A Multi-Method Investigation of Pregnancy Loss and Sexual Well-Being in Couples

Abstract

Pregnancy loss affects 1 in 4 women and is linked with poorer overall health and relationship outcomes. Sexual well-being (e.g., satisfaction, desire, distress) may also suffer post-loss. Given the limits of prior work, questions of whether pregnancy loss is linked with lower sexual well-being, what predicts sexual well-being post-loss, and how sexual well-being changes across time post-loss, remain unanswered. In my dissertation, I aimed to answer such questions. Couples, composed of women and gender diverse individuals who were pregnant when a recent pregnancy loss occurred (within the last 4 months) and men, women, and gender diverse partners who were not pregnant, provided data through four monthly surveys. In Study 1, a cross-sectional group- and couples-comparison, I found that both partners in couples with a recent pregnancy loss (n = 103 couples) were less sexually satisfied than their control counterparts—couples with no history of pregnancy loss (n =120 couples). However, I found no differences between the two groups in sexual desire, problems with sexual function, or sexual frequency. Surprisingly, men, women, and gender diverse individuals who were not pregnant at the time of the loss had lower sexual distress than their control counterparts. Women and gender diverse individuals who were pregnant when the loss occurred had lower levels of sexual desire post-loss than their partners, but did not differ from them in sexual satisfaction, problems with sexual function, or sexual distress. In Study 2, a couples-study (n = 109) on links between perinatal grief and sexual well-being, I found that when either partner reported greater than typical perinatal grief, both couple members reported lower than typical sexual satisfaction and sexual desire, and higher than typical sexual function problems and sexual distress. Those with the highest average perinatal grief had the lowest average sexual satisfaction and the highest average sexual function problems and sexual distress. In Study 3, a longitudinal study on changes in sexual well-being and perinatal grief in couples (n = 132), I found that from 10 to 25 weeks post-loss, both couple members’ sexual satisfaction increased, and their sexual desire remained stable. Sexual distress decreased only for partners who were not pregnant when the loss occurred. Both couple members’ perinatal grief decreased. Perinatal grief levels at 10 weeks post-loss did not predict sexual well-being trajectories. My dissertation provides evidence that pregnancy loss is associated with lower sexual satisfaction and greater differences between partners in sexual desire and that higher perinatal grief may be a risk factor for lower sexual well-being. It also provides evidence that sexual satisfaction, sexual desire, and sexual distress improve or stay the same from 10 to 25 weeks post-loss. Sexual well-being may change in response to the balance of couples’ post-loss demands and resources, and that perinatal grief could relate to poorer sexual well-being by negatively influencing meanings around sex. Clinicians should regularly discuss sexual well-being with both couple members after their losses and invite them to discuss how meanings around sex may have changed post-loss. They should also screen them for and discuss perinatal grief to assess for impacts to sexual well-being.