STUDY QUESTION Do involuntary definitive childless women have lower psychosocial adjustment levels than women with infertility diagnoses actively trying to conceive and presumably fertile women? SUMMARY ANSWER Involuntary definitive childless women have lower levels of sexual functioning than infertile women actively trying to conceive and presumably fertile women, and higher levels of depression than presumably fertile women. WHAT IS KNOWN ALREADY Involuntary definitive childless defines those who wanted to become parents but were unable to do so. Studies have provided evidence about infertility and its psychosocial consequences, but there is a lack of knowledge about the impact of involuntary definitive childlessness, namely on sexual function, social support, marital satisfaction, and psychological adjustment. STUDY DESIGN, SIZE, DURATION This associative study was conducted between July 2021 and January 2022 for involuntary definitive childless women and between July 2016 and February 2018 for women with an infertility diagnosis actively trying to conceive as well as presumably fertile women. An online questionnaire announced in social media and gynaecology and fertility clinics was used. The inclusion criteria for all participants were being childless, in a heterosexual relationship and cohabiting for at least 2 years. Specific inclusion criteria for involuntary definitive childless women were: trying to conceive for at least 2 years; not achieving pregnancy because of biological and medical constraints; and not undergoing fertility treatment or being a candidate for adopting a child at time of the study. For women with an infertility diagnosis the inclusion criteria were: actively trying to conceive (naturally or through fertility treatments); having a primary fertility diagnosis; and aged between 22 and 42 years old. For presumably fertile women, the inclusion criteria were: having a parenthood wish in the future; and not knowing of any condition that could prevent them from conceiving. PARTICIPANTS/MATERIALS, SETTING, METHODS Out of 360 women completing the survey, only 203 were eligible for this study (60 involuntary definitive childless women, 78 women with an infertility diagnosis actively trying to conceive, and 65 presumably fertile women). All participants completed a questionnaire including sociodemographic and clinical data, the Female Sexual Function Index, the 2-Way Social Support Scale, the Relationship Assessment Scale, and Hospital Anxiety and Depression Scale. Binary logistic regression was performed to assess the relation between sexual function, social support, marital satisfaction, anxiety, depression, and reproductive status, adjusting for age, and cohabitation length. Presumably fertile women were used as a reference group. MAIN RESULTS AND THE ROLE OF CHANCE Women were 34.31 years old (SD = 5.89) and cohabited with their partners for 6.55 years (SD = 4.57). The odds ratio (OR) showed that involuntary definitive childless women had significantly lower sexual function than infertile women actively trying to conceive (OR = 0.88, 95% CI = 0.79–0.99) and presumably fertile women (OR = 34.89, 95% CI = 1.98–614.03), and higher depression levels than presumably fertile women (OR = 99.89, 95% CI = 3.29–3037.87). Women with an infertility diagnosis actively trying to conceive did not differ from presumably fertile women in sexual function, social support, marital satisfaction, anxiety, and depression. LIMITATIONS, REASONS FOR CAUTION The majority of childless women underwent fertility treatments, and childlessness for circumstantial reasons owing to lack of a partner was not included, therefore these results may not reflect the experiences of all women with an involuntary childless lifestyle. There was a time gap in the recruitment process, and only the definitive childlessness group filled out the questionnaire after the coronavirus disease 2019 pandemic. We did not ask participants if they self-identified themselves with the groups’ terminology they were assigned to. WIDER IMPLICATIONS OF THE FINDINGS Our results emphasize the importance of future research to provide a more comprehensive understanding of the adjustment experiences of childless women and an awareness of the poor adjustment they might experience, highlighting the need to keep following women after unsuccessful treatments. Clinical practitioners must attend to these dimensions when consulting involuntary definitive childless women who might not have gone through treatments but also experience these adverse outcomes. STUDY FUNDING/COMPETING INTEREST(S) This study was partially supported by the Portuguese Foundation for Science and Technology. The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.

