Sexual health during pregnancy and the postpartum

IntroductionPregnancy and childbirth is a special period in a woman's life, which involves significant physical, hormonal, psychological, social, and cultural changes that may influence her own sexuality as well as the health of a couple's sexual relationship.AimTo comprehensively review the literature on the effects of pregnancy and the postpartum period on a couple's sexual health and well-being.Main Outcome MeasuresEvidence from the published literature of the impact of pregnancy, childbirth, and the postpartum period on sexual function.MethodsMedline and PubMed search for relevant publications on the effects of pregnancy and childbirth on sexual health and function, with particular focus on the physical, hormonal, psychological, social, and cultural changes that may occur during the antepartum, intrapartum, and postpartum period.ResultsDespite fears and myths about sexual activity during pregnancy, maintaining a couple's sexual interactions throughout pregnancy and the postpartum period can promote sexual health and well-being and a greater depth of intimacy.ConclusionsClinicians must seek to engage in an open discussion and provide anticipatory guidance for the couple on expected changes in sexual health as well as promote the design of rigorous, evidence-based studies to further elucidate our understanding of sexual function during pregnancy and the postpartum. Johnson CE. Sexual health during pregnancy and the postpartum.     

Influence of Peripartum Expectations,Mode of Delivery,and Perineal Injury on Women’s Postpartum Sexuality

BackgroundSexual health has been identified as an important factor for postpartum quality of life. Although pregnancy-related changes in anatomy and metabolism return to their prepregnancy state, female sexual function may not be at the level it was before birth because of physical and psychological changes.AimThe goal of our study was to explore the influence of the mode of delivery, perineal injury, and peripartum expectations on postpartum sexual function.MethodsBetween 2013 and 2018, 522 women were enrolled in this prospective investigation. At time of recruitment during the peripartum hospitalization, patients completed a standardized questionnaire addressing expectations concerning postpartum sexuality with focus on expected influence of the mode of delivery. Sexual function was evaluated using the Female Sexual Function Index (FSFI) and Sexual Activity Questionnaire (SAQ) at time of recruitment to evaluate baseline sexual function (4 weeks before pregnancy). Follow-up assessments were conducted at 3, 6, and 12 months postpartum.OutcomesPeripartum expectations, influence of the mode of delivery, and perineal injury were analyzed for their impact on women’s sexual function within 12 months postpartum by repetitive FSFI and SAQ assessments.ResultsA total of 522 women with 263 spontaneous vaginal deliveries, 41 operative vaginal deliveries, and 218 cesarean sections were analyzed. Although the data demonstrate a significant postpartum decline in sexual function at 3 and 6 months postpartum, sexual functioning converges to baseline prepregnancy values 12 months postpartum. This observation was independent of the mode of delivery and perineal injuries with no significant between-group differences at any of the analyzed time points. Apart from breastfeeding, for which negative anticipations resulted in impaired sexuality, women’s expectations (pertaining to quantity and quality of female orgasm, partner’s sexuality, fear of altered sexuality, frequency of intercourse, the mode of delivery) do not influence female sexual function at 12 months postpartum.Clinical ImplicationsDeciphering the potential influence of patient expectations as well as pregnancy- and childbirth-related aspects on female postpartum sexuality will help in the effort to improve women’s postpartum sexual health.Strengths & LimitationsAs a strength of this study, postpartum sexuality was independently assessed with 2 different scoring systems (FSFI and SAQ). Limitations include that our follow-up is incomplete and amounts to about 2-thirds of patients who were initially recruited.ConclusionThe mode of delivery and perineal trauma do not influence women’s postpartum sexual function. With the exception of breastfeeding, peripartum expectations do not result in altered sexual functioning at 12 months postpartum.Spaich S, Link G, Alvarez SO, et al. Influence of Peripartum Expectations, Mode of Delivery, and Perineal Injury on Women’s Postpartum Sexuality. J Sex Med 2020;17:1312–1325.     

