Female Sexual Dysfunction Among Women on Hormonal Contraceptives Compared With Those on Non-hormonal Intrauterine Contraceptive Device at the Kenyatta National Hospital, 2019-2020

Abstract

Introduction: The Kenya Demographic Health Survey (KDHS), 2014 data, shows that most women of reproductive age (15-49 years) in Kenya are on hormonal contraceptive methods. Several studies have shown that hormonal contraceptives can predispose to female sexual dysfunction (FSD). This study, therefore, intended to establish the prevalence and types of FSD among women on hormonal contraceptives compared with those on non-hormonal IUCD in our set up, thus bring to attention the need to be aware of its presence for better management. Objectives: To compare the prevalence and types of Female Sexual Dysfunction among women on hormonal contraceptives with those on non-hormonal IUCD, in the family planning clinic at the Kenyatta National Hospital, 2019-2020. Study setting and design: A cross-sectional comparative study was conducted in the family planning clinic, at the Kenyatta National Hospital, Nairobi, Kenya. Methodology: A total of 180 women on hormonal contraceptives and 180 on non-hormonal IUCD, of reproductive age (15 - 49 years old), were interviewed on several aspects of FSD including desire, arousal, pain, orgasm, pain and satisfaction disorders. The criterion of Female Sexual Dysfunction was evaluated by a Kiswahili translated version of the Female Sexual Function Index (FSFI). The questionnaire (FSFI) was used to assess sexual function for the previous 4 weeks, whereby, a score ≤ 26.55 was classified as FSD. Data on socio-demographic history was obtained. Data collection took three months, from December 2019 to February 2020. Data was analysed for prevalence with statistical significance set at p<0.05. Results: Women on hormonal contraceptives had a higher prevalence of FSD compared with those on non-hormonal IUCD, 57.1% versus 40.0%, p = 0.001. The FSD scores of the four types (domains) of FSD (desire, arousal, lubrication, satisfaction) were significantly lower among women on hormonal contraceptives compared with those on non-hormonal IUCD, except in orgasm and pain domains where the FSD scores were statistically similar in the two groups. Women on hormonal contraceptives had two times increased odds of developing FSD, compared with their counterparts on non-hormonal IUCD, after adjusting for age, marital status, education and occupation: AOR 1.71 (95%CI: 1.05 to 2.80). Having tertiary level of education reduced the likelihood of having FSD by about 73%, after adjusting for age, marital status, occupation and contraceptive type: AOR 0.27 (95%CI: 0.13 to 0.57). Conclusion: The prevalence of FSD was higher among women on hormonal contraceptives compared with those on non-hormonal IUCD. Women on hormonal contraceptives had two times increased odds of developing FSD, compared with their counterparts on non-hormonal IUCD, after adjusting for age, marital status, education and occupation. Women on hormonal contraceptives were more likely to suffer from the four types of FSD (desire, arousal, lubrication and satisfaction) compared with their counterparts on non-hormonal IUCD, except for orgasm and pain where the proportions were the same. Recommendation: Routine individualized screening of FSD, in women, during hormonal contraceptive use, based on FSFI questionnaire protocol.