Table 1 Description of therapy modules

Module 1: Put your problem into words

In this module the client describes her sexual problems, and learns how sexuality can be influenced by the treatment of breast cancer. The sexual response curve and female sexual dysfunctions are elaborated on. Furthermore, information is given about what intimacy is and how it interplays with sexuality. Women are encouraged to discuss their sexual problems with their partner.

Module 2: How is my relationship doing?

In this module the client explores the level of intimacy in her relationship, becomes aware of the amount of quality time spent with the partner, and receives psycho-education about sex and intimacy. The importance of open communication with the partner is discussed, and advice is given on how to improve communication with regard to intimacy and in particular sex. The couple evaluates how their relationship and sex life has been influenced by the diagnosis and treatment of breast cancer.

Module 3: Sex and my body

In this module sensate focus therapy is introduced. The first steps of the hierarchically structured exercise program are completed. An introduction is given with regard to the influence of thoughts and external stimuli on the experience of sex. Attention is also paid to possible tension in the pelvic floor and methods to relax this part of the body.

Module 4: Focus my attention

In this module the client receives task concentration training in order to learn to focus her attention on sexual experiences in such a way that it is beneficial to the client.

Module 5: Explore my body

In this module sensate focus therapy is elaborated on and the hierarchically structured exercise program is completed. The client reports on her experiences with the homework exercise within a cognitive behavioral framework.

Module 6: Discovering my sexual arousal feelings (version for male partners)

The topics of this module are similar to the female version (see module 7), but are written from a male perspective.

Module 7: Discovering my sexual arousal feelings (female version)

In this module psycho-education is provided about the female body and genitals, female sexual dysfunction, genital stimulation, sexual techniques, and the male body and genitals. Accompanying exercises are provided for each subject, including, for example, exposure exercises for sexual pain disorders. Attention is also paid to the importance of and ways to discuss sexual feelings and preferences with the partner.

Module 8: Change my thoughts

In this module the influence of thoughts on feelings and behavior is explained, and the client’s dysfunctional cognitions with regard to sex and intimacy are identified. Via the method of cognitive restructuring these cognitions are replaced by more functional, adaptive thoughts.

Module 9: My sexual preferences

In this module the client’s sexual development, sexual needs, myths and beliefs about sex are evaluated. The client is encouraged to talk about her sexual preferences with her partner, and an action plan for behavior change is created.

Module 10: Relapse prevention

In this module the client reflects on her former automatic behavior and possible risk factors for relapse. A plan of action is generated to use in the event of a relapse.