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Vegunta S, Houston LE, Nicholson NA, David PS. Counseling Women About Sexual Health Effects of Contraceptives. J Womens Health (Larchmt) 2024. [PMID: 38848279 DOI: 10.1089/jwh.2023.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Background: Choosing a contraceptive method is a pivotal decision for patients, whereas health care professionals (HCPs) face challenges in providing suitable recommendations. Adverse sexual effects often lead to dissatisfaction and discontinuation of contraceptives, underscoring the importance of thorough counseling and shared decision making between HCPs and patients. Objective: This article aims to investigate the relationship between contraceptive methods and female sexual function through a comprehensive review of available literature, emphasizing the importance of considering sexual health in contraceptive prescription and management. Methods: A systematic analysis of existing literature, incorporating studies utilizing validated sexual health questionnaires, was conducted to elucidate the intricate interplay between contraceptives and female sexual function. Results: The review encompasses various contraceptive methods, including combined hormonal contraceptives, progestin-only pills, depot medroxyprogesterone acetate, subdermal contraceptive implants, hormonal intrauterine devices, permanent sterilization, and barrier methods. Insights gleaned from the analysis shed light on the impact of these methods on female sexual health. Conclusion: Comprehensive understanding of the effects of contraceptives on female sexual function is crucial for both HCPs and patients. By integrating sexual health considerations into contraceptive surveillance, compliance can be improved, contraceptive efficacy optimized, and the risk of unwanted pregnancies minimized. This review underscores the significance of tailored counseling and shared decision making in contraceptive management, particularly for cisgender women.
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Affiliation(s)
- Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lisa E Houston
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Nicola A Nicholson
- Department of Medical and Surgical Gynecology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Paru S David
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
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Huang M, Gutiérrez-Sacristán A, Janiak E, Young K, Starosta A, Blanton K, Azhir A, Goldfarb CN, Kuperwasser F, Schaefer KM, Stoddard RE, Vatsa R, Merz-Herrala AA, Bartz D. Contraceptive content shared on social media: an analysis of Twitter. Contracept Reprod Med 2024; 9:5. [PMID: 38321582 PMCID: PMC10848475 DOI: 10.1186/s40834-024-00262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/13/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Information on social media may affect peoples' contraceptive decision making. We performed an exploratory analysis of contraceptive content on Twitter (recently renamed X), a popular social media platform. METHODS We selected a random subset of 1% of publicly available, English-language tweets related to reversible, prescription contraceptive methods posted between January 2014 and December 2019. We oversampled tweets for the contraceptive patch to ensure at least 200 tweets per method. To create the codebook, we identified common themes specific to tweet content topics, tweet sources, and tweets soliciting information or providing advice. All posts were coded by two team members, and differences were adjudicated by a third reviewer. Descriptive analyses were reported with accompanying qualitative findings. RESULTS During the study period, 457,369 tweets about reversible contraceptive methods were published, with a random sample of 4,434 tweets used for final analysis. Tweets most frequently discussed contraceptive method decision-making (26.7%) and side effects (20.5%), particularly for long-acting reversible contraceptive methods and the depot medroxyprogesterone acetate shot. Tweets about logistics of use or adherence were common for short-acting reversible contraceptives. Tweets were frequently posted by contraceptive consumers (50.6%). A small proportion of tweets explicitly requested information (6.2%) or provided advice (4.2%). CONCLUSIONS Clinicians should be aware that individuals are exposed to information through Twitter that may affect contraceptive perceptions and decision making, particularly regarding long-acting reversible contraceptives. Social media is a valuable source for studying contraceptive beliefs missing in traditional health research and may be used by professionals to disseminate accurate contraceptive information.
