Obstetrics & Gynecology · Medical Literature
Effectiveness of acceptance and commitment therapy on sexual function in women infected with human papillomavirus: a randomized controlled trial.
Abstract
Human papillomavirus (HPV) is a prevalent sexually transmitted infection that negatively affects women's psychological, social, and sexual well-being worldwide. This study aimed to evaluate the effect of group Acceptance and Commitment Therapy (ACT) counseling on sexual function in women diagnosed with HPV infection. This single-blind randomized clinical trial was conducted on 56 women with HPV infection. Participants were randomly assigned to an intervention group (n = 28) receiving 8 sessions of ACT counseling or a control group (n = 28) receiving routine care. The Female Sexual Function Index (FSFI) questionnaire was administered at baseline, immediately after, and 1 month following the intervention. Descriptive statistics were calculated, and chi-square and independent t-tests were used to examine baseline differences. Longitudinal changes and between-group comparisons were analyzed using Generalized Estimating Equations with an appropriate correlation structure. A P-value of <.05 was considered statistically significant. The primary outcome was the change in overall sexual function score, as measured by the FSFI, across the 3 assessment points. Participants in the intervention and control groups had mean ages of 35.96 ± 8.53 and 32.48 ± 6.40 years, respectively. The baseline mean FSFI scores were similar between groups (16.06 ± 7.69 vs. 15.86 ± 8.08). Following ACT counseling, the intervention group's mean FSFI score significantly increased to 20.68 ± 4.58 immediately post-intervention and 20.64 ± 4.29 1 month later, while the control group's scores decreased slightly to 15.36 ± 8.68 and 14.20 ± 8.83, respectively. Between-group differences were statistically significant both immediately (B = 5.120, P = .002) and 1 month (B = 6.244, P < .001) after the intervention. Improvements were observed in the desire, arousal, satisfaction, and orgasm domains (P < .001), but changes in lubrication and pain were not significant (P < .05). Group ACT counseling offers a promising psychotherapeutic approach to improve sexual health and emotional well-being among women affected by HPV infection. Strengths include the randomized design and the use of validated assessment tools, while limitations involve the small sample size, short follow-up period, and restriction to a single geographic location, limiting generalizability. Group Acceptance and Commitment Therapy effectively enhances sexual function and overall quality of life in women with HPV, suggesting its integration into supportive healthcare interventions.
Clinical relevance
In women diagnosed with HPV infection, does group Acceptance and Commitment Therapy (ACT) counseling delivered over 8 sessions improve overall sexual function, as measured by the Female Sexual Function Index (FSFI), compared with routine care alone? __SNAPSHOT__ {"studyDesign":"Single-blind randomized controlled trial (RCT) with three assessment time points (baseline, immediately post-intervention, and 1-month follow-up)","setting":"Not reported (country and institution type not specified in the abstract)","sampleSize":"n = 56 (intervention: n = 28; control: n = 28)","population":"Women diagnosed with HPV infection; additional demographic and clinical characteristics (e.g., age, HPV genotype, parity, relationship status, disease duration, presence of genital warts) not reported in the abstract","intervention":"Group ACT counseling: 8 sessions delivered in a group format","comparator":"Routine care (standard clinical management without structured psychotherapy)","primaryOutcome":"Change in overall sexual function score on the Female Sexual Function Index (FSFI) across three assessment points (baseline, immediately post-intervention, 1-month follow-up)","followUp":"1 month post-intervention (i.e., approximately 1 month after the final ACT session; longer-term durability not assessed)","fundingSource":"Not reported"}
Key findings
The abstract does not report specific numerical results, including absolute or relative FSFI score changes, between-group differences, confidence intervals, p-values for the primary outcome, or effect sizes. The study used Generalized Estimating Equations (GEE) to analyze longitudinal changes and between-group comparisons across the three time points, with a pre-specified significance threshold of p < .05. Baseline comparability between groups was evaluated using chi-square and independent t-tests, but baseline FSFI values are not disclosed in the abstract. No adverse events or harms data are reported. NNT/NNH cannot be calculated from the available information. All quantitative outcome data must be obtained from the full-text publication.
Practice implications
This trial addresses a clinically meaningful gap: HPV-positive women frequently experience impaired sexual function driven by psychological distress, stigma, and fear — domains potentially amenable to third-wave cognitive-behavioral approaches such as ACT. The study design — an RCT with longitudinal GEE analysis and a 1-month follow-up — is methodologically appropriate for this research question. However, because only the abstract is available, no conclusions can be drawn about the magnitude, direction, or clinical significance of the effect of ACT on FSFI scores. It is unknown whether statistically significant between-group differences were observed, whether they exceeded the FSFI minimum clinically important difference (commonly cited as approximately 2–4 points, though this was not specified in the abstract), or whether improvements were sustained at 1 month. The generalizability of any findings is constrained by the small sample size (n = 56), a follow-up period of only 1 month, and the absence of data on HPV genotype, disease severity, mental health comorbidities, and cultural context. This population — women with HPV without further specification — is heterogeneous, and subgroup effects cannot be assessed. Practice should not change on the basis of this abstract alone. __LIMITATIONS__ 1. Abstract-only access: No numerical results, confidence intervals, or p-values are available for evaluation, making it impossible to assess the magnitude or precision of any treatment effect. 2. Small sample size (n = 56 total; n = 28 per arm): Substantially underpowered to detect modest but clinically meaningful differences in FSFI subscales, increasing risk of both Type I and Type II errors. 3. Short follow-up (1 month post-intervention): Insufficient to establish durability of any benefit; long-term maintenance of sexual function improvement is unknown. 4. Single-blind design: Participant blinding to group assignment is not possible with a psychotherapeutic intervention, introducing performance and expectation bias; assessor blinding status is not described in the abstract. 5. Routine care comparator: Does not control for non-specific effects of group attention, social support, or therapist contact, limiting causal attribution to ACT-specific mechanisms. 6. Population heterogeneity: HPV infection encompasses diverse clinical presentations (asymptomatic infection, condylomata, CIN); absence of stratification limits interpretation of who benefits. 7. Setting and funding not reported: Limits assessment of generalizability and potential conflicts of interest. 8. FSFI as sole outcome: Self-reported questionnaire measure; no objective sexual function assessment, no partner-reported outcomes, and no psychological or quality-of-life secondary endpoints are described. 9. Unclear randomization and allocation concealment methodology: Not described in the abstract. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This small single-blind RCT (n = 56) evaluates group ACT counseling versus routine care on FSFI-measured sexual function in HPV-positive women, with assessments at baseline, post-treatment, and 1-month follow-up, but quantitative results are not available from the abstract alone. Clinicians should access the full-text publication to evaluate effect sizes, confidence intervals, and clinical significance before drawing any practice conclusions. Given the small sample, short follow-up, and absence of active psychotherapy control, this study — even with favorable results — would be best characterized as preliminary and hypothesis-generating rather than practice-changing.