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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 1  |  Page : 47-51

Sexual behavior after childbirth


1 Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
2 Department of Dermatology, Birkit Elsabae Hospital, Menoufia, Egypt

Date of Submission30-May-2019
Date of Decision18-Jul-2019
Date of Acceptance20-Jul-2019
Date of Web Publication27-Mar-2021

Correspondence Address:
Hebatalla A Younes
Department of Dermatology, Birkit Elsabae Hospital, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_193_19

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  Abstract 


Objective
To study the prevalence of female sexual dysfunction after childbirth.
Background
Women's sexual activity changes at various stages of life and is affected by numerous factors; one of them includes childbirth and maternity. After childbirth, numerous physical, psychological, and sociocultural factors may affect the sexual activity of women and the quality of their lives.
Patients and methods
This cross-sectional study included 200 Egyptian postpartum women in the period from August 2018 till April 2019. The study was performed on postpartum women who attended the gynecology clinic, Shebin El Kom Teaching Hospital.
Results
The finding of the study indicated that all domains of Female Sexual Function Index (FSFI) were affected after labor, and the most affected was the sexual desire. The mean score before labor was 4.94 ± 0.84 and after labor was 3.40 ± 1.30, and the least prevalent was the dyspareunia; the mean score before labor was 4.16 ± 0.97 and after labor it was 4.89 ± 1.54.
Conclusion
Physical and emotional health problems are common after childbirth. In this article, we found that there were significantly lowered mean score values of all domains of FSFI, except pain (increased) and overall scale score decreased after labor. Decreased sexual desire is the most prevalent disorder of the sexual relationship in postpartum and the least prevalent was the dyspareunia.

Keywords: childbirth, delivery, dyspareunia, lactation, sexual behavior


How to cite this article:
Gaber MA, Younes HA. Sexual behavior after childbirth. Menoufia Med J 2021;34:47-51

How to cite this URL:
Gaber MA, Younes HA. Sexual behavior after childbirth. Menoufia Med J [serial online] 2021 [cited 2021 Jun 21];34:47-51. Available from: http://www.mmj.eg.net/text.asp?2021/34/1/47/312012




  Introduction Top


Pregnancy, labor, and postpartum period constitute a special and very important time in every woman's life, entailing a range of physical, hormonal, psychological, and social changes. These events affect women's health, but also other aspects of their lives, including sexual activity, which is undeniably a significant aspect of human life [1]. Although many women experience sexual problems in the postpartum period, research in this subject is underexplored. Embarrassment and preoccupation with the newborn are some of the reasons why many women do not seek help. Furthermore, there is a lack of professional awareness and expertise [2]. There is some evidence that breastfeeding has an adverse effect on sexuality in the first postnatal year. It is not clear whether this could be related to differences in hormone levels or differences in feeding behavior. Fatigue and contraception have largely been ignored in studies of factors influencing postnatal sexual behavior. Women who went on to breastfeed were found to be very similar on antenatal measures of sexual behavior to those who went on to bottle-feed [3]. Low estrogen levels can cause decreased vaginal lubrication and atrophy of the vaginal epithelium, which, in turn, make physical arousal difficult and intercourse painful [4]. The other hormone that plays a major role in lactation is oxytocin that is at a high level in breastfeeding women. It is also responsible for contractions of the uterus during orgasm and labor [5]. Oxytocin provides the happy, contented feeling after breastfeeding, a reduction in stress, and the overall relaxation that breastfeeding conveys, and improves sexual function [6]. The physical, hormonal, and psychological alterations in the body from conception to postpartum and breastfeeding create a great potential for change in a woman's sexuality [7]. Our aim with this study was to compare female sexuality before pregnancy and after labor concerning particularly the following variables: sexual desire, arousal, lubrication, orgasm, pain, sexual satisfaction, and sexual function.


  Patients and methods Top


This cross-sectional study was done on 200 postpartum women who went to Shebin El Kom Teaching Hospital in the duration from August 2018 till April 2019. We included in our study literacy to complete the questionnaire, married and living with spouse, and being in the lactation period (3–6 months after childbirth). Women completed two questionnaires at that time. We excluded patients with chronic medical illness such as diabetes mellitus, hypertension, hyperthyroidism, hypothyroidism, liver disorders, endocrinal disorders as these disorders may have a negative effect on sexual functions. Patients using drugs that affect sexual behaviors (antihypertensive drugs, thiazide diuretics, antidepressants, antihistamines, barbiturates, amphetamines, diazepine, and cocaine) and stressors in the recent 6 months (parental separation, death of first-degree relatives, etc.) were also excluded.