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Affiliation(s)
- Melody Huang
- Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA
| | - Alba Gutiérrez-Sacristán
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Suite 514, 02115, Boston, MA, USA
| | - Elizabeth Janiak
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street CWN-3, 02115, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, 02115, Boston, MA, USA
| | - Katherine Young
- Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, 77 Massachusetts Ave, 02139, Cambridge, MA, USA
| | - Anabel Starosta
- Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA
| | | | - Alaleh Azhir
- Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, 77 Massachusetts Ave, 02139, Cambridge, MA, USA
| | | | | | | | | | - Rajet Vatsa
- Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA
- Harvard PhD Program in Health Policy, 14 Story Street, 02138, Cambridge, MA, USA
| | - Allison A Merz-Herrala
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 2356 Sutter Street, 94115, San Francisco, CA, USA
| | - Deborah Bartz
- Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA.
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street CWN-3, 02115, Boston, MA, USA.
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Lahoz-Pascual I, Jurado-Lopez AR, Juárez-Vela R, Santolalla-Arnedo I, Ruiz de Viñaspre-Hernández R, Repollés-Lasheras S, Tejero Sancho S, Diaz-Vega M, Lou-Mercade AC, Mendoza-Ladrón de Guevara N. A reliable and valid tool to assess the sexual acceptability of contraceptive methods. Front Public Health 2024; 11:1302675. [PMID: 38249389 PMCID: PMC10798038 DOI: 10.3389/fpubh.2023.1302675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Adequate identification of the sexual acceptability of contraceptive methods is key for designing health promotion interventions, assessing their impacts, and increasing their effectiveness. This study aimed to develop and validate a questionnaire to explore the preferences of women depending on their epidemiological characteristics and their partner relationships-the Sexual Acceptability of Contraceptive Methods Questionnaire [in Spanish, Aceptabilidad Sexual de los Métodos Anticonceptivos (ASMA)]. Methods Psychometric validation was conducted using Exploratory Factorial Analysis (EFA) and confirmatory factor analysis (CFA). The reliability of the final version of the questionnaire was explored using Cronbach's alpha and McDonald omega to estimate internal consistency. Results A three-factor model was identified. Factor 1 (explaining 28.32% of the model) corresponds to questions concerning the use and placement of the contraceptive and includes 6 items; Factor 2 (explaining 24.23%) corresponds to other factors that affect the relationship such as bleeding and side effects of the contraceptive method and includes 10 items; and Factor 3 (explaining 18.94%) corresponds to the couple relationship and includes 8 items. Conclusion and implications The ASMA questionnaire provides a valid and reliable tool for assessing the sexual acceptability of various contraceptive methods. This instrument gathers data that provide information on various aspects of women's sexuality, health, education, and beliefs, all of which can determine the preference for one contraceptive method over another. Moreover, the tool can help to identify profiles of women who have different preferences when selecting a particular method.
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Affiliation(s)
- Isabel Lahoz-Pascual
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Department of Obstetrics and Gynecology, University of Zaragoza, Zaragoza, Spain
| | | | - Raúl Juárez-Vela
- Department of Nursing, University of La Rioja, Logroño, Spain
- Biomedical Research Center of a Rioja, CIBIR, Logroño, Spain
| | - Iván Santolalla-Arnedo
- Department of Nursing, University of La Rioja, Logroño, Spain
- Biomedical Research Center of a Rioja, CIBIR, Logroño, Spain
| | | | - Sira Repollés-Lasheras
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Susana Tejero Sancho
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Department of Obstetrics and Gynecology, University of Zaragoza, Zaragoza, Spain
| | - Miguel Diaz-Vega
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Department of Obstetrics and Gynecology, University of Zaragoza, Zaragoza, Spain
| | - Ana Cristina Lou-Mercade
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Nathan SF, Berglas NF, Kaller S, Mays A, Biggs MA. Reasons for Having Unprotected Sex Among Adolescents and Young Adults Accessing Reproductive Health Services. Womens Health Issues 2022; 33:222-227. [DOI: 10.1016/j.whi.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/20/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
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Eilers MA. What a (Young) Woman Wants: Concurrent Effects of Desire to Avoid Pregnancy and Desire for Sex on Sexual Intercourse and Contraceptive Use. Demography 2022; 59:2271-2293. [PMID: 36331338 DOI: 10.1215/00703370-10295826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Of all pregnancies among young women in the United States, more than 60% are undesired, yet explanations for this phenomenon remain elusive. While research has investigated how pregnancy desires and intentions shape pregnancy-related behavior, only recently have scholars noted that desire for sex influences these same behaviors. Many young women simultaneously experience strong desires for sex alongside a strong desire to avoid pregnancy, but few studies have considered the extent to which young women adapt their reproductive behaviors in response to these potentially competing desires. Using novel weekly panel data, this analysis assesses how desires for sex may moderate the effect of the desire to avoid pregnancy on a young woman's sexual behavior and contraceptive use. Findings suggest that when a woman strongly wants to avoid pregnancy, she is less likely to have sex and more likely to use hormonal or coital contraceptives. As her desire for sex increases, however, she is instead more likely to have sex and use hormonal contraceptives. If she does not use hormonal methods, she is less likely to use coital contraceptives when she has intercourse. These findings highlight the importance of recognizing the desire for sex as a behavioral modifier for avoiding undesired pregnancy in the transition to adulthood.
