Women's Sexual Function, Satisfaction, and Perceptions After Starting Long-Acting Reversible Contraceptives

The sexual acceptability of contraceptives or how contraception affects women's sexual experiences have been rarely assessed. No studies have addressed the acceptability of long-acting reversible contraceptives (LARCs), the most effective contraceptive methods available. The results of a 2014 review examining 11 LARC studies were mixed largely because there was lack of US studies, and those examined had methodological limitations. A 2016 US study found that users of copper intrauterine devices (IUDs) were significantly less likely than users of depot medroxyprogesterone acetate to report lack of sexual desire in the previous 6 months; however, the study had methodological problems, which could have affected the results. The aim of this prospective, observational cohort study was to document the impact of LARC methods on sexual outcomes. Sexual acceptability was evaluated using a variety of measures in women initiating an LARC method. New-start IUD and contraceptive implant users attending 4 family planning clinics were enrolled. Participants selected a current LARC method (copper IUD, levonorgestrel IUD, or contraceptive implant). Primary outcomes assessed before device insertion and at 1 and 3 months after insertion were the Female Sexual Function Index, New Sexual Satisfaction Scale, and perceived sexual effects of method (positive, negative, or none). Secondary outcome measures included other factors associated with sexual acceptability of LARCs: the ability to "let go" during sex, sense of control over pregnancy, and bleeding changes. Differences between method groups at baseline were assessed using chi(2) and F tests, and differences from baseline and trends over time were examined with mixed-effects models, robust Wald chi(2) tests, and conditional logistic regression. Between December 2014 and April 2015, 195 women consented to participate in the study and had successful insertions. Of the 159 women who completed 3 survey rounds, 32 (20%) selected copper IUDs, 73 (46%) levonorgestrel IUDs, and 54 (34%) selected implants. There was no significant difference between groups in sexual functioning and satisfaction scores. Across methods, however, participants were significantly more likely to report perceived improvements to their sexual lives as a result of their contraceptive method as compared with baseline (P < 0.001). At 3months, 40% of women (n = 64) reported positive changes and 17% (n = 27) negative changes. Among women reporting positive sexual changes, a greater proportion reported the highest levels of perceived control over pregnancy and their ability to "let go" during sex. Although women who were new users of LARC methods did not report significant changes in sexual functioning or satisfaction, a sizable minority reported perceived positive method-related sexual changes.