Are obstetrics and gynecology residents sexually satisfied?

Abstract

Background

There is a dearth of data on the impact of residency on resident sexual health. What exists utilizes the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF), which primarily assess function and often refer to sexual activity as penetrative sexual intercourse. This presents a limited view on sexual activity and sexuality.

Aim

The objective of this study was to evaluate the effect of obstetrics and gynecology (OBGYN) residency on resident sexual satisfaction using the gender and relationship neutral New Sexual Satisfaction Scale (NSSS).

Methods

Between July 2022 and August 2023, 137 current US OBGYN residents were recruited and completed questionnaires at three timepoints (baseline, 6 months, and 12 months) assessing their demographic data, city and level of training, work hours, gender identity, sexual orientation, relationship status, and the NSSS.

Outcomes

We hypothesized that OBGYN residents in later years of residency would report lower sexual satisfaction than post graduate year one residents (PGY-1 s) and that sexual satisfaction would decrease later in OBGYN residency due to the cumulative effect of work stress.

Results

There was a significant increase in NSSS total scores from baseline (M = 67.5) to 12 month follow-up (M = 72.1) in all residents. However, when the sample was stratified by year of residency, postgraduate year one residents (PGY-1 s) had a decrease in their NSSS total and subscale scores over time as compared to postgraduate year two residents and above who had an overall increase in their NSSS total and subscale scores over time.

Clinical Implications

This data presents evidence to support initiatives by OBGYN residency programs to support sexual health and resilience training and opens avenues for further research into sexual satisfaction in other medical subspecialities.

Strengths & Limitations

Strengths include utilizing a validated, gender neutral survey. Limitations include small sample size and opt-in study design.

Conclusion

The increase in sexual satisfaction in later years of OBGYN residency may be due to increased resilience over the course of residency. However, the unique stress of the transition from medical school to residency may be highlighted in the decrease in sexual satisfaction scores over time demonstrated in the PGY-1 s.

Introduction

Obstetrics and gynecology (OBGYN) residency is a strenuous time in medical education and training. Residents work up to 80 hours weekly averaged over 4 weeks and frequently work 24 hour shifts.¹ There are several studies exploring the impact of residency and OBGYN residency on burnout and wellness, however there is a dearth of data investigating the impact of residency on resident sexual health.

The current available data has several gaps and necessitates the need for further study. Ferguson et al. published a single institution survey that studied the sexual lives of residents and fellows in 2008.² This was performed by distributing validated questionnaires including the International Index of Erectile Function (IIEF),³ the Index of Premature Ejaculation (IPE),⁴ and the Self-Esteem and Relationship Quality⁵ survey for male residents and the Female Sexual Function Index (FSFI)⁶ and the Index of Sex Life⁷ for female residents. This study found that 13% of males reported erectile dysfunction and 60% of females were classified as “at high risk” for sexual problems. However, this study did not evaluate OBGYN residents separately or include them within their surgical resident category.

Similarly, a 2009 study investigated the impact of residency and stress on sexual wellbeing.⁸ The results of this study found that 49% of the female residents and 11% of male residents had sexual dysfunction, and 47% and 34%, respectively, indicated being very to mostly dissatisfied with their sexual lives. This study, likewise, utilized the FSFI and the IIEF. These sexual function scales, while well validated, asses sexual function and often discuss sexual intercourse as penetrative sexual activity. These surveys fail to use inclusive terminology that is representative of the spectrum of sexual identity, expression, orientation, and preference, and present a limited and dichotomous view on sexuality. For example, Ferguson et al. stated that “a team member advised homo and bisexual subjects to adapt the surveys as best they could per their own definitions of sexual activity.”²

Sexual satisfaction is an important contributor to individual wellbeing.⁹ Thus, further research is necessary to evaluate sexual satisfaction in OBGYN residents using a gender and relationship neutral survey. Surveying OBGYN residents would also introduce an interesting opportunity to interview residents in the specialty that many patients initially turn to for advice on sexual health.¹⁰ It brings forth the question of whether OBGYN residents engage in conversation concerning their own sexual satisfaction.

Aim

The objective of this study was to evaluate the effect of OBGYN residency on resident sexual satisfaction over time using the New Sexual Satisfaction Scale (NSSS). We hypothesized that OBGYN residents in later years of residency would report lower sexual satisfaction than post graduate year one residents (PGY-1 s) and that sexual satisfaction would decrease in later years OBGYN residency training due to the cumulative effect of work stress.

Methods

Participants

Current OBGYN residents were recruited across the United States from July of 2022 to August of 2023. Participants met inclusion criteria if they were 18 years of age or older, current OBGYN residents within the United States, and consented to study participation. Predicting that residency had a moderate effect (d = 0.5) on sexual satisfaction, a one-tailed, paired t-test was performed (n = 270). Accounting for loss to follow up, we aimed to initially enroll 300 participants.

