This podcast episode focuses on this original publication.

Study Background

WHAT

• Women with varying levels of infertility and sexual satisfaction participated in The National Survey of Fertility Barriers (NSFB)

WHY

• To understand how women’s intentions towards pregnancy impact sexual satisfaction

• Hypotheses:

  • women trying to conceive (TTC) will report higher sexual satisfaction

  • women trying NOT to conceive will report lower sexual satisfaction

  • women ambivalent about conceiving will report higher sexual satisfaction

WHEN/WHERE

• September 2004 - January 2007 across the United States

WHO

• 2811 U.S. women ages 25-45

• Female Inclusion Criteria

  • 10% of participants were not at risk of or did not have a fertility barrier (the rest were experiencing some form of infertility)

• Female Exclusion Criteria

  • not married or cohabitating

  • not sexually active

  • pregnant

  • incomplete responses to survey questions

HOW

• Utilized data originally collected in National Survey of Fertility Barriers

• Called telephone numbers using Random Digit Dialing

• Over-sampled (called more often) in predominantly-minority populations (African American and Latina)

• Asked questions guided by Interpersonal Exchange Model of Sexual Satisfaction:

  • measured sexual satisfaction: “Overall, how satisfied are you with your sexual relationship? Would you say very satisfied, pretty satisfied or not too satisfied?”

  • measured reproductive orientation: “Currently, are you pregnant, trying to get pregnant, trying not to get pregnant, or are you okay either way?”

    • “ambivalent” = NFSB-added category to for women who met criteria for infertility but did not seek medical treatment.

  • measured sterilization: “Have you ever had a surgery that makes it difficult or impossible to have a baby?” and “Has your partner ever had a surgery that makes it difficult or impossible for him to father a baby?”

  • measured relationship quality : “Taking all things together, how would you describe your relationship?. Would you say that it is very happy, pretty happy, or not too happy?” and “Have you ever thought your relationship might be in trouble? 

  • race/ethnicity: What race or races do you consider yourself to be?” and “Do you consider yourself to be either Hispanic or Latino or neither one? Those indicating “other” were not included in analysis due to small cell counts (i.e., less than 50 per racial/ethnic group).

Statistics (for the Uber Curious)

• Stereotype logistic regression with odds ratios

• Used four models with variables to understand relationship associations (Chi square, F test)

• Used weight variable to adjust for over-sampling minority groups

Study Results

• 53% response rate to screening from random telephone call (considered “typical” for such surveys conducted in the 2000s)

• 48% Sterile, 35% avoiding pregnancy, 14% ambivalent, 4% TTC = 101% (?) per Table 1

• Sterilized women had longer duration relationships, more children, older (mean age 37.6 years)

• Women TTC had shortest relationships, more likely to report history of infertility, had fewer children, and were younger (mean age 32.7 years)

• Higher rates of sexual satisfaction in women TTC or pregnancy ambivalent women vs. sterilized women IF relationship quality was not a consideration

• Additional variable of relationship quality altered association between interest in pregnancy and sexual pleasure (in lower quality relationships, sexual satisfaction was higher in women TTC vs. sterilized women)

• Duration of relationship impacted sexual satisfaction (in longer relationships, sexual satisfaction was lower in women TTC)

• Women who reported high relationship quality had higher sexual satisfaction, regardless of interest in TTC

• Larger % of black and Hispanic women TTC vs. white women

• Married women did not report higher satisfaction vs. cohabitating women

• Sole statistically significant finding was higher vs. lower quality relationship reported higher sexual satisfaction (OR 9.9, p < 0.001)

Study Authors’ Thoughts

(+) national vs. regional sample of American populace, highlighted importance of understanding how TTC impacts sexual satisfaction, results consistent with past research

(-) contraceptive use not studied, sexual satisfaction measured by just one question in a survey, results from >10 years ago, did not study cause and effect

Based on these weaknesses, the authors would recommend doing a long-term study on both couples to determine the causes and effects surrounding relationship quality, sexual satisfaction, and trying to conceive. Also, the interventions needed for women reporting low sexual satisfaction may be different based on relationship status and reproductive plans. 

This Pharmacist’s Thoughts

(+) Justified analytic strategy (why excluded certain analyses and created 4 models)

(+) This sort of study needed to happen

(+) Excellent recommendation to treat women individually for sexual needs based on relationship status and reproductive intentions

(+/-) Wise to include pregnancy ambivalence, but were questions asked correctly to accurately assess ambivalence?

(-) Tables 1 & 2 were confusing - top columns could have been more easily explained - were they intentionally confusing?

(-) Should sexual orientation have been included as a variable?

(-) Despite efforts to sample minorities, did not provide results or recommendations specific to Blacks & Hispanics

Conclusions

This study posed difficult and necessary questions; future studies will hopefully tweak the underlying methodology to yield more applicable results.

Resources

Byers ES, MacNeil S. Further validation of the interpersonal exchange model of sexual satisfaction. J Sex Marital Ther. 2006;32(1):53-69. doi:10.1080/00926230500232917

Daniels K, Daugherty J, Jones J. Current contraceptive status among women aged 15-44: United States, 2011-2013. NCHS Data Brief. 2014;(173):1-8.

Johnson, David R. The National Survey of Fertility Barriers, 2010 [United States]. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2017-11-02. https://doi.org/10.3886/ICPSR36902.v1

Shreffler KM, Gibbs L, Tiemeyer S, McQuillan J, Greil AL. Is Reproductive Orientation Associated with Sexual Satisfaction Among Partnered U.S. Women? [published online ahead of print, 2021 Aug 3]. Arch Sex Behav. 2021;10.1007/s10508-021-01984-z. doi:10.1007/s10508-021-01984-z