A Qualitative Systematic Review of Women's Experiences Using Contraceptive Vaginal Rings: Implications for New Technologies

Abstract

CONTEXT Vaginal rings are available for contraception and hormone replacement, and are being developed as HIV/STD or multipurpose prevention technologies. A comprehensive understanding of women's expectations of and experiences with rings is urgently needed to inform product development and to optimize ring use. METHODS Three databases (PubMed, Global Health and CINAHL) were searched for English‐language, peer‐reviewed articles published between January 1996 and November 2017 that reported qualitative data on barriers to and facilitators of use of female‐controlled contraceptive methods. Data on study methods, findings and conclusions pertaining to contraceptive rings were extracted, organized and analyzed. RESULTS Twenty‐six articles, all published since 2008, met the inclusion criteria. Seven studies focused largely or entirely on rings (and involved current, former or potential users), while the others focused on other contraceptive methods but included ring‐specific data. Familiarity with the ring was low, and women commonly had initial concerns about the method—often related to insertion and removal, cleanliness and discomfort with touching their vagina—that were typically overcome over time. Other major themes were issues related to ring use and discontinuation, the importance of ring‐related properties and characteristics, and considerations related to sexual partners and health care providers. CONCLUSIONS Qualitative data have the potential to inform ring design and promotion. Future research should further explore women's expectations and experiences with the ring, the value of involving male partners in ring evaluation, and evaluation of interventions to improve patient–provider communication concerning ring choice and use.

Acceptability and Satisfaction of Contraceptive Vaginal Rings in Clinical Studies: A Systematic Review and Narrative Synthesis

“…Perception of the ring of user was sparsely documented and data on ring expulsions were limited in the identified studies. However, when documented, ring-related reasons (slippage, expulsion, vaginal problems, or discomfort) contributed for a proportion of women to discontinuation of all the types of CVRs and confirmed findings from previous studies ( 55 , 59 ). Expulsions and mechanical properties of the ring were included as a specific dimension in acceptability theoretical frameworks that were used in 2 included studies ( 26 , 27 ) and in vaginal ring HIV prevention studies ( 8 ) and deserve to be further addressed in future studies.…”

“…Ease of insertion/removal/reinsertion of CVRs was reported in most included studies and rated high including in Latin American or African settings. Among the included studies, qualitative data on actual experiences of women while using the ring showed that initial worries related to CVR itself or its use, such as aspect, insertion, removal, and feeling the ring inside the vagina, improved over time ( 26 , 30 , 52 ), as it is also reported in 1 qualitative systematic review of CVR and 1 systematic review of vaginal rings ( 55 , 56 ). Initial concerns sometimes required additional support from the provider or practice from the user ( 30 , 55 ) or benefited of an adjustment period as reported among adolescents and younger users in the US ( 52 ).…”

“…Among the included studies, qualitative data on actual experiences of women while using the ring showed that initial worries related to CVR itself or its use, such as aspect, insertion, removal, and feeling the ring inside the vagina, improved over time ( 26 , 30 , 52 ), as it is also reported in 1 qualitative systematic review of CVR and 1 systematic review of vaginal rings ( 55 , 56 ). Initial concerns sometimes required additional support from the provider or practice from the user ( 30 , 55 ) or benefited of an adjustment period as reported among adolescents and younger users in the US ( 52 ). In addition, 2 other CVR studies have shown that “ease of use” was a major reason reported by participants for either selecting or using CVR in Spain ( 57 , 58 ).…”

“…In total, 2 studies (one without comparison group, another 1 comparing a new CVR Kirkos ® to NuvaRing ® ) conducted in Italy reported an improvement of all the variables between baseline and follow-up ( 40 ). In total, 2 prospective controlled studies conducted by Guida et al in Italy reported improved overall and sexual relationship (“complicity”) among couples ( 27 ) and reduced anxiousness compared to COC users ( 55 ). Increased sexual desire (compared to COC or progestin-only pill) was reported among NuvaRing ® users in a small study in Belgium ( 22 ) and increased or unchanged sexual desire in another study comparing NuvaRing ® to low estrogen dose COC ( 13 ).…”

“…However, as highlighted in our results, a comparison group (i.e., including the use of another contraceptive method or another regimen) was not present in about 40% of studies. Data triangulation between quantitative and qualitative data contributed to confirm or provide more information on satisfaction and factors, such as increased lubrication, leading to satisfaction and adherence ( 26 , 36 , 55 ).…”