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Affiliation(s)
- Michelle A Eilers
- Department of Sociology, The University of Texas at Austin, Austin, TX, USA
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Gallo MF, Nguyen NC, Luff A, Luong TN, Le VT, Casterline J, Andridge R. Effects of a Novel Erectogenic Condom on Men and Women's Sexual Pleasure: Randomized Controlled Trial. JOURNAL OF SEX RESEARCH 2022; 59:1133-1139. [PMID: 35060403 PMCID: PMC9300773 DOI: 10.1080/00224499.2021.2024790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We tested whether CSD500 (Futura Medical; Guildford, UK), a novel condom containing erectogenic gel designed to increase penile firmness, penile size, and erection duration, results in greater sexual pleasure. In 2017-2020, we randomized heterosexual couples in Thanh Hoa, Vietnam to use CSD500 (N = 248) or standard condoms (N = 252) and followed them up for six months. Women completed the Quality of Sexual Experience (QSE) scale; men completed the QSE, Sexual Experience Questionnaire (SEX-Q), and 11 condom acceptability items. Female participants' mean age was 32.1 years (SD = 0.24; range 21-46). QSE scores were higher among women (B, 0.12; 95% CI, 0.03-0.21) and men (B, 0.21; 95% CI, 0.08-0.35) in the CSD500 relative to the control arm. SEX-Q scores were higher among men in the CSD500 compared to the control arm (B, 3.22; 95% CI, 1.53-4.91). Higher proportions of men in the CSD500 relative to the control arm reported the condom felt "natural" during sex (68.6% vs. 32.3%; p < .01) and that sex with the condom felt "a lot better" than condomless sex (15.5% vs. 5.3%; p < .01). Compared with standard condoms, CSD500 use was associated with higher reports of sexual pleasure and condom acceptability.
