Green said. Research suggests that these sexual concerns are reported by 68% to 87% of women.

According to Jen Gunter, MD, of San Francisco Medical Center, some clinicians have expressed skepticism about the use of CBT for physical symptoms of menopause like hot flashes. “Thoughts and mood affect our physical experience; of course, the reverse is true,” Gunter wrote in her newsletter following the meeting, referring to CBT for hot flashes. “More science-backed options are good for women. That is the hill I will die on.”

For the study, researchers used phone screening to recruit 30 women ages 40-60, in peri- or post-menopause, with an FSFI score less than 26 for an intention-to-treat analysis. Symptom measures included the FSFI, the Female Sexual Desire Questionnaire (FSDQ), and the Female Sexual Distress Scale-Revised for sexual satisfaction, distress, and desire; the Greene Climacteric Scale (GCS) and Hot Flash Rated Daily Interference Scale for menopause symptoms; along with other questionnaires for body image, relationship satisfaction, depression, and anxiety.

Participants were assessed on all measures at three timepoints: at baseline, after a 4-week waitlist control condition, and after four individual CBT sessions. CBT sessions included, among other approaches, psychoeducation, thought monitoring, identifying cognitive distortions and “unhelpful beliefs/expectations” related to their sexual concerns, behavioral experiments, and cognitive strategies to use in the future.

The mean age of participants was about 50, 80% were white, and 86.7% were married. Half of the women were using hormone therapy, and 63.3% were taking psychotropic medications. The most common sexual concerns were decreased sexual desire (96.7%), decreased sexual arousal (86.7%), and body image (60%).

Notably, the treatment effects were largest for desire and satisfaction domains on the FSFI (Cohen’s d 1.25 and 0.92, respectively, P<0.001 for both); the dyadic desire and concern domains of the FSDQ; the psychological domain of the GCS; and a measure for depression, the Beck Depression Inventory-II.

Participant scores did not change from baseline through the 4-week waitlist period, except on the FSDQ concern subscale and GCS physical domains.

Patients also completed a client satisfaction questionnaire (CSQ) after treatment. On the 32-point scale, participants indicated that they were satisfied with the intervention, with scores ranging from 29-32.

Study limitations included a small sample size, self-reported outcomes, and that it was not a randomized controlled trial design. The study was also short, and a number of participants expressed in their client satisfaction questionnaire that they wished the treatment program was longer. Researchers also did not break down outcomes by individual providers of CBT.