All patients were subjected to formal consent that they were healthy and freely accepted to fulfill the questionnaire. The questionnaire consisted of questions about sociodemographic factors in which we asked about age, age of marriage, residence, educational level, occupation, socioeconomic status, and number of children. Questions about obstetric history included mode of labor, mode of lactation, and type of contraception used [Table 1]. Questions about female sexuality were assessed in our study by Arabic translated version of FSFI questionnaire, which is a brief, multidimensional, validated tool for assessment of Female Sexual Function (FSF) during sexual activity. According to the FSFI, a 19-item questionnaire on sexual function domains consisted of: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain during sexual activity/intercourse. Sexual desire was assessed as frequency and level by two questions. Sexual arousal was assessed as frequency, level, confidence, and satisfaction by four questions. Lubrication was assessed as frequency, difficulty, maintaining of frequency, and maintaining of difficulty also by four questions. Orgasm was assessed as frequency, difficulty, and satisfaction by three questions. Satisfaction was assessed as the amount of emotion, partner relationship, and overall satisfaction by three questions. Pain was assessed as during, after vaginal penetration, and level by three questions. For each of the 19 questions there were five possible answers, a full explanation of each question and its five possible answers were done and patient answers were reported as they said. For each of the three domains a score (0–5) was calculated and based on the score of each one, the significance of each of them in comparison before and after labor.
Table 1: Sociodemographic data of the studied women

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In addition to FSFI, we asked women if their partners had sexual problems (premature/delayed ejaculation or erectile dysfunction). Also, we asked about the frequency of sexual intercourse (once a day to 2–3 time/week, every week to once a month), and the motive for sexual intercourse (get pleasure, others).

The results were collected and entered to the computer using the statistical package for the social sciences (SPSS) program for statistical analysis (version 20; SPSS Inc., Chicago, Illinois, USA). Descriptive statistics in the form of mean, SD, number, and percentage were applied.


  Results Top


The study was performed on 200 postpartum women. The mean score for the sexual desire domain before labor was 4.94 ± 0.84 and after labor was 3.40 ± 1.30, which has a statistically significant difference as the P value is less than 0.001. The mean score for the sexual arousal domain before labor was 4.88 ± 0.78, while after labor it was 3.57 ± 1.09 which has a statistically significant difference as the P value is less than 0.001. As for lubrication domain, the mean score before labor was 4.90 ± 0.76 and after labor was 3.74 ± 1.13, which has statistically significant difference as the P value is less than 0.001. Regarding orgasm domain, the mean score before labor was 4.82 ± 0.84 and after labor was 3.80 ± 1.06 with statistically significant difference a P value of less than 0.001. As for satisfaction domain, the mean score before labor was 4.87 ± 0.86 and after labor 3.94 ± 1.07 with statistically significant difference as the P value less is than 0.001. Regarding pain domain, the mean score before labor was 4.16 ± 0.97 and after labor was 4.89 ± 1.54 with statistically significant difference as the P value is less than 0.001. Regarding the overall scale, the mean score before labor was 29.31 ± 3.81 and after labor was 22.61 ± 5.17 with statistically significant difference as the P value is less than 0.001 [Table 2]. There was significant positive correlation between lubrication score and age of marriage in the studied women [Table 3]. There were significant higher mean values of overall FSFI scale score after labor in women who practice bottle-feeding than in those practice breastfeeding in the studied women. There were significant lower mean values of overall FSFI scale score after labor in the use of oral pills (P1 = 0.003) and injectable contraceptives (P3 = 0.002) than nonuse of contraception. Also, there were significant lower mean values of overall FSFI scale score after labor in the use of oral pills than the use of IUD (P5 ≤ 0.001) or mechanical contraception (P6 < 0.001). Similarly, there were significant lower mean values of overall FSFI scale score after labor in the use of injectable contraception than the use of IUD (P7 ≤ 0.001) or mechanical contraception (P8 < 0.001) [Table 4].
Table 2: Mean score for FSFI scale of the studied women before and after labor

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Table 3: Correlation between FSFI scale score after labor with age, age of marriage, and number of children in the studied women

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Table 4: Relationship between overall FSFI scale score after labor with demographic data of the studied women

