A small Dutch study suggests that a specific type of online counseling therapy, called Internet-based cognitive behavioral therapy, can help improve sexual function, body image, and menopausal symptoms in women who have been treated for breast cancer and are having problems with any of those things.
The research was published online on Feb. 27, 2017 by the Journal of Clinical Oncology. Read “Efficacy of Internet-Based Cognitive Behavioral Therapy in Improving Sexual Functioning of Breast Cancer Survivors: Results of a Randomized Controlled Trial.”
The study included 169 Dutch women who had been diagnosed with breast cancer between 1 and 5 years earlier:
- most of the women (85%) were postmenopausal
- 36% of the women had been diagnosed with one sexual function problem, 56% of the women had two sexual function problems, and about 8% had three or four sexual function problems
- more than 87% of the women said their sexual problems started during or after breast cancer treatment
- the women were about 51 years old
- about 95% of the women were married or in a relationship
- about 56% of the women had lumpectomy, about 24% had mastectomy with reconstruction, and 19.5% had mastectomy alone
- 83.4% of the women had chemotherapy
- 81.7% of the women took hormonal therapy and 72.2% were still taking it
- 81.1% had radiation therapy
- 22.5% had targeted therapy
- 67.5% of the women were sexually active when the study started
Sexual function problems included:
- lack of interest in sex
- unable to become aroused
- having pain during sexual intercourse
- vaginismus (vaginal muscles spasm when something is inserted)
- fear of sexual intercourse
- vaginal dryness
The women were randomly split into two groups:
- 84 women were assigned to participate in an online cognitive behavioral therapy program
- 85 women were assigned to the control group; this meant they were told they were on the waiting list for the online cognitive behavioral therapy program
The online cognitive behavioral therapy program consisted of weekly therapist-guided sessions focusing on sexual function problems that included background information, homework, and feedback from the therapist. Each cognitive behavioral therapy program was tailored to the needs of an individual woman. The longest the program could last was 24 weeks. Before the program started, the therapist and each woman developed goals, and these goals were included in the treatment plan. The therapist and each woman communicated via email -- the sessions did not take place in real time.
Women in the control group were given an information booklet that explained sexuality issues after breast cancer treatment.
Before the study started, all the women completed a questionnaire that asked about their sexual function and any issues or problems they were having. All the women completed the same questionnaire 10 weeks after therapy started and after therapy ended.
Overall, about 62% of the women in the online cognitive behavioral therapy program completed the program. About 31% of the women ended the program early and about 7% never started the program.
Ten weeks after the therapy program started, women in the therapy group had a larger increase in sexual desire and pleasure, as well a greater decrease in pain during sex compared to women in the control group. These differences were statistically significant, which means they likely were because of the online cognitive behavioral therapy program and not just due to chance.
After the therapy program was completed, compared to the women in the control group, women in the therapy group had:
- better improvement in overall sexual function
- a larger improvement in sexual desire
- a larger improvement in sexual arousal
- a larger improvement in vaginal lubrication
- a greater decrease in sexual distress
- a greater decrease in pain during sex
- a greater increase in sexual pleasure
- greater decrease in menopausal symptoms
- greater improvement in body image
All these differences also were statistically significant.
"Several studies have demonstrated the efficacy and applicability of Internet-based cognitive behavioral therapy for female sexual dysfunctions in the general population," said Neil Aaronson, Ph.D., of the Netherlands Cancer Institute in Amsterdam and senior author of the study, in an interview.
He added that this study is the first to evaluate and confirm the effectiveness of online cognitive behavioral therapy for sexual problems in women who’ve been treated for breast cancer.
"This is particularly important because the prevalence of sexual dysfunction in this population is two to three times higher than in the general population," he said.
While this study was small, the results are very encouraging and suggest that online cognitive therapy may be a good option for women who are struggling with sexual function problems after breast cancer treatment.
While an online program doesn’t allow you to establish the same personal relationship with a therapist that you can develop by sitting in the same room together, Aaronson said that online therapy may be a more convenient and private choice for some women. Online therapy also may be available to more women, including women who can’t travel to in-person therapy.
If you’re having problems with sexual function because of breast cancer, you may want to talk to your doctor about this study. Ask your doctor if she or he can recommend an online cognitive therapy program that might be right for your unique situation. You also may want to ask someone on your medical team if they know of programs that are available.
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