Download PDF
Z Sex Forsch 2017; 30(03): 213-247
DOI: 10.1055/s-0043-117321
Originalarbeiten
Georg Thieme Verlag KG Stuttgart · New York

Psychosoziale Interventionen für sexuelle Funktionsstörungen bei Frauen

Psychosocial Interventions for Female Sexual Dysfunction
Hannah Maren Schmidt
a   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
,
Cindy Höhna
a   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
,
Eugen Widmeier
a   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
,
Michael Martin Berner
a   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
› Author Affiliations
Further Information

Publication History

Publication Date:
05 October 2017 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Diese Arbeit gibt eine systematische Übersicht über Studien zur Wirksamkeit psychosozialer Interventionen bei Frauen mit sexuellen Funktionsstörungen. Die eingeschlossenen Studien sind randomisierte kontrollierte Studien (RCT) und kontrollierte klinische Studien (CCT), publiziert zwischen 1985 und 2014, welche mindestens eine psychosoziale Intervention im Vergleich zu einer aktiven Vergleichsgruppe (z. B. andere psychosoziale Intervention, medikamentöse oder somatische Behandlung) oder Kontrollgruppe (z. B. Warteliste, Placebo) untersuchen. Die Diagnose der sexuellen Funktionsstörung muss formal nach ICD-10/9 oder DSM-IV/III-R oder durch eine Fachperson gestellt worden sein. Studiencharakteristika und Ergebnisse sind durch zwei unabhängige Rater_innen nach einem standardisierten Manual extrahiert worden, ebenso das Risiko einer systematischen Verzerrung (Risk of Bias). Wir haben 19 Studien eingeschlossen. Sexuell bedingte Schmerzen werden am häufigsten untersucht. Die meisten psychosozialen Interventionen zeigen signifikante Verbesserungen im Vergleich zu einer Wartekontrollgruppe für verminderte sexuelle Appetenz und sexuell bedingte Schmerzen, wobei die Effekte über eine Follow-up-Periode meist erhalten bleiben. Für Orgasmusstörungen sind die Ergebnisse uneinheitlich. Erregungsstörungen werden nicht getrennt von anderen sexuellen Funktionsstörungen untersucht. Die meisten Studien untersuchen ein kognitiv-verhaltenstherapeutisches oder ein klassisch sexualtherapeutisches Behandlungskonzept. Eine willkommene Entwicklung ist es, dass in den jüngsten Studien weitere, teilweise neuartige Behandlungsansätze (z. B. interpersonelle und achtsamkeitsbasierte Ansätze sowie expressives Schreiben) geprüft werden. Eine genaue Berichterstattung und die Einhaltung methodischer Qualitätsstandards werden empfohlen.

Abstract

In this systematic review we examine the efficacy of psychosocial interventions for female sexual dysfunction. We included randomized controlled trials (RCT) and controlled clinical trials (CCT) that were published between 1985 and 2014 and which examined at least one psychosocial intervention in comparison with an active intervention (e. g. other psychosocial intervention, or medical or somatic treatment) or control group (e. g. waiting list, placebo). A formal diagnosis according to ICD-10/9, DSM-IV/III-R or made by a specialist was a necessary requirement. Extraction was conducted independently by two raters using a standardized manual. Furthermore, the risk of bias in primary studies was assessed. We included 19 studies. Most trials explored sexual pain disorders. The majority of psychosocial interventions led to significant improvements for desire and pain disorders compared to a control group. Benefits were mostly maintained at follow-up. Evidence for orgasmic disorders was contradictory. About half of all studies examined either a cognitive-behavioral or a classical sexual-therapeutic concept. We welcome the examination of new treatment approaches such as those presented in the most recent trials. Precise reporting and adherence to methodological quality standards is recommended.

Schlüsselwörter

Appetenzstörungen - Dyspareunie - Orgasmusstörungen - Psychotherapie - sexuelle Funktionsstörungen bei Frauen - Vaginismus

Keywords

dyspareunia - hypoactive sexual desire disorder - orgasmic disorder - psychotherapy - sexual dysfunction in women - vaginism
 

