Objective To determine the effect of mode of delivery and perineal injury on sexual function at 6 and 12 months postpartum.Design Prospective cohort study.Setting Tertiary women's hospital in Melbourne, Australia.Population A cohort of 440 primigravid women.Methods The Female Sexual Function Index (FSFI) was completed at first visit (7-19 weeks of gestation), and at 6 and 12 months postpartum.Main outcome measures A statistically significant difference in total FSFI or domain scores over time according to mode of delivery or perineal injury.Results In this cohort 54% of women had a normal vaginal delivery, 21% had an instrumental delivery, and 25% gave birth by caesarean section. No difference was found in total FSFI or domain scores according to mode of delivery over time between antenatal assessment and 12 months postpartum. Pain was decreased in the caesarean group only at 6 months postpartum. All groups showed pain scores at 12 months that were comparable with antenatal levels. For those who gave birth vaginally, 27% had an intact perineum, 50% had an episiotomy, and 6%, 14%, and 3% had first, second, and third-degree tears, respectively. The only differences between groups were found over time according to perineal injury at 6 months in the arousal domain. At 12 months, total FSFI and domain scores were no different to initial scores.Conclusions At 12 months postpartum sexual function has returned to early pregnancy levels, irrespective of mode of delivery or perineal injury.

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The resource management systems of indigenous people often have outcomes that are analogous to those desired by Western conservationists. They differ, however, in context, motive and conceptual underpinnings. To represent indigenous management systems as being well suited to the needs of modern conservation, or as founded in the same ethic, is both facile and wrong; it will not serve the interests of either modern conservation or disadvantaged indigenous peoples. It is argued that encounters between the interests of modern conservation and indigenous peoples must be resolved in favour of the latter.

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