Internet-based cognitive behavioral therapy for sexual dysfunctions after breast cancer

We evaluated the efficacy of Internet-based cognitive behavioral therapy (CBT) in improving the sexual functioning of breast cancer (BC) survivors with a DSM-IV sexual dysfunction. We compared the intervention to a waiting-list control group. Outcome measures were assessed at baseline, mid-CBT, immediate post-CBT, and at equivalent times in the control group. Women in the intervention group completed additional questionnaires at three and nine months follow-up. Compared to women in the waiting-list control group, women who received the CBT reported a greater improvement in overall sexual functioning, sexual desire, sexual arousal, vaginal lubrication, sexual pleasure and body image and a greater decrease in discomfort/pain during sex and sexual distress. The positive effects on most sexual functioning domains and body image were maintained well beyond the immediate post-treatment period. Partners of women in the intervention group also completed questionnaires. Although partners did not report long-term positive effects of the intervention on their sexual functioning, they did benefit in terms of overall sexual satisfaction, feelings of sexual intimacy and sexual relationship satisfaction. More research is needed to determine the prerequisites to effectuate a sustained effect in the partner’s sexual functioning. Given the rapid development of eHealth interventions, future trials should enable continuous enhancement of the intervention during the course of the study. Furthermore, more information is needed on the cost-effectiveness of Internet-based CBT programs for this population. The intervention described in this thesis can be viewed as a proof of principle for the efficacy of Internet-based CBT for sexual dysfunctions in BC survivors.