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Affiliation(s)
- M. F. Gallo
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, U.S
| | - N. C. Nguyen
- Department of Obstetrics and Gynecology, Vinmec International Hospital, Hanoi, Vietnam
| | - A. Luff
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, U.S
| | - T. N. Luong
- Thanh Hoa Center for Disease Prevention and Control, Thanh Hoa City, Vietnam
| | - V. T. Le
- Thanh Hoa Center for Disease Prevention and Control, Thanh Hoa City, Vietnam
| | - J. Casterline
- Department of Sociology, College of Arts and Sciences, Ohio State University, Columbus, Ohio, U.S
| | - R. Andridge
- Division of Biostatistics, College of Public Health, Ohio State University, Columbus, Ohio, U.S
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Maytan-Joneydi A, MacLachlan EW, Agali BI, Louis-Charles K, Chaibou S, Amadou Garba S, Moumouni AN, Speizer IS. Providers' views on hormonal family planning methods: a qualitative study from Dosso, Niger. Gates Open Res 2022; 6:75. [PMID: 36262978 PMCID: PMC9550940 DOI: 10.12688/gatesopenres.13674.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Family planning (FP) providers play an important role in ensuring that clients are offered a full range of FP methods. This qualitative study explores providers' views on three hormonal FP methods and why they think women may choose these methods in Niger. Methods: In-depth interviews were conducted with 24 FP providers in 24 government health centers in Dosso region, Niger between February-March 2020. Providers were asked about the suitability of different FP methods for women, including adolescents and married women with children. The interviews were translated and transcribed from Hausa and Zarma into French, thematically coded, and qualitatively analyzed. Results: Many providers believed discretion to be the most important method attribute for women. Providers report preferring implants for young clients because of the more rapid return to fertility. They disagreed on whether implants or injectables are more discrete for clients. That said, providers felt that clients appreciate the implant's discretion, effectiveness, long-acting nature, and simplicity of use. Providers perceived that the majority of women choose injectables due to familiarity with the method, the fact that it is "invisible" to an outsider, and a lack of awareness of implants. Providers stated that while women may not initially choose the implant, when given more information about it, they were more open to adopting it, or switching from another method, and less likely to believe local myths. Providers believed that women find pills to be indiscreet. Conclusions: The findings highlight that while providers have perspectives on suitable methods for certain women, they also recognize that clients have their own preferences, such as how discreet the method is. As programs continue to expand method choice and new contraceptive technologies undergo research and development, highly desirable features such as discretion need to be considered.
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Affiliation(s)
- Amelia Maytan-Joneydi
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA
| | | | | | - Kyria Louis-Charles
- Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, 27516, USA
| | | | | | | | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA,Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, 27516, USA,
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8
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Maytan-Joneydi A, MacLachlan EW, Agali BI, Louis-Charles K, Chaibou S, Amadou Garba S, Moumouni AN, Speizer IS. Providers' views on hormonal family planning methods for young women: a qualitative study from Dosso, Niger. Gates Open Res 2022; 6:75. [PMID: 36262978 PMCID: PMC9550940 DOI: 10.12688/gatesopenres.13674.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Family planning (FP) providers play an important role in ensuring that clients are offered a full range of FP methods. This qualitative study explores providers' views on three hormonal FP methods and why they think young women may choose these methods in Niger. Methods: In-depth interviews were conducted with 24 FP providers in 24 government health centers in Dosso region, Niger between February-March 2020. Providers were asked about the suitability of different FP methods for women, including unmarried adolescents and young married women with children. The interviews were translated and transcribed from Hausa and Zarma into French, thematically coded, and qualitatively analyzed. Results: Many providers believed discretion to be the most important method attribute for women. Providers report preferring implants for young clients because of the more rapid return to fertility. They disagreed on whether implants or injectables are more discrete for clients. That said, providers felt that clients appreciate the implant's discretion, effectiveness, long-acting nature, and ease of use. Providers perceived that the majority of women choose injectables due to familiarity with the method, the fact that it is "invisible" to an outsider, and a lack of awareness of implants. Providers stated that while women may not initially choose the implant, when given more information about it, they were more open to adopting it, or switching from another method, and less likely to believe local myths. Providers believed that women find pills to be indiscreet. Conclusions: The findings highlight that while providers have perspectives on suitable methods for certain women, they also recognize that clients have their own preferences, such as how discreet the method is. As programs continue to expand method choice and new contraceptive technologies undergo research and development, highly desirable features such as discretion need to be considered.
