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ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 2  |  Page : 503-508

Prevalence of female sexual dysfunction during pregnancy


1 Department of Dermatology and Andrology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Dermatology, Berkt Tl-Sabea Hospital, Menoufia, Egypt

Date of Submission28-Dec-2019
Date of Decision18-Feb-2020
Date of Acceptance23-Feb-2020
Date of Web Publication30-Jun-2021

Correspondence Address:
Al Shaimaa E. Eisa
MBBCh, Berkt Tl-Sabea, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_396_19

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  Abstract 


Objective
This is to evaluate the prevalence of female sexual dysfunction during pregnancy in the Delta Region of Egypt using the female sexual function index questionnaire.
Background
Pregnancy is a physiological process that causes various anatomical and physiological changes in a pregnant woman; such changes may play a part in affecting her sexual behavior and activity. Despite the increasing number of epidemiologic studies, there are no sufficient data in the medical literature regarding the prevalence of sexual dysfunction during pregnancy in Egypt.
Patients and methods
A cohort study was conducted with 300 healthy pregnant women receiving routine antenatal care at obstetric's clinic at Menoufia University Hospital in the duration from March 2019 till November 2019.
Results
The female sexual dysfunction significantly increased in the first and third trimesters, as the percentage of the female having sexual dysfunction was 68 and 72% in the first and third trimesters, respectively. Better indicators were in the second trimester, as the percentage of women having sexual dysfunction was 51% of the studied sample.
Conclusion
Specific changes that occur in each pregnancy trimester have significant influences on sexual behavior. A reduction in sexual intercourse frequency, desire, and satisfaction occurs in many women as pregnancy progresses, particularly during the third trimester, compared with before pregnancy.

Keywords: desire, female sexual dysfunction, lubrication, pregnancy, satisfaction


How to cite this article:
Gaber MA, Eisa AE. Prevalence of female sexual dysfunction during pregnancy. Menoufia Med J 2021;34:503-8

How to cite this URL:
Gaber MA, Eisa AE. Prevalence of female sexual dysfunction during pregnancy. Menoufia Med J [serial online] 2021 [cited 2024 Mar 28];34:503-8. Available from: http://www.mmj.eg.net/text.asp?2021/34/2/503/319731




  Introduction Top


Female sexuality depends on the woman's physical, emotional, and psychological states and involves the complex and dynamic interaction between these variables. Female sexual functioning is the ability to achieve sexual domains such as arousal, lubrication, orgasm, and satisfaction resulting in better well-being with a good quality of life [1].

Female sexual dysfunction (FSD) is defined as disorders of libido, arousal, and orgasm that can lead to a negative effect on women's quality of life, low self-esteem, and emotional distress. Between 30 and 77% of women may experience different degrees of sexual dysfunction during their lives [2].

However, this incidence varies, probably owing to differences in the defining criteria of sexual dysfunction, variable research methodology used in these studies, and factors affecting sexual dysfunction, that is, the population involved, culture, or lifestyle of studied women, socioeconomic level, and traditions from various societies [3].

Pregnancy is a physiological process that causes various anatomical and physiological changes to the pregnant woman, and such changes may play a part in affecting her sexual behavior and activity, although many previous studies have confirmed that sexual intercourse in normal pregnant women has no significant adverse effects, such as an increased risk of miscarriage, premature rupture of membranes, or preterm labor [4].

As sexual dysfunction during the reproductive years is gaining more and more global interest by public health providers, various diagnostic tools have been used by different researchers. The female sexual function index (FSFI) is the most widely used and acceptable tool owing to its high validity [5].

Despite the increasing number of epidemiologic studies, there are no sufficient data in the medical literature regarding the prevalence of sexual dysfunction during pregnancy in Egypt [6].

This study aims to evaluate the prevalence of FSD during pregnancy in the Delta Region of Egypt using the FSFI questionnaire.


  Patients and methods Top


A cohort study was conducted on 300 healthy pregnant women receiving routine antenatal care at obstetrics' clinic at Menoufia University Hospital in the duration from March 2019 till November 2019. The FSFI questionnaire was used to evaluate aspects of sexual activity and FSD during pregnancy.

