The effect of different progestogen only contraceptive methods on female sexual function in the first-time users: a cross sectional study

Abstract

The progestin-only contraceptive (POC) methods are used frequently by women in the childbearing period. However; these methods are associated with female sexual dysfunction (FSD) especially injectables. There are potential predictors associated with FSD among POC users which should be put in the consideration during counseling for POC use. Our objective is to assess the female sexual function (FSF) in three POC methods among first-time users. Cross-sectional study (Clinicaltrial.gov:NCT02579590). We included married women between 20-40 years with a heterosexually active relationship lasting for longer than four weeks. They were using one of the POC methods for at least six months for contraception only. Those women were first-time users with regular menstrual pattern, amenorrhea or even with minimal vaginal spotting not affecting the sexual life. The enrolled women were classified into four groups; non contraceptive users (group I), Depot Medroxyprogesterone Acetate 150 mg (DMPA) injection (group II), etonogestrel 68 mg subdermal implant (group III) and desogestrel 75 μg oral pills (group IV) users for the first time. All participants were asked to complete the Arabic form of the female sexual function index (ArFSFI). A total score of less than or equal to 28.1 points was determined as FSD. The main outcome of the study was to identify the prevalence of FSD among those users. The predictors associated with FSD among POC users were also explored. The data were analyzed using ANOVA, Chi-square test and the logistic regression model. Four hundred forty-four women consented to participate and divided into two groups; 222 women were non contraceptive users, and 222 women were POC users (88 women were DMPA users, 87 women were etonorgestrel implant users and 47 women were desogestrel containing pills users). All groups (non contraceptive users and POC users) were homogeneous in the baseline data. The mean ArFSFI score was significantly lower in POC users than non-contraceptive users (26.92±1.88 Vs 27.42±2.02, p=0.006; respectively). The mean ArFSFI score was significantly lower in DMPA users in comparison to etonogestrel implant and desogestrel pills users (26.46±1.75, 27.13±1.89, 27.37±1.93, p=0.010; respectively). Furthermore; the number of women with FSD was significantly higher in DMPA users in comparison to other users (68 women; 77.2%, 44 women; 50.5%, 16 women; 34.0%, p=0.000; respectively). The baseline characteristics that were revealed from the regression model and significantly associated with a higher likelihood of FSD with POC were circumcision (p=0.001), parity >3 times (p=0.015) and duration of use >12 months (p=0.022). A ROC curve analysis in the predictive model demonstrated that circumcision yielded the highest sensitivity (82.84%) while the parity >3 times had the lowest one (59.76%) and the duration of use >12 months had a sensitivity of 60.36%. There is a high prevalence of FSD in POC users especially DMPA users. The circumcision, parity >3 times and >12 months of use are potential significant predictors of FSD in POC users.