Psychological distress and coping mechanisms of women with sexual dysfunction using hormonal contraceptives at Kawempe Hospital

Abstract

Background: Sexual dysfunction is very distressing to women, especially if maladaptive coping is at play. The occurrence of female sexual dysfunction (FSD) varies across African regions and is highly associated with hormonal contraceptives (HCs). The prevalence of HC use among women of reproductive age (15-49 years) is 57.9% globally and 41.9% in Uganda. The literature on psychological distress (PD) and coping mechanisms among women with sexual dysfunction in sub-Saharan Africa are scanty.

Objectives: This study aimed to assess the PD and coping mechanisms of women with sexual dysfunction using hormonal contraceptives at Kawempe Hospital (KH).

Methods: This was a cross-sectional study. A female team consisting of the principal investigator and research assistants collected at Kawempe hospital family planning clinic. We included females aged 18 to 50 years, on HCs for at least six months and sexually active. We screened them for FSD and selected all who scored < 26.55 on the female sexual function index. We administered the Kessler Psychological distress scale K-6 for PD and the SexFlex scale approach coping mechanisms on these selected. We computed proportions, means, and standard deviations to describe the sample. We used chi-squares and logistic regression to determine characteristics associated with PD in women with sexual dysfunction using hormonal contraceptives.

Results: Of 401 individuals recruited, we enrolled 288 who screened positive for FSD. The average age of participants was 28.8 years. The contraceptive use in participants was 46.18% for implants, 25% for Levonorgestrel IUDs, 17.01% for injectables, 9.72% for combined oral contraceptives and 2.08% for progestin-only contraceptives. 28.47% and 24.35% used reflexive and approach coping mechanisms to deal with their sexual challenges. The prevalence of PD was 55.56%. The characteristics associated with PD were being married (AOR=0.45), injectables (AOR=7.43), implants (AOR=5.17), levonorgestrel IUD (AOR=4.17), breastfeeding (AOR=0.41), relationship dissatisfaction (AOR=4.65) and sexual pain (AOR= 2.60).

Conclusion: The prevalence of PD was high in women with FSD using HCs at Kawempe. The characteristics associated with PD included being married, hormonal contraceptives, breastfeeding, relationship dissatisfaction and sexual pain. Therefore, health workers should regularly screen for PD and encourage breastfeeding and sex education among women with FSD using HCs.