Many women planning a pregnancy experience sexual dysfunction and distress but do not discuss their sex lives with clinicians during preconception visits.

Female sexual dysfunction (FSD) is common, and its relationship with pregnancy, infertility, and menopause have been well studied. Little is known, however, about FSD in women who are planning a pregnancy. To fill that gap, Julia C. Bond, MPH, and colleagues assessed the prevalence of FSD, distress, and pain with intercourse in women during the preconception period. Published in the American Journal of Obstetrics and Gynecology, their survey-based study also explored the extent to which participants discussed their sex lives with a healthcare provider during a preconception visit.

“It’s well-documented that sexual function declines in the context of infertility, but we wanted to assess changes in sexual functioning prior to the 12-month clinical cutoff for infertility,” says Bond. “We also looked at whether the prevalence of sexual conditions changed with increasing pregnancy attempt time.”

Sexual Dysfunction & Communication Gaps

The study comprised 1,120 American and Canadian women aged 21-45 in the Pregnancy Study Online (PRESTO), a web-based survey conducted from August 2020 to October 2022. Participants were attempting to become pregnant without fertility treatments. The participants completed a detailed baseline questionnaire and an optional questionnaire about sexual function. The researchers assessed sexual dysfunction with the 6-item Female Sexual Function Index and sexual distress using the Female Sexual Distress Scale, which assess sexual function and distress in the previous 4 weeks.

The study found 25% of participants met the criteria for FSD, 12.2% met the criteria for sexual distress,  8% had both conditions, and 30% reported pain with intercourse in the past 4 weeks. The longer a woman had been attempting to conceive, the greater the likelihood that she had FSD and sexual distress (FSD and sexual distress prevalence at ≤3 months, 21.5% and 8.9%, respectively, vs at >12 months, 31.4% and 17.5%, respectively).

While more than 80% of participants said they had discussed their conception plans with a healthcare provider, 70% had not discussed their sex lives, the most common reasons for which were lack of a sexual health issue, the provider not asking, feeling nervous, uncomfortable, or ashamed, and feeling that sex was an irrelevant or inappropriate topic of conversation. When the discussions about sex were had, they were more likely to have been with midwives (39%) or nurse practitioners (36%) than with obstetrician-gynecologists (34%; Figure).

Including Sexual Health in Preconception Counseling

Because the cohort members were primarily non-Hispanic White women and had relatively high levels of education and income, the authors cautioned that their findings may not be generalizable to other populations, particularly Hispanic women. Nevertheless, they believe that FSD, distress, and pain may make attempting conception unpleasant and should therefore be part of routine preconception counseling.

“Despite the fact that the majority of our sample engaged with the healthcare system by attending a preconception counseling visit, they did not bring up their concerns about sexual function,” Bond says. “Preconception counseling may be an opportunity for physicians to ask about sexual wellness and painful sex. Just broaching the topic could encourage patients to share concerns and lead to more of them getting support for these problems.”