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Pregnancy and Sexual Relationships Study Involving Women and Men (PASSION Study)

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Pregnancy and Sexual Relationships Study Involving Women and Men (PASSION Study) ORIGINAL RESEARCH Pregnancy and Sexual Relationships Study Involving wOmen and meN (PASSION Study) Denicia S. Dwarica, MD,1 Gretchen G. Collins, MD,2 Colleen M. Fitzgerald, MD,3 Cara Joyce, PhD,4 Cynthia Brincat, MD, PhD,5 and Mary Lynn, DO3 ABSTRACT Introduction: Sexual satisfaction is believed to decrease during pregnancy; however, the effect of pregnancy on the sexual relationship in a couple is not well studied. Aim: To assess for sexual dysfunction in heterosexual couples during pregnancy. Methods: We performed a cross-sectional study of heterosexual pregnant women in the third trimester and their cohabitating partners. Main Outcome Measures: Sexual satisfaction in heterosexual couples during pregnancy was assessed with a self-reported questionnaire, the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) questionnaire. Results: A total of 53 couples met eligibility criteria, and nearly all of those approached participated (52 of 53 couples). All couples were enrolled at or after 35 weeks’ gestation. The mean age was 29.0 ± 6.4 and 31.3 ± 6.9 years for women and men, respectively. 60% of couples were married, and the remainder were cohabitating and in a committed relationship. When analyzing the results of the GRISS questionnaire for both partners, a significant difference was seen in mean avoidance of sex between women and men (3.31 vs 2.63; P ¼ .047) and non-sensuality (3.54 vs 2.75; P ¼ .040). Women reported more of a decrease in communication about sex when compared with their partners (3.79 vs 3.23; P ¼ .047). Vaginismus was more problematic during pregnancy than before (mean ¼ 4.17), and frequency of intercourse was decreased (mean ¼ 4.93) based on calculated GRISS scores. Clinical Implications: Pregnant couples reported decreased frequency of intercourse and more pain with in- tercourse in women. Women were more likely to avoid intercourse and reported more problems with communication regarding sexual needs. Strength & Limitations: This study is the first to assess both partners in pregnancy. Due to the nature of the study, we were unable to assess other factors affecting the relationship that may result in sexual dysfunction, there was no control group, and the results are limited to heterosexual couples. Conclusion: Overall sexual satisfaction and function were not problematic for these couples during pregnancy based on the GRISS scale. Dwarica DS, Garbe Collins G, Fitzgerald C, et al. Pregnancy and Sexual Re- lationships Study Involving WOmen and MeN (PASSION Study). J Sex Med 2019;XX:XXXeXXX. Copyright Ó 2019, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved. Key Words: Sexual Satisfaction; Sexual Dysfunction; Pregnancy; Couple INTRODUCTION patient discomfort with sexual topics, a lack of provider training Female sexual dysfunction affects 10%e40% of women but is in the area of sexual medicine, and a perceived lack of time to e often overlooked by patients and providers.1 4 Barriers, which address these concerns during a typical prenatal visit. One study contribute to a lack of screening for sexual dysfunction, include that evaluated the prevalence of self-reported sexual problems in Received October 19, 2018. Accepted April 18, 2019. 5Department of Obstetrics and Gynecology, Rush University Medical Cen- 1Department of Obstetrics and Gynecology, University of Oklahoma Health ter, Chicago, IL, USA Sciences Center, Oklahoma City, OK, USA; Abstract was presented as an oral presentation at the 21st Annual Scientific 2Wisconsin Fertility Institute, Middleton, WI, USA; Meeting of the Sexual Medicine Society of North America, November 2015. ª 3Department of Obstetrics and Gynecology, Loyola University Medical Copyright 2019, International Society for Sexual Medicine. Published by Center, Maywood, IL, USA; Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jsxm.2019.04.014 4Department of Public Health Science and Health Promotion, Loyola Uni- versity Chicago Heath Sciences Division, Maywood, IL, USA; J Sex Med 2019;-:1e6 1 2 Dwarica et al United States women found that sexually-related personal approximately 15 minutes to complete, evaluates 12 domains distress occurred in 10.8% of women aged 18e44 years.4 (5 female-specific, 5 male-specific, and 2 non-gender-specific). Quality of life is significantly impacted by sexual satisfaction.5 The female version produces a “Total GRISS Female Score,” Sexual satisfaction can fluctuate throughout a relationship and as well as the following subcategories: anorgasmia, vaginismus, with significant life events. non-communication, infrequency, avoidance, non-sensuality, “ Prior studies have demonstrated a decline in sexual activity and dissatisfaction. The male version produces a Total GRISS e ” during pregnancy and the postpartum period.6 10 Factors Male Score, as well as the following subcategories: impotence, contributing to the decrease in sexual activity during pregnancy