An online program called eSense appeared to be effective for the treatment of sexual interest/arousal disorder (SIAD) in women, according to new research.
The program led to significant improvement in symptoms of sexual dysfunction, such as low sexual desire and sexual distress. These improvements were maintained for 6 months, the study authors wrote.
“Low sexual desire in women is extremely common and distressing, and most women do not seek out or receive evidence-based treatment, leaving them to suffer in silence for a prolonged period,” senior author Lori Brotto, PhD, professor of obstetrics and gynecology at the University of British Columbia and executive director of the Women’s Health Research Institute at BC Women’s Hospital in Vancouver, told Medscape Medical News.
“eSense is very effective, with lasting improvements, and can be used alongside nonexpert support to increase adherence to the program,” she said. “Also, there was little difference in outcomes between mindfulness-based therapy [MBT] and cognitive-behavioral therapy [CBT], suggesting that both may be efficacious and leaving users to select which they might use.”
The study was published online on March 20 in Behaviour Research and Therapy.
Testing Digital Interventions
Brotto and colleagues have researched interventions for women with SIAD, finding that psychological treatments can be effective but may be inaccessible and underutilized because of barriers such as cost, geography, lack of awareness, lack of providers, and embarrassment. eSense, an online program with CBT and MBT options, is intended to provide accessible online help.
Brotto and colleagues previously tested and revised aspects of eSense with focus groups, pilot studies, and randomized controlled trials. The MBT program teaches nonjudgmental, present moment awareness of body sensations, the breath, sounds, thoughts, and movement, with a focus on sexual sensations. Similarly, the CBT program teaches best practice methods of cognitive restructuring and behavior change, including a focus on sexual desire and arousal.
In this study, 43 women with SIAD were randomized to the eSense CBT program, and 43 were randomized to the eSense MBT program. These two groups were compared with a waitlist control condition with 43 women. Both eSense programs included eight modules over 12 weeks and up to 12 remote meetings with nonexpert “navigators” who were trained to provide empathic listening, encouragement, and technology support (but not formal therapy).
As part of the program, participants completed self-report measures of primary outcomes, such as sexual desire/arousal and sexual distress, and secondary outcomes, such as sexual satisfaction, sexual dissatisfaction, and overall sexual function, at baseline, mid-treatment, post treatment, and 6 months post treatment.
Compared with the waitlist controls, both eSense treatment groups reported statistically significant improvements in the primary outcomes at post treatment, with desire/arousal scores improving by 10-12 points and distress scores decreasing by 7-11 points, on average. These improvements were maintained at the 6-month follow-up and were similar for the CBT and MBT groups.
Among the secondary outcomes, sexual satisfaction scores increased by about 10 points in the CBT group, with a slightly higher increase of 11 points in the MBT therapy group. Overall sexual function also improved by about 6 points in both groups. Although sexual dissatisfaction scores decreased numerically, the change was not statistically significant in either group.
In general, participants reported high satisfaction with the eSense program, giving average scores of 8 out of 10 for easy navigation and helpful content.
Now Brotto and colleagues are conducting a randomized trial with an adapted version of eSense among survivors of gynecologic cancer and will soon begin a trial of eSense-TRANScend among trans women.
“We are adapting eSense to other populations who experience low sexual desire and barriers to care,” Brotto said. “We’re also actively exploring large-scale dissemination, and anyone interested in partnering to bring eSense to their clinic or in participating in a commercial pilot can reach out to us.”
Broadening Patient Access
Although the results are promising, the authors wrote, engagement and access could be improved, given that only 60% of participants completed six or more of the eight modules in the recommended 12-week period. Additional time or support may be needed for the full program, and flexibility in an online program could be useful, they noted.
“SIAD is a very common and distressing sexual dysfunction, and psychological treatments show the most promise for helping affected women. Online options fill an important gap in increasing accessible and affordable treatment for this issue,” Natalie Rosen, PhD, clinical psychologist and professor of psychology and neuroscience and obstetrics and gynecology at Dalhousie University in Halifax, told Medscape Medical News.
Rosen, who wasn’t involved with this study, has researched the sexual, relational, and psychological concerns among women with SIAD.
“A unique aspect of eSense is that it is not delivered by an expert, which may increase its accessibility and affordability, particularly because it could reduce barriers related to stigma or embarrassment in seeking treatment,” she said. “It is critical to enhance evidence-based treatment options for women affected by SIAD, given the many effects that this problem has on women’s mental health and relationships.”
Online interventions may help address geographic, economic, and psychological barriers to treatment and offer a potential avenue for other sexual dysfunctions, such as erectile disorder, female orgasmic disorder, and premature or delayed ejaculation, said David Lafortune-Sgambato, PhD, associate professor of sexology and director of the Laboratory for the Study of Virtual Reality, Sexotechnological Tools, and Sexual Health at the University of Quebec in Montreal.
Lafortune-Sgambato, who wasn’t involved with this study, has researched sexual dysfunction prevalence, barriers to sexual health services, and CBT approaches.
“In 2025, it’s crucial for healthcare systems and insurance providers to expand funding, research support, and coverage of digital sexual health interventions and telehealth programs,” he said. “The future of sexual healthcare will increasingly be digital and patient-focused, and clinicians should become familiar with these innovative tools to ensure comprehensive, inclusive, and equitable care for their patients.”
The study was supported by a project grant from the Canadian Institutes of Health Research. Brotto, Rosen, and Lafortune-Sgambato reported no relevant financial relationships.
Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.