About this trial

Sexual desire discrepancy (SDD) occurs when partners have different levels of sexual desire and are distressed by it. It is one of the most common reasons couples seek help, but no proven dyadic treatment currently exists. This study will test STEP, an online program designed to support couples with SDD. The investigators will compare two formats of STEP: one with therapist support and one self-guided, against a waitlist control group. The investigators will also assess how satisfied couples are and how they engage with the two online formats. This study will generate new data on how effective STEP is with and without guidance, and inform treatment guidelines.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Be a couple;

Be in a romantic relationship for at least one year;

Be 19 years of age or older;

Experience perceived and/or actual SDD with personal and/or relational distress reported by at least one partner;

Disqualifiers

Cases where the discrepancy is attributable to at least one partner identifying as asexual (asexuality is not considered a sexual dysfunction; APA, 2013);

Presence of untreated psychiatric conditions at the time of recruitment (e.g., depression) that would interfere with participating in the treatment and homework;

Receive dyadic psychosexual treatment for SDD elsewhere during the study period.

Trial design

Design model

Parallel

Treatments tested in this trial

STEP-T
Behavioral
Couples in the STEP-T group will meet online with a therapist for 120 minutes once a week over 8 weeks. Each meeting consists of a therapist-led session focused on the psychoeducational content from the STEP module. Sessions begin with a review of the homework completed during the previous week and end with the assignment of new sex therapy homework related to that day's session. After each session, the therapist will email the couple the module that includes the session's psychoeducational handouts and the sex therapy homework to be completed prior to the next session.
STEP-NT
Behavioral
Couples in the STEP-NT group will receive STEP (i.e., one module per week for 8 weeks, including psychoeducational handouts and sex therapy homework), without the therapist-led online sessions. However, like couples in STEP-T, they will be allowed to contact the research team for clarifications related to the structure, instructions, or technical aspects of the exercises. This support will be limited to non-clinical guidance and will not involve any individualized feedback regarding participants' personal experiences or relationship dynamics.
Waitlist
Other intervention
While couples randomized to STEP-T and STEP-NT will complete one online baseline assessment battery before randomization, those assigned to the waitlist control condition will complete two baseline assessments online, spaced 10 weeks apart, before being randomized to one of the active treatment groups (i.e., STEP-T or STEP-NT). The 10-week waiting period was selected to match the time it takes couples to complete the 8 modules of STEP. This design allows us to determine that improvements in clinical outcomes are due to the STEP intervention rather than the mere passage of time. Following the post-waiting period assessment (i.e., the second baseline battery), waitlist participants will be randomized to STEP-T or STEP-NT.

Treatment groups

216 Participants

are divided into 3 treatment groups

Group A: STEP-TActive comparator 1 intervention

Group B: STEP-NTActive comparator 1 intervention

Group C: WaitlistOther 1 intervention

Trial outcomes

Primary outcomes

1

A change in relational sexual distress

Relational sexual distress will be measured using the 6-item Relational Concern subscale of the 30-item Sexual Satisfaction Scale (SSS; Meston \& Trapnell, 2005).

Time frame

At baseline (T1), post-treatment (2-4 weeks after STEP completion; T2), and 6-month follow-up (T3).

2

A change in personal sexual distress

Personal sexual distress will be measured using the 13-item Female Sexual Distress Scale-Revised (female version: FSDS-R; Derogatis et al., 2008; male version: Santos-Iglesias et al., 2018).

Time frame

At baseline (T1), post-treatment (2-4 weeks after STEP completion; T2), and 6-month follow-up (T3).

3

A change in perceived sexual desire discrepancy

Perceived sexual desire discrepancy will be measured by asking participants questions on their personal desire and their personal perception of partner's desire. Personal desire will be assessed by the 7-item Partner-related sexual desire subscale of the 13-item SDI-2 (Castro-Calvo et al., 2024). The personal perception of partner's desire will be measured by adapting the original version of SDI-2. SDD will be calculated by doing the absolute difference between one's personal desire and the personal perception of partner's desire scores.

Time frame

At baseline (T1), post-treatment (2-4 weeks after STEP completion; T2), and 6-month follow-up (T3).

4

A change in actual sexual desire discrepancy

The actual sexual desire discrepancy will be measured by calculating the absolute difference between both partners' personal desire scores. Personal desire will be assessed by the 7-item Partner-related sexual desire subscale of the 13-item SDI-2 (Castro-Calvo et al., 2024).

Time frame

At baseline (T1), post-treatment (2-4 weeks after STEP completion; T2), and 6-month follow-up (T3).

Secondary outcomes

1

A change in sexual satisfaction

Sexual satisfaction will be measured by the 20-item The New Sexual Satisfaction Scale (NSSS; Stulhofer et al., 2010).

Time frame

At baseline (T1), post-treatment (2-4 weeks after STEP completion, T2), and 6-month follow-up (T3).

2

A change in relational satisfaction

Relational satisfaction will be measured using the 7-item Relationship Satisfaction Scale (RAS; Hendrick et al., 1998).

Time frame

At baseline (T1), post-treatment (2-4 weeks after STEP completion, T2), and 6-month follow-up (T3).

3

A change in sexual pleasure

Sexual pleasure will be measured using the Experiences of Sexual Pleasure Scale (ESPS; Jabs \& Brotto, manuscript in preparation).

Time frame

At baseline (T1), post-treatment (2-4 weeks after STEP completion, T2), and 6-month follow-up (T3).

4

Treatment satisfaction

Treatment satisfaction will be measured by the 11-item Erectile Dysfunction Inventory of Treatment Satisfaction - Patient Version (Patient EDITS; Althof et al., 1999; adapted for use with a dyadic sample with SDD).

Time frame

At post-treatment (2-4 weeks after STEP completion, T2).

Other outcomes

1

Mediator through which STEP-T and STEP-NT improve the primary endpoints (self-compassion/self-criticism)

Self-compassion/self-criticism will be measured by the 26-item Self-Compassion Scale (Costa et al., 2016).

Time frame

At baseline (T1), post-treatment (2-4 weeks after STEP completion, T2), and 6-month follow-up (T3).

2

Mediator through which STEP-T and STEP-NT improve the primary endpoints (Interoceptive awareness)

Interoceptive awareness will be measured by the 37-item Multidimensional Assessment of Interoceptive Awareness (MAIA-2; Mehling et al., 2018).

Time frame

At baseline (T1), post-treatment (2-4 weeks after STEP completion, T2), and 6-month follow-up (T3).

3

Mediator through which STEP-T and STEP-NT improve the primary endpoints (Emotional Intimacy)

Emotional Intimacy will be assessed using the 6-item Emotional Intimacy subscale of the Personal Assessment of Intimacy in Relationships Inventory (PAIR Inventory; Schaefer \& Olson, 1981).

Time frame

At baseline (T1), post-treatment (2-4 weeks after STEP completion, T2), and 6-month follow-up (T3).

4

Mediator through which STEP-T and STEP-NT improve the primary endpoints (Quality of sexual communication)

Quality of sexual communication will be assessed using the 13-item Dyadic Sexual Communication Scale (DSCS; Catania, 2013).

Time frame

At baseline (T1), post-treatment (2-4 weeks after STEP completion, T2), and 6-month follow-up (T3).

Evaluating Sexual Psychoeducation in Couples With Sexual Desire Discrepancy

About this trial

Eligibility criteria

Qualifiers

Disqualifiers

Trial design

Treatments tested in this trial

Treatment groups

Trial outcomes

Primary outcomes

Secondary outcomes

Other outcomes

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