Patients not discussing sexual dysfunction with physicians despite high prevalence

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According to a recent study published in the American Journal of Obstetrics & Gynecology, women in the preconception period often experience sexual dysfunction, distress, and painful intercourse.

Female sexual dysfunction (FSD) may present in patients as trouble orgasming, pain, or low sexual desire. This impacts sexual satisfaction and wellbeing, often having a negative effect on quality of life. Sexual dysfunction has been associated with impacts on mental health, relationship satisfaction, and overall life satisfaction.

FSD has been estimated in 43% of women aged 18 to 59 years. Studies have evaluated the impact of FSD on pregnancy, infertility, and menopause, but there is little data on FSD in the preconception period. As FSD is highly prevalent, it may have an unrecorded impact on pregnancy planning.

To determine the prevalence of FSD in the preconception period and whether these issues are discussed with health care providers, investigators consulted data from a web-based prospective cohort study known as Pregnancy Study Online. Participants included female individuals aged 21 to 45 years residing in the United States or Canada.

Participants were in a relationship with a male individual aged 21 years or older and were not using contraception or fertility treatments. Questionnaires were completed by participants at enrollment and every 8 weeks until pregnancy or 12 months following enrollment was reached. Follow-up surveys were provided to patients who reported pregnancy.

In March 2021, an optional survey on participants’ sexual health and feeling toward their sex life was offered. This survey was completed by 59.2% of participants. Participants who completed this survey after over 1 year of the baseline questionnaire or who reported pregnancy or fertility treatment initiation before completing the optional follow-up were excluded from the analysis.

Sexual dysfunction was assessed through a 6-item Female Sexual Function Index scale based on the 19-question Female Sexual Function Index. Responses were scored from 1 being the lowest to 5 being the highest, with scores of 19 or less indicating sexual dysfunction. Patients with a reported infection causing vaginal pain were classified as not having sexual dysfunction.

Sexual distress was evaluating using a 12-item Female Sexual Distress Scale. Questions focused on participants’ feelings toward their sex life and were scored using a 4-point Likert scale. Scores of 20 and above indicated sexual distress. A variable combining sexual distress and sexual dysfunction was also included, measured as both dysfunction and distress, only dysfunction, only distress, or neither. 

A question was included to measure pain during intercourse, with responses including: “Did not attempt vaginal penetration,” “Almost never or never,” “A few times,” “Sometimes,” “Most times,” and “Almost always or always.” Patients not attempting vaginal penetration were excluded from the pain evaluation.

Individuals who experienced pain a few times or more were classified as having pain with intercourse. Patients with a vaginal infection causing pain were categorized as not having pain during intercourse.

Chronic health conditions assessed in patients included vulvodynia, vaginismus, chronic pain condition, chronic pelvic condition, chronic fatigue syndrome, and interstitial cystitis. Patient responses included diagnosed, suspected, and no. Responses of diagnosed and suspected were considered positive.

Participants were also asked if they discussed plans to conceive with a health care provider. Responses of at one visit or at multiple visits were categorized as having a preconception discussion and were asked what provider type they saw and whether they discussed their sex life.

Most patients were aged 25 to 34 years, with over 80% having a college degree, over 80% being non-Hispanic White, and over 50% having an annual household income of $100,000 or more. At baseline, participants had attempted pregnancy at a mean 5.2 months and a median 2 months. Under 6 months of attempts were reported by 73% of participants.

FSD criteria was met by 25% of participants and sexual distress criteria by 12.2%. When examined together, both were reported by 8.5%, dysfunction only by 16.7%, distress only by 3.7%, and neither by 71.1%. Vaginal discomfort or pain during penetration in the past 4 weeks was reported by 30% of participants, but distress was only reported by 20%.

Lower income and education levels were seen more often in individuals with sexual dysfunction and sexual distress. These individuals were also more likely to have anxiety, depression, infertility, or posttraumatic stress disorder history. A chronic pelvic condition was reported in 22% of participants and chronic fatigue or pain in 11.8%, with sexual health issues more common in these patients.

Conception plans were discussed with a health care provider by 83.2% of participants, of which 69.5% did not discuss their sex life. Of those who did, 52.1% brought up the topic themselves, 38.9% discussed after the health care provider raised it, and 8.9% did not remember.

Common reasons for not discussing conception plans with a provider include the provider not raising the topic, no sexual health issue being present, not feeling it was relevant to pregnancy, and the patient feeling uncomfortable with the topic. Some participants also reported negative experiences with a provider in the past preventing them from raising the topic.

Overall, these results indicated a high prevalence of FSD and sexual distress, but a low prevalence of conception and sex life discussions with providers. Investigators recommended health care providers include the topic in their routine preconception counseling.

Reference

Bond JC, White KO, Abrams JA, Wesselink AK, Wise LA. Sexual dysfunction, distress, and care-seeking among females during the preconception period. American Journal of Obstetrics & Gynecology. 2023;229(1). doi:10.1016/j.ajog.2023.03.037