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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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Schlegel EC, Pickler RH, Tate JA, Alexander KA, Williams KP, Smith LH. 'Taking Care': A qualitative study of emerging adult-aged women's sexual and reproductive health definitions. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100877. [PMID: 37399761 PMCID: PMC10530474 DOI: 10.1016/j.srhc.2023.100877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/01/2023] [Accepted: 06/08/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Emerging adult-aged (EA;18-25 years) women have disproportionately high rates of unintended pregnancy and sexually transmitted infections compared to other women of reproductive age. Little is known about how EA women define and prioritize various aspects of sexual and reproductive health. The purpose of this study was to identify EA women determined definitions of sexual and reproductive health. METHODS Between September 2019 and September 2020, 13 women were interviewed about their sexual and reproductive health. Interview transcripts were used to conduct qualitative content analysis. RESULTS Definitions provided by participants were grouped according to three distinct thematic categories, Being Safe, Healthcare as a Tool, and Mind-Body Connection. Being Safe included using condoms and taking steps to prevent sexually transmitted infections. Healthcare as a Tool referred to utilization of healthcare services (e.g., an annual exam) to manage sexual and reproductive health. Mind-Body Connection included acknowledgement of both the physical and mental aspects of sexual and reproductive health, as well as awareness of physical and emotional discomfort related to it. These categories highlight EA women's holistic definitions of sexual and reproductive health. CONCLUSIONS Healthcare providers and researchers can use the holistic sexual and reproductive health definitions endorsed by EA women in this study as a starting point for creating and delivering sexual and reproductive healthcare and counseling that is developmentally appropriate and sensitive to population-specific needs.
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Affiliation(s)
- Emma C Schlegel
- Center for Nursing Research, Scholarship and Innovation, College of Nursing, Michigan State University, East Lansing, MI, USA; Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, OH, USA.
| | - Rita H Pickler
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Judith A Tate
- Center for Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, OH, USA
| | | | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Laureen H Smith
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, OH, USA
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Gashaye KT, Gebresilassie KY, Kassie BA, Zenebe CB, Mengistu Z, Ferede SE, Andualem Z, Merid MW, Taddese AA, Abera M. Reasons for modern contraceptives choice and long-acting reversible contraceptives early removal in Amhara Region, Northwest Ethiopia; qualitative approach. BMC Womens Health 2023; 23:273. [PMID: 37208658 DOI: 10.1186/s12905-023-02375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Women use modern contraceptive methods, mainly either to limit or space pregnancy and both are not identical in their choices. One method may not best fit an individual's need irrespective of the time of spacing. Cognizant of this, the context with which women base in choice of contraceptives, their lived experiences in using, and factors for early removal/ discontinuation of long-acting reversible contraceptives (LARCs) are not much investigated in the study setting and our study aimed to bridge the gap through exploring the underlying reasons. METHOD A phenomenological study design was used to explore sampled women's reasons and experiences. Reproductive-aged women (15-49 years) who removed long-acting methods in the past 6 months were included. A criterion sampling approach was employed to recruit study participants. Data was collected using an interview guide for in-depth (IDIs) and key informant interviews and were tape-recorded with interviewees' consent. Audio data were transcribed verbatim and translated into English. The data was first saved in plain text format and imported into Atlas.ti 7.0 software to facilitate coding and categorizing. The content analysis method was used to classify, organize data, and interpret the qualitative data according to key categories. RESULTS Several misconceptions about contraceptives (e.g., implants are not appropriate for daily laborers, women who use contraceptives (such as injectables) can only bear girl-child, etc.) were reported by clients and health providers. These misconceptions might not have scientific merit but they are powerful enough to affect actual behaviors toward contraceptives, including early removal. The awareness, attitude, and use of contraceptives tend to be lower in rural areas. For premature removal of LARCs, side effects, and heavy menstrual bleeding, was the most commonly identified reason. The IUCD is the least preferred method and users said it is not comfortable during sex. CONCLUSION AND RECOMMENDATION Our study found different reasons and misconceptions for modern contraceptive methods' non-use and discontinuation. Standardized counseling approaches like the REDI (Rapport Building, Exploration, Decision Making, and Implementation) framework should be implemented in the country consistently. Some of the concrete providers' conceptions should be well-studied considering contextual factors to bring scientific evidence.
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Affiliation(s)
- Kiros Terefe Gashaye
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Belayneh Ayanaw Kassie
- Midwifery Directorate, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chernet Baye Zenebe
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelalem Mengistu
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Emyu Ferede
- Department of RFPH, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zewudu Andualem
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, Collège of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mehari W/Mariam Merid
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asefa Adimasu Taddese
- PhD Student, Department of Health Informatics /Biostatistics/, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mikyas Abera
- Department of Sociology, College of Social Science and Humanities, University of Gondar, Gondar, Ethiopia
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4
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FSRH Guideline (March 2023) Intrauterine contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:1-142. [PMID: 37188461 DOI: 10.1136/bmjsrh-2023-iuc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Ogle K, Handy AB. The Effects of Hormonal and Non-Hormonal Intrauterine Devices on Female Sexual Function: A Systematic Review. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:67-81. [PMID: 38596762 PMCID: PMC10903617 DOI: 10.1080/19317611.2022.2155898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/22/2022] [Accepted: 11/25/2022] [Indexed: 04/11/2024]
Abstract
Objectives The goal of this paper was to review and synthesize the extant literature exploring the impact, if any, of copper (Cu) and levonorgestrel (LNG) intrauterine devices on female sexual function. Methods To review the literature, Medline, PubMed, and PsychINFO, were searched for primary research articles that were available in English and measured female sexual function in Cu- and LNG-IUD users. 35 quantitative and 2 qualitative research papers met criteria for inclusion in this systematic review. The 35 quantitative articles were then rated based on the STROBE statement. Results The included articles indicated a positive impact of LNG-IUDs on sexual pain, and a positive-to-neutral effect of IUDs on sexual desire, however more research is warranted. This review also found IUDs to be generally non-impactful on other domains of sexual function, including arousal, lubrication, orgasm, satisfaction, and overall sexual function. Conclusions As this review highlights that LNG-IUDs may improve sexual pain, future research should explore this connection further. Additional RCTs should also be conducted to confirm effects on sexual function with little bias. A better understanding of the impact of both Cu- and LNG-IUDs is necessary to expand upon this field of research and uncover any other benefits or detriments from IUDs.