Procedures

Online surveys were distributed to participants at three timepoints – at baseline (Time 1), at 6 months (Time 2), and at 12 months (Time 3). Participants completed an online questionnaire derived by study authors assessing demographic data, work hours, city of training, gender identity, sexual orientation, relationship status, and the NSSS.

Sexual satisfaction

The NSSS was created to introduce a gender and relationship neutral sexual satisfaction score.^9,11 The NSSS is a 20-item scale with two subscales – the ego-centered and partner-centered subscale. The ego-centered subscale is a measure of sexual satisfaction based one’s personal experiences and sensation. The partner-centered subscale is a measure based on one’s partners sexual behaviors and diversity and frequency of sexual activities.

The NSSS has been has been validated in the United States in both student and community samples (total NSSS scores M = 74.07, SD = 15.36 and M = 72.96, SD = 72.96 respectively; α = .94 - .96).^9,11 The ego-centered and partner-centered subscales have likewise been validated (α = .91-.93 and α = .90-.94, respectively). The NSSS also demonstrated a significant positive association with a global measure of life satisfaction.¹¹

Data analysis

Demographic data was analyzed using descriptive statistics for all participants who completed the initial survey. Our primary outcome was change in sexual satisfaction over time. A one-tailed, paired t-test was performed to compare change in NSSS scores from the baseline (Time 1) to the 12 month follow up survey (Time 3). Further exploratory statistical analysis was performed on baseline data to identify if there was difference in sexual satisfaction based on possible confounding factors, including partner status.

Results

A total of 137 participants completed the baseline survey and were included in the analysis. Forty-one participants (29.9%) completed the 6 month follow up survey (Time 2) and 43 participants (31.3%) completed the 12 month follow up survey (Time 3). The mean age of residents surveyed was 29.1 years old (SD = 2.3, range = 25-41) and residents worked, on average, 71.6 hours weekly (SD = 7.1). The majority of participants identified as women, were partnered, and had been sexually active in their lifetime and the past 6 months (Table 1). Comparatively, in 2022, of the 1836 positions available within the OBGYN residency match, 86.4% of candidates were female and 13.5% of candidates were male.¹²

Table 1.

Obstetrics and gynecology resident participants demographic data.

Variable	N (%)
Gender identity
Woman	130 (94.9%)
Man	6 (4.4%)
Non-binary	1 (0.7%)
Transgender woman/transfeminine	0 (0.0%)
Transgender man/transmasculine	0 (0.0%)
Non-binary	0 (0.0%)
Gender queer/gender fluid	0 (0.0%)
Two spirit	0 (0.0%)
Relationship status
Single	18 (13.1%)
Married	43 (31.3%)
Dating/not living together	31 (22.6%)
Unmarried partner, living together	45 (32.8%)
Sexually active in lifetime
Yes	135 (98.5%)
No	2 (1.5%)
Sexually active in past 6 months
Yes	132 (97.8%)
No	3 (2.2%)

There was a significant increase in NSSS total scores from Time 1 (M = 67.5, SD = 15.7) to Time 3 (M = 72.1; SD = 15.6), t(42) = −1.7; P < 0.05 demonstrated in all residents (Graph A.1). There was also a significant increase in the NSSS ego-centered subscale score (Time 1 (M = 32.9, SD = 9.1) to Time 3 (M = 35.7, SD = 8.3)); t (42) = −2.0; P = 0.03. There was no significant difference in the partner-centered subscale scores from Time 1 to Time 3 for all participants (Time 1 (M = 34.6, SD = 8.1) vs Time 3 (M = 36.5, SD = 49), t (42), = −1.33; P = .10).

Graph A.1.

New Sexual Satisfaction Scale score at time 1 (T1) vs time 3 (T3).

However, when the sample was stratified by year of residency, PGY-1 s had a decrease in their NSSS total scores and subscale scores over time as compared to PGY-2 s and above who had an overall increase in their NSSS total scores and subscale scores over time. Due to small sample size, PGY-2 s and above were combined into one group. On the total NSSS scores, PGY-1 s had a significant decrease in their score by 4.2 points (SD = 14.5) from Time 1 to Time 3 whereas PGY-2 s and above had a significant increase in their score by 8.0 points from Time 1 to Time 3 (SD = 17.8), p = 0.02 (Graph A.2). On the ego-centered subscale, the PGY-1 s had a significant decrease of 1.1 points (SD = 7.9) and the PGY-2 s and above had a significant increase of 4.2 points (SD = 9.3), p = 0.04 (Graph A.3) from Time 1 to Time 3. On the partner-centered subscale, the PGY-1 s had significant decrease of 2.3 points (SD = 7.5) and PGY-2 s and above had significant increase of 9.4 points (SD = 9.4); p = 0.01 (Graph A.4) from Time 1 to Time 3.

