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Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WIDepartments of Gender and Women’s Studies, University of Wisconsin-Madison, Madison, WI
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.
contraception is one of the most frequently used medical products. Contraception prevents millions of unwanted pregnancies annually, positively influencing pregnancy- and birth-related health and social outcomes. Many birth control methods are used for noncontraceptive purposes or treatment of certain gynecologic conditions.
This study assessed contraceptive satisfaction among new-start contraceptive users and examined whether sexual acceptability predicted contraceptive satisfaction at 3 months.
Key findings
Most patients (82.8%) were “somewhat” or “completely” satisfied with their contraceptive method at 3 months. Patients whose method made their sex life “a lot better” had nearly 8 times greater satisfaction than those whose method made their sex life “a lot worse.”
What does this add to what is known?
Among new-start contraceptive users, the patients’ sexual experiences with their birth control method were highly associated with contraceptive satisfaction at 3 months, more so than changes in vaginal bleeding, mood-related side effects, or physical side effects.
Satisfaction and continuation are likely closely aligned for many users,
For example, some dissatisfied users of long-acting reversible contraceptives (LARCs)—intrauterine devices (IUDs) and implants—may continue use because of difficulties having their devices removed.
Furthermore, discontinuation may not indicate dissatisfaction, as patients’ preferences or behaviors might change on the basis of relationship context, pregnancy desires, or other life circumstances.
Although researchers and clinicians often focus on contraceptive continuation, “satisfaction” is a more person-centered outcome that better captures users’ actual experiences of their contraceptive method.
To understand and improve patients’ contraceptive satisfaction, researchers have examined characteristics, such as effectiveness, side effects, affordability, mode of administration, method, and use of one’s preferred method.
However, an important but underexamined factor in contraceptive satisfaction is “sexual acceptability,” a broad construct of how contraceptives affect people’s sexual well-being.
Despite evidence of associations between sexual acceptability and contraceptive behaviors, at least 3 critical gaps remain. First, we lack evidence linking sexual acceptability to contraceptive satisfaction, which is a more person-centered outcome than continuation, “adherence,” or “compliance.”
which gauges factors, such as lubrication, arousal, and orgasm. However, patients’ “perceptions” of their methods’ sexual impacts may be equally if not more important than physiological sexual functions.
Relationships between condoms, hormonal methods, and sexual pleasure and satisfaction: an exploratory analysis from the Women’s Well-Being and Sexuality Study.
; thus, patients’ experiences of the full range of methods warrant greater attention.
Here, to document individual-level factors associated with contraceptive satisfaction at 3 months, we used data from a study in which participants selected any method at no cost and could switch methods at any time. We selected this time horizon to capture as many users as possible, based on findings that few people discontinue after 1 month and most discontinuations occur after 3 months.
We hypothesized that sexual acceptability–related changes at 1 month would be correlated with contraceptive satisfaction at 3 months and that these effects would be consistent with if not greater in magnitude than factors such as reported side effects and bleeding changes.
Materials and Methods
Overview, data source, and population
Data derive from the HER Salt Lake Contraceptive Initiative, a longitudinal cohort nested in a quasi-experimental, observational study (ClinicalTrials.gov Identifier: NCT02734199).
Recruitment occurred at 4 participating family planning health centers in Salt Lake County, Utah, from September 2015 to March 2017. Individuals could enroll in the survey arm if they were 18 to 45 years old, spoke English or Spanish, were a new patient or were receiving a new contraceptive method, and did not want to become pregnant for at least 1 year. Compared with the all-served cohort, survey arm participants were more likely to be 18 to 24 years old, non-Hispanic White, parous, and self-paying, and to select a LARC method.
All participants engaged in standardized contraceptive counseling with a trained clinic staff member. This study was approved by the University of Utah Institutional Review Board.
For 1 year beginning on March 28, 2016, clients received their method at no cost and could freely switch or discontinue methods for up to 3 years (n=3709). We excluded participants who continued an existing method (n=307), did not select one of the 6 most common methods (n=87), lacked valid data on the length among surveys (n=286), or discontinued their enrollment method before 1 month (n=147). Because we used measures designed for sexually active populations, we excluded participants not sexually active at baseline or 1 month (n=335). Finally, we excluded respondents missing complete data on our outcome or main explanatory variables (n=668). Our final analytical sample included 1879 individuals (Figure).
