Women's Sexual Function, Satisfaction, and Perceptions After Starting Long-Acting Reversible Contraceptives

Abstract

Objective To document how long-acting reversible contraception (LARC) affects women’s sexual outcomes. Methods In this prospective, observational cohort study, we enrolled new-start intrauterine device (IUD) and contraceptive implant users attending four family planning clinics. Data collection occurred at baseline, one month, and three months. Primary outcomes were the Female Sexual Function Index, New Sexual Satisfaction Scale, and perceived sexual effects of method (positive, negative, or none). Secondary outcomes included other factors associated with LARC’s sexual acceptability, including the ability to “let go” in sex, sense of control over pregnancy, and bleeding changes. Chi-square and F-tests assessed differences between method groups at baseline, and mixed effects models, robust Wald chi-square tests, and conditional logistic regression documented differences from baseline and trends over time. Results In December 2014-April 2015, 200 patients consented and enrolled in the study. Among 159 women who completed three survey rounds, 20% selected copper IUDs, 46% levonorgestrel IUDs, and 34% implants. Sexual functioning and satisfaction scores did not change over time. However, across methods, participants were more likely to report improvements to their sexual lives compared to baseline (χ2 p<0.001). By 3 months, 40% (n=64) reported positive changes and 17% (n=27) negative changes. Positive sexual changes were associated with one’s sense of control over pregnancy and one’s ability to “let go” in sex. Negative sexual changes were largely attributable to increased vaginal bleeding. Conclusion Although new LARC users reported no measurable objective change in sexual function or satisfaction, a sizable minority reported perceived positive, method-related sexual changes. Clinical Trial Registration ClinicalTrials.gov, www.clinicaltrials.gov, NCT02734199.

Beyond safety and efficacy: sexuality-related priorities and their associations with contraceptive method selection

“…Here, we focus on contraceptive preferences. Participants responded to the query, “How important are each of the following characteristics to you in deciding which birth control method to use?” Characteristics included: “it doesn't contain hormones,” “it is acceptable to my partner,” “it doesn't interrupt sex,” “it doesn't reduce my libido,” “it is in line with my religious beliefs,” “it is recommended by my friend(s),” “it is the most effective method,” “it doesn't have side effects” and “it is safe for me to use.” Response options were “not at all important,” “slightly important,” “quite important” and “extremely important.” The sexual-related preferences arose from prior qualitative [ 13 , 14 ], theoretical [ 15 ] and clinical pilot work [ 10 ] by members of this research team.…”

“…Growing research documents that patients have a variety of preferences beyond safety and efficacy that could influence method selection [ 8 , 9 ]. This team's earlier study of 188 intrauterine device (IUD) or implant users indicated that although methods' efficacy influenced contraceptive decision making, so did their potential sexual impacts [ 10 ]. When selecting their new method, these patients ranked factors of “doesn't reduce my libido” and “doesn't interrupt sex” just as highly as efficacy and more highly than all other criteria.…”

The Impact of Sexual Satisfaction, Functioning, and Perceived Contraceptive Effects on Sex Life on IUD and Implant Continuation at 1 Year

“…We previously published information about this patient population’s baseline characteristics and shorter-term sexual outcomes as measured by the FSFI-6, the NSSS, and subjective measures of impact of contraception on one’s sex life (Higgins et al, 2016). In the current paper, we share data from beyond the first three months of use, including the relationship between women’s sexual outcomes and contraceptive method continuation out to one year.…”

“…The original study was powered to detect differences in FSFI-6 scores between Cu IUD, LNG IUD, and ENG implant users. Published results of the power analyses appear elsewhere (Higgins et al, 2016).…”

“…Such measures were not designed to identify contraceptive-related sexual outcomes in younger, healthy women. Moreover, other key sexual facets, including psychological factors such as sexual disinhibition, relationship aspects such as partner preferences, side effects such as vaginal bleeding, and women’s perceptions of whether their methods affect sexuality, may also be important in shaping contraceptive satisfaction and use over time ( Higgins & Hirsch, 2008; Higgins, Ryder, Skarda, Koepsel, & Bennett, 2015; Higgins, Sanders, Palta, & Turok, 2016).…”