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Affiliation(s)
- Katherine Ogle
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
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Su S, Vincent KL. Lactic acid, citric acid and potassium bitartrate non-hormonal prescription vaginal pH modulator (VPM) gel for the prevention of pregnancy. Expert Rev Clin Pharmacol 2022; 15:659-670. [PMID: 35802958 DOI: 10.1080/17512433.2022.2100347] [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: 11/04/2022]
Abstract
INTRODUCTION A non-hormonal prescription vaginal pH modulator (VPM) gel (Phexxi®), with active ingredients lactic acid, citric acid and potassium bitartrate, has recently been approved for prevention of pregnancy in the United States. The objective of this review is to compile the evidence available from published preclinical and clinical trials to support its use. AREAS COVERED PubMed was searched for published literature on VPM gel. Two Phase III trials were found on clinicaltrials.gov database. The results demonstrated that VPM gel is safe, with minimal side effects, and effective (cumulative 6-7 cycle pregnancy rate of 4.1-13.65%, (Pearl Index 27.5) as a contraceptive. Microbicidal effects suggest potential for the prevention of sexually transmitted infections (STIs); currently a Phase III clinical trial is being conducted to evaluate prevention of chlamydia and gonorrhea. EXPERT OPINION Non-hormonal reversible contraceptive options have been limited to the highly effective copper-releasing intrauterine device that requires insertion by a trained clinician, and less effective coitally-associated barrier and spermicide options which are typically available over-the-counter. Spermicides, which improve efficacy of barrier devices, may increase the risk of HIV/STIs. VPM gel provides a new safe, effective non-hormonal contraceptive option, with potential for prevention of STIs.
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Affiliation(s)
- Shanna Su
- St James' University Hospital, Leeds, United Kingdom
| | - Kathleen L Vincent
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, TX, 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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Higgins JA, Kramer RD, Wright KQ, Everett B, Turok DK, Sanders JN. Sexual Functioning, Satisfaction, and Well-Being Among Contraceptive Users: A Three-Month Assessment From the HER Salt Lake Contraceptive Initiative. JOURNAL OF SEX RESEARCH 2022; 59:435-444. [PMID: 33560155 PMCID: PMC8349922 DOI: 10.1080/00224499.2021.1873225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Few large, longitudinal studies document multiple contraceptive methods' effects on sexual functioning, satisfaction, and well-being. We leveraged data from the HER Salt Lake Contraceptive Initiative, a prospective cohort study with patient surveys at baseline, one month, and three months. Surveys assessed bleeding changes, contraceptive-related side effects, sexual functioning and satisfaction, and perceptions of methods' impact on sexual well-being. Individuals in the final sample (N = 2,157) initiated either combined oral contraceptives, levonorgestrel intrauterine devices (IUDs), copper IUDs, implants, injectables, or vaginal rings. Across methods, participants exhibited minimal changes in sexual function (Female Sexual Function Index-6 scores) or satisfaction (New Scale of Sexual Satisfaction scores) over three months. However, many perceived contraception-related changes to sexual well-being. Half (51%) reported their new method had made their sex life better; 15% reported it had made their sex life worse. Sexual improvements were associated with decreased vaginal bleeding, fewer side effects, and IUD use. Negative sexual impacts were associated with physical side effects (e.g., bloating and breast tenderness), increased bleeding, and vaginal ring use. In conclusion, contraceptive users did not experience major changes in sexual functioning or satisfaction over three months, but they did report subjective sexual changes, mostly positive, due to their method.
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Affiliation(s)
- Jenny A. Higgins
- Departments of Obstetrics and Gynecology and Gender and Women’s Studies, University of Wisconsin
| | - Renee D. Kramer
- Department of Population Health Sciences, University of Wisconsin
| | | | - Bethany Everett
- Department of Sociology, University of Utah
- Department of Obstetrics and Gynecology, University of Utah
| | - David K. Turok
- Department of Obstetrics and Gynecology, University of Utah
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9
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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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Garrett CC, Vaisey A. 'Most women really actually do just appreciate being asked': clinicians' views on integrating sexual wellbeing into contraceptive care. CULTURE, HEALTH & SEXUALITY 2022; 24:315-329. [PMID: 33170110 DOI: 10.1080/13691058.2020.1840630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
A growing body of literature suggests that contraceptives' impact on sexual experiences influences willingness to initiate and continue with a method. Little is known, however, about how clinicians engage with clients on this topic during contraceptive consultations. Fifteen clinicians in South Eastern Australia participated in semi-structured interviews between April and June 2019. Interviews were analysed using inductive, semantic thematic analysis. Participants varied in their evaluation and management of contraceptives' sexual side effects and the legitimacy given to women's bodily experience versus their own understanding of the evidence in the medical literature. We identified two distinct groups of clinicians: those who prioritised sexual wellbeing as a primary issue in contraceptive consultations and those who perceived sexual wellbeing as a secondary concern. The difference in practices was influenced by whether participants considered sexual wellbeing to be part of holistic care provision and their views on the clinician's role in raising the topic. Strategies to equip clinicians to integrate sexual wellbeing into contraceptive consultations include interactive clinical training and incorporating information about sexual side effects into contraceptive guidelines and client resources. Benefits gained from normalising sexual wellbeing could extend beyond contraceptive care to help clinicians address clients' sexual wellbeing in other contexts.
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Affiliation(s)
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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11
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Caruso S, Palermo G, Caruso G, Rapisarda AMC. How Does Contraceptive Use Affect Women's Sexuality? A Novel Look at Sexual Acceptability. J Clin Med 2022; 11:810. [PMID: 35160261 PMCID: PMC8836660 DOI: 10.3390/jcm11030810] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 02/05/2023] Open
Abstract
Among the components of a healthy life, sexuality is essential, contributing to both the psychophysical and social well-being of women and, consequently, to their quality of life. A poorly investigated standpoint is the acceptability of contraceptive methods, both in terms of their tolerability and metabolic neutrality and in terms of their impact on sexual life. In this context, we will provide an overview of the different methods of contraception and their effects on female sexuality, from biological changes to organic, social, and psychological factors, which can all shape sexuality. A MEDLINE/PubMed review of the literature between 2010 and 2021 was conducted using the following key words and phrases: hormonal contraception, contraceptives, female sexual function, libido, sexual arousal and desire, and sexual pain. Recent studies have supported the effects of contraceptives on women's sexuality, describing a variety of positive and negative events in several domains of sexual function (desire, arousal, orgasm, pain, enjoyment). However, satisfaction with sexual activity depends on factors that extend beyond sexual functioning alone. A more holistic approach is needed to better understand the multitude of factors linked to women's sexuality and contraception. Contraceptive counseling must consider these important elements since they are closely related to good compliance and maximize non-contraceptive health benefits.
