Proposal to conduct an eight-session mindfulness-based CBT intervention for women experiencing low sexual desire in a Portuguese hospital outpatient setting

Abstract

Introduction: Sexual problems and dysfunctions can be distressing and harm both psychological and physical health. Low sexual desire is a common sexual problem among women, with research indicating that it affects up to one-third of them. Studies and expert guidelines (e.g., International Consultation on Sexual Medicine) emphasise that mindfulness-based treatments have strong evidence for effectively addressing low sexual desire in women, whether delivered in group, couples, or individual formats. However, to our knowledge, such interventions have not yet been investigated in group settings within Portuguese hospital outpatient clinics, despite evidence supporting the cost-effectiveness of group programmes. Also, many people experiencing sexual difficulties do not seek treatment; one of the barriers is the long healthcare waiting lists, which makes a group intervention for sexual desire problems valuable. Therefore, we plan to conduct a group intervention for women with low sexual desire in a hospital setting, addressing the question: “Is an eight-session mindfulness-based cognitive-behavioural therapy (CBT) program feasible, acceptable, and potentially effective for women with low sexual desire in a Portuguese hospital outpatient setting?” Objective: This proposal involves a single-arm intervention conducted by a CBT sex therapist and a CBT clinical psychologist in a hospital outpatient setting to evaluate the feasibility, acceptability, and limited effectiveness of an eight-session mindfulness-based CBT group intervention designed for women experiencing low sexual desire. Methods: The expected sample includes 6–8 cisgender women aged 18–65 years, experiencing distress related to absent or low sexual desire, and in a monogamous relationship for at least six months (timeline for diagnosis of sexual dysfunction, DSM-5). Exclusion criteria include current treatment for psychological or sexual difficulties and sexual desire problems primarily attributable to pain-related conditions. Limited efficacy is expected to be evaluated using a pre- and post-treatment design with self-administered measures, where the primary outcome is sexual desire (SDI-2) and secondary outcomes include levels of sexual distress (SDS), sexual pleasure (SPS) and sexual function (FSFI). At the beginning of each session, we will ask participants to anonymously identify what they liked most and least through a brief questionnaire about the previous session. Additionally, we plan to gather participants' qualitative feedback after the intervention, including which components they found most and least helpful, their perceived difficulty of homework assignments, and any improvements they experienced. Results: This cost-effective intervention is expected to show preliminary improvements in key variables of interest. Conclusions: Expected findings will assess whether the intervention is feasible and acceptable in this hospital setting, guiding the design of a future randomised controlled trial focused on women's sexual desire. Due to the expected small sample size and single-arm design, results should be interpreted cautiously, considering limitations such as the preliminary nature of the data on improvements, potential selection bias (i.e., the intervention involving patients seeking professional help in a hospital setting), and challenges in controlling confounding variables (e.g., medication).