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Affiliation(s)
- Amelia Maytan-Joneydi
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA
| | | | | | - Kyria Louis-Charles
- Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, 27516, USA
| | | | | | | | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA,Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, 27516, USA,
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Dalessandro C, Thorpe R, Sanders J. "For Me, It's Having Something Meaningful": Women's Emotional Understandings of Sex and the Sexual Acceptability of Contraception. JOURNAL OF SEX RESEARCH 2022; 59:445-456. [PMID: 34357808 PMCID: PMC8818050 DOI: 10.1080/00224499.2021.1958194] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
While the sexual acceptability of contraception - or, the impact of contraceptive methods on individuals' sexual experiences - is a growing area of research, less frequently do studies engage the importance of individual emotions around sex when it comes to perceptions of sexual acceptability. Building on Higgins and Smith's model of sexual acceptability and drawing upon insights from the sociology of gender, we used qualitative interview data with 30 women in Utah (USA) to explore the importance of emotional understandings of sex for women's assessments of the sexual acceptability of different contraceptives. Here we posit that emotional understandings of sex are not just individualistic - they are also structured by experiences with sexual partners and broader gendered expectations. This work adds insight into the importance of emotions in sexual acceptability and suggests the need for an amendment to Higgins and Smith's model that reflects the synergistic nature of the micro/individual, meso/interactional, and macro factors related to sexual acceptability. We conclude that assessing the sexual acceptability of contraceptives requires a nuanced multi-level interaction framework.
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Affiliation(s)
- Cristen Dalessandro
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT USA 84132
| | - Rachael Thorpe
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT USA 84132
| | - Jessica Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT USA 84132
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Sanders JN, Kean J, Zhang C, Presson AP, Everett BG, Turok DK, Higgins JA. Measuring the Sexual Acceptability of Contraception: Psychometric Examination and Development of a Valid and Reliable Prospective Instrument. J Sex Med 2022; 19:507-520. [PMID: 35034837 PMCID: PMC9258908 DOI: 10.1016/j.jsxm.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/23/2021] [Accepted: 12/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND People's sexual experiences have a strong association with contraceptive satisfaction and continuation, but no measures exist to specifically assess contraceptive-related sexual acceptability. AIM This study developed and examined the psychometric properties of reliability, separation, and item fit of a new Contraceptive Sexual Acceptability (CSA) instrument. METHODS Enrolled participants initiating a new contraceptive method from the HER Salt Lake longitudinal cohort study contributed baseline survey responses for scale development. The study included the Female Sexual Function Index, the New Sexual Satisfaction Scale, measures of physical and mood-related side effects, and self-reported perceptions of contraception's sexual impacts. Items from these measures' served as the basis for analyses. We analyzed responses using descriptive techniques and modeled using exploratory factor (EFA) and bifactor analyses (BFA). The Masters' Partial Credit Rasch method modeled reliability, separation, and item fit statistics. Here we evaluate (i) the reproducibility of relative measure location on the modeled linear latent variable, (ii) the number of statistically unique performance levels that can be distinguished by the measure, and (iii) the discrepancy between item responses and expectations of the model. Psychometric findings and theoretical models informed item reduction and final scale development. OUTCOMES We developed a 10-item Contraceptive Sexual Acceptability scale that exceeded the thresholds and sufficiently covered domains for use in contraceptive research and clinical settings. RESULTS Starting with data on 39-items from 4,387 individuals, we identified 10-items that best measured the CSA latent construct. The Rasch model included a total of 5 calibrations. We reduced items based on bifactor analysis and surpassed unidimensionality thresholds (OH = 0.84, ECV = 0.74) set a priori. The final items included questions with scaled responses about pleasure and orgasm (orgasm quality, orgasm frequency, giving partner pleasure), physical (arousal and function) and psychological (emotional connection, surrender) components, general questions of satisfaction and frequency, and a measure of perceived impact of contraception on sexual experiences in the previous 4 weeks. CLINICAL IMPLICATIONS The 10-item CSA instrument covers physical and psychological aspects of contraceptive sexual acceptability and can be used in clinical settings. STRENGTHS & LIMITATIONS The unidimensional CSA instrument offers a brief, yet comprehensive assessment of sexual acceptability. Given the limited diversity of the sample, implementation of this scale in contraceptive research and clinical interactions should be evaluated and validated in more diverse settings. CONCLUSION Attuning to sexual acceptability could ultimately help contraceptive clients find methods that better meet their needs and preferences. Sanders JN, Kean J, Zhang C, et al. Measuring the Sexual Acceptability of Contraception: Psychometric Examination and Development of a Valid and Reliable Prospective Instrument. J Sex Med 2022;19:507-520.
