About this trial
Sexual health is a fundamental aspect of quality of life; a satisfying sexual relationship is linked to better physical, psychological, and relationship health and well-being. In fact, people who maintain a satisfying, active sex life over time live longer than those who report lower sexual frequency and satisfaction. Yet problems with sexual function are extremely common, especially for women: chronic difficulties with sexual desire and/or arousal that are personally upsetting-Sexual Interest/Arousal Disorder (SIAD)-affects 7% to 23% of the general population. SIAD is linked to more healthcare costs, depressive symptoms and anxiety, and lower relationship satisfaction. Experts suggest that relationship factors play a critical role in SIAD and couple-based sex therapy is a common approach used by clinicians. However, there are no treatment options available for couples that have been tested in research to confirm that they work. The goal of this three-centre randomized clinical trial is to evaluate the efficacy of a novel 16-session cognitive-behavioural couple therapy (CBCT), offered online to increase accessibility, for an inclusive sample of women with SIAD compared to a waitlist control group. The investigators expect that, compared to a waitlist control group, CBCT will lead to greater improvements in SIAD symptoms (e.g., higher sexual desire/arousal, lower sexual distress) and better sexual, relational, and psychological adjustment for both partners at post-treatment and 6-months later. Given that less than a third of those affected by SIAD access treatment, this study addresses the urgent need for an accessible couple-based treatment for the most common sexual dysfunction. Results will be used by clinicians to provide couples with a scientifically based, accessible treatment option, that will improve their sexual, relationship, and psychological health.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
One member of the couple must identify as a cisgender woman, a trans woman, or a gender diverse person assigned female at birth;
One member of the couple must meet diagnostic criteria for SIAD;
Both partners must be fluent in English or French;
Both partners must be in a committed, cohabiting relationship for at least one year (with a partner of any gender/sex).
Disqualifiers
Pregnancy, breastfeeding or one year postpartum;
No prior sexual experience;
Severe relational distress or conflict as determined by baseline measures and interview;
Are currently undergoing treatment for SIAD, or are in couple or sex therapy.
Trial design
Parallel
Treatments tested in this trial
Cognitive-behavioral therapy
Other interventionThe intervention will be delivered in 16, 60-minute sessions (1st session 90 mins). The treatment manual was informed by a 12-session (75 min each) CBCT developed by our team for genito-pelvic pain. The SIAD manual focuses on empirically supported interpersonal factors relevant to SIAD, informed by the Interpersonal Emotion Regulation Model of women's sexual dysfunction. The goals of the CBCT are to: (1) re-conceptualize low sexual desire/arousal as multidimensional in which both partners affect and are affected by the SIAD symptoms (2) modify and/or accept those factors that are associated with low sexual desire/arousal to increase adaptive coping, facilitate sexual desire/arousal, and reduce sexual distress, (3) as per our theoretical model, improve couple interactions related to sexuality (e.g., communication, intimacy) via enhanced emotion regulation, and (4) consolidate skills.
Treatment groups
Trial outcomes
Primary outcomes
Sexual Desire
As a core symptom of SIAD, partner-focused dyadic sexual desire will be assessed using the 7-item subscale of the Sexual Desire Inventory. This subscale measures interest in sexual activity, including one's thoughts on approaching or being responsive to sexual stimuli with a partner, in a Likert-type response format (e.g., 1 = not at all, 7 = a lot). Higher scores indicate greater partner-focused dyadic sexual desire. For the in-treatment surveys, a shorter version of the Sexual Desire Inventory-2, including two items, will be used to minimize participant burden. This version has been used in prior studies and showed adequate psychometric properties.
Sexual Distress
As a core symptom of SIAD, sexual distress will be measured with the 5-item Sexual Distress Scale-SF (SDS-SF). Using a 5-point Likert scale, participants rate how frequently (e.g., 1 = never, to 5 = always) they experience an emotion or sexuality related problem. These items showed greatest function at the item level, greatest contribution to the scale's reliability, and good capacity to discriminate between participants with distressing sexual problems and those without distressing sexual problems. This measure is valid regardless of whether participants are sexually active. For the in-treatment surveys, the three-item version of the SDS-SF will be used to minimize participant burden. It has been used in previous studies and showed adequate psychometric properties.
Secondary outcomes
Sexual Satisfaction
The Global Measure of Sexual Satisfaction (GMSEX) assesses overall sexual satisfaction. This scale consists of five items assessing a subjective evaluation of the sexual relationship on five 7-point dimensions: good vs. bad, pleasant vs. unpleasant, positive vs. negative, satisfying vs. unsatisfying, and valuable vs. worthless. Ratings are summed such that possible scores range from 5 to 35, with higher scores indicating greater sexual satisfaction. For the in-treatment surveys, a one-item measure of sexual satisfaction will be used to minimize participant burden. Previously used by our team and showing adequate psychometric properties, the single-item measure asks participants to rate, on a scale of 1 (Very dissatisfied) to 5 (Very satisfied), their answer to the following question: "Since the last survey, how satisfied have you been with your relationship with your partner?".
Relationship Satisfaction
It will be assessed with the 16-item Couples Satisfaction Index. Participants will rate their relationship on a number of factors. For example, participants will indicate how happy they are with their relationship, how frequently they disagree with their partner, and how they feel their relationship compares to others. For the in-treatment surveys, participants will fill the four-item shorter version.
Relationship intimacy
Intimacy will be measured using 9 items on a 7-point scale (1 = not at all, 7 = a lot) where participants rate in general how much they perceived their partner to be responsive, self- and partner-disclosure of private thoughts and feelings and the level of overall intimacy they feel in their relationship.
Psychological adjustment
It will be measured using the Hospital Anxiety and Depression Scale. This 14-item measure includes two subscales: depression (seven items) and anxiety (seven items). Using a time reference of the last 7 days, participants score each item on a scale from 0 (e.g., Not at all) to 3 (e.g., Most of the time), with higher scores indicating greater severity of symptoms. This measure has been shown to have good reliability and validity.
Sponsors and contacts
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Dalhousie University
Lead sponsor
Université de Montréal
Collaborator
University of British Columbia
Collaborator