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Affiliation(s)
- Salvatore Caruso
- Research Group for Sexology, Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Via Santa Sofia, 78, 95125 Catania, Italy; (G.P.); (G.C.); (A.M.C.R.)
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12
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Mahony H, Spinner C, Vamos CA, Daley EM. Social Network Influences on Young Women's Choice to Use Long-Acting Reversible Contraception: A Systematic Review. J Midwifery Womens Health 2021; 66:758-771. [PMID: 34491002 DOI: 10.1111/jmwh.13280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Long-acting reversible contraception (LARC; including intrauterine devices and implants) is recommended as the first-line contraceptive choice by several professional organizations (eg, American College of Obstetricians and Gynecologists); however, rates of uptake are lower than those of other contraceptive methods. A young woman's social network may influence the decision to use LARC. The purpose of this review was to determine the role of health care providers (HCPs), family, peers, and sexual partner(s) on young women's decisions to initiate LARC. METHODS Several databases (PubMed, CINAHL, and PsycINFO) were searched for articles published between 2000 and 2020 that studied the social network influences of HCPs, family, peers, and sexual partner(s) on LARC initiation among women in the United States aged 18 to 25. A narrative synthesis of the included articles was conducted. RESULTS Twenty-nine articles met the inclusion criteria (21 qualitative, 6 quantitative, 2 mixed methods). HCPs are an important influence on a young woman's LARC decision-making. Peers and family also have a role but were often sources of negative or inaccurate information. Gaps in the literature were identified, including a lack of data on implant users and a dearth of studies on the role of sexual partner influence; most studies were not guided by theory. DISCUSSION HCPs are integral to LARC initiation and may be more influential than other social network members. Future research should focus on understanding how social network members interact to result in LARC initiation. Gaining insight into these influences may improve existing interventions or contribute to the development of new interventions and ultimately promote LARC use among young women.
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Affiliation(s)
- Helen Mahony
- College of Public Health, University of South Florida, Tampa, Florida
| | - Chelse Spinner
- College of Public Health, University of South Florida, Tampa, Florida
| | - Cheryl A Vamos
- College of Public Health, University of South Florida, Tampa, Florida
| | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, Florida
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Montgomery MC, Ellison J, Chan PA, Harrison L, van den Berg JJ. Sexual satisfaction with daily oral HIV pre-exposure prophylaxis (PrEP) among gay and bisexual men at two urban PrEP clinics in the United States: an observational study. Sex Health 2021; 18:319-326. [PMID: 34446149 DOI: 10.1071/sh20207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/14/2021] [Indexed: 01/23/2023]
Abstract
Background Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV infection among men who have sex with men (MSM). However, limited data are available on the effect of PrEP use and sexual satisfaction among MSM taking PrEP. METHODS We conducted a one-time, cross-sectional survey of MSM receiving PrEP care at two hospital-based PrEP clinics in Providence, Rhode Island and Boston, Massachusetts, USA (April-September 2017). We oversampled Black and Hispanic/Latino individuals. Participants completed the 20-item New Sexual Satisfaction Scale (NSSS) twice, once for before and once for after starting PrEP. Participants reported sexual behaviours, PrEP adherence, PrEP attitudes, and quality of life with PrEP. RESULTS A total of 108 gay and bisexual men (GBM) participated. Overall, 15.7% were Black (non-Hispanic/Latino) and 23.1% were Hispanic/Latino, with an average age of 36.6 years. Most participants reported private health insurance coverage (71.3%), and 88.9% identified as homosexual, gay, or same gender-loving. The mean NSSS score before PrEP initiation across all 20 items was 3.94 (maximum = 5; 95% CI: 4.22, 4.43), and increased significantly after PrEP initiation (4.33, 95% CI: 4.22, 4.43; P < 0.001). Most participants (73.2%) reported that PrEP increased quality of life. This was associated with significant change in pre- to post-PrEP NSSS scores (linear regression coefficient = 1.21; 95% CI: 0.585, 1.84). CONCLUSIONS Initiating PrEP and reporting improved quality of life were significantly associated with an increase in sexual satisfaction. PrEP implementation efforts should consider sexual satisfaction to promote PrEP engagement and retention, and researchers and providers should adopt a sex-positive approach with PrEP patients, especially among MSM.
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Affiliation(s)
- Madeline C Montgomery
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; and Corresponding author.
| | - Jacqueline Ellison
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Philip A Chan
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Laura Harrison
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jacob J van den Berg
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; and Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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14
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Murphy N, Williams H, Nguyen J, McNamee K, Coombe J, Hocking J, Vaisey A. Condom use in young women using long-acting reversible contraception (LARC): a qualitative study. CULTURE, HEALTH & SEXUALITY 2021; 23:1153-1164. [PMID: 32644012 DOI: 10.1080/13691058.2020.1758344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
Young women in Australia disproportionately experience unintended pregnancy and sexually transmissible infections (STIs). As the promotion of highly effective pregnancy prevention methods such as long-acting reversible contraception (LARC) increases, concurrent use of condoms with LARC remains optimal for pregnancy and STI prevention. There is little data exploring condom use behaviour in young Australian women using LARC. In this qualitative study we interviewed twenty women using LARC about their experiences of making decisions regarding condom use. We used inductive thematic analysis to identify factors influencing participant decision-making. We found that while LARC had an impact on condom use and sexual practices, decisions regarding condom use were influenced by multiple factors including mood, menstrual changes related to LARC, and relationship dynamics. Participants' views of 'safe sex' extended beyond pregnancy and STI protection, to include desired outcomes such as pleasure, consent and communication. Access to STI testing and treatment was key to how participants managed STI risk. Findings highlight the need for a more comprehensive approach to safer sex health promotion, and the importance of ensuring STI testing and treatment services continue to be available and accessible to all young people.