FigureFlow chart of the inclusion criteria for analytical sample
Surveys were available in English and Spanish and could be completed in person (baseline survey only), online, or by phone, depending on patient preference. Participants were compensated for survey completion.
At the 3-month follow-up survey, we asked participants to rate their satisfaction with their contraceptive method in the last 4 weeks on a 5-point Likert scale (“completely dissatisfied,” “somewhat dissatisfied,” “neither satisfied nor dissatisfied,” “somewhat satisfied,” or “completely satisfied”). A small number of patients (n=103) discontinued their enrollment method between 1 and 3 months and are therefore missing data on 3-month satisfaction. However, we did not want to exclude these participants because doing so may have biased our results toward more satisfied users. Thus, we examined participants’ reason for discontinuation, and if they discontinued due to method-related reasons (eg, bleeding, cramping, pain), we coded them as “completely dissatisfied” (n=77). Notably, 26 participants discontinued their method between 1 and 3 months for other reasons (eg, wanting to become pregnant) or did not provide a reason. We excluded these participants from our regression model because we could not ascertain their 3-month contraceptive satisfaction.
We examined 3 measures related to sexual acceptability—the study’s main predictor variables—at baseline and 1 month. Validated surveys included the 6-item version of the FSFI (FSFI-6),
which includes 20 items that capture physiological, psychological, partner-related, and activity-focused components of sexuality. These measures assess patient experiences in the last month, with higher values reflecting higher levels of functioning and satisfaction, respectively. Furthermore, follow-up surveys captured patients’ perceptions of contraceptive-related sexual effects: “In the last 4 weeks, would you say that your birth control method has improved your sex life a lot, improved your sex life a little, had no effect on your sex life, has made your sex life a little worse, or has made your sex life a lot worse?”
Primary covariates included bleeding changes and other physical and mood-related changes that could contribute to contraceptive satisfaction. The enrollment and follow-up surveys contained the validated Menstrual Symptom Questionnaire (MSQ),
which captures both physical (headaches, bloating, cramping, breast tenderness, acne, diarrhea or constipation, and weight gain or loss) and mood domains (feelings of depression or mood changes). Higher MSQ values indicated more side effects.
Moreover, follow-up surveys assessed whether respondents’ vaginal bleeding had increased, decreased, or not changed in the past month. Fixed sociodemographic control measures came from the enrollment survey and included age, race and ethnicity, relationship status, sexual orientation, annual household income, and the validated World Health Organization-5 Well-Being Index.
Participants with missing data on control variables were coded into the “other” category for variables with this category; otherwise, we coded them as “missing” on that variable in the regression.
Analyses
We first described percent distributions for contraceptive satisfaction at 3 months. Then we documented the perceived impact of the contraceptive method on sex life and changes in vaginal bleeding, sexual functioning and satisfaction, and frequency of menstrual side effects at baseline and 1 month. Next, we created multivariate ordered logistic regression models, with satisfaction with the contraceptive method at 3 months as the outcome of interest. Main covariates included 1-month assessments of whether the contraceptive method had impacted one’s sex life in the past 4 weeks and changes in vaginal bleeding, sexual functioning and satisfaction, and physical side effects from baseline to 1 month. We ran 2 sensitivity analyses, in which we (1) coded participants who discontinued for method-related reasons as “somewhat dissatisfied” rather than “completely dissatisfied” and (2) excluded participants who discontinued between 1 and 3 months from the analysis. We conducted all analyses using Stata (version 16; StataCorp LLC, College Station, TX).
Table 1 presents descriptive statistics among the full analytical sample (n=1879). The most commonly selected methods were the levonorgestrel 52 mg IUD (31.2%), the etonogestrel contraceptive implant (23.1%), oral contraceptive pills (16.0%), and the copper T380A IUD (15.5%). Here, 62% of respondents were under the age of 25 years. One-third of respondents (33.5%) identified as persons of color. Furthermore, 40% had a high school diploma or less, and 38.0% reported household incomes at or below the federal poverty level. About half of respondents (52.2%) were cohabiting or in a committed relationship, and most respondents (86.5%) identified as “exclusively” or “mostly” heterosexual. The 6-month retention rate of participants in the study was 92%.
