The sex effect: the prevalence of sex life reasons for contraceptive discontinuation. A systematic review and meta-analysis.

The ability to have sex without having an unintended pregnancy is a key motivator for contraceptive use, yet factors related to patients' sexual lives are critically understudied in contraceptive decision-making. We report the first systematic review and meta-analysis examining the extent to which a contraceptive method's effect on a satisfying sexual life results in contraception discontinuation or switching. We searched for relevant qualitative and quantitative literature published during 2004-2023 in 9 databases and included 64 studies, comprising a total of 125,586 participants and corresponding to at least 52,705 discontinuers in need, aged 12-54 and surveyed in clinical or public health settings in diverse global contexts. Our main outcome measures were discontinuation or switching of modern contraceptive methods (excluding condoms) while in need. A meta-analysis of 25 studies indicated that sex life concerns as a reason for contraceptive discontinuation have an overall prevalence of 5% (95% CI: 0.03, 0.08; I2 = 94%, τ2 = 1.31; Q = 381, p < 0.001). Sub-group meta-analyses and follow-up meta-regressions do not support any differences based on the hormonal content of the contraceptive method, the specific contraceptive method type, or the specific type of sex life reasons. Sex life reasons are important, common reasons for contraceptive discontinuation. Their prevalence is comparable to other reasons for discontinuation, such as cost or access. Future research should investigate impacts of contraceptive methods on sex life more directly and clinicians should include counselling on a method's sexual acceptability as part of the wider conversation on common contraceptive side effects.