Effect of different long-acting reversible contraceptive methods on female sexual function: a retrospective cohort study

The impact of long-acting reversible contraception (LARC) on female sexual function remains a controversial and often overlooked issue. This study aimed to evaluate the effects of three common LARC methods on female sexual function.

This retrospective cohort study included 90 women, divided into three groups based on their chosen contraceptive: copper-containing intrauterine device (Cu-IUD, n = 30), levonorgestrel intrauterine system (LNG-IUS, n = 30), and the etonogestrel subcutaneous implant (Implanon, n = 30). Changes in sexual frequency and partner sexual satisfaction were recorded. Sexual function was assessed using the Female Sexual Function Index (FSFI) prior to insertion and at one, three, and six months post-insertion. Female sexual dysfunction (FSD) was defined as an FSFI total score of ≤ 19. Differences in these outcomes were compared among the three groups and across the different time points.

The frequency of sexual activity at six months post-insertion was significantly higher than at one month (p < 0.001) and three months (p = 0.034). Cu-IUD users reported significantly better partner sexual satisfaction compared to LNG-IUS users (B=-2.267, p < 0.001) and Implanon users (B=-2.072, p < 0.001). LNG-IUS users had the lowest total FSFI scores at all assessed time points (p = 0.004), while Cu-IUD users scored highest in the desire and satisfaction domains (p < 0.001 and p = 0.003, respectively). Both Cu-IUD and Implanon users reported better outcomes in lubrication and orgasm compared to LNG-IUS users (p < 0.001 and p = 0.004, respectively). Implanon users scored highest in the pain domain (p = 0.002). No significant differences were observed in the arousal domain at six months. FSD was significantly associated with the type of LARC used, a history of abortion, and changes in the frequency of sexual activity. Specifically, LNG-IUS users had a higher probability of experiencing FSD than Implanon users (p = 0.023). A history of abortion (p = 0.005) and a decreased frequency of sexual activity (p < 0.001) were identified as independent risk factors for FSD.

This study reveals that the LNG-IUS was associated with the poorest sexual function outcomes and a higher risk of FSD. Given the differences observed across various dimensions, clinicians can provide more personalized counseling when recommending contraceptive options. Additionally, dynamic follow-up for women using LARC is crucial, particularly within the first three months after insertion.