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Affiliation(s)
- Jessica N Sanders
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA.
| | - Jacob Kean
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Bethany G Everett
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA
| | - David K Turok
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Jenny A Higgins
- Departments of Gender and Women's Studies and Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, USA
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Kramer RD, Higgins JA, Everett B, Turok DK, Sanders JN. A prospective analysis of the relationship between sexual acceptability and contraceptive satisfaction over time. Am J Obstet Gynecol 2022; 226:396.e1-396.e11. [PMID: 34656551 PMCID: PMC8916969 DOI: 10.1016/j.ajog.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/19/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Contraceptives are used to prevent unwanted pregnancies and treat certain gynecologic conditions, but many women report non-use or inconsistent use because of method dissatisfaction. The sexual acceptability of contraception-how birth control methods affect users' sexual well-being-is likely an important component of contraceptive satisfaction but has yet to be systematically examined. OBJECTIVE This study aimed to assess contraceptive satisfaction among new-start contraceptive users and examine whether sexual acceptability measures predict contraceptive satisfaction at 3 months while controlling for more commonly measured contraceptive side effects. STUDY DESIGN This analysis used data derived from the baseline, 1-month, and 3-month surveys of the HER Salt Lake Contraceptive Initiative, a prospective cohort study of new contraceptive clients. From March 2016 to March 2017, enrolled participants received their desired contraceptive method at no cost and could switch or discontinue at any time (up to 3 years). This analysis included individuals who continued their new contraceptive method for at least 1 month and completed all relevant survey measures. We used ordered logistic regression modeling to predict contraceptive satisfaction at 3 months. Primary predictor variables included changes in sexual functioning (6-item Female Sexual Function Index), sexual satisfaction (New Sexual Satisfaction Scale), and perceived impact of the contraceptive method on sex life at 1 month. Covariates included vaginal bleeding changes, physical side effects, and mood-related side effects. RESULTS Our analytical sample included 1879 individuals. At 3 months, 52.1% of participants were "completely satisfied" with their contraceptive method, 30.7% were "somewhat satisfied," 4.2% were "neither satisfied nor dissatisfied," 6.9% were "somewhat dissatisfied," and 6.2% were "completely dissatisfied." Compared with patients who said their contraceptive method made their sex life "a lot" worse at 1 month, patients whose method improved their sex life "a lot" had a 7.7 times increased odds of greater satisfaction at 3 months (95% confidence interval, 4.02-14.60; P<.0001) and patients whose method improved their sex life a "little" had a 5.88 times increased odds of greater satisfaction (confidence interval, 3.12-11.11; P<.001). To a much lesser degree, experiencing less or no bleeding was significantly associated with increased satisfaction, whereas worsening of physical side effects was linked to decreased satisfaction. The only other factors significantly associated with satisfaction were changes in bleeding and physical side effects. CONCLUSION Our findings suggest that patients' sexual experiences of their contraceptive methods are important correlates of satisfaction. Clinicians may wish to underscore that sexual experiences of birth control methods matter and encourage patients to find a contraceptive method that works for them sexually.
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Affiliation(s)
- Renee D Kramer
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI.
| | - Jenny A Higgins
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI; Departments of Gender and Women's Studies, University of Wisconsin-Madison, Madison, WI
| | - Bethany Everett
- Department of Sociology, The University of Utah, Salt Lake City, UT
| | - David K Turok
- Departments of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Jessica N Sanders
- Departments of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
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Verma N, Cwiak C, Kaunitz AM. Hormonal Contraception: Systemic Estrogen and Progestin Preparations. Clin Obstet Gynecol 2021; 64:721-738. [PMID: 34668886 DOI: 10.1097/grf.0000000000000634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Combined hormonal contraception (CHC) are short-acting, reversible methods containing both estrogen and progestin. Available CHC methods include combined oral contraceptives, transdermal patches, and vaginal rings. The combined oral contraceptive remains the most commonly used contraceptive method in the United States. The general principles of CHC will be reviewed, including mechanism of action and effectiveness. Unless otherwise stated, these principles apply to all CHCs. When discussing clinical studies and specific considerations related only to pills, patches, or rings, the method(s) will be specified. Words that specify sex are used when discussing studies in which sex was specified.
