Abstract
Introduction: Acceptability of and satisfaction with contraceptive methods are paramount for uptake and continuation. In the current context of multipurpose prevention of pregnancy and sexually transmitted diseases/HIV development, it is critical to have a better understanding of acceptability of and satisfaction with the contraceptive vaginal ring (CVR) including sexual satisfaction. The objective of this study was to review the evidence about acceptability of CVRs and general and sexual satisfaction of users.Methods: We searched PubMed, CINAHL, and Web of Science (until December 31, 2020) and selected original studies documenting actual use of hormonal CVR and explicitly addressing any of the 3 outcomes.Results: Of a total of 1,129 records screened, 46 studies were included. Most studies (n = 43, 93%) were prospective, conducted in high-income settings (n = 35), and reported on NuvaRing® use (n = 31). Overall, 27 (59%) studies included a comparison group, 38 (82%) studies used exclusively quantitative questionnaires, with qualitative only (n = 4, 9%), or mixed methods (n = 4, 9%) studies being less common. Ease of CVR insertion/removal/reinsertion was high in all the settings and improved with time of use, with qualitative studies supporting these findings. When mentioned, ring-related events were associated with discontinuation, and results on continuation of use were mixed. Among NuvaRing® studies, general satisfaction (being satisfied or very satisfied) was between 80 and 90% and tended to mirror continuation. Sexual satisfaction was less commonly reported and results were mixed. Overall, limited information was provided on actual CVR experiences of women (and men) and cultural norms that may affect sexuality and CVR use.Conclusion: Positive aspects of acceptability of and satisfaction with CVRs were reported, but ring-related events and factors, which may affect long-term CVR use, deserve further study. More information is needed on actual experiences of women using CVRs, relationship aspects, male partner opinions, and contextual norms to better understand the acceptability of and satisfaction with CVRs.
Highlights
Acceptability of and satisfaction with contraceptive methods are paramount for uptake and continuation
Ease of contraceptive vaginal ring (CVR) insertion/removal/reinsertion was high in all the settings and improved with time of use, with qualitative studies supporting these findings
More information is needed on actual experiences of women using CVRs, relationship aspects, male partner opinions, and contextual norms to better understand the acceptability of and satisfaction with CVRs
Summary
Acceptability of and satisfaction with contraceptive methods are paramount for uptake and continuation. Satisfaction tends to reflect the perceptions of the product of user and is assessed quantitatively through levels of satisfaction during actual use and/or indirectly assessed through willingness to use in the future or recommend the method (1) Both the concept of acceptability and satisfaction are intertwined as illustrated by validated quantitative tools in which overall satisfaction is considered a dimension of acceptability (5, 6). Recent studies documenting the effectiveness of vaginal products and devices in the field of HIV prevention have confirmed the key contribution of acceptability to adherence and theoretical frameworks presenting pathways from various acceptability dimensions toward satisfaction and to adherence have been developed to aid further inquiry (8)
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