Abstract
It is unclear whether sexual well-being, which is an important part of individual and relational health, may be at risk for declines after a pregnancy loss given the limits of prior work. Accordingly, in a cross-sectional study, we used structural equation modeling to (1) compare sexual well-being levels—satisfaction, desire, function, distress, and frequency—of both partners in couples who had experienced a pregnancy loss in the past four months (N = 103 couples) to their counterparts in a control sample of couples with no history of pregnancy loss (N = 120 couples), and (2) compare sexual well-being levels of each member of a couple to one another. We found that gestational individuals and their partners in the pregnancy loss sample were less sexually satisfied than their control counterparts but did not differ in sexual desire, problems with sexual function, nor sexual frequency. Surprisingly, we found that partners of gestational individuals had less sexual distress than their control counterparts. In the pregnancy loss sample, gestational individuals had lower levels of sexual desire post-loss than their partners but did not differ in sexual satisfaction, problems with sexual function, nor sexual distress. Our results provide evidence that a recent pregnancy loss is associated with lower sexual satisfaction and greater differences between partners in sexual desire, which may be useful information for clinicians working with couples post-loss. Practitioners can share these findings with couples who may find it reassuring that we did not find many aspects of sexual well-being to be related to pregnancy loss at about three months post-loss.
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Data Availability
The data and materials for this study can be found at https://osf.io/z427u/.
Notes
The control sample data came from a broader study. Thus, there are some differences in eligibility criteria between the samples, such as the required relationship duration.
Percentages do not add to 100% as one couple was missing information on the number of weeks pregnant when the loss occurred.
Initially, in line with Mitchell et al. (2022) and our pre-registration, we utilized the full Problem Distress subscale of the Sexual Function Evaluation Questionnaire. In addition to the max score item we describe, the full subscale includes three other items relating to lacking interest, enjoyment, and excitement/arousal during sex. Per the pattern provided by Mitchell et al. (2022), we attempted to model this construct as a latent variable. Reliability was good for gestational individuals (ω = .79), partners of gestational individuals (ω = .77), and control AFAB individuals (ω = .77). However, reliability was poor for partners of control AFAB individuals (ω = .42) (and poorer yet for control partners who indicated their sex was male: ω = .36). Upon further inspection, we observed that the three items relating to lacking interest, enjoyment, and enjoyment/arousal were heavily kurtote and skewed toward no concern at all (a score of zero) and were poorly correlated with one another and the max item (r = .11–.48). Rather than exclude control partners because their subscale had poor reliability, we decided to directly compare the four groups on the maximum score item, which was neither skewed nor kurtote and adequately represented our aim to examine problems in sexual function and we had separately measured sexual desire. It is plausible the Problem Distress subscale of the SFEQ works best when men and individuals assigned male at birth have a specific sexual stressor or problem (like pregnancy loss) but not as well when they do not have a specific problem (i.e., are part of a control sample); this subscale may work well for women and AFAB regardless of if they have a specific stressor/problem or not. The subscale was originally validated among a clinical sample, and more work with this scale among community samples may be insightful.
The original power analysis as posted on the study’s OSF page assumed a sample size of 105 for the pregnancy loss sample and 128 for the control sample. The numbers reported in this paragraph came from an updated power analysis ran on October 21, 2022, which used the exact same model parameters as before, but updated the sample sizes for the pregnancy loss and control samples respectively to 103 and 120, which are the actual sample sizes used in the current study. This updated power analysis is also posted on the OSF page. Differences in expected and actual sample sizes are a result of data cleaning.
For sexual satisfaction, sexual desire, and sexual distress, CFI, RMSEA, and normed \(\chi^{{2}}\) were in typically accepted ranges, but SRMR was too high (less than .10 is recommended; Hair, et al, 2010). This result may be an artifact of the “reliability paradox” (Hancock & Mueller, 2011), where a latent factor with low factor loadings (poor reliability) may have better model fit than a latent factor with high factor loadings (good reliability). For example, Ximénez and colleagues (2022) found that SRMR tends to be higher when standardized factor loadings are high (close to 1); the factor loadings for indicators of sexual satisfaction (GMSEX), sexual desire (SDI-2), and sexual distress (SDS-SF) were predominantly high (~ .7–.9). Considering this reliability paradox, and the fact that CFI, RMSEA and normed χ2 were acceptable for all models, we proceeded with caution to test mean differences between groups on these outcomes.
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This study was funded by an award given to David Allsop and Natalie Rosen from the IWK Health Centre (Project No. 1026674) and an award given to Natalie Rosen from the Social Sciences and Humanities Research Council of Canada (Grant No. 435-2017-0534).
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Allsop, D.B., Huberman, J.S., Cohen, E. et al. What Does a Pregnancy Loss Mean for Sex? Comparing Sexual Well-Being Between Couples With and Without a Recent Loss. Arch Sex Behav 53, 423–438 (2024). https://doi.org/10.1007/s10508-023-02697-1
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DOI: https://doi.org/10.1007/s10508-023-02697-1