PHS Monday Seminar- Jenny Higgins, PhD, MPH: Addressing the “Pleasure Deficit” to Improve Public Health: Contraceptives’ Effects on Sexual Functioning, Satisfaction, and Well-Being

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@ 12:00 pm

Associate Professor of Gender and Women’s Studies
and Obstetrics and Gynecology
Director, UW Collaborative for Reproductive Equity
University of Wisconsin-Madison


Background: Although contraception is designed to prevent pregnancy during sexual activity, few large, longitudinal studies examine contraceptive methods’ effects on sexual functioning, satisfaction, and well-being over time. Nor have researchers documented potential sex-enhancing aspects of contraception.

Methods: Participants from the HER Salt Lake Contraceptive Initiative, a prospective cohort study providing no-cost contraceptives, completed a range of survey items at baseline and one, three, and six months. Sexuality measures included the Female Sexual Function Index (FSFI-6), the New Sexual Satisfaction Scale (NSSS), and a five-point scale of perceived sexual changes due to contraceptive method in the last month (with responses ranging from “improved my sex life a lot” to “made my sex life a lot worse”).

Results: Approximately 3,500 individuals in the final sample initiated one of six short- or long-acting methods (combined oral contraceptives, levonorgestrel IUDs, copper IUDs, implants, injectables, and vaginal rings), with no significant sexual differences by method type selected at baseline. Across methods, participants exhibited no significant changes in sexual function or satisfaction over six months. However, a significant minority perceived contraception-related changes to their sex lives. For example, at one month, 45% of patients reported their new method had made their sex life better in the last month; 14% reported it had made their sex life worse (χ2 p<.001). Perceived sexual improvements were associated with decreased vaginal bleeding; perceived negative sexual effects were associated with greater number of reported physical side effects such as bloating, headaches, and breast tenderness.

Conclusions: Most new-start contraceptive users may not experience changes in sexual functioning or satisfaction, but many perceive both positive and negative sexual changes due to their method. A substantial minority of people experience contraceptive-related sexual improvements, particularly when experiencing minimal side effects and decreased vaginal bleeding. Future research efforts should work to understand and promote the sex-enhancing aspects of contraceptive methods, as well as how to best match clients with methods that will work for them sexually.

Clinical Trial Registration:,, NCT02734199.

Learning objectives:
At the end of this session, participants will be able to:

  1. Identify and explain the gendered “pleasure deficit” in relation to the majority of research and development related to contraception.
  2. Articulate aspects of “contraceptive sexual acceptability”—that is, ways in which contraceptives can affect people’s sexual lives.
  3. Understand how contraceptive methods shaped a variety of sexual outcomes among a large cohort of individuals starting new contraceptive methods of their choice.
  4. Recognize that regardless of changes (or lack thereof) in sexual functioning or sexual satisfaction, many contraceptive users claim that their methods have changed their sexual lives in both positive and negative ways.
  5. Consider ways we might better promote sex-enhancing aspects of contraceptive methods.

References to support this work:
Ertekin Pinar S, Demirel G, Yildirim G, Daglar G. Sexual experiences and quality of life in Turkish women using methods of contraception. Journal of Obstetrics and Gynaecology. 2019;39(6):782-787.

Higgins JA, Hirsch JS. Pleasure, power, and inequality: Incorporating sexuality into research on contraceptive use. American Journal of Public Health. 2008;98(10):1803-1813.

Higgins JA, Sanders JN, Palta M, Turok DK. Women’s sexual function, satisfaction, and perceptions after starting long-acting reversible contraceptives. Obstetrics and gynecology. 2016;128(5):1143-1151.

Higgins JA, Smith NK. The sexual acceptability of contraception: Reviewing the literature and building a new concept. Journal of Sex Research. 2016;53(4-5):417-456.

Lessard LN, Karasek D, Ma S, et al. Contraceptive features preferred by women at high risk of unintended pregnancy. Perspectives on Sexual and Reproductive Health. 2012;44(3):194-200.’

Sanders JN, Myers K, Gawron LM, Simmons RG, Turok DK. Contraceptive method use during the community-wide HER Salt Lake Contraceptive Initiative. American Journal of Public Health. 2018;108(4):550-556.