Graph A.2.

Total New Sexual Satisfaction Scale score for postgraduate year one residents vs postgraduate year two residents from time 1 (T1) to time 3 (T3).

Graph A.3.

Ego subscale score for postgraduate year one residents PGY-1 vs postgraduate year two residents from time 1 (T1) to time 3 (T3).

Graph A.4.

Partner subscale score for postgraduate year one residents vs postgraduate year two residents from time 1 (T1) to time 3 (T3).

Discussion

The transition to residency is a difficult time. The unique stress of this transition may be highlighted in the decrease in sexual satisfaction scores over time demonstrated in the PGY-1 s. However, overall, there was an increase in sexual satisfaction in OBGYN residents over time, specifically demonstrated in the increase in total NSSS scores and ego-centered subscale scores. Our data suggests that sexual satisfaction may increase over time because resilience may increase over the course of residency. There is data within the literature that supports that resilience increases in later years of residency. A national US survey of accredited residencies demonstrated higher resilience scores in senior residents as compared to junior residents, as well as higher resilience scores in surgical residents as compared to medical residents.¹³ As residents learn to cope with the stressors of residency, they may have increased sexual satisfaction. This may be supported further by the increase seen specifically in the ego-centered subscale scores overtime. Data supports that residents who exhibit increased resilience were seen to have increased wellbeing.¹⁴ As OBGYN residents were able to prioritize their wellbeing, their personal sexual satisfaction may have increased.

This study has several strengths including addressing several gaps in the field by utilizing a validated, gender neutral survey as the foundation of the study design. It utilizes a validated survey to assess sexual satisfaction, regardless of relationship status, gender, or sexual orientation.

Limitations include a small sample size and being underpowered. This may be attributed to the sensitive subject matter, which may lead to higher opt out and difficulty enrolling the calculated participant size. There also may be nonresponse bias attributed to those who chose not to complete the survey We did not have sufficient resources to conduct a probability sampling method and opted for a convenience sampling method. This study could be expanded upon by using longitudinal measures to follow a cohort of OBGYN residents across all four years of residency, utilizing probability sampling. Further research may also examine potential moderators of the relationship between residency and sexual satisfaction. Also, we discussed partner status but did not inquire if residents had children or were caretakers, which could be a potential cofounder or affect sexual satisfaction. Lastly, the sexual activity we investigated was always partnered; we did not discuss self-pleasure as a form of sexual activity.

Clinical implications

Beyond introducing a gender and relationship neutral survey for evaluation of resident sexual satisfaction, this study yields broader clinical implications. Emerging studies have demonstrated that OBGYN residents have decreased comfort with addressing patient sexual health and function.^10,15 This introduces an area for improvement, as many patients turn to OBGYN providers for sexual health and function concerns. Thus, this study supports the growing wealth of data that suggests that improvement is needed in OBGYN resident sexual health didactics and training.^10,15 We propose that OBGYN residents’ engagement in their own sexual health will improve their comfort and ability to better support their patients with sexual health concerns. The National Coalition for Sexual Health discusses the importance of provider comfort in engaging in sexual health conversations with patients. Additionally, we propose that the increased OBGYN resident sexual satisfaction demonstrated in this study may be attributed to an increase in resilience over time in residency that has been demonstrated in the literature.^13,14 We encourage initiatives by OBGYN residency programs to help improve sexual satisfaction, resilience, and wellbeing within OBGYN residency. Improving access to behavioral health for OBGYN residents and dedicating portions of OBGYN resident curriculum to resilience development and sexual health training would support this goal.

Conclusion

There was a decrease in sexual satisfaction scores over time for PGY-1 s as compared to all other years of OBGYN residency, which may be attributed to the difficult transition into residency. However, overall, there was an increase in sexual satisfaction scores in OBGYN residents over time, perhaps due to an increase in resilience in later years of residency training.^13,14

Author contributions

Natasha Kamat (Conceptualization, Data curation, Investigation, Methodology, Project administration, Writing—original draft),. Sheryl Kingsberg (Conceptualization, Methodology, Supervision, Writing—review & editing) and Erika Kelley (Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Writing—review & editing)

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest

Sheryl Kingsberg has received consulting fees or honoraria from Astellas, Bayer, Daré, Freya, Reunion Neuroscience, Materna Medical, Madorra, Ms. Medicine, Pfizer, ReJoy, Sprout, Strategic Science Technologies, Vella, Perrigo, and stock options from J3 Bioscience. She sits on the board of directors for J3 Bioscience.