Progestin-only contraceptives and sexual function among first-time users

A recent presentation at the 2019 American Society for Reproductive Medicine Scientific Congress & Expo assessed female sexual function (FSF) in three progestin-only contraceptives (POCs) among first-time users. Although POCs are used frequently by childbearing women, these methods carry risk for female sexual dysfunction (FSD).

Methods
The cross-sectional study included married women between aged 20 to 30 in a heterosexual relationship for more than 4 weeks. Participants had been using one of the POC methods for at least 6 months for contraception only and were first-time users with a regular menstrual pattern or amenorrhea. The women were classified into four groups:  a control group of non-contraceptive users (group I), depot medroxyprogesterone acetate (DMPA) 150 mg injection (group II), etonogestrel 68 mg subdermal implant (group III) and desogestrel 75µg oral pills (group IV). Participants were asked to fill out the female sexual function index (ArFSFI) and a total score ≤ 28.1 points was deemed FSD. 

A total of 444 women were included in the study, divided into two groups: 222 non-contraceptive users and 222 POC users (88 women group II, 87 women group III, and 47 women group IV). Baseline data for the non-contraceptive and POC users were homogenous.

Results
The authors found that mean ArFSFI score was significantly lower in POC users than non-contraceptive users (26.92 ± 1.88vs 27.42 ± 2.02, P =0.006; respectively). Mean ArFSFI score was significantly lower in DMPA users in comparison to etonogestrel implant and desogestrel pills users (26.46 ± 1.75, 27.13 ± 1.89, 27.37 ± 1.93, P = 0.010, respectively). The authors also noted that the number of women with FSD was significantly higher in the DMPA group compared with the other POC user groups (68 women; 77.2%, 44 women, 50.5%, 16 women (34.0%, P = 0.0001 respectively). Baseline characteristics significantly associated with higher FSD with POC likelihood based on regression model were circumcision (P = 0.001), parity greater than three times (P = 0.015) and duration of use > 12 months (P = 0.022).

Conclusion
The authors believe their findings indicate that there is a high prevalence of FSD in POC users, especially among women who use DMPA. Women whose partner is circumcised, have a parity greater than three times, and have used POCs for more than 12 months appear to have a greater risk, and ob/gyns may want to consider FSD likelihood when counseling these patients.