Female Sexual Dysfunction and Distress in the Preconception and Perinatal Period

PROJECT SUMMARY Female sexual dysfunction, defined as distressing impairments in sexual function, affects up to 40% of premenopausal women and represents a major public health problem. Despite its prevalence, the etiology is incompletely characterized. Knowledge gaps about sexual dysfunction are exacerbated by the fact that women are unlikely to discuss sexual dysfunction with healthcare providers, even after months of symptoms, resulting in prolonged, preventable suffering. Prospective, longitudinal studies, which track sexual function across the life course, are necessary to understand the causes of sexual dysfunction and identify opportunities for interventions to support population-level sexual health. The preconception and perinatal periods represent a promising time period in which to study sexual dysfunction, because of high engagement with the healthcare system and well-documented patient concerns about sex during pregnancy. The overall aim of this proposal is to create a first-of-its-kind longitudinal study that captures detailed data about sexual function from the preconception through postpartum periods to generate insights which will inform the development of a clinical tool. This proposal builds upon ongoing data collection from the Pregnancy Study Online (PRESTO; R01- HD086742), the largest preconception cohort study to date (n>21,000 female participants), in which participants actively complete validated sexual function measures. This proposal will support a translational research project that will use epidemiologic research to identify causes and consequences of sexual dysfunction in the preconception and perinatal periods, coupled with qualitative research with patients and providers, to develop a tool that will improve patient-provider discussions about sexual function. In Aim 1, sexual function will be assessed using validated measures during preconception, early and late pregnancy, and postpartum, to identify predictors of sexual dysfunction that may be salient to clinical interventions. Aim 2 involves the creation of a novel sub-cohort in which participants complete daily diaries tracking sexual activity for two 30-day periods during preconception and in early pregnancy. These daily diary assessments will enable detailed tracking of the timing and frequency of sexual intercourse, serving to elucidate the relationship between sexual function and subfertility and early pregnancy loss, frequent sources of concern for patients. These insights, coupled with insights from qualitative research, will support Aim 3, the development of a patient-facing clinical tool to help support productive clinical conversations about sexual dysfunction in the preconception and perinatal period. The results of this project have high potential to improve both the scientific understanding and the clinical management of female sexual dysfunction, a prevalent but understudied public health issue. This award will allow Dr. Julia Bond to launch her independent research career as an epidemiologist focused on conducting research to inform interventions to improve population-level sexual and reproductive health throughout the life course.