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Affiliation(s)
- Nabreesa Murphy
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Henrietta Williams
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
| | - Julie Nguyen
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kathleen McNamee
- Family Planning Victoria, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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15
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Morison T, Eagar D. Women's perspectives on long-acting reversible contraception: a critical scoping review of qualitative research. Women Health 2021; 61:527-541. [PMID: 34006210 DOI: 10.1080/03630242.2021.1927284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Long-acting Reversible Contraception (LARC) has significant promise both from a public health outlook and a social justice perspective. However, if women's empowerment is to be supported, then perspectives and experiences of LARC must be considered. This scoping review assesses research about contraceptive users' perspectives and experiences of contraceptive decision-making and practices. A content analysis was conducted to identify research trends in qualitative studies of contraceptive-user perspectives (n = 54), located by means of a systematic search. Interpreting findings through a reproductive justice lens, three main limitations in the scholarship were identified, viz., (1) an instrumentalist, individual-level focus; (2) a lack of consideration for diverse perspectives; and (3) an uncritical focus on young women. While the small body of qualitative research on LARC offers some valuable insights, when viewed from a sexual and reproductive justice perspective, it is not sufficiently user-centered or grounded within the reproductive politics surrounding contraceptive care and provision. Research is needed that draws on appropriate social theory; widens its focus beyond dominant groups; and is cognizant of the multi-level power relations surrounding LARC. Such work provides a nuanced picture of the complex social and contextual factors at play and inform person-centered approaches in sexual and reproductive health policy and programming.
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Affiliation(s)
- Tracy Morison
- School of Psychology, Massey University, Palmerston North, New Zealand & Critical Studies in Sexualities and Reproduction, Rhodes University, Grahamstown, South Africa
| | - Daygan Eagar
- School of Health Sciences, Massey University, Palmerston North, New Zealand
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16
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Mahanova T, Tkachenko N. Conjoint analysis to understand preferences of contraceptives among women of reproductive age in Ukraine. PHARMACIA 2021. [DOI: 10.3897/pharmacia.68.e62794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article describes the results of marketing research using conjoint analysis that was conducted to establish the preferences of contraceptives among women of reproductive age in Ukraine to further use the results for effective marketing decisions making in the pharmaceutical industry.
It was established that the women`s choice differs significantly depending on their main socioeconomic characteristics: age, income level, and level of education. Priority contraceptives from hormonal, non-hormonal contraceptives, as well as contraceptive medical devices for different age groups of women, was identified. Alfred Marshall’s main economic law was confirmed and the existence of price elasticity according to preferences was established.
The results obtained on women’s preferences for certain types of contraceptives will improve the level of compliance, women’s pharmaceutical safety and promote a balance between women’s needs and the capabilities of the contraception supply system.
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17
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Brian JD, Grzanka PR, Mann ES. The age of LARC: making sexual citizens on the frontiers of technoscientific healthism. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2020; 29:312-328. [PMID: 33411601 DOI: 10.1080/14461242.2020.1784018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/12/2020] [Indexed: 06/12/2023]
Abstract
Routinely positioned as the 'first-line option' for contraceptive choice-making, long-acting reversible contraception (LARC) promotion efforts have come under critical scrutiny by reproductive justice advocates for the extent to which public health actors' preference for LARC devices may override potential users' ability to freely (not) choose to use contraception among an array of options. We identify LARC promotion discourse as constituting 'The Age of LARC': multifarious strategies for producing responsible sexual citizens whose health behaviours are empowered via a LARC-only approach to contraceptive use. We suggest that immediate postpartum LARC insertion policies, which have proliferated in the U.S. since 2012, exemplify the new era of LARC hegemony, in which urgency, efficiency, cost-effectiveness, and outcomes dominate both health policy and clinical practice around these contraceptive technologies. By following these efforts to facilitate access to and use of immediate postpartum LARC, we find a discourse on sexual citizenship that paradoxically constructs sexual health freedom through the use of a single class of contraceptive technologies.
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Affiliation(s)
- Jenny Dyck Brian
- Barrett, The Honors College, Arizona State University, Tempe, AZ, USA
| | - Patrick R Grzanka
- Department of Psychology, The University of Tennessee, Knoxville, TN, USA
| | - Emily S Mann
- Department of Health Promotion, Education, and Behavior and Women's and Gender Studies Program, University of South Carolina, Columbia, SC, USA
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18
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Caetano C, Bliekendaal S, Engler Y, Lombardo M. From awareness to usage of long-acting reversible contraceptives: Results of a large European survey. Int J Gynaecol Obstet 2020; 151:366-376. [PMID: 32852798 PMCID: PMC7756577 DOI: 10.1002/ijgo.13363] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/09/2020] [Accepted: 09/08/2020] [Indexed: 11/13/2022]
Abstract
Objective The PULSE survey investigated contraceptive decision making, focusing on the use of long‐acting reversible contraceptives (LARCs) to determine reasons for their low adoption rates. Methods An online questionnaire was sent to women aged 18–49 years in 14 European countries who were considering starting or changing contraceptive method and asked questions based on four stages of contraceptive decision making: awareness, consideration, consultation, and adoption. Results Overall, 7221 women responded. LARC awareness was high (~73%) but current usage was low (11.3%). Only 24% of LARC‐aware women would consider switching to them. Factors associated with decision making differed depending on the stage: e.g. at the awareness phase, women were concerned with suitability, reversibility, and whether the method is hormonal; and at the consideration phase, the efficacy, convenience, and adverse‐effect profile were important. Healthcare professionals (HCPs) were the most trusted information source for women’s contraceptive decision making. LARCs were discussed less frequently during consultations than other contraceptives and HCPs may be perceived to hold negative opinions on LARCs. Conclusion A lack of knowledge about the features and benefits of LARCs can contribute to misconceptions and low adoption rates. HCPs play an important role in addressing this, as information conveyed during consultations influences women’s contraceptive choices. European women are usually aware of long‐acting reversible contraceptives but often do not choose these methods, perhaps through misinformation about their effectiveness, suitability, and safety profile.
