Strategies for self-management of painful intercourse among female pregnancy planners.

Background: Despite the fact that painful intercourse is common among reproductive-aged females, little research has evaluated how people manage painful intercourse while trying to conceive.

Aim: To characterize the self-reported frequency and effectiveness of various self-management strategies among a population of pregnancy planners reporting painful intercourse in the past 4 weeks.

Methods: We used cross-sectional data from Pregnancy Study Online, an online preconception cohort study of pregnancy planners. Female-identified participants completed a baseline questionnaire that included questions about demographic, medical, and reproductive factors. Participants additionally completed an optional questionnaire asking about sexual function. We used a single question from the Female Sexual Function Index to evaluate painful intercourse: "Over the past 4 weeks, how often did you experience discomfort or pain during vaginal penetration (intercourse)?," with responses captured on a Likert scale from "Almost never or never" to "Almost always or always." Those who reported pain more frequently than "Almost never or never" were categorized as experiencing "any pain" with intercourse and completed additional questions about how they mitigated it. For each endorsed strategy, participants ranked how effective it was at improving pain on a Likert scale from "Never effective" to "Always effective." For analyses, we grouped "often" and "always" effective into a single category. We described the reported effectiveness of self-management strategies.

Outcomes: The prevalence of participants reporting a strategy as being "often" or "always" effective at improving pain.

Results: In our sample of 2855 pregnancy planners, 855 (30.7%) reported any painful intercourse in the past 4 weeks. The most commonly tried pain management strategy was trying a different sex position (66.6% of participants), while the least common strategy was not allowing full penetration of the penis (29.9%). Lubricant was most effective, with 74.3% of participants reporting that it was "often or always" effective. The least effective strategy was finishing intercourse quickly, with only 32.5% of attempters reporting it was "often or always" effective.

Clinical implications: Providers should be aware of strategies to improve painful intercourse to aid in patient counseling, both in the preconception period and more broadly when pursuing the diagnosis of, and medical management strategies for, dyspareunia.

Strengths and limitations: Large geographic heterogeneity and low data missingness. Limitations include potential for misclassification and the use of non-validated self-report measures.

Conclusion: In a population of females trying to conceive, lubricant use and changing sex positions were frequently reported as "often or always" effective at improving painful intercourse.