Table 1Percentage distribution of baseline characteristics
Changes in bleeding, sexuality measures, and side effects from baseline to 1 month
Table 2 presents the main independent variables’ and covariates’ descriptive values, including the average change in NSSS, FSFI-6, and MSQ scores from baseline to 1 month. Most respondents (53.4%) reported that their contraceptive method improved their sex life a little or a lot from baseline to 1 month, 16.7% stated that their method made their sex life a little or a lot worse, and 29.9% said their method had no sexual effect. NSSS scores
decreased by only 0.39 of 36 points, although both changes had wide distributions (standard deviations [SDs], 16.6 and 5.3, respectively). The physical and mood domains from the MSQ both increased (ie, worsened) by 0.3 of 5 points throughout the first month (SDs, 1.5 and 0.9, respectively). Forty-seven percent reported increased vaginal bleeding in the first month of use, 25.6% reported less bleeding than before, 14.3% reported no bleeding, and 13.5% reported no change.
Table 2Sexuality measures, bleeding changes, and side effects, 0 to 1 months
Sexuality measures, bleeding changes, and side effects
Impact of method on sex life (measured at 1 mo only)
n (%)
Has made my sex life a lot worse
43 (2.3)
Has made my sex life a little worse
271 (14.4)
Has had no effect on my sex life
561 (29.9)
Improved my sex life a little
508 (27.0)
Improved my sex life a lot
496 (26.4)
New sexual satisfaction scale (range 20–100)
Mean (95% CI)
Average baseline score
75.8 (75.0–76.5)
Average change in score from 0 to 1 mo
−2.1 (−2.8 to −1.3)
Female sexual functioning index-6 (range 5–30)
Mean (95% CI)
Average baseline score
23.4 (23.2–23.6)
Average change in score from 0 to 1 mo
−0.39 (−0.63 to −0.15)
Changes in vaginal bleeding (measured at 1 mo only)
n (%)
I have had no vaginal bleeding
269 (14.3)
I have had less bleeding than before
481 (25.6)
I have had no change from before
254 (13.5)
I have had more bleeding than before
875 (46.6)
Menstrual symptoms questionnaire: mood-related side effects (range 0–5)
At 3 months, 95% of our sample patients were still using their enrollment method. Of participants who had discontinued their contraceptive method between 1 and 3 months (n=103), approximately three-quarters (n=77) indicated a method-related reason for discontinuation and thus were coded as “completely dissatisfied” at 3 months.
Table 3 shows contraceptive satisfaction at 3 months among patients for whom satisfaction at 3 months could be determined (n=1853). Approximately half of participants (52.1%) were “completely satisfied,” and approximately one-third of participants (30.7%) were “somewhat satisfied.” Moreover, 4% were “neither satisfied nor dissatisfied,” 6.9% were “somewhat dissatisfied.” Notably, 6%—primarily patients who had discontinued between 1 and 3 months—were classified as “very dissatisfied.”
There are 38 respondents who reported being “completely dissatisfied” at 3 months and 77 respondents who discontinued between 1 and 3 months and cited a methods-related reason for discontinuation.
115
6.2
Kramer et al. Sexual acceptability and contraceptive satisfaction. Am J Obstet Gynecol 2022.
a There are 38 respondents who reported being “completely dissatisfied” at 3 months and 77 respondents who discontinued between 1 and 3 months and cited a methods-related reason for discontinuation.
Multivariable analyses predicting contraceptive satisfaction at 3 months
Table 4 presents results from ordered logistic regression analyses, which modeled the association between covariates and contraceptive satisfaction at 3 months, net of control variables at enrollment. Here, proportional odds ratios (ORs) larger than 1 represent greater odds of reporting more contraceptive satisfaction. Compared with respondents whose contraceptive method “made their sex life a lot worse” throughout the first month, respondents whose method “improved their sex life a lot” had 7.7 times increased odds of greater contraceptive satisfaction at 3 months (95% confidence interval [CI], 4.02–14.60; P<.0001), and respondents whose method improved their sex life a “little” had 5.88 times increased odds of greater satisfaction (95% CI, 3.12–11.11; P<.0001). Participants whose method did not affect their sex life had 5.10 times increased odds of greater satisfaction (95% CI, 2.72–9.54, P<.0001), and those whose method made their sex life a “little” worse had 2.64 times increased odds of greater satisfaction (95% CI, 1.41–4.93; P<.01).