The Relationship Between Mode of Delivery and Sexual Health Outcomes after Childbirth

IntroductionSeveral factors are implicated in the women's sexuality after childbirth. Nevertheless, there is conflicting evidence about the influence of mode of delivery (MD)AimTo prospectively evaluate the relationship between MD and sexual health outcomes after childbirthMethodsA prospective cohort study conducted between May 2005 and March 2007 included 831 pregnant women recruited from primary care clinics of the public sector in São Paulo, Brazil. The exposure variable was MD: uncomplicated vaginal delivery (spontaneous vaginal delivery without episiotomy or any kind of perineal laceration); complicated vaginal delivery (either forceps or normal, with episiotomy or any kind of perineal laceration) and cesarean delivery. Socio-demographic and obstetric data were obtained through a questionnaire applied during the antenatal and postnatal period. Crude and adjusted risk ratios, with 95% confidence intervals, were calculated using Poisson regression to examine the associations between MD and sexual health outcomes.Main Outcome MeasuresThe three main sexual health outcomes were later resumption of sexual life, self-perception of decline of sexual life (DSL), and presence of sexual desire.ResultsOne hundred and forty-one women (21.9%) resumed sexual life 3 or more months after delivery. Although 87.1% of women had desire, DSL occurred in 21.1% of the cohort. No associations were found between MD and sexual health outcomes.ConclusionsWomen's sexuality after childbirth were not influenced by the type of delivery. Efforts to improve the treatment of sexual problems after childbirth should focus beyond MD. Faisal-Cury A, Menezes PR, Quayle J, Matijasevich A, and Diniz SG. The relationship between mode of delivery and sexual health outcomes after childbirth. J Sex Med 2015;12:1212–1220.     

The Relationship Between Depressive/Anxiety Symptoms During Pregnancy/Postpartum and Sexual Life Decline after Delivery

IntroductionSeveral factors have been found to be independently associated with decline in sexual activity after delivery. However, the association between depression in pregnancy/postpartum and sexual problems is less clear.AimTo prospectively evaluate the relationship between depressive/anxiety symptoms (DAS) during the perinatal period and sexual life in the postpartum period.MethodsA prospective cohort study conducted between May 2005 and March 2007 included 831 pregnant women recruited from primary care clinics of the public sector in São Paulo, Brazil. Four groups with DAS during antenatal and postpartum periods were identified using the Self Report Questionnaire (SRQ‐20): absence of both antenatal and postpartum DAS; presence of antenatal DAS only; presence of postpartum DAS only; and presence of both antenatal and postpartum DAS. The primary outcome was perception of sexual life decline (SLD) before and after pregnancy/delivery. Crude and adjusted risk ratios (RR), with 95% confidence intervals (95% CI), were calculated using Poisson regression to examine the associations between DAS and SLD.Main Outcome MeasureThe main outcome measure of this study is the perception of SLD before and after pregnancy/delivery.ResultsSLD occurred in 21.1% of the cohort. In the multivariable analysis, the following variables were independently associated with SLD: DAS during both pregnancy and postpartum (RR: 3.17 [95% CI: 2.18–4.59]); DAS during only the postpartum period (RR: 3.45 [95% CI: 2.39–4.98]); a previous miscarriage (RR: 1.54 [95% CI: 1.06–2.23]); and maternal age (RR: 2.11 [95% CI: 1.22–3.65]).ConclusionsPostpartum women with DAS have an increased likelihood for SLD up to 18 months after delivery. Efforts to improve the rates of recognition and treatment of perinatal depression/anxiety in primary care settings have the potential to preserve sexual functioning for low‐income mothers.     