Participants in the study sample were pregnant women chosen through random sampling from those receiving prenatal examinations at obstetrics' clinic at Menoufia University Hospital. A total of 300 pregnant women (100 pregnant women in each pregnancy trimester) participated in this study. The pregnant women were divided into three groups according to gestational age in weeks: pregnant women in the first trimester (gestational age 7–12 weeks) (GI), pregnant women in the second trimester (gestational age 13–24 weeks) (GII), and pregnant women in the third trimester (gestational age 25–39 weeks) (GIII).

Inclusion criteria were women who visited an outpatient clinic in Menoufia University Hospital for any medical condition other than a sexual problem; were pregnant, which was confirmed by a pregnancy test or transvaginal ultrasound done by a gynecologist; were aged between 20 and 40 years; were able to read the Arabic language and willing to answer the questionnaire; had a stable marital state in the last 6 months and active sexual life defined as sexual activity with penetration within the previous 4 weeks; and had consented to participate and signed the informed consent approved by the ethics committee.

Exclusion criteria were pregnant women experiencing problems such as heart disease, hypertension, or other serious complication of pregnancy that restricted sexual activity or with a psychiatric condition that made impossible completion of the questionnaire.

Regarding the study instrument, among the available assessment instruments for measuring female sexual function, FSFI was chosen. It was originally developed by Rosen et al. [6]. Because of its appropriate wording and clear-scale structure, it was replicated in other languages. The Arabic version of the FSFI questionnaire was used in this study. Its administration time is 10–15 min, and its target populate is clinical trials and community populations [7–9].

The questionnaire used contained questions concerning demographic data such as maternal age, educational level, and work, and obstetrical data such as gestational age, parity, gravidity, and complications during the current pregnancy. The FSFI questionnaire is a validated self-administered questionnaire containing 19 questions divided into six domains (desire, excitement, lubrication, orgasm, satisfaction, and pain). According to its structure, responders are asked to base their responses on the past 4 weeks. Questions 1, 2, 15, and 16 were scored from 1 to 5, and all the others were scored from 0 to 5.

Procedures

The investigator recruited pregnant women after explaining the content and purpose of the study. Individual face-to-face interviews were held in a private room with guaranteed confidentiality. Permission to carry out the study was obtained from the ethical committee at the Department of Dermatology and Andrology at the Faculty of Medicine, Menoufia University.

Calculation of FSFI score

The answers for each FSFI question have values that generate a score for each domain. The score is the sum of the responses to each question of a specific domain multiplied by a factor that potentiates the influence of the domain on the total score. The final result (2–36) points are the sum of all domains, and the higher the score, the better the sexual function of the respondent. A total score of 26.5 or less characterizes deficiency of female sexual function. In addition, the data were interpreted according to the classification in which each domain is assessed separately [6].

Statistical analysis

The clinical and scoring data were recorded on an 'investigation report form.' These data were tabulated, coded, and then analyzed using the computer program Statistical Package for Social Science, version 16.

Descriptive data

Description of quantitative variables was in the form of mean and SD. Description of qualitative variables was in the form of frequency and percentage.

Analytical statistics

In the statistical comparison between the different groups, the significance of difference was tested using one of the following tests: Student t test was used to compare between the mean of two groups of numerical (parametric) data. Z test, test of proportion, to compare between two percentages. χ2 test was used to compare more than two percentages.

Level of significance was set as follows: P value more than 0.05 was considered statistically insignificant, P value less than 0.05 was considered statistically significant (S), and P value less than 0.01 or less than 0.001 was considered high statistically significant.

Statistical analysis of data was done by Dell computer using Statistical Package for the Social Sciences, version 22 (SPSS Inc., Chicago, Illinois, USA) as follows: description of quantitative variables as mean, SD, or median and range as appropriate. Description of qualitative variables as number or frequency and percentage. Student t test and Mann–Whitney test were used for comparison between two groups regarding quantitative variables. Spearman correlation coefficient test (r) was used to test a positive or negative correlation between two variables (nonparametric). Results were considered statistically significant if P value less than or equal to 0.05, and the nonsignificant difference if P value more than 0.05. However, P value less than 0.001 was considered highly significant.


