Sammendrag
Purpose: A systematic review of the evidence base for non-pharmaceutical sexual therapies for males, females, couples, in illness, physical or mental handicaps and after sexual offences. Methods: A search in June 2008 retrieved 2805 references that were screened for relevance, critically appraised, and then summarized in narrative and tables. Studies examining the effect of devices and drugs were excluded. Results: 25 systematic reviews and 32 randomized controlled trials fulfilled inclusion criteria. Sexual therapy seems to be effective when treating lack of sexual response in women (libido, orgasm) and premature ejaculation. The effects seem more pronounced for women than for men, and may be optimized to weekly treatments with partner present. Short interventions and self-help (bibliotherapy) may also be effective, but not for all patients. Behavioural therapy and desensitization seem to help women with vaginismus, but not women with chronic pelvic pain. Group therapy and psychotherapy have beneficial effects on erectile dysfunction, also if the men use sildenafil. In general, however, it is important to be aware that many studies suffer from methodical limitations (e.g. selection bias), possibly leading to over-estimation of the effect. For some patient groups (e.g. physically or psychologically disabled, many illnesses and gender identity problems) the lack of knowledge regarding effects of sexual therapy is striking, given the high reported prevalence of sexual dysfunctions in these groups. Conclusions: Sexology is effective for selected patient population, but for some patient groups the field appears to be neglected.
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