Table 4Effects of sexuality measures, bleeding changes, and side effects on contraceptive satisfaction at 3 months
Unadjusted models include only design-related variables (site of enrollment in study, period of enrollment in study, and average length between survey responses in days). Adjusted models include these variables in addition to age, race and ethnicity, relationship status, federal poverty level category, contraceptive method, sexual orientation, and general well-being and the other variables in the table
Sexuality measures, bleeding changes, and side effects
Unadjusted OR
95% CI
Significance
Adjusted OR
95% CI
Significance
1-point increase in satisfaction at 3 mo
1-point increase in satisfaction at 3 mo
Impact of contraceptive method on sex life at 1 mo
Has made my sex life a lot worse
Ref
—
Ref
—
Has made my sex life a little worse
3.14
(1.71–5.80)
∗∗∗
2.64
(1.41–4.93)
∗∗
Has had no effect on my sex life
6.60
(3.63–12.01)
∗∗∗
5.10
(2.72–9.54)
∗∗∗
Improved my sex life a little
7.71
(4.23–14.05)
∗∗∗
5.88
(3.12–11.11)
∗∗∗
Improved my sex life a lot
10.92
(5.96–20.02)
∗∗∗
7.66
(4.02–14.60)
∗∗∗
Change in FSFI from 0 to 1 mo
1.04
(1.02–1.06)
∗∗∗
0.99
(0.97–1.01)
Change in NSSS from 0 to 1 mo
1.01
(1.01–1.02)
∗∗∗
1.01
(1.00–1.01)
Changes in bleeding reported at 1 mo
I have had more vaginal bleeding than before
Ref
—
Ref
—
I have had no change in vaginal bleeding
1.21
(.92–1.59)
1.24
(.92–1.67)
I have had less vaginal bleeding than before
1.55
(1.25–1.92)
∗∗∗
1.56
(1.23–1.97)
∗∗∗
I have had no vaginal bleeding
1.67
(1.27–2.19)
∗∗∗
2.22
(1.61–3.07)
∗∗∗
Change in mood-related side effects from 0 to 1 mo
Physical symptoms include headaches, bloating, cramping, diarrhea or constipation, acne, weight gain or loss, and breast tenderness.
0.74
(.66–.82)
∗∗∗
0.80
(0.70–0.91)
∗∗
∗=P<.05. ∗∗=P<.01. ∗∗∗=P<.001.
CI, confidence interval; FSFI, Female Sexual Functioning Index; NSSS, New Sexual Satisfaction Scale; OR, odds ratio; Ref, reference.
Kramer et al. Sexual acceptability and contraceptive satisfaction. Am J Obstet Gynecol 2022.
a Unadjusted models include only design-related variables (site of enrollment in study, period of enrollment in study, and average length between survey responses in days). Adjusted models include these variables in addition to age, race and ethnicity, relationship status, federal poverty level category, contraceptive method, sexual orientation, and general well-being and the other variables in the table
b Mood-related side effects include feelings of depression or changes in mood
c Physical symptoms include headaches, bloating, cramping, diarrhea or constipation, acne, weight gain or loss, and breast tenderness.
Compared with respondents who experienced increased vaginal bleeding, respondents who reported no bleeding (OR, 2.22; 95% CI, 1.61–3.07; P<.0001) or less bleeding (OR, 1.56; 95% CI, 1.23–1.97; P<.0001) more frequently reported contraceptive satisfaction at 3 months. Participants who experienced increases in the frequency of physical side effects from baseline to 1 month had lowered odds of satisfaction at 3 months (P<.0001). No other predictors or covariates were significantly associated with contraceptive satisfaction. Our results were substantively similar when we coded participants who discontinued for method-related reasons as “somewhat dissatisfied” and when we excluded participants who discontinued their method between 1 and 3 months (Supplemental Tables 1 and 2).
Comment
Principal findings
In this longitudinal study of new-start contraceptive users, we found that most patients reported satisfaction with their birth control method at 3 months. Furthermore, we found strong associations between satisfaction and patients’ perceptions of how their method impacted their sex life at 1 month and changes in bleeding and physical side effects—although to a lower degree. Changes in sexual functioning and satisfaction and mood-related side effects were not predictive of contraceptive satisfaction at 3 months.
