A randomized trial of internet‐based versus traditional sexual counseling for couples after localized prostate cancer treatment

TLDR

After prostate cancer treatment, couples’ multidisciplinary sexual rehabilitation appears more promising than traditional urologic approaches for erectile dysfunction. The study compared traditional face‑to‑face counseling, two internet‑based programs, and a waitlist control to assess their impact on couples’ sexual function after prostate cancer treatment. Couples were adaptively randomized to a 3‑month waitlist, a 3‑session face‑to‑face format, or one of two internet‑based formats, and sexual and psychological outcomes were measured at baseline, post‑waitlist, post‑treatment, and at 6‑ and 12‑month follow‑ups using validated questionnaires. Significant improvements in erectile and female sexual function were observed over 12 months, with no difference between face‑to‑face and internet groups, and greater gains in the web program linked to higher completion, demonstrating that internet‑based counseling is as effective as traditional therapy.

Abstract

After treatment for prostate cancer, multidisciplinary sexual rehabilitation involving couples appears more promising than traditional urologic treatment for erectile dysfunction (ED). The authors of this report conducted a randomized trial comparing traditional or internet-based sexual counseling with waitlist (WL) control.Couples were randomized adaptively to a 3-month WL, a 3-session face-to-face format (FF), or an internet-based format (WEB1). A second internet-based group (WEB2) was added to examine the relation between web site use and outcomes. At baseline, post-WL, post-treatment, and 6-month, and 12-month follow-up assessments, participants completed the International Index of Erectile Function (IIEF), the Female Sexual Function Index (FSFI), the Brief Symptom Inventory-18 to measure emotional distress, and the abbreviated Dyadic Adjustment Scale.Outcomes did not change during the WL period. Of 115 couples that were randomized to FF or WEB1 and 71 couples in the WEB2 group, 34% dropped out. Neither drop-outs nor improvements in outcomes differed significantly between the 3 treatment groups. In a linear mixed-model analysis that included all participants, mean ± standard deviation IIEF scores improved significantly across time (baseline, 29.7 ± 17.9; 12 months, 36.2 ± 22.4; P < .001). FSFI scores also improved significantly (baseline, 15.4 ± 8.5; 12 months, 18.2 ± 10.7; P = .034). Better IIEF scores were associated with finding an effective medical treatment for ED and normal female sexual function at baseline. In the WEB2 group, IIEF scores improved significantly more in men who completed >75% of the intervention.An internet-based sexual counseling program for couples was as effective as a brief, traditional sex therapy format in producing enduring improvements in sexual outcomes after prostate cancer.