Sexual dysfunction affects a substantial proportion of the population, with an estimated 40%-45% of adults experiencing a sexual disorder at some point in their lives. Despite the demonstrated effectiveness of psychosexual interventions, access to care remains limited due to stigma, shame, fear of judgment, and practical barriers that contribute to the inadequate management of sexual dysfunction.

Immersive digital technologies, such as virtual reality (VR) and metaverse-based environments, have drawn increasing attention to sexology. These tools are being explored as ways to improve access to psychological and educational interventions while enabling therapeutic exposure to conditions such as sex-related posttraumatic stress disorder (PTSD), anorgasmia, sexual aversion, erectile dysfunction (ED), and premature ejaculation (PE). Early clinical studies suggest that these technologies may improve sexual symptoms and associated psychological distress. However, most available evidence is based on small samples and noncontrolled designs, highlighting the need for larger randomized controlled trials (RCTs) before these approaches can be broadly implemented in routine care settings.

Technology Defined

VR is an immersive technology that simulates a three-dimensional environment using specialized electronic devices, such as headsets and controllers. This creates a sense of presence and allows users to experience and interact with virtual worlds and simulated scenarios. This distinguishes it from the metaverse, which consists of shared virtual spaces accessed remotely, where users interact via avatars in socially interactive settings.

These technologies allow interventions to be provided at home in secure and discreet environments. This may be particularly valuable for individuals who are reluctant to attend in-person consultations because of embarrassment, stigma, or logistical constraints related to sexual health.

In addition, immersive environments make it possible to recreate situations that are difficult to access using conventional therapy, especially when mental imagery is limited. Therefore, real-time exposure to realistic scenarios can function as flexible and modifiable therapeutic exposure.

Clinical Applications

VR interventions in sexual therapy rely exclusively on psychological methods. They primarily targeted sex-related PTSD, ED, PE, anorgasmia, and sexual aversion.

The treatment protocols were heterogeneous. Some involve brief sessions lasting only a few minutes, while others consist of structured programs comprising 12-15 1-hour sessions over several months. The scenarios were tailored to the age, clinical presentation, and therapeutic goals of the participants.

Most interventions are based on graduated exposure or desensitization models derived from cognitive-behavioral therapy. Others have drawn on psychodynamic frameworks that integrate multimedia support and virtual experiences.

Early Evidence

Most published studies assessing VR- or metaverse-based interventions in sexology have used pre-post designs without control groups.

Several studies have examined VR exposure in individuals with PTSD related to sexual traumas. A nonrandomized controlled study of women undergoing systematic desensitization in a virtual environment simulating sexual assault reported reductions in anxiety and depressive symptoms, with no statistically significant difference compared with participants who were non-victims of sexual assault exposed to a virtual scenario.

In a pre-post study of veterans (n = 15), a VR exposure protocol with repeated immersive exposure sessions was associated with significant reductions in PTSD and depressive symptoms from baseline, with improvements maintained at the 3-month follow-up and medium-to-large effect sizes. Another uncontrolled study using a comparable protocol similarly reported sustained symptom reduction at 3 months.

For sexual aversion, a proof-of-concept study involving 15 adults used graduated exposure to VR. Symptoms decreased over 6 months, although transient increases in anxiety and disgust were observed during the treatment sessions.

An uncontrolled pre-post study of 160 men with erectile dysfunction or premature ejaculation found that a course of psychodynamic psychotherapy integrating audiovisual stimulation delivered via a helmet-mounted display was associated with symptom improvement or resolution in approximately half of the participants after 12 sessions over 25 weeks, with no statistical analysis.

An RCT conducted in a metaverse environment among women with female orgasmic disorder found recovery in all participants in the intervention group after 12 sessions, with improvements in sexual function and satisfaction maintained at 3 months of follow-up, unlike in the minimally supported control group (n = 31).

Future Directions

Several conceptual limitations were identified. Current interventions often do not sufficiently emphasize patient autonomy and treatment ownership. Partners are frequently excluded from treatment, despite the relational dimensions of many sexual disorders. Important variables such as body image, sexual self-esteem, and sexual communication have also been inconsistently addressed.

Although metaverse-based solutions may partially reduce financial barriers, costs remain high.

Overall, while immersive technologies show promise for improving access to care and therapeutic exposure in sexology, the existing evidence remains limited. Larger RCTs are needed to clarify their efficacy, optimize protocols, and define their appropriate clinical roles.

This story was translated from Univadis France, part of the Medscape Professional Network.