Sexual function of women during the first year after childbirth: Effect of parity (giving birth after the 20th week of pregnancy), depression and relationship satisfaction

Abstract

The aim of the present study was to measure the effect of parity, relationship satisfaction and depression on the sexual function of postpartum women during the first year after childbirth. This was a cross-sectional online study, guided by a survey methodology. Postpartum women who had given birth 0-12 months ago were invited to participate in this anonymous study. A multi-section questionnaire requesting information concerning demographics, obstetrics and gynaecological history, baby’s characteristics, medical history and sexual life was designed. In order to measure sexual function of postpartum women, the Female Sexual Function Index (FSFI) was used. Symptoms of depression were assessed by the use of the Patient Health Questionnaire (PHQ-8) and the Relationship Assessment Scale (RAS) was employed to investigate the level of relationship satisfaction. Also, women were asked seven open-ended questions about sexual function, mental health and relationships of women during pregnancy and after childbirth. The questionnaire was available online for a period of four months, from May to August 2012. Responses from 325 women who met the inclusion criteria were considered for analysis. The data were analysed using Chi-square test, independent samples t test and multiple logistic regression analysis. P-value less than 0.05 was considered as statistically significant. The qualitative data were analysed using content analysis.This study collected quantitative and qualitative data. Results of the quantitative section of the study showed that 64.3% of the postpartum women studied experienced sexual dysfunction. The most prevalent forms of sexual dysfunction were reported to be sexual desire disorder (81.2%), sexual dissatisfaction (70.5%), orgasmic dysfunction (53.5%), arousal disorder (52.3%), lubrication disorder (43.4%) and pain disorder (39.4%). When analysed as a group, less than one-third of participants in the study (24%) reported symptoms of depression and more than one-third of participants in the study (37.2%) reported dissatisfaction with their relationships. Postpartum sexual dysfunction was shown to be significantly (p<0.05) associated with the following: less frequent sexual activity (fortnightly or less), not being the initiator of sex during a sexual activity with the partner, late resumption of sexual activity (9+ weeks postpartum), 0-5 months postpartum, primiparity, depression and relationship dissatisfaction.Less than one-fourth of primiparous and less than one-third of multiparous women reported having postnatal depression (18.4% and 26.1%, respectively) (p=0.187). Postpartum depression was shown to have a statistically significant association with the following variables: diploma or lower educational level, sexual dysfunction and relationship dissatisfaction (p<0.05).Primiparous (66.7%) and multiparous (61.3%) participants in heterosexual relationships reported high levels of relationship satisfaction (p=0.437). The following variables were shown to be statistically significant risk factors for relationship dissatisfaction after childbirth: annual income less than $50,000, sexual dysfunction, being clinically diagnosed with depression and having symptoms of depression on the PHQ-8 (p<0.05). In contrast, women who were in a same-sex relationship were less likely to report relationship dissatisfaction and at 6-12 months postpartum these women reported a higher level of relationship satisfaction compared to 0-5 months postpartum (p<0.05).According to the findings of the qualitative questions in the study, the following factors were reported to make women happy in their sexual relationships: emotion (emotional closeness, intimacy, exclusivity); love (affection and love, feeling desired in a loving and open relationship, sharing friendship, humour, feeling uninhibited, compatibility, caring about each other’s needs); meeting sexual needs (foreplay, having an orgasm, mutual sexual enjoyment and high libido of the partner); and physical attractiveness. In addition, women reported that the following factors resulted in unhappiness within sexual relationships: unmet sexual needs (feeling pressure to have sex when not being in the mood; lack of sexual drive, lack of time, lack of emotion); birth related issues (breastfeeding, fluctuation of hormones); physical and physiological issues (tiredness, low self-confidence due to weight gain, sharing bed or room with baby); and conflicts with partners.Some women reported that pregnancy and childbirth had positive impacts on their sexual function and they had a better sexual life during pregnancy and after childbirth. However, other women reported that pregnancy and childbirth had negative effects on their sexual life for the following reasons: sexual problems (lack of desire for sex or intimacy, lack of lubrication, inability to orgasm, painful intercourse due to vaginal trauma); physical issues (painful caesarean scar, tiredness, sleep deprivation); and intrapersonal issues (role conflict, relationship issues).Some women reported that pregnancy and childbirth had positive impacts on their sexual function and they had a better sexual life during pregnancy and after childbirth. However, other women reported that pregnancy and childbirth had negative effects on their sexual life for the following reasons: sexual problems (lack of desire for sex or intimacy, lack of lubrication, inability to orgasm, painful intercourse due to vaginal trauma); physical issues (painful caesarean scar, tiredness, sleep deprivation); and intrapersonal issues (role conflict, relationship issues).Women’s sexual function, mental health and relationships can be significantly disturbed during pregnancy and one year after childbirth. Findings confirmed the importance of assessing these aspects of life of women during pregnancy and after childbirth in order to promote the quality of life of women, their families and society.