Prevalence and Predictors of Genito-Pelvic Pain in Pregnancy and Postpartum: The Prospective Impact of Fear Avoidance

IntroductionThere is limited knowledge regarding the symptom profile of genito-pelvic pain in pregnancy and postpartum, and potential psychosocial predictors of this pain. Prior studies have reported a positive association between prepregnancy pain and postpartum genito-pelvic pain. Greater fear avoidance has been associated with increased genital pain intensity in women, unrelated to childbirth. This relationship has not been examined prospectively in a postpartum population.AimsThe study aims were to examine the symptom profile of genito-pelvic pain during pregnancy and at 3 months postpartum, and the impact of prepregnancy nongenito-pelvic pain and fear avoidance in pregnancy on genito-pelvic pain at 3 months postpartum.MethodsFirst-time expectant mothers (N = 150) completed measures of fear avoidance (pain-related anxiety, catastrophizing, hypervigilance to pain), prepregnancy nongenito-pelvic pain, childbirth-related risk factors (e.g., episiotomy), and breastfeeding.Main Outcome MeasuresThose reporting genito-pelvic pain in pregnancy and/or at 3 months postpartum answered questions about the onset (prepregnancy, during pregnancy, postpartum) and location (genital, pelvic, or both) of the pain and rated the intensity and unpleasantness of the pain on numerical rating scales.ResultsOf 150 women, 49% reported genito-pelvic pain in pregnancy. The pain resolved for 59% of women, persisted for 41%, and 7% of women reported a new onset of genito-pelvic pain after childbirth. Prepregnancy nongenito-pelvic pain was associated with an increased likelihood of postpartum onset of genito-pelvic pain. Greater pain-related anxiety was associated with greater average genito-pelvic pain intensity at 3 months postpartum.ConclusionsResults suggest that about half of women may develop genito-pelvic pain during pregnancy, which will persist for about a third, and a subset will develop this pain after childbirth. Prior recurrent nongenito-pelvic pain may enhance the risk of developing genito-pelvic pain postpartum, while greater pain-related anxiety in pregnancy may increase the risk for greater intensity of postpartum genito-pelvic pain. Glowacka M, Rosen N, Chorney J, Snelgrove−Clarke E, and George RB. Prevalence and predictors of genito-pelvic pain in pregnancy and postpartum: The prospective impact of fear avoidance. J Sex Med 2014;11:3021–3034.     

Postpartum dyspareunia and sexual functioning: a prospective cohort study

Objectives: Sexual functioning is an important concern for women in the postpartum period. The aim of this research was to investigate the prevalence and determinants of dyspareunia and sexual dysfunction before and after childbirth.

Methods: Between November 2013 and April 2014, 109 women in their third trimester of pregnancy were enrolled in a prospective cohort study at Ghent University Hospital. Dyspareunia, sexual functioning and quality of life (QOL) were evaluated at enrolment and again 6 weeks and 6 months postpartum. Sexual functioning and QOL were assessed using validated self-report questionnaires: the Female Sexual Function Index and the Short Form-36 health survey. Dyspareunia was evaluated by a specific self-developed questionnaire.

Results: One hundred and nine women were enrolled; respectively, 71 (65.1%), 66 (60.6%) and 64 (58.7%) women returned the questionnaires prepartum, and 6 weeks and 6 months postpartum. Sexual functioning at 6 weeks was predictive of sexual functioning at 6 months postpartum (r_s?=?0.345, p?=?.015). The prevalence of dyspareunia in the third trimester of pregnancy, and 6 weeks and 6 months postpartum was, respectively, 32.8%, 51.0% and 40.7%. The severity of pain decreased significantly between 6 weeks and 6 months postpartum (p?=?.003). In the first 6 weeks postpartum, the degree of dyspareunia was significantly associated with breastfeeding (p?=?.045) and primiparity (p?=?.020). At 6 months, only the association with primiparity remained significant (p?=?.022).

Conclusions: The impaired postpartum sexual functioning, the high prevalence of dyspareunia postpartum and their impact on QOL indicate the need for further investigation and extensive counselling of pregnant women, especially primiparous women, about sexuality after childbirth.     

