{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T21:17:16Z","timestamp":1783372636937,"version":"3.54.6"},"reference-count":76,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Research for Patient Benefit","award":["NIHR202006"],"award-info":[{"award-number":["NIHR202006"]}]},{"name":"NIHR or the Department of Health and Social Care"},{"name":"Department of Health via the National Institute for Health Research"},{"name":"Specialist Biomedical Research Centre for Mental Health"},{"DOI":"10.13039\/100009362","name":"South London and Maudsley NHS Foundation Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009362","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Institute of Psychiatry at King's College London"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sexual difficulties affect 50%-80% of people with multiple sclerosis (PwMS) and arise from neurogenic, symptom-mediated, and psychosocial mechanisms. Despite their prevalence, sexual dysfunction remains under-recognized in multiple sclerosis (MS) care and underrepresented in clinical guidelines. Non-pharmacological interventions\u2014such as psychosexual counseling, educational programs, and physiotherapy\u2014may provide accessible and scalable management options. However, their effectiveness and quality remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This review aimed to systematically evaluate and meta-analyze controlled clinical trials of non-pharmacological interventions for sexual difficulties in adults with MS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eight databases were searched from inception to May 2023, May 2025, and March 2026. Eligible studies were randomized or quasi-randomized trials assessing non-pharmacological interventions targeting sexual function or related outcomes using validated measures. Primary outcomes were sexual function or difficulty; secondary outcomes included sexual distress, satisfaction, and quality of life. Risk of bias was assessed using Version 2 of the Cochrane Risk of Bias tool for randomized trials or Risk of Bias in Non-randomized Studies of Interventions and Grading of Recommendations Assessment, Development, and Evaluation determined the certainty of evidence. Random-effects models were used for meta-analysis. The review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and was registered with the international prospective register of systematic reviews (PROSPERO; CRD42023399271).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-two studies (N\u2009=\u20091844) met inclusion criteria; 23 contributed to the meta-analysis. Most interventions were psychobehavioral (n\u2009=\u200924), with 4 involving exercise\/physiotherapy, 3 combining components and one other non-pharmacological intervention. The pooled effect was large (Hedges g\u00a0=\u20092.1, SE\u2009=\u20090.62, P\u00a0=\u2009.001) with high heterogeneity (I2\u00a0=\u200998.88%). Removing 2 outliers reduced the effect to g\u00a0=\u20091.27 with high heterogeneity (I2\u00a0=\u200985.15%). Structured counseling models, particularly Permission-Limited Information-Specific Suggestion-Intensive Therapy (PLISSIT)-based interventions for women, showed the largest benefits. However, studies were small, unregistered, and at high risk of bias; most only included heterosexual married women from Iran, limiting generalizability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Structured psychosexual interventions, especially PLISSIT-based models, show promise for improving sexual outcomes in PwMS. Nonetheless, the certainty of evidence and evidence quality are very low, highlighting the need for larger, more diverse, and methodologically rigorous trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sxmrev\/qeag032","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T21:01:25Z","timestamp":1783371685000},"source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of non-pharmacological treatments for sexual difficulties in adults with multiple sclerosis: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6722-1243","authenticated-orcid":false,"given":"Emily","family":"White","sequence":"first","affiliation":[{"name":"Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London , London SE1 9RT,","place":["United 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Psychology, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London , London SE1 9RT,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2927-3446","authenticated-orcid":false,"given":"Rona","family":"Moss-Morris","sequence":"additional","affiliation":[{"name":"Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London , London SE1 9RT,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6743-3773","authenticated-orcid":false,"given":"Ashley","family":"Brown","sequence":"additional","affiliation":[{"name":"Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London , London SE1 9RT,","place":["United 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