Female Sexual Dysfunction in Pregnancy and Its Associated Factors Among Low-risk Pregnant Women Seeking Care at Kenyatta National Hospital Between January and April 2023: a Mixed Method Study

Abstract

Background: Female sexual dysfunction is commonly undiagnosed and therefore undertreated during pregnancy. Pregnancy is associated with changes that affect the sexual functioning of women. Factors that may contribute to female sexual dysfunction during pregnancy include; risk of contracting sexually transmitted infections, anxiety and fear of harming the unborn baby as well as body changes that diminish a pregnant woman’s interest in sexual activities. Female sexual dysfunction in pregnancy may affect a couple’s relationship and overall harmony. Declining partner relationships may lead to infidelity with attendant risk of sexually transmitted infections, intimate partner violence and a reduced quality of life among women. Evaluating and managing pregnant women for female sexual dysfunction forms an important pillar in improving the pregnancy experience of women and improving couple relationships during pregnancy. To the best of our knowledge at the time of this study, no similar studies have been conducted in Kenya. This study aimed at establishing the prevalence of female sexual dysfunction in pregnancy and its associated factors to empower reproductive healthcare givers to discuss with their clients, diagnose and manage female sexual dysfunction in pregnancy. This will help improve the quality of life of pregnant women and give them a holistic antenatal experience that is cognizant of the importance of sexual health to women and their partners. Objectives: To assess the prevalence, the types and factors associated with female sexual dysfunction during pregnancy amongst low-risk pregnant women seeking care at Kenyatta National Hospital Methodology: This study was a partially mixed sequential dominant status (QUANT→qual) study entailing a quantitative and a qualitative arm. For the quantitative arm, the sample size was 385 low-risk pregnant women recruited using consecutive sampling. Data on the socio-demographic and clinical characteristics of the patients was collected using questionnaires prepared by the primary investigator. The Female Sexual Function Index tool was administered by the primary investigator and the research assistants. For the qualitative study, 12 low-risk pregnant women were recruited purposively from among the participants recruited for the quantitative arm. In-depth interviews were conducted using an interview guide prepared by the PI and the sessions audio-recorded, each lasting 30-45 minutes. Data collected in the in-depth interviews was transcribed verbatim and the transcripts used for thematic analysis. Quantitative data analysis was done using SPSS version 26. The categorical data was expressed as frequencies and percentages as appropriate while continuous data is presented as means and standard deviations. Chi square test was used to test association of selected factors with female sexual dysfunction in pregnancy. Multivariate logistic regression analysis was conducted for factors found to be statistically significant. Statistical significance was at 95% CI, p< 0.05. For the qualitative data, the NVIVO version 12 was used to organize the data into codes. Data analysis was done thematically using the coding tree while using the iterative approach to identify key themes. Repetitive words, phrases and sentences were picked from the transcripts and assigned to codes that were used to generate themes. These themes were categorized accordingly to reflect the study objectives...