Prevalence and Risk Factors of Sexual Dysfunction in Postpartum Australian Women

IntroductionFemale sexual dysfunction is highly prevalent and reportedly has adverse impacts on quality of life. Although it is prevalent after childbirth, women rarely seek advice or treatment from health care professionals.AimThe aim of this study was to assess the sexual functioning of Australian women during the first year after childbirth.MethodsPostpartum women who had given birth during the previous 12 months were invited to participate in this cross‐sectional study. A multidimensional online questionnaire was designed for this study. This questionnaire included a background section, the Female Sexual Function Index, the Patient Health Questionnaire (PHQ‐8), and the Relationship Assessment Scale. Responses from 325 women were analyzed.ResultsAlmost two‐thirds of women (64.3%) reported that they had experienced sexual dysfunction during the first year after childbirth, and almost three‐quarters reported they experienced sexual dissatisfaction (70.5 %). The most prevalent types of sexual dysfunction reported by the affected women were sexual desire disorder (81.2%), orgasmic problems (53.5%), and sexual arousal disorder (52.3%). The following were significant risk factors for sexual dysfunction: fortnightly or less frequent sexual activity, not being the initiator of sexual activity with a partner, late resumption of postnatal sexual activity (at 9 or more weeks), the first 5 months after childbirth, primiparity, depression, and relationship dissatisfaction.ConclusionSexual satisfaction is important for maintaining quality of life for postpartum women. Health care providers and postpartum women need to be encouraged to include sexual problems in their discussions. Khajehei M, Doherty M, Tilley PJM, and Sauer K. Prevalence and risk factors of sexual dysfunction in postpartum Australian women. J Sex Med 2015;12:1415–1426.     

Comparison of overall sexual function, sexual intercourse/activity, sexual satisfaction, and sexual desire during the three trimesters of pregnancy and assessment of their determinants

IntroductionPregnancy affects women's sexual function. However, few reports have addressed this phenomenon.AimTo examine overall sexual function and three dimensions of the Taiwan version of the Female Sexual Function Index and to assess their determinants during the three trimesters of pregnancy.MethodsCross‐sectional investigation of 663 pregnant women using the International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form, the Body Image Scale for Pregnant Women, and demographics questions.Main Outcome MeasuresUrinary incontinence, body image, obstetrical history, demographics, and other factors potentially influencing overall sexual function, intercourse/activity, satisfaction, and desire during pregnancy.ResultsMean scores for overall sexual function, intercourse/activity, and satisfaction differed significantly among the three trimesters (P = or <0.02), whereas mean scores for sexual desire did not. Mean scores for overall sexual function and intercourse were significantly lower during the third trimester than during the first trimester (P < 0.001) or second trimester (P < 0.001). Mean score for satisfaction was significantly higher during the third trimester than during the first trimester (P = 0.01). Significant effects included the following: (i) the discomfort and infertility experiences on overall sexual function and on intercourse, the interaction between body image and artificial abortion on satisfaction, spontaneous abortion on desire during the first trimester; (ii) the full‐time work and infertility experiences on overall sexual function and on intercourse, the interactions between body image and medical condition on desire during the second trimester; and (iii) the interaction between gestational age and HoLou ethnicity on overall sexual function, the interaction between body image and discomfort on overall sexual function and on intercourse, the interactions between body image and infertility experiences and gravidity on satisfaction, urinary incontinence on desire during the third trimester.ConclusionsResults demonstrated that biopsychosocial and cultural factors affected Female Sexual Function Index (FSFIT) scores throughout pregnancy. Chang S‐R, Chen K‐H, Lin H‐H, and Yu H‐J. Comparison of overall sexual function, sexual intercourse/activity, sexual satisfaction, and sexual desire during the three trimesters of pregnancy and assessment of their determinants. J Sex Med 2011;8:2859–2867.     

