title: A randomized trial of internet-based versus traditional sexual counseling for couples after localized prostate cancer treatment.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1439, USA. lschover@meanderson.org
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Schover
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Canada
authors.forename: Ying
authors.initials: Y
authors.lastname: Yuan
authors.forename: Dawen
authors.initials: D
authors.lastname: Sui
authors.forename: Leah
authors.initials: L
authors.lastname: Neese
authors.forename: Rosell
authors.initials: R
authors.lastname: Jenkins
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Rhodes
mesh_terms: D000328:Adult; D000368:Aged; D019546:Couples Therapy; D007172:Erectile Dysfunction / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000534:rehabilitation* / Q000628:therapy; D012731:Sex Counseling; D016896:Treatment Outcome