Internet-based cognitive behavioral therapy, web-based counseling, and online/digital psychoeducation for male sexual dysfunction: a systematic review
Clinical Snapshot
PICO Framework
| P — Population | Men with sexual dysfunction (erectile dysfunction, performance anxiety, sexual satisfaction issues) |
| I — Intervention | Internet-based cognitive behavioral therapy (ICBT), web-based counseling, and online/digital psychoeducation |
| C — Comparator | Control conditions (waitlist, usual care, or placebo interventions) |
| O — Outcomes | Primary: improvement in erectile/sexual function; Secondary: relationship satisfaction, anxiety, depression, performance anxiety, sexual confidence |
Bottom Line
This systematic review of 21 studies suggests that internet-based cognitive behavioral therapy and digital psychoeducation can improve sexual function in men with sexual dysfunction, with remission rates of 20-30%. However, the evidence quality is limited by significant heterogeneity in interventions, poor adherence rates (<60%), and lack of rigorous quality assessment. While these digital interventions offer promising accessibility and reduced stigma, clinicians should be aware of the substantial dropout rates and variable effectiveness. The 6-12 week intervention duration appears standard, but long-term outcomes remain unclear. For Australian practice, these interventions could complement traditional face-to-face therapy, particularly for men in rural areas or those reluctant to seek conventional treatment, but should not replace comprehensive sexual health assessment and management.
Key Findings
P Value: Not reported
Effect Size: Remission rates for erectile dysfunction: 20-30%
Primary Outcome: Improvement in erectile/sexual function with web-based ICBT and psychoeducational interventions
Nnt Or Sensitivity: Based on 20-30% remission rates, estimated NNT approximately 3-5 patients
Confidence Interval: Not reported
Clinical Application
Moderate - requires digital literacy and sustained engagement over 6-12 weeks Relevant for Australian practice given Medicare telehealth expansion and RACGP digital health guidelines; could complement existing sexual health services and reduce geographical barriers Men with sexual dysfunction seeking accessible, stigma-reduced treatment options
Abstract
INTRODUCTION: Male sexual dysfunctionhas a substantial impact on psychological well-being and intimate partner relationships. The expanding availability of digital health services has enabled online interventions, such as internet-based cognitive behavioral therapy (ICBT), digital psychoeducation, and web-based counseling, to emerge as alternatives to conventional therapies. OBJECTIVE: To evaluate the effectiveness, feasibility, and acceptability of digital and online interventions for male sexual dysfunction, and to synthesize evidence from randomized, non-randomized, and observational studies on clinical outcomes and patterns of digital engagement. METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted across several databases using predefined keywords. Eligible studies included randomized controlled trials, experimental studies, and analytical observational studies published between 2007 and 2024. Extracted data comprised country, participant characteristics, type and duration of intervention, control conditions, outcome measures, and main findings. The primary outcome was improvement in erectile/sexual function using certain parameters, while secondary outcomes included relationship satisfaction, anxiety, and depression. RESULTS: Of 2482 records identified, and 21 met the inclusion criteria. Overall, web-based ICBT and psychoeducational interventions improved erectile function and sexual satisfaction compared with control conditions. Most interventions lasted 6-12 weeks and incorporated therapist feedback or automated systems. Remission rates for erectile dysfunction ranged from 20% to 30%; however, participant adherence was low (<60%). Several studies also reported reductions in performance anxiety and improvements in sexual confidence, with no serious adverse effects. CONCLUSION: Online interventions are promising approaches for managing male sexual dysfunction. Nevertheless, low adherence rates and heterogeneity in intervention formats remain major challenges. The findings also suggest heterogeneous benefits of digital interventions, alongside improved accessibility, reduced stigma, and increased engagement in help-seeking among men with sexual dysfunction. Future research should prioritize strategies to enhance adherence, integrate mobile health technologies, and assess long-term outcomes through large-scale clinical trials.
References
- 1.Srisadono, A., Adamas, M., Pakpahan, C., & Branco, C. C. (2026). Internet-based cognitive behavioral therapy, web-based counseling, and online/digital psychoeducation for male sexual dysfunction: a systematic review. Sexual Medicine Reviews. https://doi.org/10.1093/sxmrev/qeag020
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