Cognitive behavioural therapy for sexual concerns during menopause: evaluation of a four session protocol

J Sex Med. 2025 May 19:qdaf085. doi: 10.1093/jsxmed/qdaf085. Online ahead of print.

ABSTRACT

BACKGROUND: Sexual concerns are reported by 43%-82.5% of peri- and post-menopausal women and negatively impact physical and emotional well-being. Despite the high prevalence and negative impact, treatment options are limited, particularly those which are non-pharmacological.

AIM: The primary objective of this pilot trial was to evaluate the effectiveness of a novel four-session individual Cognitive Behavioural Therapy protocol for improving sexual functioning (CBT-SC-Meno) during peri- and post-menopause. Secondary objectives included assessing body image, relationship satisfaction, and common menopause symptoms (eg, vasomotor), depression, anxiety, and self-reported health.

METHODS: Participants (n = 32) were peri- or post-menopausal women experiencing primary sexual concerns and reporting a score of 26.55 or lower on the Female Sexual Function Index (FSFI), indicating impaired sexual functioning. Eligible participants were assigned to a waitlist control condition for 4 weeks, after which they were reassessed and then completed the CBT protocol.

OUTCOMES: Measures assessing sexual functioning, satisfaction, distress, and desire, as well as body image, relationship satisfaction, common menopause symptoms (eg, vasomotor), depression, anxiety, and self-reported health were completed at baseline, post-waitlist, and post-treatment. Treatment satisfaction was captured with the Client Satisfaction Questionnaire along with qualitative data.

RESULTS: During the waitlist period, no significant changes were observed across measures, apart from the FSDQ concern subscale and GCS physical subscale. Following CBT-SC-Meno, participants experienced a significant improvement in overall sexual functioning (eg, desire, arousal, reduced pain, satisfaction), a decrease in symptoms of sexual distress, concern, and resistance, menopausal symptoms, symptoms of depression and anxiety, as well as improved body image, couple satisfaction, and overall health (P < 0.001). All participants endorsed high treatment satisfaction and indicated that treatment helped them better cope with their symptoms more effectively.

CLINICAL IMPLICATIONS: To our knowledge, this is the first study examining the effectiveness of a CBT protocol specifically designed to target sexual concerns experienced during peri- and post-menopause. Results suggest that CBT-SC-Meno leads to significant improvements in sexual functioning across several important sexual concern domains and related areas (eg, body image), in addition to several other commonly comorbid menopausal symptoms (eg, vasomotor), depression, anxiety, and self-reported overall health.

STRENGTHS AND LIMITATIONS: Although CBT-SC-Meno appears to be a promising treatment for sexual concerns, the sample was small and homogeneous.

CONCLUSIONS: This study provides preliminary evidence of CBT as a non-pharmacological treatment for peri- and post-menopausal women experiencing sexual concerns and offers the basis for a larger randomized clinical trial.

CLINICAL TRIAL REGISTRATION: Trial # NCT04922385 and Accessible at: https://clinicaltrials.gov/ct2/show/NCT04922385?term=NCT04922385&draw=2&rank=1.

PMID:40384525 | DOI:10.1093/jsxmed/qdaf085