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19
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Beyond safety and efficacy: sexuality-related priorities and their associations with contraceptive method selection. Contracept X 2020; 2:100038. [PMID: 32954251 PMCID: PMC7486436 DOI: 10.1016/j.conx.2020.100038] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 01/22/2023] Open
Abstract
Objectives Sexuality-related preferences have been understudied in contraceptive selection and uptake. Investigators endeavored to assess contraceptive preferences among patients selecting new methods at family planning clinics and to evaluate the degree to which two sexuality-related preferences are (a) valued and (b) associated with method selection. Study design Data were derived from the HER Salt Lake Contraceptive Initiative, a longitudinal cohort nested in a quasi-experimental, observational study enrolling 18–45-year-old patients at four family planning health centers in Salt Lake County. At the time of selecting the new method of their choice, participants reported the importance of nine factors in contraceptive method selection, including two sexuality-related preferences: a method's lack of impact on libido and its lack of sexual interruption. Analyses involved multinomial logistic regression with method selected as the outcome, sexuality-related factors as the main explanatory variables, and a range of controls and covariates. Results Among 2188 individuals seeking new contraceptive methods, the factors most frequently cited as quite or extremely important were safety (98%), effectiveness (94%), not interrupting sex (81%), not impacting libido (81%) and lack of side effects (80%). Less frequently cited factors included partner acceptability (46%), lack of hormones (39%), friend recommendation (29%) and alignment with religious beliefs (11%). Multivariate models documented no significant associations between sexual-related priorities and method selection. Conclusions Many contraceptive seekers rank sexual-related priorities alongside safety and efficacy as very important, but a range of methods align with people's sexual priorities. Implications Since patients endorse the importance of sexual-related contraceptive factors (impact on libido, impact on sexual interruption) alongside safety and efficacy, contraceptive research, counseling and care should attend to people's sexuality.
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20
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Mann ES, White AL, Beavin C, Dys G. Foreign objects in college bodies: young women’s feelings about long-acting reversible contraception (LARC). Women Health 2020; 60:719-733. [DOI: 10.1080/03630242.2019.1710891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Emily S. Mann
- Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Ashley L. White
- Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Cynthia Beavin
- Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Gabrielle Dys
- Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
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21
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Butt MR, Lema V, Mukaindo A, Mohamoud G, Shabani J. Prevalence of and factors associated with female sexual dysfunction among women using hormonal and non-hormonal contraception at the AGA Khan University Hospital Nairobi. Afr J Prim Health Care Fam Med 2019; 11:e1-e9. [PMID: 31714117 PMCID: PMC6852410 DOI: 10.4102/phcfm.v11i1.1955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 11/03/2022] Open
Abstract
Background Female sexual function (FSD) is a complex phenomenon. It integrates all body systems and is influenced by a variety of factors. Contraceptives have shown to have variable effects on FSD. In Kenya, the majority of women use hormonal contraception with high rates of discontinuation of use, attributed to related side effects such as weight loss and loss of libido. Aim To determine the prevalence of and the factors affecting FSD among women using contraception in our setting. Setting The study was carried out at the Aga Khan University Hospital, Nairobi, at various clinical sites. Methods A cross-sectional study was conducted. Consecutive sampling of women of reproductive age using either hormonal or non-hormonal contraception was conducted. Two questionnaires were completed after obtaining informed consent. Independent associations of factors with the outcome variables were assessed using the chi-square test of association, and variables with a p < 0.25 were used in the multivariate analysis. Factors associated with FSD were determined using binary logistic regression. Results A total of 566 participants were included. The prevalence of FSD among those using hormonal and those using non-hormonal contraception was 51.5% and 29.6%, respectively (p < 0.0001). We found that the factors associated with FSD were presence of chronic illness and use of chronic medication, being self-employed or unemployed, alcohol intake and history of miscarriage(s). Conclusion There was a high prevalence of and a strong association between hormonal contraception and FSD. More studies on this topic in different settings are recommended to investigate the effect of each type of hormonal method on FSD.
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Affiliation(s)
- Momin R Butt
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi.
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22
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Vargas SE, Midoun MM, Guillen M, Getz ML, Underhill K, Kuo C, Guthrie KM. A Qualitative Systematic Review of Women's Experiences Using Contraceptive Vaginal Rings: Implications for New Technologies. INTERNATIONAL PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 45:25-34. [PMID: 31592770 DOI: 10.1363/45e7619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
CONTEXT Vaginal rings are available for contraception and hormone replacement, and are being developed as HIV/STD or multipurpose prevention technologies. A comprehensive understanding of women's expectations of and experiences with rings is urgently needed to inform product development and to optimize ring use. METHODS Three databases (PubMed, Global Health and CINAHL) were searched for English-language, peer-reviewed articles published between January 1996 and November 2017 that reported qualitative data on barriers to and facilitators of use of female-controlled contraceptive methods. Data on study methods, findings and conclusions pertaining to contraceptive rings were extracted, organized and analyzed. RESULTS Twenty-six articles, all published since 2008, met the inclusion criteria. Seven studies focused largely or entirely on rings (and involved current, former or potential users), while the others focused on other contraceptive methods but included ring-specific data. Familiarity with the ring was low, and women commonly had initial concerns about the method-often related to insertion and removal, cleanliness and discomfort with touching their vagina-that were typically overcome over time. Other major themes were issues related to ring use and discontinuation, the importance of ring-related properties and characteristics, and considerations related to sexual partners and health care providers. CONCLUSIONS Qualitative data have the potential to inform ring design and promotion. Future research should further explore women's expectations and experiences with the ring, the value of involving male partners in ring evaluation, and evaluation of interventions to improve patient-provider communication concerning ring choice and use.
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Affiliation(s)
- Sara E Vargas
- Research scientist, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI,
| | - Miriam M Midoun
- Graduate student, Department of Comparative Human Development, University of Chicago
| | - Melissa Guillen
- Project director, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | | | - Kristen Underhill
- Associate professor, Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York
| | - Caroline Kuo
- Associate professor (research), Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Kate M Guthrie
- Senior research scientist, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
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23
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Coombe J, Harris ML, Loxton D. Examining long-acting reversible contraception non-use among Australian women in their 20s: findings from a qualitative study. CULTURE, HEALTH & SEXUALITY 2019; 21:822-836. [PMID: 30612512 DOI: 10.1080/13691058.2018.1519119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/30/2018] [Indexed: 06/09/2023]
Abstract
Australian women use less effective, short-term methods of contraception more often than any other method, despite the availability of much more effective long-acting reversible contraception (LARC). Although research examining the low uptake of LARC among Australian women has increased over the past few years, we still know little about the factors influencing this phenomenon. Using data from semi-structured telephone interviews with 15 Australian women in their 20s, this paper explores contraceptive experience to better understand the non-use of LARC. Findings highlight the ubiquity of the use of the oral contraceptive pill and perceptions of LARC as a more serious contraceptive choice. Among participants, the intrauterine device (IUD) was viewed particularly unfavourably. Furthermore, LARC was shown to be only considered for use after dissatisfaction with shorter-term methods (usually the Pill) if at all. Overall, these findings suggest further education in dispelling myths and discomfort around LARC use, while simultaneously recognising and respecting women's decisions to not use LARC methods.