premature ejaculation, avoidance, non-sensuality, and dissatis- fi include physical discomfort, fear of injury to the fetus, loss of faction. The non-gender-speci c domains were non- interest, physical awkwardness, painful coitus, and perceived lack communication and infrequency, and the scores reported are of attractiveness.11,12 Unfortunately, return to pre-pregnancy calculated from the average of the scores for women and men. sexual function may take up to 2 years.13 Aslan et al14 evalu- Total GRISS scores are calculated based on a survey-provided e ated intercourse frequency and satisfaction in couples before and scoring sheet and resulted in a 1 9 score, with non- e after pregnancy and found that the physical effects of pregnancy problematic relationships scoring between 1 4. The higher the > and the stress of a new infant had long-lasting effects. The third transformed score, the greater the sexual dysfunction. A score 4 16,17 trimester has been found to be an independent variable for indicates a problem of that couple. The GRISS was chosen decreased sexual activity frequency and sexual function.15 because it is validated to capture the sexual relationship of both partners in a heterosexual relationship. There is a paucity of data regarding the sexual satisfaction of partners during pregnancy. Given the importance of intimate The Research Electronic Data Capture web application was relationships for emotional well-being and overall health, this used to manage data. All data were compiled into the Research topic warrants further investigation. The aim of our study is to Electronic Data Capture web application and prepared for sta- assess for sexual dysfunction in heterosexual couples during tistical analysis using SAS 9.4 (SAS Institute, Cary, NC, USA) by pregnancy. a statistician. Descriptive values were reported with percentages. Means and SDs were used where applicable. Significance was defined as MATERIALS AND METHODS P .05 and was calculated using a paired sample t-test. Impact The Loyola University Medical Center Institutional Review of previous pregnancy or body mass index (BMI) on GRISS Board approved this study. We performed a cross-sectional study scores were compared using separate sample t-tests. The corre- of a convenience sample of married or cohabitating couples who lation between years in the relationship and overall GRISS score presented at or after 35 weeks’ gestation to an outpatient was assessed using Spearman’s r. obstetrics clinic or the labor and delivery unit. To be eligible for A previous study examining relationships in couples under- the study, each participant needed to be 18 years old, married going in vitro fertilization found a mean female GRISS score in or cohabitating, planning to deliver at Loyola University Medical the non-sensuality domain of 3.52 (±1.86) and a mean GRISS Center or Gottlieb Memorial Hospital, able to provide informed score in their male partners of 2.59 (±1.47). Given that there is consent, and able to complete a written questionnaire. Partici- no current data in pregnancy regarding the GRISS score, using pants were excluded if they were <18 years old, non-English this previously published work in couples, for 80% power with speaking, or if the male partner was not present at the time of an a of 0.05, we needed a total of 52 couples based on a 2-group recruitment. comparison via a 2-sample t-test (STATA 11.0, College Station, Participants were recruited and consented at our academic TX, USA).18 medical center and its affiliated community hospital by the in- vestigators if they met eligibility criteria from July 1, 2015eFebruary 1, 2016. No patient identifiers were included. RESULTS Participants completed a demographic questionnaire and the Our sample included 52 matched pairs (n ¼ 52 women and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) sur- n ¼ 52 men). 53 couples met eligibility criteria, and 52 of the 53 16,17 vey. We asked participants to answer survey questions based couples approached agreed to participate in this study. All par- on their experience for the entire pregnancy. Consenting male ticipants approached, except for 1 couple, agreed to participate in partners completed similar demographic variables and the GRISS the study. Table 1 describes the participant’s demographics by survey. Each individual was asked to complete their respective sex. The mean age of participants was 29.0 ± 6.4 years in women questionnaires in a separate space to avoid discussion with their and 31.3 ± 6.9 years in men. The mean BMI was 34.4 ± 6.6 kg/ partner. m2 and 31.9 ± 6.9 kg/m2 for women and men, respectively. The GRISS survey is a 28-item, self-administered question- When comparing women and men, 35% vs 48% identified as naire that was developed by therapists to assess for sexual Hispanic, respectively. Most participants were white (56% vs dysfunction in a heterosexual couple. The survey, which takes 52%, women vs men). In our cohort, 60% of the couples were J Sex Med 2019;-:1e6 Sexual Dysfunction in Pregnant Couples 3 Table 1. Demographics >4 signifies a problem in that category.
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