  • Literatur

  • Basson R. Testosterone Therapy for Reduced Libido in Women. Ther Adv Endocrinol Metab 2010; 1: 155-164
    CrossrefPubMedGoogle Scholar
  • Basson R, McInnes R, Smith MD. et al. Efficacy and Safety of Sildenafil Citrate in Women with Sexual Dysfunction Associated with Female Sexual Arousal Disorder. J Womens Health Gend Based Med 2002; 11: 367-377
    CrossrefPubMedGoogle Scholar
  • Beier KM, Loewit K. Lust in Beziehungen: Einführung in die Syndyastische Sexualtherapie. Ein biopsychosoziales und fächerübergreifendes Therapiekonzept der Sexualmedizin. Berlin: Springer; 2004
    CrossrefGoogle Scholar
  • Bergeron S, Binik YM, Khalife S. et al. A Randomized Comparison of Group Cognitive-behavioral Therapy, Surface Electromyographic Biofeedback, and Vestibulectomy in the Treatment of Dyspareunia Resulting from Vulvar Vestibulitis. Pain 2001; 91: 297-306
    CrossrefPubMedGoogle Scholar
  • Bergeron S, Khalife S, Glazer H. et al. Surgical and Behavioral Treatments for Vestibulodynia: Two-and-one-half-year Follow-up and Predictors of Outcome. Obstet Gynecol 2008; 111: 159-166
    CrossrefPubMedGoogle Scholar
  • Berner M, Günzler C. Efficacy of Psychosocial Interventions in Men and Women with Sexual Dysfunctions. A Systematic Review of Controlled Clinical Trials: Part 1. The Efficacy of Psychosocial Interventions for Male Sexual Dysfunction. J Sex Med 2012; 9: 3089-3107
    CrossrefPubMedGoogle Scholar
  • Braunstein GD, Sundwall DA, Katz M. et al. Safety and Efficacy of a Testosterone Patch for the Treatment of Hypoactive Sexual Desire Disorder in Surgically Menopausal Women: A Randomized, Placebo-controlled Trial. Arch Int Med 2005; 165: 1582-1589
    CrossrefPubMedGoogle Scholar
  • Brotto LA, Basson R. Group Mindfulness-based Therapy Significantly Improves Sexual Desire in Women. Behav Res Ther 2014; 57: 43-54
    CrossrefPubMedGoogle Scholar
  • Caruso S, Intelisano G, Farina M. et al. The Function of Sildenafil on Female Sexual Pathways: A Double-blind, Cross-over, Placebo-controlled Study. Eur J Obstet Gynecol Reprod Biol 2003; 110: 201-206
    CrossrefPubMedGoogle Scholar
  • Chivers ML, Rosen RC. Phosphodiesterase Type 5 Inhibitors and Female Sexual Response: Faulty Protocols or Paradigms?. J Sex Med 2010; 7: 858-872
    CrossrefPubMedGoogle Scholar
  • Clement U. Systemische Sexualtherapie. Suttgart: Klett-Cotta; 2006
    Google Scholar
  • Danielsson I, Torstensson T, Brodda-Jansen G. et al. EMG Biofeedback versus Topical Lidocaine Gel: A Randomized Study for the Treatment of Women with Vulvar Vestibulitis. Acta Obstet Gynecol Scand 2006; 85: 1360-1367
    CrossrefPubMedGoogle Scholar
  • DeRogatis LR, Komer L, Katz M. et al. Treatment of Hypoactive Sexual Desire Disorder in Premenopausal Women: Efficacy of Flibanserin in the VIOLET Study. J Sex Med 2012; 9: 1074-1085
    CrossrefPubMedGoogle Scholar
  • Foster DC. Vulvar Disease. Obstet Gynecol 2002; 100: 145-163
    PubMedGoogle Scholar
  • Frühauf S, Gerger H, Schmidt HM. et al. Efficacy of Psychological Interventions for Sexual Dysfunction: A Systematic Review and Meta-analysis. Arch Sex Behav 2013; 42: 915-933
    CrossrefPubMedGoogle Scholar
  • Ginzburg R, Wong Y, Fader JS. Effect of Bupropion on Sexual Dysfunction. Ann Pharmacother 2005; 39: 2096-2099
    CrossrefPubMedGoogle Scholar
  • Gromus B. Sexualstörungen der Frau. Göttingen: Hogrefe; 2002
    Google Scholar
  • Günzler C, Berner MM. Efficacy of Psychosocial Interventions in Men and Women With Sexual Dysfunctions – A Systematic Review of Controlled Clinical Trials. J Sex Med 2012; 9: 3108-3125
    CrossrefPubMedGoogle Scholar
  • Hawton K. Treatment of Sexual Dysfunctions by Sex Therapy and Other Approaches. Br J Psychiatry 1995; 167: 307-314
    CrossrefPubMedGoogle Scholar
