Fertilité Contraception Dysfonctions Sexuelles – FECOND

OBJECTIVE In the context of increased medicalization within the field of sexual and reproductive health, this project aims to study the current sexual and reproductive health issues in France that are still considered problematic. For instance, contraceptive failures remain frequent (more than 300,000 failures per year), despite a high rate of medical contraceptive use, and recourse to elective abortion has increased in recent years among young people, who carry the highest burden of the risk of sexually transmiited infection risk (STI). On the other hand, individuals over the age of 35, who did not begin their sexual lives during the era of HIV/AIDS, appear little concerned with the risks posed by STIs. In addition, medical care for infertility, which concerns almost 15% of couples over the course of their lives, remains largely unexplored, as do problems with sexual function, which involve 15% of women (painful sexual relations) and men (erectile problems) over a 12 month period. Today, these questions are studied independently based on researches that most often elect to study women. Based on the WHO concept of sexual and reproductive health, we seek, for the first time in France, to study sexual and reproductive health as a continuum of physical, psychological, and sociocultural well-being associated with sexuality. In this perspective, we will explore the social and medical determinants that structure women's behavior, as well as men's behavior. We also seek to study the social, medical, and institutional factors that inform the practices of health care professionals. THEORITICAL FRAMEWORK AND HYPOTHESIS: We will use a global approach, simultaneously exploring different sexual and reproductive health topics from the various points-of-view of the actors involved. This approach will favor the scientific reflection on the role of men in sexual health and reproduction, following the example of the research that has emerged from several Anglo-Saxon countries. This reflection on the attitudes and the practices of the population will be supplemented by the first study on the practices of physicians with regard to sexual and reproductive health care in France. In addition, due to the fact that these questions are structured differently according to their social contexts, this project will be grounded in a perspective of international comparison with collaborations taking place in the U.S. (The Guttmacher Institute in New York, Princeton University) and Britain (London School of Hygiene and Tropical Medicine). In particular, questions regarding conditions that lead to contraceptive failure, practical efficacy of contraceptive methods, and sexual and reproductive health implications for men are common areas of research interest in the three countries. METHODOLOGY The research will rely on two quantitative studies. The first will draw from randomly selected samples of the French population aged 15-49 years old (5000 women and 3000 men), from which a random sub-sample of female (n=500) and male (n=500) partners will be isolated to more closely study factors pertaining to sexual relationships. A two-phase sample design will be put into place, with stratification by region, and the base of the survey will include exclusive users of portable phones. This study will be conducted by telephone. The second study will be conducted by internet, administered to a random, representative sample of doctors (400 gynecologists and 600 generalists). The questionnaires will be developed in manner which ensures compatibility with British and American studies conducted on the same topics. RESEARCH TEAM The research will be conducted using a multidisciplinary approach, employing a team of epidemiologists, sociologists, demographers, and clinicians from INSERM, INED, and the Université Paris I. These researchers are specialists in different domains studied within the context of this project: sexuality, contraception, infertility, STIs, sexual dysfunction, and they have already conducted national and international projects on random, representative samples. The scientific responsibility will be guaranteed by Nathalie Bajos, sociologist and demographer, and Caroline Moreau, medical doctor and epidemiologist. APPLICATION OF RESULTS The results of this study will serve to inform the development of informational and preventive campaigns and to generate reflection on the content of medical training programs, both at the university and the professional level, for doctors who address topics of sexual and reproductive health in their practice.