Results in the context of what is known
This study is one of surprisingly few to focus on contraceptive satisfaction, although this outcome is more person-centered than contraceptive continuation or adherence. Furthermore, the study examined multiple measures of sexual acceptability—a phenomenon surprisingly absent from previous contraceptive research. We innovated on previous research by examining the relationship between sexuality measures and contraceptive satisfaction in a large, real-world cohort of patients starting the method of their choice. More than 80% of participants reported being satisfied with their method at 3 months, and a few—approximately 1 in 16 participants—either reported being dissatisfied (2.0%) or discontinued their contraceptive method because of dissatisfaction before 3 months (4.1%). Moreover, we found that contraceptive users’ perceived impact of their method on their sex life in the first month strongly predicted satisfaction at 3 months, whereas mood-related side effects, such as depression, changes in sexual functioning, and sexual satisfaction, did not significantly predict contraceptive satisfaction.
In addition to integrating sexual acceptability into the literature on person-centered contraceptive care—and demonstrating that perceived impact on sex life is a strong predictor of method satisfaction—this study amplifies research demonstrating that efficacy, safety, and side effects are not the only factors that matter to patients in their experiences with contraception.
Results from this study underscore the importance of patients’ sexual experiences of birth control in shaping their likelihood of continuation and their satisfaction with their method over time.
Clinical implications
These sexual effects suggest the need for a potential shift in how medical professionals think of contraception: contraceptives are not just medical products with numerous health benefits; they can also enhance or inhibit people’s sex lives. Clinicians may wish to underscore that sexual experiences of contraceptive methods are important and encourage patients to find a method that works for them sexually. Doing so may increase patients’ satisfaction with their contraceptive method, improving their overall quality of life.
Research implications
We recommend that future research examine how to address sexual acceptability when providing contraceptive care to patients. Although this quantitative analysis provides strong evidence of the association between sexual acceptability and contraceptive satisfaction, we need research examining how clinicians can better attend to sexuality in contraceptive counseling and how to best support them in these efforts (eg, developing and implementing continuing medical education training on sexual acceptability for contraceptive care professionals). Furthermore, future research should consider whether the relationship between sexual acceptability and contraceptive satisfaction varies by socioeconomic characteristics.
Strengths and limitations
The study strengths includes its large sample size, longitudinal design, inclusion of 6 contraceptive methods (whereas previous studies of contraceptive satisfaction often focused on LARC), and use of multiple validated measures to assess patients’ sexual experiences while using contraceptives. Study limitations include the exclusion of some eligible participants to meet the inclusion criteria for these analyses, including those missing values on the outcome variable or primary covariates. Although those excluded participants tended to report somewhat more favorable impacts of their contraceptives on their sex lives, they closely resembled included participants on our other primary covariates, including FSFI-6, NSSS, and MSQ scores.
This cohort’s survey arm participants has different characteristics compared with all those served during the initiative, including a preferential selection of IUDs and contraceptive implants in the survey arm compared with all those served.
In addition, because the study design included only reversible methods, our sample has a greater proportion of LARC users than the general population of reproductive-aged women, among whom the most common method is female sterilization.
Furthermore, we had very small samples of certain contraceptive methods, most notably male condoms. Although only 0.2% of patients selected condoms as their primary contraceptive method, condoms are a vital tool in the dual prevention of unwanted pregnancy and sexually transmitted infections.
This low representation of condoms and other behavioral methods was likely because of the study design and the clinic-based recruitment approach. In terms of generalizability, our study population did not include adolescents, whose contraceptive choices may differ from adults.
In addition, people in Utah may differ from the average US contraceptive-seeking population; however, Salt Lake City has a more religiously diverse population than Utah overall and is more similar to national demographics. For example, 26% of Salt Lake City residents—and one-third of our sample—are people of color compared with 9% of residents in Utah and 24% of residents in the United States.
Finally, the very high levels of satisfaction we observed may reflect the ability of participants to freely select from the full range of contraceptive methods at no cost and to switch or discontinue methods at any time. In settings where contraceptive access is more limited, patients may face cost- and insurance-related barriers to obtaining their preferred method.
patients who cannot obtain their preferred method may report lower satisfaction with the method they ultimately select.
Conclusions
In this cohort of contraceptive clients who could switch or discontinue methods at any time, findings demonstrated a high degree of contraceptive satisfaction. Contraceptive users’ perceptions of how their contraceptive method affected their sex lives over the first month of contraceptive use significantly predicted their satisfaction with their contraceptive method at 3 months. Patients may benefit from finding a contraceptive method that improves their sexual well-being.