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Affiliation(s)
- Jacqueline Coombe
- a Research Centre for Generational Health and Ageing, University of Newcastle , Callaghan , New South Wales , Australia
| | - Melissa L Harris
- a Research Centre for Generational Health and Ageing, University of Newcastle , Callaghan , New South Wales , Australia
| | - Deborah Loxton
- a Research Centre for Generational Health and Ageing, University of Newcastle , Callaghan , New South Wales , Australia
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24
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Vargas SE, Midoun MM, Guillen M, Getz ML, Underhill K, Kuo C, Guthrie KM. A Qualitative Systematic Review of Women's Experiences Using Contraceptive Vaginal Rings: Implications for New Technologies. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:71-80. [PMID: 31108027 PMCID: PMC6662569 DOI: 10.1363/psrh.12103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/28/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT Vaginal rings are available for contraception and hormone replacement, and are being developed as HIV/STD or multipurpose prevention technologies. A comprehensive understanding of women's expectations of and experiences with rings is urgently needed to inform product development and to optimize ring use. METHODS Three databases (PubMed, Global Health and CINAHL) were searched for English-language, peer-reviewed articles published between January 1996 and November 2017 that reported qualitative data on barriers to and facilitators of use of female-controlled contraceptive methods. Data on study methods, findings and conclusions pertaining to contraceptive rings were extracted, organized and analyzed. RESULTS Twenty-six articles, all published since 2008, met the inclusion criteria. Seven studies focused largely or entirely on rings (and involved current, former or potential users), while the others focused on other contraceptive methods but included ring-specific data. Familiarity with the ring was low, and women commonly had initial concerns about the method-often related to insertion and removal, cleanliness and discomfort with touching their vagina-that were typically overcome over time. Other major themes were issues related to ring use and discontinuation, the importance of ring-related properties and characteristics, and considerations related to sexual partners and health care providers. CONCLUSIONS Qualitative data have the potential to inform ring design and promotion. Future research should further explore women's expectations and experiences with the ring, the value of involving male partners in ring evaluation, and evaluation of interventions to improve patient-provider communication concerning ring choice and use.
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Affiliation(s)
- Sara E. Vargas
- Research scientist, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Miriam M. Midoun
- Graduate student, Department of Comparative Human Development, University of Chicago
| | - Melissa Guillen
- Project director, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | | | - Kristen Underhill
- Associate professor, Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York
| | - Caroline Kuo
- Associate professor (research), Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence
| | - Kate M. Guthrie
- Senior research, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
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25
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Coombe J, Harris ML, Loxton D. Motivators of contraceptive method change and implications for long-acting reversible contraception (non-)use: A qualitative free-text analysis. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 19:71-77. [PMID: 30928138 DOI: 10.1016/j.srhc.2018.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To develop a greater understanding of the motivators of contraceptive method change over time for young Australian women, with a particular interest in long-acting reversible contraception (LARC) use. METHOD Free-text comments from the Contraceptive Use, Pregnancy Intention and Decisions (CUPID) Study were used to explore the reasons for contraceptive method change among women who reported one or more contraceptive changes across the three CUPID surveys. RESULTS 512 women reported making at least one contraceptive method change, with 740 comments explaining these changes between them. Participants reported a multitude of reasons motivating their contraceptive change. Five key themes were developed to explain these motivators: the natural, sexual and fertile body, specific contraceptive characteristics and other important people. Findings suggest that women's decisions to switch or discontinue a contraceptive depended largely on her ability (and desire) to juggle its impact on her sexual, fertile and natural body. Importantly, the transient and fluid nature of contraceptive practices were demonstrated, as the women adjusted their method to suit their needs at the time. CONCLUSION Regarding LARC use, these findings suggest that rather than being appealing, the 'temporarily permanent' nature of these methods may be unappealing and incongruent with the needs of some women.
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Affiliation(s)
- Jacqueline Coombe
- Research Centre for Generational Health and Ageing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Melissa L Harris
- Research Centre for Generational Health and Ageing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
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26
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Sanders JN, Higgins JA, Adkins DE, Stoddard GJ, Gawron LM, Turok DK. The Impact of Sexual Satisfaction, Functioning, and Perceived Contraceptive Effects on Sex Life on IUD and Implant Continuation at 1 Year. Womens Health Issues 2018; 28:401-407. [PMID: 30131221 PMCID: PMC6281294 DOI: 10.1016/j.whi.2018.06.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Contraceptives improve women's lives and public health, but many women discontinue their contraceptive method owing to dissatisfaction. An underexamined aspect of contraceptive discontinuation is sexual acceptability, or how contraception affects sexual experiences. Investigators' aims were two-fold: 1) to document changes in multiple domains of women's sexual experiences with their intrauterine device (IUD) or contraceptive implant over time and 2) to examine whether these sexuality factors were associated with method continuation at 12 months. METHODS We enrolled 200 eligible family planning clients and collected data at baseline and at 1, 3, 6, and 12 months. Sexual acceptability measures included the Female Sexual Function Index-6, the New Sexual Satisfaction Scale, and participants' perceptions of whether their contraceptive method had had a neutral, positive, or negative effect on their sex life. Survival analysis and Cox regression with time-varying covariates related sexuality measures to method continuation over time while controlling for other relevant factors. RESULTS Among 193 women who received an IUD or implant, 20% selected the copper IUD, 46% the levonorgestrel IUD, and 34% the etonogestrel implant. Ten percent discontinued their method during the year. Although changes in Female Sexual Function Index-6 and New Sexual Satisfaction Scale scores were not associated with discontinuation, individuals who perceived that their method detracted from their sexual experience had significantly higher removal rates than those who reported no sexual changes or positive sexual changes (adjusted hazard ratio, 8.04; 95% CI, 1.53-42.24), even when controlling for method type, bleeding changes, and a variety of covariates and controls. CONCLUSIONS Although limited by the small sample of discontinuers, we found that women's perceptions of how their method affects their sex life were associated with contraceptive continuation over time. Sexual acceptability should receive more attention in both contraceptive research and counseling.
