Preconception Sexual Dysfunction Linked to Delayed Conception, Suggests Study

Fertility success in mixed-sex couples is commonly linked to the frequency and timing of sexual intercourse. However, there has been limited research examining the role of preconception sexual function in influencing time-to-pregnancy. Julia C. Bond, Department of Epidemiology, Boston University School of Public Health, Boston, MA, and colleagues aimed to assess how factors such as female sexual dysfunction, distress related to sexual function, and painful intercourse impact the time it takes for couples to conceive. By exploring these elements, the research aims to shed light on how sexual health issues before conception can affect fertility outcomes.

For this purpose, the researchers followed 2,500 participants from the Pregnancy Study Online, a cohort study of self-identified females attempting pregnancy without fertility treatments, enrolled between 2021 and 2024. Thirty days post-enrollment, participants completed a questionnaire assessing sexual health, including the Female Sexual Function Index and the Female Sexual Distress Scale. Time-to-pregnancy was estimated through self-reported pregnancy status on follow-up questionnaires.

The researchers calculated fecundability ratios and 95% confidence intervals, adjusting for confounders using proportional probabilities regression. As an exploratory analysis, they also explored the relationship between individual sexual function domains and time-to-pregnancy.

Key Findings:

• The study population was predominantly non-Hispanic White, high-income, and had college or graduate education.
• The prevalence of exposure was 20.1% for female sexual dysfunction, 8.8% for distress, and 29.6% for any pain with intercourse.
• No association was observed between female sexual dysfunction and time-to-pregnancy when using a clinically validated cut point (adjusted fecundability ratio of 1.00).
• However, individuals in the first, second, and third quartiles of sexual function scores experienced delayed conception compared to those in the highest (fourth) quartile.
• Participants with sexual distress had an 18% reduced fecundability (adjusted fecundability ratio of 0.82).
• Those reporting painful intercourse most or all of the time had a longer time to pregnancy than those with no pain (adjusted fecundability ratio 0.81).
• Exploratory analyses found that lower function in the orgasm and lubrication domains, but not in interest, desire, and arousal, were associated with longer time-to-pregnancy.

Preconception sexual dysfunction, particularly sexual distress, and frequent painful intercourse, was found to be associated with delayed conception.

"Our findings also highlighted that difficulties with lubrication and reduced frequency of orgasm were linked to a longer time-to-pregnancy. Given that sexual health is rarely discussed with healthcare providers, these issues may often go unrecognized as contributors to prolonged conception attempts," the authors noted. They concluded, "Therefore, preconception clinical assessments of sexual function, including a discussion of individual domains, can help identify modifiable factors that may improve fertility outcomes and guide more comprehensive reproductive care."

Reference:

Bond, J. C., Heaton, B., White, K. O., Abrams, J. A., Kuohung, W., Fisher, R. R., Wesselink, A. K., Fox, M. P., & Wise, L. A. (2025). Female sexual function and distress and time-to-pregnancy in a prospective preconception cohort. American Journal of Obstetrics and Gynecology, 232(4), 375.e1-375.e24. https://doi.org/10.1016/j.ajog.2024.09.117