  Results Top


A total of 300 pregnant women, with 100 pregnant women in each pregnancy trimester, participated in this study. The mean score for the sexual desire domain of FSFI in GI was 3.5 ± 1.2, GII was 3.7 ± 1.2, and GIII was 3.4 ± 1.1, and in comparing between them, there was no statistically significant difference in desire domain among the studied groups (P > 0.05). The mean score for the sexual arousal domain of FSFI in GI was 3.8 ± 1, GII was 4.3 ± 1, and GIII was 3.9 ± 0.9, and in comparing between them, there was a highly significant difference in arousal domain between GI and GII, and GII and GIII (P < 0.001 and < 0.01, respectively), but there was no statistically significant difference between GI and GIII (P > 0.05). The mean score for the sexual lubrication domain of FSFI in GI was 4.3 ± 0.9, GII was 4.4 ± 0.9, and GIII was 4.1 ± 0.8, and in comparing between them, there was a highly significant difference in lubrication domain between GII and GIII (P < 0.01). The mean score for the sexual orgasm domain of FSFI in GI was 4.1 ± 1, GII was 4.5 ± 0.9, and GIII was 4.1 ± 1, and in comparing between them, there was a highly significant difference in orgasm domain between GI and GII, and GII and GIII (P < 0.01). The mean score for the sexual satisfaction domain of FSFI in GI was 4.2 ± 1.1, GII was 4.8 ± 0.8, and GIII was 4.6 ± 1, and in comparing between them, there was a highly significant difference in satisfaction domain between GI and GII, and GI and GIII (P < 0.001 and <0.01, respectively). The mean score for the sexual pain domain of FSFI in GI was 3.5 ± 1.2, GII was 4.1 ± 1, and GIII was 3.7 ± 1.1, and in comparing between them, there was a highly significant difference in pain domain between GI and GII, and GII and GIII (P < 0.001 and <0.01, respectively) [Table 1].
Table 1: Comparing the studied groups according to six domains of female sexual function index

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FSD significantly increased in the first and third trimesters, as the percentage of the women having sexual dysfunction was 68 and 72% in the first and third trimester, respectively. In comparing the female having sexual dysfunction (FSFI score ≤26.5) between GI and GII and between GII and GIII, there was a highly significant difference (P < 0.05), whereas between GI and GIII, there was no statistically significant difference (P > 0.5) [Table 2].
Table 2: Comparing the female sexual function index score according to cutoff point (26.5) between the studied groups

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In comparing the women having sexual dysfunction (FSFI score ≤26.5) and those not having according to women age distribution, there was no statistically significant difference in GII and GIII, whereas GI, there was a highly significant difference in young group (<30) and older group (>30) (P < 0.01 and <0.05, respectively) [Table 3].
Table 3: Relation between the female having sexual dysfunction (female sexual function index score ≤26.5) and women age in each studied group

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  Discussion Top


Female sexual function, dysfunction, and heath during pregnancy are primary topics of concern for women health care providers. Painless and satisfactory sexual intercourse (which is an important component to establish the relationship of many couples) is frequently influenced by gestational, physical, and emotional demands [10]. The effect of these factors over the pregnant women's sexual life can have a wide range of variation reflecting the idiosyncratic nature of human sexuality [11]. The study was conducted on 300 healthy, sexually active pregnant women who filled out the FSFI questionnaire, which is a valid and safe measurement of the female sexual function. The FSFI presents domains that reflect the female sexual response and pain. It was chosen for this study because it is a specific and multidimensional research instrument, following the evolution of new concepts of FSD [6].