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Affiliation(s)
- Nisha Verma
- Department of GYN/OB, Emory University School of Medicine, Atlanta, Georgia
| | - Carrie Cwiak
- Department of GYN/OB, Emory University School of Medicine, Atlanta, Georgia
| | - Andrew M Kaunitz
- Department of Obstetrics & Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
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Le Guen M, Schantz C, Régnier-Loilier A, de La Rochebrochard E. Reasons for rejecting hormonal contraception in Western countries: A systematic review. Soc Sci Med 2021; 284:114247. [PMID: 34339927 DOI: 10.1016/j.socscimed.2021.114247] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Over the past decade, women in Western countries have taken to various social media platforms to share their dissatisfactory experiences with hormonal contraception, which may be pills, patches, rings, injectables, implants or hormonal intrauterine devices (IUDs). These online testimonials have been denounced as spreading "hormonophobia", i.e. an excessive fear of hormones based on irrational causes such as an overestimation of health risks associated with their use, that was already aroused by the recurring media controversies over hormonal contraception. In order to move toward a reproductive justice framework, we propose to study the arguments that women and men (as partners of female users) recently put forward against hormonal contraception to see whether they are related to hormonophobia. The aim of this article is to conduct a systematic review of the recent scientific literature in order to construct an evidence-based typology of reasons for rejecting hormonal contraception, in a continuum perspective from complaints to choosing not to use it, cited by women and men in Western countries in a recent time. The published literature was systematically searched using PubMed and the database from the French National Institute for Demographic Studies (Ined). A total of 42 articles were included for full-text analysis. Eight main categories emerged as reasons for rejecting hormonal contraception: problems related to physical side effects; altered mental health; negative impact on sexuality; concerns about future fertility; invocation of nature; concerns about menstruation; fears and anxiety; and the delegitimization of the side effects of hormonal contraceptives. Thus, arguments against hormonal contraception appeared complex and multifactorial. Future research should examine the provider-patient relationship, the gender bias of hormonal contraception and demands for naturalness in order to understand how birth control could better meet the needs and expectations of women and men in Western countries today.
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Affiliation(s)
- Mireille Le Guen
- Centre for Demographic Research, Université catholique de Louvain, Place Montesquieu 1, L2.08.03, B-1348, Louvain-la-Neuve, Belgium; Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France.
| | - Clémence Schantz
- Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France; Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD) and Université de Paris, Inserm ERL 1244, 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Arnaud Régnier-Loilier
- Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France.
| | - Elise de La Rochebrochard
- Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France; Univ. Paris-Saclay, UVSQ, Inserm, CESP, F-94807, Villejuif, France.
