Psychological treatments for sexual concerns in perimenopausal and postmenopausal women: a systematic review and meta-analysis
Bibliographic record
Abstract
IMPORTANCE: Sexual concerns are commonly reported by perimenopausal and postmenopausal women. Nonpharmacological treatments, including psychological-based treatments, may serve as an alternative and/or complementary option for those who cannot, or choose not, to take medication or who continue to experience symptoms despite their use. OBJECTIVE: This systematic review and meta-analysis examined psychological interventions that directly targeted and/or assessed sexual functioning in perimenopausal and postmenopausal women using standardized measures. EVIDENCE REVIEW: Web of Science, MEDLINE, and PubMed were searched for studies that evaluated the effects of psychological interventions for sexual concerns during perimenopause and postmenopause. Risk of bias assessments were done using the Cochrane Risk-of-Bias Tool and the Newcastle-Ottawa Scale. Data were pooled in a primary meta-analysis using the Female Sexual Function Index (FSFI), as well as subgroup analyses based on psychological intervention type, with effects reported separately for each subgroup. FINDINGS: Sixteen articles (n=1,445) met the eligibility criteria and were included in the systematic review and meta-analysis. Overall, nine randomized controlled trials (n=738) containing FSFI data were pooled in a meta-analysis showing psychological interventions were associated with significant improvements in sexual concerns (standardized mean difference [SMD]=1.37, 95% CI=1.17-1.58, P <0.00001; n=475). Subgroup analysis based on type of psychological intervention revealed that cognitive-behavioral therapy (SMD =-0.00, 95% CI=-0.26 to 0.25; n=233; I2 =0%) and mindfulness-based interventions (SMD =0.02, 95% CI=-0.40 to 0.45; n=86; I2 =0%) had no to small effect on the sexual function in perimenopausal and postmenopausal women, while education programs (SMD=2.53, 95% CI=-2.19 to 2.86; P <0.00001; n=268; I2 =94%) and counseling (SMD=2.43, 95% CI=1.92-2.94; P <0.00001; n=106; I2 =0%) had a large effect. Only one motivational interviewing study (effect size of 0.72) was included, but it revealed a large effect on sexual functioning. Overall risk of bias ranged from low to some concerns, with one study scoring high. CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis suggests that psychological interventions are an effective nonpharmacological treatment option for addressing sexual concerns in perimenopausal and postmenopausal women. Although cognitive-behavioral therapy and mindfulness-based approaches showed small to no effects on sexual concerns, these findings should be interpreted with caution, as the included studies did not directly target sexual concerns but instead assessed them as secondary outcomes. Psychological interventions should be considered when discussing treatment options for sexual concerns in perimenopausal and postmenopausal women.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.024 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.033 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".