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Affiliation(s)
- Jessica N Sanders
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, Utah.
| | - Jenny A Higgins
- Department of Obstetrics and Gynecology and Department of Gender Studies, University of Wisconsin, Madison, Wisconsin
| | - Daniel E Adkins
- Department of Sociology and Department of Psychiatry, The University of Utah, Salt Lake City, Utah
| | - Greggory J Stoddard
- Department of Internal Medicine, The University of Utah, Salt Lake City, Utah
| | - Lori M Gawron
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, Utah
| | - David K Turok
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, Utah
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27
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Pohjoranta E, Mentula M, Hurskainen R, Suhonen S, Heikinheimo O. Sexual well-being after first trimester termination of pregnancy: Secondary analysis of a randomized contraceptive trial. Acta Obstet Gynecol Scand 2018; 97:1447-1454. [PMID: 30125336 DOI: 10.1111/aogs.13440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/19/2018] [Accepted: 07/29/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although termination of pregnancy is one of the most common procedures conducted worldwide, little is known about sexual well-being after termination of pregnancy. The objective of this study was to assess sexual well-being after termination of pregnancy, and factors affecting it during a 1-year follow up. MATERIAL AND METHODS In total, 748 women requesting first trimester termination of pregnancy and participating in a randomized controlled trial on early provision of intrauterine contraception were provided with questionnaires regarding their sexual life, anxiety, quality of life and contraceptive method used at the time of termination of pregnancy, 3 and 12 months after termination of pregnancy. Sexual well-being was measured by the 9-item McCoy Female Sexuality Questionnaire. Anxiety and quality of life were assessed by the State-Trait Anxiety Inventory (STAI) Scale and EuroQoL questionnaire (EQoL). RESULTS The McCoy index remained unchanged during the follow up. At all three time-points measured, higher (ie, better) McCoy scores were associated with a lower STAI index (mean difference -2.26 [95% CI -3.23 to -1.29], P < 0.001; -3.76 [95% CI -4.79 to -2.74], P < 0.001; -4.50 [95% CI -5.88 to -3.12], P < 0.001) and being in a relationship (1.16 [95% CI 0.08-2.25], P = 0.023; 1.67 [95% CI 0.43-2.89], P < 0.001; 2.81 [95% CI 1.28-4.34], P < 0.001), and correlated positively with a higher EQoL index (r = 0.20, r = 0.20, r = .27, P < 0.001) and higher frequency of intercourse (r = 0.50, r = 0.46, r = 0.42, P < 0.001). Women using intrauterine contraception had higher McCoy index measurements at 3 months compared with others. There were no significant differences between users of hormonal vs non-hormonal contraceptive methods. CONCLUSIONS Sexual well-being does not change significantly after termination of pregnancy. Instead, it is strongly and positively associated with quality of life, relationship status and frequency of intercourse. Anxiety is negatively associated with sexual well-being.
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Affiliation(s)
- Elina Pohjoranta
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ritva Hurskainen
- Department of Obstetrics and Gynecology, Hyvinkää Hospital, Hyvinkää, Finland
| | - Satu Suhonen
- Centralized Family Planning, Department of Social Services and Health Care, City of Helsinki Health Center, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Zeal C, Higgins JA, Newton SR. Patient-Perceived Autonomy and Long-Acting Reversible Contraceptive Use: A Qualitative Assessment in a Midwestern, University Community. Biores Open Access 2018; 7:25-32. [PMID: 29588877 PMCID: PMC5868328 DOI: 10.1089/biores.2017.0037] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Long-acting reversible contraceptives (LARCs) are the most effective contraceptives and are first-line recommendations for most women. However, young women use these methods at relatively low rates. Given concern with contraceptive coercion, an underexamined factor contributing to LARC attitudes is women's perceived reproductive and bodily autonomy in regard to LARC. We conducted focus group discussions and interviews regarding LARC perceptions and knowledge with 50 women between the ages of 18 and 29. We used a modified grounded theory approach to analyze young women's impressions of autonomy in relation to contraceptives more generally and LARC more specifically, both among ever-users and never-users. Four themes emerged regarding women's perceived autonomy with LARC. Control over pregnancy, active participation versus external agent, control over bleeding patterns, and autonomy in the provider/patient relationship. Within most themes, women made both positive and negative associations between perceived autonomy and LARC. The provider/patient relationship was a modifier of other themes, in that cooperative relationships may overshadow other perceived reductions in autonomy, and more unbalanced relationships may heighten perceived reductions in autonomy. Ever-users were more likely to report increased autonomy with LARC use, whereas never-users were more likely to express concerns about loss of autonomy with LARC. This study suggests that perceived autonomy may influence women's perceptions of LARC as well as their uptake of these contraceptive methods, with several factors both positively and negatively related to women's perceived autonomy. We encourage the integration of these findings into patient-centered counseling as well as educational materials for LARC.
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Affiliation(s)
- Carley Zeal
- Division of Family Planning, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jenny A Higgins
- Department of Obstetrics and Gynecology, Gender and Women's Studies, University of Wisconsin-Madison, Madison, Wisconsin
| | - Shaunna R Newton
- School of Public Health, University of Maryland College Park, College Park, Maryland
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Higgins JA. Pregnancy Ambivalence and Long-Acting Reversible Contraceptive (LARC) Use Among Young Adult Women: A Qualitative Study. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2017; 49:149-156. [PMID: 28419700 PMCID: PMC5597464 DOI: 10.1363/psrh.12025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/09/2017] [Accepted: 02/17/2017] [Indexed: 05/16/2023]
Abstract
CONTEXT Many young adults are unclear about how much they want to have, or prevent having, a baby. However, pregnancy ambivalence is an underexamined factor in the uptake of long-acting reversible contraceptive (LARC) methods-IUDs and implants-the most effective methods available. METHODS In 2014, investigators conducted six focus groups and 12 interviews with 50 women aged 18-29 in Dane County, Wisconsin; participants were either university students or community residents receiving public assistance. A modified grounded theory approach was used to analyze the data. RESULTS Four themes emerged. First, participants described a pregnancy desire spectrum: Those strongly motivated to avoid pregnancy were most receptive to LARC methods, while those with less clear or mixed desires worried that these methods would prevent "accidental" pregnancies that might not be unwelcome. Second, women within a few years of wanting children perceived LARC methods as too "permanent," despite awareness of their reversibility. Third, age and life stage were important factors: Younger women and those attending school or beginning careers were more likely than others to consider these methods because they had clearer motivations to avoid pregnancy. Finally, relationship stage influenced receptiveness to LARC methods: Women in newer relationships were more receptive than were those in longer term relationships who imagined having a baby with their partner someday. CONCLUSION Effectiveness is not the only factor in women's selection and use of contraceptive methods. Individual preferences will lead some women to choose non-LARC methods even when fully informed of their options.