According to the interpretation proposed by Weigel et al. [12], an FSFI score less than or equal to 26.5 characterizes deficiency of sexual function. In the present study, the FSD significantly increased in the first and third trimesters, as the percentage of the female having sexual dysfunction was 68 and 72% in the first and third trimester, respectively. Better indicators were in the second trimester, as the female having sexual dysfunction percentage was 51% of the studied sample. These results are in agreement with a meta-analysis of 59 studies by Von Sydow [13], who observed that, Sexual enjoyment and orgasm before pregnancy was observed in 76–79% of the women, in the first trimester was 59%, in the second was 75–84% and in the last was 40–41%. It should be taken into consideration that all studies evaluated in that detailed review were conducted before the development of objective measures of the female sexual function as FSFI. In this study, a significant reduction of the FSFI score was observed in the first and the third trimesters, whereas in the second trimester, it is increased, in agreement with data observed by Reamy et al. [14], and Atputharajah [15], and in contrast to Pongthai et al. [16], Haines et al. [17], Uwapusitanon and Choobun [18]; and Senkumwong et al. [19], who observed a linear decrease of sexual function and desire in particular during pregnancy. The second gestational trimester is considered the most emotionally stable period of gestation when pregnancy seems to be clearly established – diminishing, this way, fear of fetal loss. Reaffirmation of femininity through the duo woman/maternity – associated with the pregnant pelvis vascular changes and to the cessation of nausea – allows an increase in orgiastic quality as well as in the level of eroticism. These factors can explain the presence of the sexual function's best indicators in the second trimester [20]. Moreover, according to Bitzer and Alder [21], psychosomatic complaints and anxiety are reduced during this period, with possible positive effects on sexual function during the second trimester.

The third trimester of pregnancy is characterized by significant changes in the women's body. These changes could be the reason for the decrease in libido and sexual activity during this period. Increase in both the abdominal volume and fetal weight cause lack of balance and compensatory postural changes forcing the female organism to begin using muscles seldom used before pregnancy, which can cause lumbar pain – a specific symptom of the gestational period's end. Moreover, fat7igue, anxiety, and the natural fear felt owing to proximity of labor tend to make the sexual relationship unattractive for pregnant women. Another factor that contributes to decrease in the female sexual function is the partner's loss of sexual interest because of worries with the woman and the body, as well as the nonerotic effect of the women's appearance at the end of pregnancy [5]. Moreover, other authors indicate that restricted position during sexual activity, especially in the last trimester of pregnancy, could influence and even decreased sexual function period [22]. The restriction to adopt certain positions is related to several causes, such as raising the abdomen over the last trimester of pregnancy, the physical discomfort during intercourse, to psychological factors, the myths, and beliefs that create fear and insecurity in relation to sex during this period [18],[23].

The FSFI scores of arousal, lubrication, and orgasm domains were found to be significantly decreased in first and third trimesters. Considering the pregnant women's age, when comparing the female having sexual dysfunction in different age groups, there was a significant increase in dysfunction among a young group (<30) except in the first trimester where the dysfunction was more among an older group (>30). Regardless of this exception, this significant relationship between sexual dysfunction and age group (<30) was in contrast to Leite et al. [20], who concluded that sexual function and activity declined among older throughout pregnancy. However, many investigations did not detect an association between this variable and sexual function in pregnant women [17],[24]. No association between parity, gravidity, and sexual dysfunction was detected in this work. This is in agreement with previous reports by Gruszecki et al. [25] and Pauls et al. [24]. In the present study, evaluation of the pregnant' partners was not done, as the pregnant one and her partner are worrying about the consequences of sexual activity on pregnancy. Egypt is a country of large dimensions with a population of great social and cultural diversity; therefore, the sample studied here cannot be generalized to the population of Egyptian pregnant women as a whole.


  Conclusion Top


The present study results showed that the sexual function is affected during pregnancy with a significant change in all FSFI domains in first and third trimesters in both age groups – even though this decrease was more easily noticed among young age group (<30 years) and that the prevalence of sexual dysfunction is high during pregnancy. The desire domain shows no significant difference between trimester. However, arousal, lubrication, and orgasm domains were found to be significantly decreased in the first and third trimesters. Pain was found to be increased significantly in the first trimester. Although there was a significant decrease in FSFI domains, most women were satisfied with their emotional closeness to their partner, with their relationship, and with their sex life in general.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3]


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[Pubmed] | [DOI]



 

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