Effect of Mindfulness-based Intervention on the Treatment of Women’s Sexual Dysfunction: A Literature Scoping Review
Correspondence Address :
Dr. Shaghayegh Dehghan Nayeri,
Masters, Department of Midwifery, Iran University of Medical Sciences, Tehran, Iran.
Introduction: The significance and role of sexual function in quality of life is an undeniable fact that should be taken into account in the care provided for individuals. The use of modern non pharmacological methods in the treatment of sexual dysfunction, especially in women, is required to be investigated.
Aim: To review the effect of mindfulness-based interventions in the treatment of women’s sexual dysfunction in the previous studies.
Materials and Methods: This literature scoping review was conducted on all observational and experimental studies published in Persian and English languages, from 2008 to 2021.The databases that were searched for relevant studies were Google Scholar, Web of Sciences, PubMed and Scopus. The keywords used for the search included, mindfulness, mindfulness-based interventions, sexual dysfunction, women. Data related to the study year of publication, place, type of study, sample population, and the effect of mindfulness-based interventions in the treatment of women’s sexual dysfunction were recorded.
Results: A total of 742 studies were found, of which 23 studies were extracted. Among the reviewed articles, five articles (21.74%) are published in Persian and 18 articles (78.26%) in English. In total, 22 articles confirmed positive effects and one article found no effects on mindfulness-based interventions in improving sexual function in women suffering sexual dysfunction.
Conclusion: Mindfulness-based interventions, though it is implemented based on different approaches (stress reduction, cognitive-behavioral and sex therapy), are effective in treating all types of sexual dysfunction in women.
Female, Quality of life, Sexual function, Sexual problems, Sexual desire, Sexual arousal
Sexual health is recognized as an important component of human rights in the international community and every human being has the right to achieve the highest level of sexual health (1). Most of the diseases and disorders around the world are caused by failing to give due attentionto sexual health (2). Sexual health is sometimes disordered for various reasons such as fertility and childbirth (3), menopause (4), suffering from special diseases (5), sexual function of couples and especially women, which is reported to be 40-45% (6). According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a person’s sexual dysfunction is a feeling of extreme discomfort and individual stress for at least six months (7), which is divided into three categories: sexual activity, sexual boredom, and sexual abnormalities (8). The prevalence of sexual dysfunction among Iranian women varies in different societies and has been reported between 39-66% (9).Given the direct effect of sexual satisfaction on the quality of life of individuals, it is very important to give due attention to this issueas the persistence of sexual dysfunction is followed bynumerous complications (10).
One of the interventions that has been conducted to help reduce sexual dysfunction is mindfulness-based interventions (11). Mindfulness is described as awareness by paying attention to the goal in the present moment without having any judgment and prejudice, which is accompanied by accepting the experiences, admitting them, and living the moments (12). At different mental states, the mindful individual is aware of himself/herself at every moment and focuses his/her attention on various mental states (13). Mindfulness-based Cognitive Therapy (MBCT) is a therapeutic approach based on a theory that has been developed by Teasdale, Segal and Williams based on the Mindfulness-based Stress Reduction (MBSR) model developed by Kabat-Zinn by adding the principles of cognitive therapy, with the aim of replacing negative emotions with pleasant ones (14). This treatment includes a combination of mindfulness meditation training and cognitive therapy interventions. During mindfulness exercises, self-regulatory abilities are taught through exercises focusing on internal attention such as breathing awareness, or focusing on external objects such as sounds, both of which focus on present experiences (15). Mindfulness exercises can lead to an immediate shift of attention from unrelated worrying thoughts in the present moment (16). The MBSR intervention has been used to reduce depression, anxiety, chronic pain, cancer, diabetes, hypertension and autoimmune disorders (17).
Ashiri et al. (2015) showed that this treatment significantly increases women’s marital satisfaction (18). Despite the effectiveness and importance of mindfulness in some studies, there are researchers who reported contradictory findings (19),(20). It is argued that there are biological, behavioral, and psychosocial mechanisms for sexual dysfunction, and therefore, there is a need to develop integrated therapies that can effectively treat people with mental and physical illnesses (21).
To this end, finding a simple, effective, cheap, and uncomplicated non pharmacological midwifery intervention that can have biological, behavioral, and psychosocial effects is of great importance. Since sexual function has a significant impact on married life and the quality of life and given the lack of evidence about the positive effects of mindfulness on sexual dysfunction, this study aimed to review published articles on mindfulness-based interventions and their impact on sexual dysfunction in women.