Appendix
Supplemental Table 1Effects of sexuality measures, bleeding changes, and side effects on contraceptive satisfaction at 3 months (with patients discontinuing between 1 and 3 months coded as “somewhat dissatisfied”)
Unadjusted models include only design-related variables (site of enrollment in study, period of enrollment in study, and average length among survey responses in days). Adjusted models include these variables in addition to age, race and ethnicity, relationship status, federal poverty level category, contraceptive method, sexual orientation, and general well-being and the other variables in the table
Sexuality measures, bleeding changes, and side effects
Unadjusted OR
95% CI
Significance
Adjusted OR
95% CI
Significance
1-point increase in satisfaction at 3 mo
1-point increase in satisfaction at 3 mo
Impact of contraceptive method on sex life at 1 mo
Has made my sex life a lot worse
Ref
—
Ref
—
Has made my sex life a little worse
3.51
(1.86–6.62)
∗∗∗
3.10
(1.62–5.90)
∗∗
Has had no effect on my sex life
7.34
(3.94–13.67)
∗∗∗
5.85
(3.08–11.13)
∗∗∗
Improved my sex life a little
8.57
(4.59–15.99)
∗∗∗
6.81
(3.55–13.07)
∗∗∗
Improved my sex life a lot
12.09
(6.44–22.68)
∗∗∗
8.81
(4.55–17.06)
∗∗∗
Change in FSFI from 0 to 1 mo
1.04
(1.03–1.06)
∗∗∗
0.99
(0.97–1.01)
Change in NSSS from 0 to 1 mo
1.01
(1.01–1.02)
∗∗∗
1.01
(1.00–1.01)
Changes in bleeding reported at 1 mo
I have had more vaginal bleeding than before
Ref
—
Ref
—
I have had no change in vaginal bleeding
1.24
(0.95–1.62)
1.26
(0.94–1.70)
I have had less vaginal bleeding than before
1.56
(1.25–1.94)
∗∗∗
1.58
(1.25–2.00)
∗∗∗
I have had no vaginal bleeding
1.69
(1.29–2.22)
∗∗∗
2.30
(1.66–3.17)
∗∗∗
Change in mood-related side effects from 0 to 1 mo
Physical symptoms include headaches, bloating, cramping, diarrhea or constipation, acne, weight gain or loss, and breast tenderness.
0.74
(0.66–0.82)
∗∗∗
0.80
(0.70–0.91)
∗∗
∗=P<.05. ∗∗=P<.01. ∗∗∗=P<.001.
CI, confidence interval; FSFI, Female Sexual Functioning Index; NSSS, New Sexual Satisfaction Scale; OR, odds ratio; Ref, reference.
Kramer et al. Sexual acceptability and contraceptive satisfaction. Am J Obstet Gynecol 2022.
a Unadjusted models include only design-related variables (site of enrollment in study, period of enrollment in study, and average length among survey responses in days). Adjusted models include these variables in addition to age, race and ethnicity, relationship status, federal poverty level category, contraceptive method, sexual orientation, and general well-being and the other variables in the table
b Mood-related side effects include feelings of depression or changes in mood
c Physical symptoms include headaches, bloating, cramping, diarrhea or constipation, acne, weight gain or loss, and breast tenderness.
Supplemental Table 2Effects of sexuality measures, bleeding changes, and side effects on contraceptive satisfaction at 3 months (with patients discontinuing between 1 and 3 months excluded)
Unadjusted models include only design-related variables (site of enrollment in study, period of enrollment in study, and average length among survey responses in days). Adjusted models include these variables in addition to age, race and ethnicity, relationship status, federal poverty level category, contraceptive method, sexual orientation, and general well-being and the other variables in the table
Sexuality measures, nleeding changes, and side effects
Unadjusted OR
95% CI
Significance
Adjusted OR
95% CI
Significance
1-point increase in satisfaction at 3 mo
1-point increase in satisfaction at 3 mo
Impact of contraceptive method on sex life at 1 mo
Has made my sex life a lot worse
Ref
—
Ref
—
Has made my sex life a little worse
3.27
(1.64–6.55)
∗∗
2.81
(1.40–5.65)
∗∗
Has had no effect on my sex life
6.86
(3.48–13.54)
∗∗∗
5.11
(2.55–10.24)
∗∗∗
Improved my sex life a little
7.71
(3.90–15.25)
∗∗∗
5.83
(2.88–11.80)
∗∗∗
Improved my sex life a lot
10.43
(5.25–20.71)
∗∗∗
7.19
(3.53–14.67)
∗∗∗
Change in FSFI from 0 to 1 mo
1.04
(1.03–1.06)
∗∗∗
0.99
(0.97–1.02)
Change in NSSS from 0 to 1 mo
1.01
(1.01–1.02)
∗∗∗
1.01
(1.00–1.01)
Changes in bleeding reported at 1 mo
I have had more vaginal bleeding than before
Ref
—
Ref
—
I have had no change in vaginal bleeding
1.47
(1.10–1.95)
∗∗
1.47
(1.07–2.00)
∗
I have had less vaginal bleeding than before
1.55
(1.24–1.94)
∗∗∗
1.60
(1.26–2.05)
∗∗∗
I have had no vaginal bleeding
1.93
(1.45–2.56)
∗∗∗
2.69
(1.91–3.78)
∗∗∗
Change in mood-related side effects from 0 to 1 mo
Physical symptoms include headaches, bloating, cramping, diarrhea or constipation, acne, weight gain or loss, and breast tenderness.