  • Hayes RD, Dennerstein L, Bennett CM. et al. What is the “True” Prevalence of Female Sexual Dysfunctions and Does the Way We Assess these Conditions Have an Impact?. J Sex Med 2008; 5: 777-787
    CrossrefPubMedGoogle Scholar
  • Heiman JR. Sexual Dysfunction: Overview of Prevalence, Etiological Factors, and Treatments. J Sex Res 2002; 39: 73-78
    CrossrefPubMedGoogle Scholar
  • Heiman JR, Meston CM. Empirically Validated Treatment for Sexual Dysfunction. Annu Rev Sex Res 1997; 8: 148-194
    PubMedGoogle Scholar
  • Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Vol. 5. Chichester: Wiley-Blackwell; 2008
    Google Scholar
  • Hurlbert DF. A Comparative Study Using Orgasm Consistency Training in the Treatment of Women Reporting Hypoactive Sexual Desire. J Sex Marital Ther 1993; 19: 41-55
    CrossrefPubMedGoogle Scholar
  • Hurlbert DF, White C, Powel DR. Orgasm Consistency Training in the Treatment of the Women Reporting Hypoactive Sexual Desire: An Outcome Comparison of Women-only Groups and Couples-only Groups. J Behav Ther Exp Psychiatry 1993; 24: 3-13
    CrossrefPubMedGoogle Scholar
  • Ishak IH, Low WY, Othman S. Prevalence, Risk Factors, and Predictors of Female Sexual Dysfunction in a Primary Care Setting: A Survey Finding. J Sex Med 2010; 7: 3080-3087
    CrossrefPubMedGoogle Scholar
  • Kaplan SA, Reis RB, Kohn IJ. et al. Safety and Efficacy of Sildenafil in Postmenopausal Women with Sexual Dysfunction. Urology 1999; 53: 481-486
    CrossrefPubMedGoogle Scholar
  • Kilmann PR, Mills K, Caid C. et al. Treatment of Secondary Orgasmic Dysfunction: An Outcome Study. Arch Sex Behav 1986; 15: 211-229
    CrossrefPubMedGoogle Scholar
  • Kingsberg S. Testosterone Treatment for Hypoactive Sexual Desire Disorder in Postmenopausal Women. J Sex Med 2007; 4: 227-234
    CrossrefPubMedGoogle Scholar
  • Laan E, Rellini AH, Barnes T. Standard Operating Procedures for Female Orgasmic Disorder: Consensus of the International Society for Sexual Medicine. J Sex Med 2013; 10: 74-82
    CrossrefPubMedGoogle Scholar
  • Landry T, Bergeron S, Dupuis MJ. et al. The Treatment of Provoked Vestibulodynia: A Critical Review. Clin J Pain 2008; 24: 155-71
    CrossrefPubMedGoogle Scholar
  • Lewis RW, Fugl-Meyer KS, Corona G. et al. Definitions/Epidemiology/Risk Factors for Sexual Dysfunction. J Sex Med 2010; 7: 1598-1607
    CrossrefPubMedGoogle Scholar
  • LoPiccolo J, Heiman JR, Hogan DR. et al. Effectiveness of Single Therapists versus Cotherapy Teams in Sex Therapy. J Consult Clin Psychol 1985; 53: 287-294
    CrossrefPubMedGoogle Scholar
  • MacPhee D, Johnson SM, van der Veer MM. Low Sexual Desire in Women: The Effects of Marital Therapy. J Sex Marital Ther 1995; 21: 159-182
    CrossrefPubMedGoogle Scholar
  • Masheb RM, Kerns RD, Lozano C. et al. A Randomized Clinical Trial for Women with Vulvodynia: Cognitive-behavioral Therapy vs. Supportive Psychotherapy. Pain 2009; 141: 31-40
    CrossrefPubMedGoogle Scholar
  • Masters WH, Johnson VE. Human Sexual Inadequacy. Toronto, New York: Bantam Books; 1970
    Google Scholar
  • Meston CM, Lorenz TA, Stephenson KR. Effects of Expressive Writing on Sexual Dysfunction, Depression, and PTSD in Women with a History of Childhood Sexual Abuse: Results from a Randomized Clinical Trial. J Sex Med 2013; 10: 2177-2189
    CrossrefPubMedGoogle Scholar
  • Mitchell KR, Mercer CH, Ploubidis GB. et al. Sexual Function in Britain: Findings from the Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet 2013; 382: 1817-1829
    CrossrefPubMedGoogle Scholar
  • Palacios S. Hypoactive Sexual Desire Disorder and Current Pharmacotherapeutic Options in Women. Womens Health 2011; 7: 95-107
    PubMedGoogle Scholar
  • Pfammatter M, Tschacher W. Wirkfaktoren der Psychotherapie – eine Übersicht und Standortbestimmung. ZPPP 2012; 60: 67-76
    CrossrefPubMedGoogle Scholar
