Internet-Based CBT and Online Counseling for Male Sexual Dysfunction: Systematic Review

21 studies found online CBT improved erectile function; ED remission rates were 20–30%, but fewer than 60% of participants stayed engaged

Journal: Sexual Medicine Reviews | Published: 2026-04-02 | Type: Systematic Review | PMID: 41926207 Authors: Arya Srisadono, Muhammad Adamas, Cennikon Pakpahan (Universitas Airlangga, Indonesia); Camil C Branco (University of Barcelona, Spain) Funding/COI: Not reported

Summary

A systematic review of 21 studies found that internet-based cognitive behavioral therapy (ICBT) and online psychoeducation improved erectile function and sexual satisfaction compared to control conditions. Remission rates for ED reached 20–30% across included studies, with most programs running 6–12 weeks. The headline caveat: fewer than 60% of participants actually completed the interventions.

Claims

• Of 2,482 records screened, 21 studies met inclusion criteria (RCTs, experimental, and observational designs published 2007–2024)
• Remission rates for erectile dysfunction ranged from 20% to 30% across included studies
• Most interventions lasted 6–12 weeks, incorporating either therapist feedback or automated systems
• Participant adherence was below 60% across studies
• Secondary outcomes included reductions in performance anxiety and improvements in sexual confidence
• No serious adverse effects were reported across any included study

Study Quality

This is a PRISMA-compliant systematic review—appropriate methodology for synthesizing a heterogeneous literature. The included studies span both RCTs and observational designs, a deliberate choice to capture feasibility and real-world engagement data alongside efficacy signals, but one that makes pooling results difficult. The review covers 17 years of literature (2007–2024), a period when digital intervention formats changed substantially; early web-based tools and contemporary mobile-integrated platforms are not equivalent, and the review does not stratify by era.

No meta-analysis was attempted, which is defensible given the stated heterogeneity in outcome measures, intervention types, and control conditions. Without quantitative pooling, the 20–30% remission figure should be read as a range across disparate studies rather than a pooled estimate with confidence intervals.

Red Flags

• Funding and conflicts of interest are not reported—a significant transparency gap for a 2026 systematic review
• Adherence below 60% is a substantial problem labeled a "major challenge" but not analyzed in depth; efficacy in completers versus intent-to-treat populations is not clearly separated
• No meta-analysis means effect sizes cannot be pooled or statistically compared across interventions
• Heterogeneity across intervention formats (ICBT vs. psychoeducation vs. web counseling) limits comparability—these are not equivalent treatments
• The 2007–2024 date range conflates early web-based tools with modern platforms without stratification
• Three of four authors share the same institution and study program; geographic concentration could introduce selection bias

Strengths

• PRISMA-compliant methodology with broad database search across 2,482 identified records
• Explicitly separates primary outcomes (erectile/sexual function) from secondary outcomes (anxiety, relationship satisfaction)
• Addresses a clinically relevant access gap: online delivery lowers barriers for men who won't seek in-person psychological care
• Captures both RCT and observational designs, providing real-world engagement data alongside efficacy signals
• No serious adverse effects across all 21 included studies—a relevant safety signal

Verdict

A workmanlike systematic review confirming what the prior literature suggested: online CBT-type interventions can move the needle on ED, with remission rates in the 20–30% range across a heterogeneous set of 21 studies. The missing funding and COI disclosures are sloppy for a 2026 publication. The larger problem is that sub-60% adherence undermines every efficacy claim—if most participants drop out, you're measuring outcomes in motivated completers, not a generalizable treatment population. Worth reading for the breadth of the synthesis, but the absence of a meta-analysis and the wide variation in intervention formats mean there's no clean effect size to extract.