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  Discussion Top


In this study we aimed to determine the sexual function of lactating women after childbirth. In all 200 women were included with a mean age of 31.17 years, mean age of marriage was 22.86 years, mean number of children was 2.56, most of them from urban and education till University, 67% were working, regarding mode of delivery 61% had a cesarean section, 74.5% breastfeeding, and most of them had IUD. The Eid et al. [8] study included 200 women with a mean age of 29.1 ± 3.11 years. The highest percentage of women were aged 25–30 years and the majority were residents in urban areas. Three-fourth of the women were highly educated whereas 39% were housewives. The percentage of women who underwent normal labor was 45% whereas 55% underwent Caesarean section (CS). For normal labor group, 59% of women had lateral episiotomy, 41% had posterior episiotomy with a mean healing period of 3.12 ± 2.96 weeks. The mean time for the first intercourse after labor was 6.1 ± 1.92 weeks in the normal labor group and 6.1 ± 2.4 weeks in the elective CS group [9]. In this study, we found that there were significantly lowered mean score values of all domains (except pain) of FSFI and overall scale score after labor than before in the studied women. The Boroumandfar et al. [9] study indicated that 58.6% of the mothers had proper sexual function and 41.4% of them had improper sexual function. Th e studies of Kline et al. [10] and Dixon et al. [11] assessed the prevalence of sexual problems in the postpartum period which was 49–83%. In agreement with our result, Banaei et al. [12] found that in nulliparas and postpartum women the mean score of sexual function between the two groups was not significantly different. Also, 4 weeks after consultation, there existed significant difference in the mean score of sexual function between two groups (P < 0.001). Also, Rostamkhani et al. [13] showed that there was significant difference between the control and intervention groups with regard to FSFI mean scores in different domains, before counseling and during 2 and 4 weeks after counseling. Eid et al. [8] agree with our result as they showed that 12 weeks after labor, there was a significant decrease in desire, arousal, and lubrication domains between pre-labor and post-labor mean FSFI scores for the normal labor group, while there was nonsignificant difference in orgasm, satisfaction, or pain domains. Significant difference in the desire domain was demonstrated only between pre-labor and post-labor scores for the CS group whereas there was nonsignificant difference in other domains [8]. In this study we found that sexual pain was significantly increased after labor than before in all items of sexual pain score in the studied women. Moreover, the findings of the Boroumandfar et al. [9] study considered dyspareunia as the most common sexual dysfunction and goes without result. In this study we found that there was significant positive correlation between lubrication score and age of marriage in the studied women. There were significant lower mean values of overall FSFI scale score after labor in the use of oral pills (P1 = 0.003) and injectable contraceptives (P3 = 0.002) than the nonuse of contraception. Also, there were significant lower mean values of overall FSFI scale score after labor in the use of oral pills than the use of IUD (P5 ≤ 0.001) or mechanical contraception (P6 < 0.001). Similarly, there were significant lower mean values of overall FSFI scale score after labor in the use of injectable contraception than the use of IUD (P7 ≤ 0.001) or mechanical contraception (P8 < 0.001). Few studies have reported on the effects of specifically relevant factors such as using contraception on postpartum sexual activity. Most reports are primarily concerned with comparing the immediate and delayed insertion of an IUD. However, the evidence base for IUD promotion in low-income and middle-income countries was weak and offered few lessons on what strategies are most effective [14]. Home dispensing of hormonal contraceptives may improve the use of postpartum contraceptives by women [15]. Barrett et al. [16] showed that of the women who had resumed (or attempted to resume) sexual intercourse, 82% (350/425) reported using a method of contraception. Four women were pregnant again. Of the 350 women using contraception, 45% (n = 156) were using hormonal contraception (predominantly the pill), 43% (n = 151) were using condoms, 2% (n = 6) were using an intrauterine device, 3% (n = 12) were using the diaphragm, and 7% (n = 25) were using safe period or withdrawal methods. There was no association between the method of contraception and dyspareunia at 3 months (d.f.=3, P = 0.8) or at 6 months (d.f.=3, P = 0.8) and this does not match our results.


  Conclusion Top


Physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them. In this article, we found that there were significantly lowered mean score values of all domains of FSFI, except pain (increased) and overall scale score decreased after labor. Decreased sexual desire is the most prevalent disorder of the sexual relationship in postpartum and the least prevalent was the dyspareunia. There was significant positive correlation between lubrication score and age of marriage. There were significant higher mean values of overall FSFI scale score after labor in women who practice bottle-feeding than in those who practice breastfeeding. There were significant lower mean values of overall FSFI scale score after labor in the use of oral pills and injectable contraception than the nonuse of contraception.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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