  • Plint AC, Moher D, Morrison A. et al. Does the CONSORT Checklist Improve the Quality of Reports of Randomised Controlled Trials? A Systematic Review. Med J Aust 2006; 185: 263-267
    PubMedGoogle Scholar
  • Safarinejad MR. Female Sexual Dysfunction in a Population-based Study in Iran: Prevalence and Associated Risk Factors. Int J Impot Res 2006; 18: 382-395
    CrossrefPubMedGoogle Scholar
  • Schmidt HM, Höhn C, Widmeier E. et al. Psychosoziale Interventionen für sexuelle Funktionsstörungen bei Männern. Z Sexualforsch 2017; 30: 95-137
    Article in Thieme ConnectPubMedGoogle Scholar
  • Schnarch D. Die Psychologie sexueller Leidenschaft. Stuttgart: Klett-Cotta; 2006
    Google Scholar
  • Schnyder U, Schnyder-Lüthi C, Ballinari P. et al. Therapy for Vaginismus: In Vivo versus In Vitro Desensitization. Can J Psychiatry 1998; 43: 941-944
    CrossrefPubMedGoogle Scholar
  • Segraves RT, Clayton A, Croft H. et al. Bupropion Sustained Release for the Treatment of Hypoactive Sexual Desire Disorder in Premenopausal Women. J Clin Psychopharmacol 2004; 24: 339-342
    CrossrefPubMedGoogle Scholar
  • Segraves RT, Croft H, Kavoussi R. et al. Bupropion Sustained Release (SR) for the Treatment of Hypoactive Sexual Desire Disorder (HSDD) in Nondepressed Women. J Sex Marital Ther 2001; 27: 303-316
    CrossrefPubMedGoogle Scholar
  • Shifren JL, Davis SR, Moreau M. et al. Testosterone Patch for the Treatment of Hypoactive Sexual Desire Disorder in Naturally Menopausal Women: Results from the INTIMATE NM1 Study. Menopause 2006; 13: 770-779
    CrossrefPubMedGoogle Scholar
  • Shifren JL, Monz BU, Russo PA. et al. Sexual Problems and Distress in United States Women (Prevalence and Correlates). Obstet Gynecol 2008; 112: 970-978
    CrossrefPubMedGoogle Scholar
  • Spence SH. Group versus Individual Treatment of Primary and Secondary Female Orgasmic Dysfunction. Behav Res Ther 1985; 23: 539-548
    CrossrefPubMedGoogle Scholar
  • Stravynski A, Gaudette G, Lesage A. et al. The Treatment of Sexually Dysfunctional Women without Partners: A Controlled Study of Three Behavioural Group Approaches. Clin Psychol Psychother 2007; 14: 211-220
    CrossrefPubMedGoogle Scholar
  • ter Kuile MM, van Lankveld JJ, de Groot EH. et al. Cognitive-behavioral Therapy for Women with Lifelong Vaginismus: Process and Prognostic Factors. Behav Res Ther 2007; 45: 359-373
    CrossrefPubMedGoogle Scholar
  • Trudel G, Marchand A, Ravart M. et al. The Effect of a Cognitive-behavioral Group Treatment Program on Hypoactive Sexual Desire in Women. Sex Relation Ther 2001; 16: 145-164
    CrossrefPubMedGoogle Scholar
  • Trudel G, Saint-Laurent S, Proulx S. Traitement Béhavioral des Dysfonctionnements Sexuels par Bibliothérapie: Les Résultats de Deux Études. Revue de Modification du Comportement 1985; 15: 76-81
    PubMedGoogle Scholar
  • van Lankveld JJ, Everaerd W, Grotjohann Y. Cognitive-behavioral Bibliotherapy for Sexual Dysfunctions in Heterosexual Couples: A Randomized Waiting-list Controlled Clinical Trial in the Netherlands. J Sex Res 2001; 38: 51-67
    CrossrefPubMedGoogle Scholar
  • van Lankveld JJ, Melles R, Nefs J. et al. Cognitive-behavioral Therapy for Women with Lifelong Vaginismus: A Randomized Waiting-list Controlled Trial of Efficacy. J Consult Clin Psychol 2006; 74: 168-178
    CrossrefPubMedGoogle Scholar
  • Weijmar Schultz WCM, Gianotten WL, van der Meijden WI. et al. Behavioral Approach with or without Surgical Intervention to the Vulvar Vestibulitis Syndrome: A Prospective Randomized and Non-randomized Study. J Psychosom Obstet Gynaecol 1996; 17: 143-148
    CrossrefPubMedGoogle Scholar
  • Zimmer D. Does Marital Therapy Enhance the Effectiveness of Treatment for Sexual Dysfunction?. J Sex Marital Ther 1987; 13: 193-209
    CrossrefPubMedGoogle Scholar