This literature scoping review was conducted in Iran University of Medical Sciences from August 2021 to October 2021.
Inclusion criteria: All observational and experimental studies, published in Persian and English languages, published between 2008 to 2021.
Exclusion criteria: All qualitative studies, systematic review, meta-analysis, full text not available were excluded from the study. Also the articles published before 2008, as interested year of study in the EndNote software were excluded.
Keywords related to mindfulness and sexual function were combined based on Medical Subject Headings (MeSH) using Boolean operators (Table/Fig 1). This search strategy for Scopus and Web of Science (WoS) databases was translated to fit the characteristics of each database. To triangulate the data, Google Scholar was also searched using single words or a few multiple words.
As many as 742 articles were found in the initial search. After removing duplicates and considering the inclusion criteria for the titles, only 97 studies remained and their abstracts were reviewed. Later 61 articles were excluded. In the next stage, the full text of 36 articles were reviewed and 5 articles were deleted due to lack of access to the full text of the article and 8 articles were deleted as they were irrelevant to the title and purpose; a total of 23 articles remained (Table/Fig 2).
Among the reviewed articles, five articles (21.74%) are published in Persian (11),(13),(22),(23),(24) and 18 (78.26%) in English (20),(25),(26),(27),(28),(29),(30),(31),(32),(33),(34),(35),(36),(37),(38),(39),(40),(41). Regarding the places of the studies, as for the Iranian studies, five had been conducted in Tehran, two in Isfahan and one study each in Bushehr, Yasuj, Karaj, Qazvin, Ahvaz and Yazd. As for the remaining studies, three studies were conducted in the United States, three in Colombia, three in Canada and one in Portugal. Twenty-one articles were original interventional studies, while two were descriptive (13),(36). A review of intervention studies extracted indicated that a total of 12 articles were randomized clinical trials and nine articles were quasi-experimental studies.The sample size in the intervention studies varied from 20 patients (37) to 660 individuals (30). The number of groups was two in 13 studies (11),(22),(23),(24),(25),(27),(28),(29),(30),(32),(33),(34),(35),(37),(38),(40), three in five studies (20),(26),(28),(30),(39), and one in three studies (34),(35),(41). The number of sessions for mindfulness-based programs in most studies (12 studies) were eight. The lowest number of sessions was three (33),(38),(41).The highest number of sessions was 12 (39).
The duration of each session varied from one hour (41) to two hours (26). However, in most studies (14 studies), the session lasted for 90 minutes (20),(22),(23),(24),(28),(30),(31),(32),(33),(34),(35),(37),(38),(40). The target group was women with cancer in four studies (27),(31),(38),(41), women with Multiple Sclerosis (MS) in two studies (20),(25), women with vaginal disorders (26), women with drug abuse in one study (22), women with epilepsy in one study (30), women with recurrent miscarriage (22). As many as eight studies considered the effectiveness of mindfulness-based interventions on the total sexual dysfunction (11),(13),(22),(23),(24),(28),(29),(41). Other types of variables that were investigated included sexual satisfaction, sexual self-efficacy, sexual desire, sexual response, and sexual support and arousal. The role of mindfulness-based interventions was investigated in 18 studies (11),(13),(22),(25),(26),(27),(28),(30),(31),(32),(33),(34),(35),(36),(37),(38),(40),(41). Different types of mindfulness-based interventions included sex therapy, stress management techniques, and cognitive-behavioral therapy. As many as 22 studies (11),(13),(22),(23),(24),(25),(26),(27),(28),(29),(30),(31),(32),(33),(34),(35),(36),(37),(38),(39),(40),(41) confirmed the effectiveness of this method and only in one study the results showed that mindfulness-based interventions do not affect sexual function in women with multiple sclerosis (Table/Fig 3) (20).
Many people suffer from sexual dysfunction and they do not to seek to solve their problem for many reasons. Sexual disorders amongthe important health problems that are in need of effective and new methods of treatment (42). Many interventions have been used to solve sexual problems including training on sexual skills, couple therapy, desensitization, and motivational therapies (43). One of these methods is using mindfulness-based interventions and the purpose of this study was to review and summarize the studies conducted on the effect of mindfulness-based interventions in the treatment female sexual dysfunction. In this regard, the results have indicated that mindfulness-based interventions, even when they are conducted based on different approaches (stress reduction, cognitive-behavioral and sex therapy), are effective in treating women’s sexual dysfunction.