The Role of Pregnancy Awareness on Female Sexual Function in Early Gestation

IntroductionFemale sexual function is negatively influenced by pregnancy due to the physical and emotional changes. Although the most significant effect is seen in the third trimester of pregnancy, a considerable decrease in the frequency of intercourse and sexual desire in the first trimester has also been shown.AimTo investigate the factors that affect sexuality in early pregnancy and the impact of awareness of pregnancy on female sexual function in the first trimester of pregnancy using two self‐reported questionnaires.MethodsIn this cross‐sectional study, 130 healthy, married pregnant women who were admitted to the Gynecology Clinic between the 4th and 10th week of gestation were asked to complete a self‐administered questionnaire and the Female Sexual Function Index (FSFI).Main Outcome MeasuresThe factors associated with FSFI score and monthly sexual activity frequency in the first trimester, as well as the differences in sexual activity frequency and FSFI scores between the women who were previously aware of their pregnancy and those who were yet unaware of their pregnancy.ResultsWomen who were unaware of their pregnancy had significantly higher coitus frequency in comparison with the aware group (P = 0.002). Total FSFI score was 21.99 ± 8.13 in the aware group and 24.66 ± 3.76 in the unaware group (P = 0.02). None of the obstetric and sociodemographic variables had an influence on desire and pain scores. Arousal, lubrication, and satisfaction scores were adversely affected by awareness of pregnancy. Orgasm scores were influenced negatively by awareness and positively by love marriage; however, in multivariate linear regression analysis none of these were defined as independent factor for orgasm scores. Overall FSFI scores and monthly frequency of sexual activity were only affected by awareness.ConclusionThe results of this study suggest that in early gestation, awareness of pregnancy is associated with lower female sexual function. Furthermore, obstetric and sociodemographic factors seem to be ineffective on sexual function in early pregnancy. Corbacioglu A, Bakir VL, Akbayir O, Cilesiz Goksedef BP, and Akca A. The role of pregnancy awareness on female sexual function in early gestation. J Sex Med 2012;9:1914–1920.     

The Sexual Function Questionnaire's Medical Impact Scale (SFQ‐MIS): Validation Among a Sample of First‐time Mothers

IntroductionChanges in sexual function can be difficult to capture, especially when an attempt is made to assess the effects of pregnancy or childbirth on the sexual function of first‐time mothers. Commonly used sexual function measures are limited and fail to account for pregnancy or birth in assessment of function.AimsThe purpose of this study was to explore the utility of the Sexual Function Questionnaire Medical Impact Scale (SFQ‐MIS) in assessing impact of childbirth on sexual function among first‐time mothers with infants aged one year or younger.MethodsA total of 255 women completed a cross‐sectional, web‐based survey. Exploratory factor analysis was utilized to assess the factor structure of the SFQ‐MIS scores in this sample. Variations in SFQ‐MIS scores based upon participant characteristics were conducted to further evaluate the SFQ‐MIS scores.Main Outcome MeasuresSFQ‐MIS score was the primary measure of interest. Factors related to pregnancy and childbirth, such as mode of delivery, infant date of birth, last menstrual period, need for an episiotomy or perineal stitches, breastfeeding status, and score on the Perceived Stress Scale, were also assessed in order to further evaluate the validity and predictive capacity of the SFQ‐MIS.ResultsResults indicated one factor that accounted for 58.27% of the variance in impact on sexual function due to childbirth. Cronbach's α coefficient for all five items was acceptable (0.82). Women who were breastfeeding (P < 0.05), those who had received perineal stitches after a vaginal delivery (P < 0.05), and those who reported no sexual activity in the past month (P < 0.001) experienced significantly greater impact than those who were not breastfeeding, those who had not required stitches, and those who had been sexually active in the past month.ConclusionThe SFQ‐MIS appears to be a useful and valid indicator of changes in sexual function following childbirth, such as those related to arousal, desire, and orgasm. Jawed‐Wessel S, Schick V, and Herbenick D. The Sexual Function Questionnaire's Medical Impact Scale (SFQ‐MIS): Validation among a sample of first‐time mothers. J Sex Med 2013;10:2715–2722.     

