Women's sexual health after childbirth

Objective To investigate the impact of childbirth on the sexual health of primiparous women and identify factors associated with dyspareunia.
Design Cross-sectional study using obstetric records, and postal survey six months after delivery.
Setting Department of Obstetrics and Gynaecology, St George's Hospital, London.
Population All primiparous women (   n = 796  ) delivered of a live birth in a six month period.
Methods Quantitative analysis of obstetric and survey data.
Main outcome measures Self reported sexual behaviour and sexual problems (e.g. vaginal dryness, painful penetration, pain during sexual intercourse, pain on orgasm, vaginal tightness, vaginal looseness, bleeding/irritation after sex, and loss of sexual desire); consultation for postnatal sexual problems.
Results Of the 484 respondents (61% response rate), 89% had resumed sexual activity within six months of the birth. Sexual morbidity increased significantly after the birth: in the first three months after delivery 83% of women experienced sexual problems, declining to 64% at six months, although not reaching pre-pregnancy levels of 38%. Dyspareunia in the first three months after delivery was, after adjustment, significantly associated with vaginal deliveries (   P = 0.01  ) and previous experience of dyspareunia (   P = 0.03  ). At six months the association with type of delivery was not significant (   P = 0.4  ); only experience of dyspareunia before pregnancy (   P < 0.0001  ) and current breastfeeding were significant (   P = 0.0006  ). Only 15% of women who had a postnatal sexual problem reported discussing it with a health professional.
Conclusions Sexual health problems were very common after childbirth, suggesting potentially high levels of unmet need.