0.76
(0.68–0.85)
∗∗∗
0.80
(0.70–0.92)
∗∗
∗=P<.05. ∗∗=P<.01. ∗∗∗=P<.001.
CI, confidence interval; FSFI, Female Sexual Functioning Index; NSSS, New Sexual Satisfaction Scale; OR, odds ratio; Ref, reference.
Kramer et al. Sexual acceptability and contraceptive satisfaction. Am J Obstet Gynecol 2022.
a Unadjusted models include only design-related variables (site of enrollment in study, period of enrollment in study, and average length among survey responses in days). Adjusted models include these variables in addition to age, race and ethnicity, relationship status, federal poverty level category, contraceptive method, sexual orientation, and general well-being and the other variables in the table
b Mood-related side effects include feelings of depression or changes in mood
c Physical symptoms include headaches, bloating, cramping, diarrhea or constipation, acne, weight gain or loss, and breast tenderness.
Relationships between condoms, hormonal methods, and sexual pleasure and satisfaction: an exploratory analysis from the Women’s Well-Being and Sexuality Study.
This study was supported by nonfinancial contributions from Bayer Pharmaceuticals, Merck Pharmaceuticals, and Teva Pharmaceuticals, who all provided contraceptive devices (D.K.T.). Sebela Pharmaceuticals has contracts with the Department of Obstetrics and Gynecology, University of Utah, for D.K.T.’s work as a scientific advisor outside the submitted work. Medicines360, Merck Pharmaceuticals, and Sebela Pharmaceuticals have contracts with the Department of Obstetrics and Gynecology, University of Utah, to serve as a clinical research site outside the submitted work (D.K.T.). The remaining authors report no conflict of interest.
This study was funded by an award (number R01 HD095661) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Support for the HER Salt Lake Contraceptive Initiative comes from the Society of Family Planning Research Fund, the William and Flora Hewlett Foundation, and a large, anonymous family foundation. The following companies contributed contraceptive products: Bayer Women’s Healthcare, Merck & Co Inc, and Teva Pharmaceuticals. Furthermore, the authors acknowledge the support from 2 NICHD infrastructure grants (numbers P2C HD047873 for the University of Wisconsin; the Building Interdisciplinary Researchers in Women’s Health K12 HD085852 for the University of Utah). Study data were collected and managed using the Research Electronic Data Capture, hosted at the University of Utah; this service is supported by the Center for Clinical and Translational Sciences grant number 8UL1TR000105. D.K.T. is funded by an NICHD Midcareer Investigator Award (number K24 HD087436). B.E. is supported by the NICHD of the National Institutes of Health (NIH; grant number R01HD091405). J.N.S. is funded by the Agency for Healthcare Research and Quality Mentored Research Scientist Research Career Development Award (number K01HS027220). None of the funders were involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. This content is solely the responsibility of the authors and does not necessarily represent the official view of any of the funding agencies or participating institutions, including the NIH, the University of Wisconsin-Madison, the University of Utah, and the Planned Parenthood Federation of America, Inc.
Cite this article as: Kramer RD, Higgins JA, Everett B, et al. A prospective analysis of the relationship between sexual acceptability and contraceptive satisfaction over time. Am J Obstet Gynecol 2022;226:396.e1-11.
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