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Lori Brotto, a psychologist who holds the Canada Research Chair in Women’s Sexual Health, co-developed eSense, a groundbreaking new online therapy for women struggling with low desire, arousal and orgasm.Martin Dee/Handout

Before it was understood how the pandemic would deaden desire for many co-habitating couples, and before most Canadians knew much about marital-counselling-via-Zoom, psychologist Lori Brotto was quietly testing out an innovative online therapy for women struggling in their intimate lives.

Little would the researcher know how urgent these conversations would turn out to be, as couples struggled for time, space and any semblance of sexiness in lockdown. Sexual activity between live-in partners dwindled in the summer of 2020, as did their desire, according to Dr. Brotto’s study of 1,019 Canadians, published in July in the International Journal of Sexual Health. Those first-wave assumptions about quarantined couples having more sex did not come to pass, said Dr. Brotto, whose private practice saw a spike in calls during the global crisis.

“It’s the burnt-out person stressed from the day-to-day grind. We saw a lot of that through COVID, particularly women, who on top of their full-time jobs, were now doing full-time child-rearing, teaching and taking care of elders,” said Dr. Brotto, a professor of obstetrics and gynecology at the University of British Columbia who holds the Canada Research Chair in Women’s Sexual Health. “There’s also the effect of too much time with a partner. That’s a major deterrent to sexual desire, not having distance between you and your partner, not having that feeling of missing them.”

Dr. Brotto and her team are now working to expand and commercialize her online therapy model for women struggling with low desire, arousal and orgasm. The goal is to decrease wait times for in-person therapy and reach women in non-urban areas, where expertise in sexual therapy is not easy to find.

“The program closes the access gap for women living in rural and remote areas, or for those who simply do not speak to a health care provider about their sexual concerns,” which is the majority of women, according to Dr. Brotto, director of the UBC Sexual Health Laboratory.

The therapy, called eSense, is a prebuilt, online experience that participants run through alone; there is no live interaction with therapists or other patients. Woven throughout are videos with mental-health care providers; educational information on anatomy, physiology, the sexual response cycle and prevalence of sexual concerns, as well as discussions on consent and communication. The sessions are open to English-speaking cisgender women, transgender women and non-binary people. Dr. Brotto developed eSense with Kyle Stephenson, an associate professor of psychology at Xavier University in Cincinnati.

Researchers have run about 200 women ages 19 to 65 through three feasibility studies to gauge the appeal of the program. Here, participants reported that their sexual arousal and satisfaction significantly improved, while sexual distress decreased after they completed the program’s eight in-depth modules.

Participants liked doing the therapy on their own time, in short bursts or longer stretches, as their days allowed; most took 11 weeks to complete the program. Some women said the privacy of the online sessions helped alleviate their reticence to divulge these deeply personal issues to a therapist, according to Natasha Zippan, a research assistant at UBC Sexual Health Research who co-ordinated the feasibility studies. “A few women mentioned how difficult it was to raise their sexual issues with their primary care provider – usually a GP – who was often dismissive and did not get them the care they needed,” Ms. Zippan said.

The sessions are free for now for women regardless of where they live, as part of grant-funded research. Dr. Brotto received grants from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research, a B.C.-based funding agency. Dr. Brotto’s team is now in the process of commercializing eSense in British Columbia, working with established, hospital-based, sexual medicine programs and community sex therapy centres to make the online sessions available to patients on waiting lists. The researchers want to know if their online program can replace or reduce the need for in-person therapy sessions. The goal is to expand internationally, possibly through a subscription or one-time-fee model.

“As people are waiting a year to get in to see a sexual health professional, can this meet their needs?” Dr. Brotto said. “People wait so long to see a qualified professional. These symptoms worsen over time and none of these issues remain in a bubble. They affect so many other parts of peoples’ lives.”

Emma, 59, completed the virtual therapy last summer in Sechelt, B.C. The Globe and Mail is not using her full name to protect her privacy. After menopause, Emma felt her desire wane. She was troubled by the uneven levels of libido between her and her husband of 36 years.

“We’re very open and know each other super well but it’s a tricky subject. There’s a lot of years of bias that get layered on,” Emma said. “There was a lot of shame around my circumstances and not being able to be as active as I want to be.”

She said the therapy – which encourages women’s partners to read the modules and add their perspectives – helped her and her husband talk openly about sex again.

“A study like this can give you some opportunity to look at things differently,” said Emma, an arts and culture administrator. “It unearthed a willingness from both of us to try new things, to make things work.”

The pandemic stalled their progress: Emma’s work hours intensified and the spouses found themselves locked down with their two sons, 19 and 21. Their efforts are “waiting in the wings to be reignited,” Emma said.

Still, she feels the virtual therapy is a gift for women like her, living in smaller communities. “In small towns, everybody knows you,” Emma said. “The likelihood of someone specializing in sexual health is very small.”

Some sessions feature cognitive behavioural therapy, which helps women identify triggers, challenge thought patterns and overcome self-blame. Others involve mindfulness exercises that Dr. Brotto taped in a recording studio. The mindfulness work is meant to help women stop disconnecting, mentally multitasking and judging themselves during sex – focusing on physical sensation instead.

Interspersed throughout are case studies featuring three women, who are drawn from Dr. Brotto’s 19 years seeing patients with sexual issues. “They are three very different cases but in some ways, very standard cases,” the psychologist said. “Users are able to see the struggles someone else might face and how they overcome them.”

One is a young lesbian whose loss of desire and arousal began after her treatment for cervical cancer. Another is a woman who was sexually abused, struggles with shame around sexuality and lacks information about sexual health. The third is a middle-age nurse staring down overwork, low desire and a long history of depression.

“She’s exhausted. She’s probably the most common phenotype I see in my office,” Dr. Brotto said.

Kirsten, a 32-year-old nurse in Vancouver, completed the therapy in the fall of 2019 for a research study. She found her desire had changed in her romantic relationship of nearly a decade, this after the trauma of a sexual assault from years ago.

“When I was sexually assaulted, I lost a lot of my own power in my voice to be able to know what I needed or wanted around sexual desire and arousal,” Kirsten said.

In-person therapy wasn’t doable with her demanding work schedule as a nurse. The independence of the virtual sessions appealed to her, as did the nuance of each module: “My family doctor wouldn’t have the expertise to be able to deal with this type of thing,” she said.

The therapy helped her and her long-term partner “be vulnerable in a way that we weren’t before with each other,” said Kirsten, who would like to see a similar intervention developed for men.

The nurse said eight weeks in therapy normalized her situation: “This reflects the true experiences of different women – that there is no ‘normal’ or ‘good’ way to be.”

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