Psychological therapies for female sexual function: a systematic review and network meta-analysis

Abstract Introduction Various clinical trials have evaluated psychological interventions for female sexual function; however, their comparative effectiveness remains insufficiently defined. To date, no network meta-analysis (NMA) has systematically synthesized and ranked these interventions to guide evidence-based clinical decision-making in the management of female sexual function. Objectives To compare the efficacy of various psychological interventions for female sexual function using network meta-analysis and to establish a hierarchy of therapeutic strategies to inform clinical practice. Methods A systematic review and NMA were conducted to assess all psychological interventions evaluated for female sexual function. Comprehensive literature searches were conducted in the Web of Science, PubMed, and Embase, and statistical analyses were performed using Stata version 18.0. Results A total of 45 studies encompassing 4726 women met the inclusion criteria. The NMA demonstrated that sex education, cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), PLISSIT model–based sexual counseling, and general sexual counseling significantly improved Female Sexual Function Index scores compared with usual care or control groups (P < .05). According to surface under the cumulative ranking curve values, the PLISSIT model showed the greatest improvement in Female Sexual Function Index, followed by CBT, general sexual counseling, MBI, and sex education. Regarding Female Sexual Distress Scale outcomes, CBT, MBI, and sex education were associated with significant reductions in sexual distress relative to usual care or control (P < .05). MBI ranked highest for reducing Female Sexual Distress Scale, followed by sex education and CBT. Conclusion The available evidence indicates that MBI is the most effective approach for alleviating sexual distress, whereas the PLISSIT model appears to offer the greatest benefit for improving sexual function. However, the limited number of trials for certain interventions and the heterogeneity of psychological approaches suggest that the current evidence base remains incomplete and warrants further investigation.