Abstract Introduction Sexual disorders in males, particularly erectile dysfunction, premature ejaculation, as well as compulsive sexual behavior, are common disorders associated with decreased sexual confidence, psychological distress, and relationship tension. Conventional approaches typically involve face-to-face counseling or psychotherapy; however, stigma, geographical limitations, cost, and privacy concerns often hinder access to face-to-face services. The development of digital health platforms has enabled online psychological interventions, including internet-based cognitive-behavioral therapy (ICBT) and structured web-based psychological education programs, designed to improve sexual function and reduce performance-related anxiety. In addition, broader digital tools, such as artificial intelligence (AI)-based chatbots and voice assistants, mobile health applications, and anonymous peer support forums, offer alternative channels for sexual health information and support. While these innovations increase accessibility and anonymity, the clinical effectiveness and feasibility of structured online interventions still vary across studies. Systematic evaluation is needed to clarify therapeutic outcomes, adherence patterns, and comparisons with traditional treatment modalities. Objective To examine the efficacy, remission outcomes, and treatment adherence of online psychological interventions for male sexual dysfunction, and to evaluate their comparability to conventional in-person therapeutic approaches Methods A systematic search was conducted across six electronic databases (PubMed, SpringerLink, SAGE, Web of Science, ProQuest, and EBSCO) using PRISMA guidelines and was registered with PROSPERO. The search identified 1,690 records. Two reviewers independently screened titles and abstracts based on predefined criteria, with disagreements resolved by a third reviewer. Nineteen studies met full-text eligibility criteria, of which six randomized controlled trials were included in the final synthesis. Data extracted included intervention format, duration, comparison conditions, outcome measures, and adherence rates. The primary outcomes were improvements in erectile or sexual function; secondary outcomes included sexual confidence, relationship satisfaction, and psychological distress. Risk of bias was evaluated using the Cochrane Risk of Bias 2 tool. Results A total of six randomized controlled trials, six non-randomized trials, and several observational studies evaluating online psychological and educational interventions for male sexual dysfunction were identified. Most structured interventions involved ICBT or web-assisted psychoeducation, typically delivered over 6–8 weeks with therapist or automated support. Across the included studies, significant improvements in erectile function and sexual satisfaction were reported compared to control or wait-list groups, with remission rates typically ranging from 20% to 30%. However, treatment adherence was frequently suboptimal, with completion rates often below 60%, attributed to limited motivation, misaligned expectations, and challenges in sustaining self-directed engagement. Reductions in performance anxiety and improvements in sexual confidence were observed, though effect sizes varied. Emerging digital resources such as mobile apps, voice assistants, and anonymous forums were described as useful for psychoeducation, but their therapeutic effectiveness has not been systematically evaluated. No severe adverse events were reported. Conclusions Online interventions, particularly therapist-guided ICBT, demonstrate clinical effectiveness and feasible implementation for improving male sexual function and psychological well-being. However, adherence remains a key limitation, and intervention formats vary widely. While applications, online forums, and voice assistants are considered helpful in providing sex education. Future work should prioritize engagement-enhancing strategies, integration of adaptive digital support systems, and large-scale trials assessing long-term outcomes. Disclosure No
Pakpahan et al. (2026) studied this question.