Perinatal distress,an appraisal perspective

Objective: The aim of this study was to identify the particular appraisals that shape maternal distress using the theoretical framework of Appraisal Theory of Emotions, which suggests that experienced emotions are triggered by the appraisal of specific situations. Background: Perinatal distress has been extensively studied. Symptoms range from mild to clinically significant. While major risk factors have been elucidated, cognitive components that may trigger distress need further clarification. Method: 122 women recruited during their third trimester of pregnancy completed measures of distress and appraisal during late pregnancy, within 7–10 days after delivery, and at 10–12 weeks postpartum. Mood scales included the Edinburgh Postnatal Depression Scale and the Depression, Anxiety and Stress Scale. Appraisal items addressed the experiences of pregnancy and motherhood. Results: Correlation and regression analyses showed a significant and stable association between symptoms of depression, anxiety and stress, and appraisals of low coping potential and future expectancy across the three assessment times. Low motivational congruence (incongruence) was associated with depression, anxiety, and stress during late pregnancy and the first days after childbirth, and with symptoms of depression at 10–12 weeks postpartum. Conclusion: In this sample of women experiencing low to moderate distress, findings suggest that the perceived ability to cope practically and emotionally with pregnancy and maternal-related issues, as well as pessimistic ideas about the future, form the core appraisal basis of perinatal distress. Implications for practice and intervention are discussed.     

A cross-sectional study of female sexual function and dysfunction during pregnancy

IntroductionAlthough women may undergo changes in sexual function during pregnancy, there are limited studies correlating possible sexual function changes to androgen blood levels during the pregnancy.AimTo search for a possible correlation, we performed a cross-sectional observational study to assess sexual function scores and androgen blood levels of women during pregnancy.Materials and MethodsA total of 589 healthy pregnant women were recruited to the present cross-sectional study. Of these patients, 116 (19.6%), 220 (37.3%), and 253 (42.9%) were in their first, second, and third trimesters, respectively. They were evaluated with a detailed medical and sexual history, including IFSF questionnaire. In addition, maternal serum androgen levels (testosterone, dehydroepiandrosterone sulphate, free testosterone) were determined in each trimester during regular follow-ups.Main Outcome MeasuresAssessment of Index of Female Sexual Function (IFSF) domains and serum androgen levels in each trimester.ResultsThe mean age of the three groups were similar (P > 0.05). Overall, total IFSF scores of women in the first and second trimesters were 21.4 ± 10.1 and 22.3 ± 10, respectively, while it was 15.9 ± 12.3 during the third trimester (P < 0.05). The most common sexual dysfunction symptom was diminished clitoral sensation, observed in 94.2% of the patients, followed by lack of libido in 92.6% and orgasmic disorder in 81%. No correlation was detected between total IFSF score and serum androgen levels.ConclusionsIn this cross-sectional study, we noted lower sexual function scores in women in the third trimester of their pregnancies compared with those in their first two trimesters of pregnancy. These lower sexual function scores in the third trimester were not associated with lower androgen levels. We plan to perform a future prospective study to better assess both the change in sexual function and also its possible relation to androgen levels in pregnant women. Erol B, Sanli O, Korkmaz D, Seyhan A, Akman T, and Kadioglu A. A cross-sectional study of female sexual function and dysfunction during pregnancy.     

Sexual pleasure and emotional satisfaction in the first 18 months after childbirth

Objectiveto investigate the experiences of first time mothers with regard to emotional and sexual intimacy in the period from birth to 18 months postpartum.Designprospective pregnancy cohort, with follow-up at 3, 6, 12 and 18 months postpartum.Setting and participantsfirst-time mothers were recruited in early pregnancy at 6 public maternity hospitals in Melbourne, Australia.Findings1239 women who completed the baseline questionnaire and all follow up questionnaires were included in the sample for analysis: 78% resumed vaginal sex by 3 months postpartum, 94% by 6 months and 98% by 12 months postpartum. Emotional satisfaction with intimate partner relationships declined over time, from 67.3% reporting high satisfaction at 3 months to 53.9% at 18 months postpartum. In contrast, sex was described as extremely or very pleasurable by 40.1% of women at 3 months postpartum, compared with 49.1% at 18 months postpartum. There was a strong association between emotional satisfaction and the degree to which women experienced physical pleasure in their sexual relationship. Women who were happy with their partner's contribution to household tasks were markedly more likely to report high emotional satisfaction (OR 10.31, 95% CI6.7-15.9) and somewhat more likely to report greater physical pleasure in their sexual relationship (OR 2.32, 95% CI 1.5–3.5).Key conclusionswomen experience profound changes in their sexual and intimate relationships in the first 18 months postpartum. While sex appears to improve over time, emotional satisfaction appears to decline. Partner involvement in household tasks is associated with greater emotional satisfaction.Implications for practicepregnant women and their partners may benefit from information and discussion about the likelihood of changes to their emotional and sexual relationships after childbirth.     

