Background
Breast cancer and its treatment can have a significant and sustained impact on sexual health. While sexual problems can be treated effectively with office-based cognitive behavioral therapy (CBT), many women consider face-to-face therapy to be too confronting. It has been suggested that internet-based therapy may be a more acceptable and less threatening approach. We evaluated the efficacy of an internet-based CBT program on sexual health and related outcomes in breast cancer survivors with a DSM-IV diagnosis of sexual dysfunction.
Methods
We randomly assigned 169 breast cancer survivors to either internet-based CBT or a waiting-list control group. The CBT consisted of approximately 20 weekly, therapist-guided sessions. Self-report questionnaires were completed by the intervention group at baseline (T0), mid-therapy (T1), and immediate post-therapy (T2), and at equivalent times by the control group, with additional follow-up assessments of the intervention group at 3- and 9-months post-therapy. We used mixed-effect modeling to compare the groups over time, and growth curve models to evaluate the longer-term trajectory of outcomes in the intervention group.
Results
Compared with the control group, the intervention group reported significantly greater improvement over time in overall sexual functioning, which was reflected in an increase in sexual desire, sexual arousal, and vaginal lubrication. The intervention group also reported more improvement over time in sexual pleasure, less discomfort during sex, less sexual distress, greater improvement in body image, and fewer menopausal symptoms than the control group. Most of these positive changes in sexual health were maintained in the intervention group during the follow-up period.
Conclusions
Internet-based CBT has a sustained, positive effect on the sexual health of breast cancer survivors with a DSM-IV diagnosis of sexual dysfunction. The availability of clinically effective, internet-based sex therapy for BC survivors will hopefully increase the likelihood that women who otherwise might not seek professional help will do so.