Sexual dysfunction, distress, and care-seeking among females during the preconception period

Abstract

Background: Despite the high prevalence of female sexual dysfunction in population-based studies and the importance of sexual functioning for mixed-sex couples attempting conception, little is known about female sexual function in the preconception period.

Objective: This descriptive study aimed to assess the prevalence of female sexual dysfunction, distress, and pain with intercourse in a preconception population of pregnancy planners. The study also explored the extent to which participants discussed their sex lives with a healthcare provider during a preconception visit.

Study design: We used data from Pregnancy Study Online, a web-based preconception cohort study (August 2020-October 2022). Eligible participants identified as female and were aged 21 to 45 years, residents of the United States or Canada, attempting pregnancy, and not using fertility treatments at cohort entry. At enrollment, participants completed a detailed baseline questionnaire. Thirty days after enrollment, participants were invited to complete an optional questionnaire about sexual function. Our study included 1120 participants who responded to the sexual function questionnaire within 1 year of completing their baseline questionnaire. We assessed sexual dysfunction using the 6-item Female Sexual Function Index, and sexual distress using the Female Sexual Distress Scale, which assess sexual function and distress in the previous 4 weeks, respectively. We also asked participants whether they had discussed their plans to conceive with a healthcare provider, and if so, whether they discussed their sex lives. If not, we collected information on perceived barriers.

Results: Twenty-five percent of the sample met criteria for female sexual dysfunction, whereas 12.2% met the criteria for sexual distress; 8% of our sample reported both sexual dysfunction and sexual distress. Thirty percent reported at least some pain with intercourse in the past 4 weeks. Although over 80% of the sample reported discussing their conception plans with a healthcare provider, 70% of these participants did not discuss their sex lives. The most commonly reported reasons for not discussing their sex life with a provider was not experiencing a sexual health issue, the provider not asking, feeling nervous/uncomfortable/ashamed, and feeling it was not relevant to becoming pregnant or inappropriate to discuss. The percentage of participants who reported discussing their sex lives varied across provider type, with those seeing midwives having the highest percentage (39%), followed by nurse practitioners (36%) and obstetrician-gynecologists (34%).

Conclusion: Sexual dysfunction, distress, and painful intercourse are prevalent in the preconception period, but participants frequently did not discuss their sex lives when discussing plans to conceive. The provider not asking was a commonly reported barrier. Providers may consider raising the issue of sexual functioning at the time of a preconception visit to better support patients who may be dealing with a sexual function issue while attempting pregnancy. These findings may not generalize beyond a primarily non-Hispanic White, highly educated, and high-income population.

Keywords: help-seeking behaviors; preconception care; sexual dysfunction; sexual health.

Figure 1.

Cohort creation from Pregnancy Study Online (PRESTO), 2021 – 2022 Flow chart depicting creation of analytic cohort. Abbreviation: SHQ, sexual health questionnaire, an optional supplemental survey included in the PRESTO protocol.

Figure 2.

Discussion of sex life and whether provider brought up the topic during discussions of conception plans, by provider type Percentage of participants reporting discussing their sex lives with providers, and percentage reporting the provider initiated the conversation, stratified by provider type Note: Participants responded yes or no to the following question: “Did you discuss your sex life (including any issues with pain, arousal desire, etc.) with your healthcare provider at any of these visits in which you discussed your plans to conceive?” Participants who reported discussing conception plans with multiple provider types are repeated. The sample sizes for the orange columns are smaller than listed, because only those who reported that they talked about their sex life with a provider responded to the question “Who brought it up?”

Figure 3.

Reasons that participants did not discuss their sexual health with a provider when discussing conception plans among those participants who reported a preconception visit but not reporting their sex lives (N=637) Count of participants endorsing reasons for not discussing their sex lives at a visit in which pregnancy attempts were discussed. Note: Participants who reported discussing their plans to conceive with a healthcare provider but not discussing their sex life responded to the question “Why Not?” and could check all that apply