A prospective analysis of the relationship between sexual acceptability and contraceptive satisfaction over time

• Published in: American journal of obstetrics and gynecology 2022-03, Vol.226 (3), p.396.e1-396.e11
• Main Authors: Kramer, Renee D., Higgins, Jenny A., Everett, Bethany, Turok, David K., Sanders, Jessica N.
• Format: Article
• Language: English
• Subjects: birth control; bleeding; contraception; Contraception - methods; Contraceptive Agents; Contraceptive Devices; Female; Humans; Personal Satisfaction; Pregnancy; Prospective Studies; satisfaction; sexual acceptability; side effects
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2021.10.008

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. 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. 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. 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