Sexual Function in Women 3 Days and 6 Weeks After Childbirth: A Prospective Longitudinal Study Using the Taiwan Version of the Female Sexual Function Index

IntroductionChildbirth impacts sexual function in women, but few reports have addressed sexual function shortly after childbirth.AimUsing the Taiwan version of the Female Sexual Function Index (FSFIT), this study aimed to describe women's sexual function and to examine differences between groups in sexual function shortly after delivery.MethodsA prospective longitudinal investigation was performed in women who completed the FSFIT, a numeric analog scale, the Taiwan version of the Center for Epidemiologic Studies Depression Scale (CES-D), and a demographic questionnaire in a Taiwanese medical center at 3 days and 6 weeks postpartum.Main Outcome MeasuresUsing a general linear model, differences were tested between groups, including those defined by delivery mode, type of feeding, depression score, pain score, and birth history.ResultsAfter adjusting for covariates, (i) significant differences in sexual function and desire were found between the vaginal delivery and Cesarean section groups at day 3 and week 6 postpartum (P = 0.0419 and <0.0001, respectively); (ii) differences in desire and satisfaction between the tubal ligation and not groups were significant at both time points (P = 0.0346 and 0.0338); (iii) differences in sexual function and sexual activity or intercourse between low and high CES-D scores were significant at 6 weeks postpartum (P = 0.0040 and 0.0043, respectively); and (iv) differences between pain level groups in sexual activity or intercourse and desire were significant at 6 weeks (P = 0.0493 and 0.0004). At 3 days postpartum, significant differences between educational level and ethnic groups were observed (P = 0.0002 and 0.0414).ConclusionsThe results showed significant differences in sexual function shortly after delivery between groups based on delivery method, tubal ligation, depression, pain, ethnicity, and educational level. This information may help health professionals to be more aware of women's perception of sexuality and may foster sensitivity in assessing their sexual function after childbirth. Chang S-R, Chang T-C, Chen K-H, and Lin H-H. Sexual function in women 3 days and 6 weeks after childbirth: A prospective longitudinal study using the Taiwan version of the Female Sexual Function Index.     

Managing Pregnancy and Delivery in Women with Sexual Pain Disorders (CME)

IntroductionVaginismus and dyspareunia most commonly affect women in their childbearing years, yet sexual function, and not childbirth, has been the focus of most research.AimThe aim of this study is to discuss pregnancy and birth outcomes in women with sexual pain disorders (SPDs) and address practical concerns of patients and practitioners regarding management during pregnancy, pelvic examination, labor, and delivery.MethodsReview of the relevant literature and recommendations based on clinical expertise of the authors.ResultsA review of SPD, conception, and birth outcomes is provided as well as clinical recommendations for prenatal, labor, and delivery management of women with SPD.ConclusionsPractitioners involved in obstetrical care should be knowledgeable about SPD and provide appropriate modifications and interventions. Rosenbaum TY and Padoa A. Managing pregnancy and delivery in women with sexual pain disorders. J Sex Med 2012;9:1726–1735.     

