reproductive health

Many Patients Don’t Discuss Sexual Dysfunction, Distress, or Pain with Doctors 

A new study found that nearly 30 percent of women trying to conceive experienced sexual pain, but nearly 70 percent of these participants did not discuss this issue with their doctor. 

Research suggests that female sexual dysfunction (FSD), distress, and pain are common, but largely unaddressed, issues in healthcare and there is limited knowledge about how these issues may affect women who are trying to become pregnant. 

A new study led by a School of Public Health researcher surveyed women trying to conceive and found that 25 percent of women experienced sexual dysfunction (such as low desire/arousal), 8 percent experienced this dysfunction with mental or emotional distress, and 30 percent of women experienced some form of sexual pain in the past four weeks of taking the survey. 

Published in the American Journal of Obstetrics & Gynecology, the study also found that nearly 70 percent of women who discussed their plans to conceive with their doctor did not talk about their sex life in these conversations, and more than half of this group said that their provider did not bring up this subject in these conversations.  

Given the importance of sexual function for couples trying to conceive without fertility treatments, it is necessary to understand the barriers that prevent people from addressing these issues and improving their sexual health.

“The preconception period is a unique period because even if people are having sexual health issues they are still having sex to try to conceive,” says study lead and corresponding author Julia Bond, a PhD student studying epidemiology. “This could potentially result in more stress, more unhappiness, and more strain on relationships. One of the encouraging things that our study suggests is that just asking about sexual health issues may get patients talking about these problems.”

For the study, Bond and colleagues from SPH, Boston University Chobanian & Avedisian School of Medicine, and Yale School of Public Health examined the prevalence of FSD among participants enrolled between 2020 and 2022 in Pregnancy Study Online (PRESTO), a prospective preconception cohort study of North American couples attempting conception. Participants provided sociodemographic, behavioral, and reproductive factors for up to 12 months to ascertain pregnancies.

Many participants were hesitant to discuss this personal issue. Nearly 25 percent of participants who did not discuss their sex life with their doctor said they didn’t do so because they felt ashamed, nervous, uncomfortable, or they didn’t think it was appropriate to mention. Among the participants who did have these conversations, more than half said that they raised the topic themselves. 

The team also observed that FSD was common among participants with other health challenges, including depression, anxiety, chronic pain/fatigue, and pelvic comorbidities.

The researchers say that providers should initiate FSD conversations during visits with their patients who are planning to conceive, particularly if the patients experience any of the above health conditions, or fertility issues.

In future work, Bond will investigate whether sexual dysfunction affects time to conception and if this possible association is related to frequency or timing of intercourse, as well as the broader links between sexual health and mental health during this time period.

“Sexual health is definitely related to mental health but it can be a ‘chicken or egg’ type of question,” Bond says. “If sexual health issues contribute to mental health issues for some folks, then this area may represent an important avenue to help support the wellbeing of people trying to conceive.”

The study’s senior author is Lauren Wise, professor of epidemiology. At SPH, the study was coauthored by Amelia Wesselink, research assistant professor of epidemiology. The study was also coauthored by Katharine O’Connell White, associate professor of obstetrics & gynecology at the Chobanian & Avedisian School of Medicine, and Jasmine Abrams, Presidential Visiting Fellow at Yale School of Public Health.