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14
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Lavelanet AF, Ralph JA, Ti A, Duggaraju A, Yeh PT. A systematic review exploring the contraception values and preferences of sex workers, transmasculine individuals, people who inject drugs, and those living in humanitarian contexts. Contraception 2021; 111:32-38. [PMID: 34153317 PMCID: PMC9233148 DOI: 10.1016/j.contraception.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/14/2021] [Accepted: 06/13/2021] [Indexed: 11/17/2022]
Abstract
Objective We sought to systematically review the literature on values and preferences regarding contraception among individuals within selected key populations. Study design As part of a larger set of reviews on patients’ and providers’ values and preferences related to contraception globally, we searched ten electronic databases for articles from January 1, 2005 to July 27, 2020. No language restrictions were applied. Data was independently abstracted by two authors and study rigor was assessed using an 8-item measure developed by the Evidence Project for quantitative studies and an adapted CASP checklist for qualitative studies. Results We identified 12 studies that met our inclusion criteria examining selected key populations, including sex workers, transmasculine individuals, people who inject drugs, or those living in humanitarian contexts. Seven key themes that spoke to values and preferences emerged related to: autonomy, perceived effectiveness and safety, birth spacing and family outcomes, impacts on sexual experience, hormonal effects (e.g. desire for non-hormonal method or perception that the method is more natural as compared to hormonal methods), physical attributes (e.g. appearance and/or ease of use), and stigma. Six studies were of high rigor, five were of moderate rigor, and one was of low rigor. One study described the values and preferences of two of the selected key populations. The research available on the values and preferences of sex workers regarding methods of contraception was limited to female condoms. Conclusion Consideration of the values and preferences of individuals within selected key populations can inform providers, programme managers and policy makers participating in the delivery of contraceptive care. Contraceptive research among sex workers, transmasculine individuals, people who inject drugs, or those living in humanitarian contexts is quite limited; further research is needed to better understand the values and preferences of these populations.
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Affiliation(s)
- Antonella F Lavelanet
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Jessika A Ralph
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, MN, United States
| | - Angeline Ti
- Departments of Gynecology and Obstetrics, and Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Avani Duggaraju
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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15
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Bertotti AM, Mann ES, Miner SA. Efficacy as safety: Dominant cultural assumptions and the assessment of contraceptive risk. Soc Sci Med 2020; 270:113547. [PMID: 33455813 DOI: 10.1016/j.socscimed.2020.113547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/15/2020] [Accepted: 11/19/2020] [Indexed: 12/17/2022]
Abstract
To reduce rates of unintended pregnancy, medical and public health associations endorse a contraceptive counseling model that ranks birth control methods by failure rate. This tiered model outlines all forms of birth control but recommends long-acting reversible contraceptives (LARC) to eliminate user error and increase continuation. Our critical discourse analysis of gynecology textbooks and medical recommendations examines how gendered and neoliberal ideas influence risk assessments underlying the tiered contraceptive counseling model. Specifically, we explore how embodied, lifestyle, and medical risks are constructed to prioritize contraceptive failure over adverse side effects and reproductive autonomy. We find that the tiered model's focus on contraceptive failure is justified by a discourse that speciously conflates distinct characteristics of pharmaceuticals: efficacy (ability to produce intended effect) and safety (lack of unintended adverse outcomes). Efficacy discourse, which filters all logic through the lens of intended effect, magnifies lifestyle and embodied risks over medical risks by constructing two biased risk assessments. The first risk assessment defines ovulation, menstruation, and pregnancy as hazardous (i.e., embodied risk); the second insinuates that cisgender women who do not engage in contraceptive self-management are burdensome to society (i.e., lifestyle risk). Combined, these assessments downplay side effects (i.e., medical risks), suggesting that LARC and other pharma-contraceptives are worth the risk to protect cisgender women from their fertile bodies and to guard society against unintended pregnancy. Through this process, ranking birth control methods by failure rates rather than by side effects or reproductive autonomy becomes logical as efficacy is equated with safety for cisgender women and society. Our analysis reveals how technoscientific solutions are promoted to address social problems, and how informed contraceptive choice is diminished when pharma-contraceptives are framed as the most logical option without cogent descriptions of their associated risks.
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Affiliation(s)
- Andrea M Bertotti
- Department of Sociology and Criminology, Gonzaga University, Spokane, WA, 99258, USA.
| | - Emily S Mann
- Department of Health Promotion, Education, and Behavior and Women's and Gender Studies Program, University of South Carolina, Discovery I, Room 547, 915 Greene Street, Columbia, SC, 29208, USA.
| | - Skye A Miner
- Department of Sociology. McGill University, Room 712, Leacock Building, 855 Sherbrooke Street West, Montreal, Quebec, H3A 2T7, Canada.
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