Changes in the Sexual Function During Pregnancy

IntroductionThe physiological changes during each trimester of pregnancy have a significant impact on women's sexual behavior.AimThe aim of the work was to assess changes in the sexual function during pregnancy.MethodsThe prospective study encompassed 520 pregnant women aged between 18 and 45, of whom 168 were qualified for the final analysis. The research tool was a purpose‐designed research questionnaire and the standardized Female Sexual Function Index.Main Outcome MeasuresTo assess changes in the sexual function among pregnant women aged 18–45 in the three pregnancy trimesters.ResultsAll the studied parameters, i.e., desire, arousal, lubrication, orgasm, satisfaction, and pain, decreased significantly with the progression of pregnancy. Analyzing the frequency of sexual intercourse in the studied group before and during pregnancy, a statistically significant decrease (P < 0.000001) was observed. Sexual desire changed statistically significantly (P = 0.0004). The direction of change concerned decreased sexual desire in the three trimesters compared with the situation before pregnancy. Statistical significance was demonstrated for: decreased sexual desire (P = 0.00007), partner's reluctance (P = 0.002), and pregnancy‐related changes in appearance (P = 0.03).ConclusionsSexual function was compromised and sexual activity decreased as the pregnancy progressed. Changes in the domains of arousal, lubrication, and orgasm were particularly notable in primaparae in the third trimester of pregnancy. Unsatisfying partner relationship was a significant factor affecting the quality of sexual life during pregnancy. Gałązka I, Drosdzol‐Cop A, Naworska B, Czajkowska M, and Skrzypulec‐Plinta V. Changes in the sexual function during pregnancy. J Sex Med 2015;12:445–454‥     

Depressive Symptoms as a Predictor of Sexual Function during Pregnancy

IntroductionBiopsychological and sociocultural factors have been reported to be associated with sexual function in pregnancy. To date, very few studies have focused on the relationship between sexual function and depression during pregnancy.AimTo determine whether depressive symptoms predict overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain during pregnancy by using the Female Sexual Function Index (FSFI).MethodsPregnant women undergoing prenatal examinations were randomly selected for this cross‐sectional investigation. The study included 555 pregnant women who completed the Taiwanese versions of the Center for Epidemiologic Studies Depression Scale (CES‐D), FSFI, and a demographic questionnaire during pregnancy.Main Outcome MeasuresCES‐D scores for depressive symptoms, scores for overall sexual function on the FSFI, and the FSFI domains: desire, arousal, lubrication, orgasm, satisfaction, and pain.ResultsAfter adjusting for demographic factors, CES‐D scores during the first trimester negatively predicted overall sexual function (P = 0.0004), arousal (P = 0.0104), lubrication (P = 0.0016), orgasm (P = 0.0022), and pain (P < 0.0001). Moreover, CES‐D scores during the third trimester negatively predicted sexual desire (P = 0.0005) and satisfaction (P < 0.0001). Furthermore, gestational age negatively predicted overall sexual function, arousal, lubrication, orgasm, and pain (all P < 0.0001). Parity was a positive predictor of overall sexual function, arousal, lubrication, and orgasm (all P < 0.0005). Medical conditions were positive predictors of sexual desire (P = 0.0023).ConclusionsThe present study revealed that depressive symptom scores during early and late pregnancy were significant negative predictors of sexual function during pregnancy. Chang S‐R, Ho H‐N, Chen K‐H, Shyu M‐K, Huang L‐H, and Lin W‐A. Depressive symptoms as a predictor of sexual function during pregnancy. J Sex Med **;**:**–**.     

Childbirth experience and postpartum emotional disturbance

Abstract

One hundred and sixty-one randomly selected Norwegian women (participants in a longitudinal family project) were studied during their stay at the birth clinic. They were interviewed the first day after delivery about the childbirth process: pain, anxiety, loss of control, confusion, joy, happiness, exaltation, cooperation with companion and with staff. Then they were interviewed the fifth day after delivery. The interviewer (clinical psychologist) made a global rating of each mother's emotional functioning the fifth day postpartum. Specific factors in mothers' childbirth experiences relate individually to postpartum emotional disturbance the fifth day after delivery, such as difficult childbirth, pain, loss of control, loss of awareness of time and space, anxiety, negative emotional reaction to the birth, dissatisfaction with own coping with the delivery process, and unmet needs in relation to midwife during delivery.