The high number of studies conducted in Iran and outside Iran have shown the significance of the issue, and the high prevalence of sexual dysfunction in women calls for more attention, care and effective interventions. In a study conducted by Mohammadian et al in 2019, the prevalence of female sexual dysfunction in Tehran (77.6%) was higher than that of the global rate (40%) (44). However, this study considered the general population.
This study focused on the general population, chronic diseases, while chronic diseases such as breast cancer affect sexual satisfaction and function. Therefore, in addition to conducting detailed and numerous studies on patients, some measures should be taken to reduce sexual dysfunction and improve sexual satisfaction. Accordingly, cognitive programs and mindfulness-based interventions are effective therapies to reduce sexual problems.
The sample size in the intervention studies varied from 20 patients (37) to 660 individuals (30). In some studies, the group training method had been used (32),(40). This case is worth considering in Islamic countries, especially Iran, with their special conditions. On the one hand, group therapy has numerous benefits, such as expressing people’s feelings; they find out they are not alone and that there are many people with their problems. On the other hand, it is not easy to raise sexual issues and problems, and people are so ashamed and embarrassed in this regard that they sometimes hide their problems from their confidants and even doctors, and it is even more serious in women (45).
The number of sessions for mindfulness-based programs was three to 12 session, yet in most studies,the number of sessions was eight. The duration of each session varied from one to two hours, but the sessions were mostly 90 minutes.A review of the number and duration of intervention sessions conducted in previous studies indicated that even studies conducted with a smaller number of sessions and shorter interventions have been effective in reducing sexual problems (25),(28),(33),(35),(37),(38),(40),(41). Thus, given that clients are normally too busy to attend intention sessions, therapists can conduct fewer sessions in a shorter time. However, it should be possible to cover all the content and ensure the proper delivery of content and the proper implementation of the programs within the prefixed number of sessions. In addition, training and implementation of programs during the Coronavirus Disease 2019 (COVID-19) pandemic should be towards virtualization and using online technology; the advantages of this method are lower cost, flexibility, ease of access, inclusiveness and the possibility of self-direction in learning and adaptation to individual learning goals (46).
In line with the objectives of the present study, most studies have examined the effectiveness of mindfulness-based interventions on the whole sexual dysfunction. However, since sexual dysfunction as a whole is divided into different categories, researchers are recommended to examine these disorders separately. This enables them to design more specific interventions. Sexual satisfaction and sexual arousal in women have also been considered by researchers, indicating the importance of these domains. Other variables considered were sexual satisfaction, sexual self-efficacy, sexual desire, sexual response, sexual support, and arousal. Thus, it seems that the promotion of each of these factors can promote the overall sexual function.
A variety of mindfulness-based interventions including sex therapy, stress management techniques, and cognitive-behavioral therapy have been conducted for the patients. The role of stress and anxiety in predicting and reducing the quality of women’s marital relationship is obvious (47). Thus, using stress management and control methods can be implemented in the form of mindfulness-based programs.
As one of the limitations of this study, only articles addressing sexual dysfunction in women were reviewed. Thus, its findings cannot be generalized to men. Furthermore, this study focused on articles that were published in English and Persian. Accordingly, the present review findings have less generalizability. Hence, a more comprehensive review of all articles published in this field is essential.
Since sexual health and good marital relationship have known effects on physical, mental and social health, and sexual health and good marital relationship provide the basis for strengthened emotions between couples by creating a sense of satisfaction, peace and increased self-confidence, and as sexual health prevents the onset of mental disorders and family disintegration and social problems, it is required to be taken into serious account by caregivers and physicians, nurses and psychologists and midwives. Moreover, since the studies support the effectiveness of mindfulness-based interventions, it can be stated that this method is effective in improving women’s sexual function and it is recommended to be used.
Date of Submission: Jan 11, 2022
Date of Peer Review: Feb 08, 2022
Date of Acceptance: Apr 18, 2022
Date of Publishing: Jun 01, 2022
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 14, 2022
• Manual Googling: Apr 11, 2022
• iThenticate Software: May 20, 2022 (13%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)