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非自愿最终无子女妇女的心理社会经历：基于生育状况的比较研究

研究问题 非自愿确定无子女的女性的心理社会调整水平是否比诊断为不孕不育、积极尝试怀孕且可能具有生育能力的女性低？答案摘要：非自愿的最终无子女妇女的性功能水平低于积极尝试怀孕的不孕妇女和可能具有生育能力的妇女，并且比可能具有生育能力的妇女患抑郁症的程度更高。已知信息 非自愿明确的无子女定义为那些想要成为父母但无法这样做的人。研究提供了有关不孕症及其社会心理后果的证据，但人们对非自愿明确无子女的影响（即对性功能、社会支持、婚姻满意度和心理调整的影响）缺乏了解。研究设计、规模、持续时间 这项关联研究是在 2021 年 7 月至 2022 年 1 月期间针对非自愿最终无子女的女性进行的，以及在 2016 年 7 月至 2018 年 2 月期间针对被诊断为不孕症并积极尝试怀孕的女性以及可能具有生育能力的女性进行的。使用了在社交媒体以及妇科和生育诊所发布的在线调查问卷。所有参与者的纳入标准是没有孩子、处于异性关系中并且同居至少两年。非自愿最终无子女妇女的具体纳入标准是： 尝试怀孕至少 2 年；由于生物学和医学限制而未能怀孕；在研究期间未接受生育治疗或成为收养孩子的候选人。对于诊断为不孕症的女性，纳入标准为： 积极尝试怀孕（自然或通过生育治疗）；进行初步生育诊断；年龄在22岁至42岁之间。对于可能有生育能力的女性，纳入标准是： 有未来为人父母的愿望；并且不知道任何可能阻止她们怀孕的情况。参与者/材料、背景、方法 在完成调查的 360 名女性中，只有 203 名符合本研究的资格（60 名非自愿确定无子女的女性、78 名被诊断为不孕症并积极尝试怀孕的女性，以及 65 名可能有生育能力的女性）。所有参与者都完成了一份调查问卷，包括社会人口统计和临床数据、女性性功能指数、双向社会支持量表、关系评估量表以及医院焦虑和抑郁量表。采用二元逻辑回归来评估性功能、社会支持、婚姻满意度、焦虑、抑郁和生育状况之间的关系，并根据年龄和同居时间进行调整。据推测，生育妇女被用作参考组。主要结果和机会的作用 女性年龄为 34.31 岁（SD = 5.89），与伴侣同居 6.55 年（SD = 4.57）。比值比 (OR) 显示，非自愿最终无子女女性的性功能显着低于积极尝试怀孕的不孕女性（OR = 0.88，95% CI = 0.79–0.99）和可能生育的女性（OR = 34.89，95% CI = 1.98–614.03），并且抑郁水平高于可能具有生育能力的女性（OR = 99.89，95% CI = 3.29–3037.87）。被诊断为不孕症并积极尝试怀孕的女性在性功能、社会支持、婚姻满意度、焦虑和抑郁方面与可能具有生育能力的女性没有差异。局限性和注意理由 大多数无子女妇女接受了生育治疗，由于缺乏伴侣而导致的间接原因不生育的情况不包括在内，因此这些结果可能无法反映所有非自愿无子女生活方式的妇女的经历。招募过程存在时间间隔，只有最终无子女群体在 2019 年冠状病毒病大流行后填写了调查问卷。我们没有询问参与者是否使用分配给他们的小组的术语来自我认同。研究结果的更广泛影响我们的研究结果强调了未来研究的重要性，以更全面地了解无子女女性的适应经历，并认识到她们可能经历的不良适应，强调在治疗不成功后继续跟踪女性的必要性。临床医生在咨询非自愿的最终无子女女性时必须注意这些方面，这些女性可能没有接受过治疗，但也会经历这些不良后果。研究经费/竞争利益 这项研究得到了葡萄牙科学技术基金会的部分支持。作者声明他们没有利益冲突。试用注册号 不适用。研究结果的更广泛影响我们的研究结果强调了未来研究的重要性，以更全面地了解无子女女性的适应经历，并认识到她们可能经历的不良适应，强调在治疗不成功后继续跟踪女性的必要性。临床医生在咨询非自愿的最终无子女女性时必须注意这些方面，这些女性可能没有接受过治疗，但也会经历这些不良后果。研究经费/竞争利益 这项研究得到了葡萄牙科学技术基金会的部分支持。作者声明他们没有利益冲突。试用注册号 不适用。研究结果的更广泛影响我们的研究结果强调了未来研究的重要性，以更全面地了解无子女女性的适应经历，并认识到她们可能经历的不良适应，强调在治疗不成功后继续跟踪女性的必要性。临床医生在咨询非自愿的最终无子女女性时必须注意这些方面，这些女性可能没有接受过治疗，但也会经历这些不良后果。研究经费/竞争利益 这项研究得到了葡萄牙科学技术基金会的部分支持。作者声明他们没有利益冲突。试用注册号 不适用。