How Does Paying Attention Improve Sexual Functioning in Women? A Review of Mechanisms

Female sexual dysfunction (FSD), consisting of a constellation of distressing sexual symptoms, is highly prevalent worldwide. Given the central role played by psychological factors in the development of FSD, psychologically and in particular mindfulness-based interventions have arisen as potential treatment options for women. Although mindfulness-based interventions have been evaluated in samples of women with gynecologic cancer; a history of sexual abuse; multiple sclerosis; and spinal cord injury; and provoked vestibulodynia, the mechanisms by which mindfulness leads to improvements in sexual functioning are largely unstudied.

To summarize the literature on mechanisms of mindfulness interventions in general and to hypothesize which mechanisms most likely apply to samples of women with FSD.

Medline was searched with terms such as mindfulness, meditation, mediator, mode, moderator, mechanism, sex, and sexual dysfunction. Only studies that conducted a formal mediation or moderation analysis were included. We also conducted a broader review on mechanisms in other populations, with slightly modified inclusion criteria: the terms sex and sexual dysfunction were removed and only studies from 2012 to 2016 and studies that included an active mindfulness intervention were included.

In general populations, trait mindfulness and decentering were the most common mechanisms identified for the efficacy of mindfulness. In four studies that examined mediators of improvement in samples with FSD, the following mediators were found to be significant: relationship satisfaction, genital self-image, interoceptive awareness, depressed mood, anxiety, and trait mindfulness, of which interoceptive awareness had the most supporting evidence.

Clinicians and researchers can use the identified mediators of improvement (ie, interoceptive awareness, depression, and trait mindfulness) when making decisions about which patient might be more likely to benefit from a mindfulness-based approach to treating sexual dysfunction. Future work should examine these mediators and other putative mediators and moderators in randomized controlled trials of mindfulness. Arora N, Brotto LA. How Does Paying Attention Improve Sexual Functioning in Women? A Review of Mechanisms. Sex Med Rev 2017;5:266-274.