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Affiliation(s)
- Jenny A Higgins
- associate professor of gender and women's studies, University of Wisconsin-Madison
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Higgins JA, Sanders JN, Palta M, Turok DK. Women's Sexual Function, Satisfaction, and Perceptions After Starting Long-Acting Reversible Contraceptives. Obstet Gynecol 2016; 128:1143-1151. [PMID: 27741195 PMCID: PMC5082420 DOI: 10.1097/aog.0000000000001655] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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 and contraceptive implant users attending four family planning clinics. Data collection occurred at baseline, 1 month, and 3 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. Mixed-effects models, robust Wald χ tests, and conditional logistic regression documented differences from baseline and trends over time. RESULTS In December 2014 to April 2015, 200 patients consented and enrolled in the study. Among 159 women who completed three survey rounds, 20% selected copper intrauterine devices, 46% levonorgestrel intrauterine devices, 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 with baseline (χ P<.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.
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Affiliation(s)
| | | | - Mari Palta
- University of Wisconsin, Madison Wisconsin
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Higgins JA, Kramer RD, Ryder KM. Provider Bias in Long-Acting Reversible Contraception (LARC) Promotion and Removal: Perceptions of Young Adult Women. Am J Public Health 2016; 106:1932-1937. [PMID: 27631741 PMCID: PMC5055778 DOI: 10.2105/ajph.2016.303393] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 11/04/2022]
Abstract
Long-acting reversible contraception (LARC) is effective and acceptable. However, concern exists about potential provider bias in LARC promotion. No study has documented contraceptive users' attitudes toward or experiences with provider influence and bias regarding LARC. We collected qualitative data in 2014 to address this gap. Participants were 50 young adult women with any history of contraceptive use (including LARC) in Dane County, Wisconsin. Women often described providers as a trusted source of contraceptive information. However, several women reported that their preferences regarding contraceptive selection or removal were not honored. Furthermore, many participants believed that providers recommend LARC disproportionately to socially marginalized women. We encourage contraceptive counseling and removal protocols that directly address historical reproductive injustices and that honor patients' wishes.
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Affiliation(s)
- Jenny A Higgins
- Jenny A. Higgins is with the Department of Gender and Women's Studies, University of Wisconsin-Madison. Renee D. Kramer is with the Department of Population Health Sciences, University of Wisconsin-Madison. At the time of the study, Kristin M. Ryder was with the Department of Health Behavior and Health Education, University of Michigan, Ann Arbor
| | - Renee D Kramer
- Jenny A. Higgins is with the Department of Gender and Women's Studies, University of Wisconsin-Madison. Renee D. Kramer is with the Department of Population Health Sciences, University of Wisconsin-Madison. At the time of the study, Kristin M. Ryder was with the Department of Health Behavior and Health Education, University of Michigan, Ann Arbor
| | - Kristin M Ryder
- Jenny A. Higgins is with the Department of Gender and Women's Studies, University of Wisconsin-Madison. Renee D. Kramer is with the Department of Population Health Sciences, University of Wisconsin-Madison. At the time of the study, Kristin M. Ryder was with the Department of Health Behavior and Health Education, University of Michigan, Ann Arbor
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Francis JKR, Fraiz LD, Catallozzi M, Rosenthal SL. Qualitative Analysis of Sexually Experienced Female Adolescents: Attitudes about Vaginal Health. J Pediatr Adolesc Gynecol 2016; 29:496-500. [PMID: 27133374 PMCID: PMC5003631 DOI: 10.1016/j.jpag.2016.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To explore adolescent's perceptions of vaginal health, practices, and vaginally-placed products. DESIGN Semistructured interviews were audio-recorded and transcribed until theoretical saturation was achieved. SETTING Adolescent medicine clinics in New York City. PARTICIPANTS Female adolescents (N = 22) who were sexually experienced, predominately Hispanic (73%, n = 16) with a mean age of 17.7 years (range, 15-20 years). INTERVENTIONS None. MAIN OUTCOME MEASURES Interviews were used to assess perspectives on vaginal health, specific vaginal hygiene practices, and attitudes about vaginally-placed products (contraceptive rings, intrauterine devices), and proposed multipurpose technologies administered as ring or gel). The interviews were transcribed and coded for relevant themes. RESULTS Overlapping themes included young women's view of their vagina as a space that needed to be healthy for sexual partners and future fertility. The vagina could not be presumed to be healthy and conversations about vaginal health were limited to include only specific individuals. All reported a variety of practices to maintain their vaginal health, including showering 1-5 times a day and using soaps specifically for the vagina. Attitudes about vaginally-placed products revealed concerns about the sensory experience of having a product in the vagina, safety concerns and interest in the product's objective (prevention of pregnancy or infection). CONCLUSION Adolescents have very specific views and practices about their vaginas. Clinicians should initiate conversations about vaginal health and hygiene with adolescents and focus on the normalcy of the vagina. Development of vaginally-placed products should focus on the sensory experience, safety, and purpose of the product.
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Affiliation(s)
- Jenny K R Francis
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York.
| | - Lauren Dapena Fraiz
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York; Heilbrunn Department of Population & Family Health, Columbia University Medical Center - Mailman School of Public Health, New York, New York
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York
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Higgins JA, Smith NK. The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept. JOURNAL OF SEX RESEARCH 2016; 53:417-56. [PMID: 26954608 PMCID: PMC4868075 DOI: 10.1080/00224499.2015.1134425] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
How contraceptives affect women's sexual well-being is critically understudied. Fortunately, a growing literature focuses on sexual aspects of contraception, especially hormonal contraception's associations with libido. However, a more holistic approach to contraceptive sexual acceptability is needed to capture the full range of women's sexual experiences. We conducted a narrative literature review of this topic, working with an original sample of 3,001 citations published from 2005 to 2015. In Part 1, we draw from a subset of this literature (264 citations) to build a new conceptual model of sexual acceptability. Aspects include macro factors (gender, social inequality, culture, and structure), relationship factors (dyadic influences and partner preferences), and individual factors (sexual functioning, sexual preferences, such as dis/inhibition, spontaneity, pleasure, the sexual aspects of side effects, such as bleeding, mood changes, sexual identity and sexual minority status, and pregnancy intentions). In Part 2, we review the empirical literature on the sexual acceptability of individual methods (103 citations), applying the model as much as possible. Results suggest contraceptives can affect women's sexuality in a wide variety of positive and negative ways that extend beyond sexual functioning alone. More attention to sexual acceptability could promote both women's sexual well-being and more widespread, user-friendly contraceptive practices.
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