Constraints and/or determinants of return to sexual activity in the puerperium

Abstract

Objective: to identify factors which constrain or determine the return to sexual activity in the puerperium. Method: exploratory and descriptive study undertaken in a university hospital in the South of Brazil. Fifteen women who had recently given birth, who received a consultation with the nurse in the period August -October 2011, took part in the study. Data was collected after the consultation had finished through semi-structured interviews, in which the women who had recently given birth were asked about the return to sexual activity and the feelings involved in this process. Results: the principal determinant/constraint for return to sexual activity in the post-natal period was the fear of a new pregnancy. Fear of feeling pain, permission from the health professional, shame of their own bodies and changes in libido emerged as constraining and/or determinant factors in the thematic analysis. Conclusion: it is considered fundamental for the issue of contraception to be addressed with the woman/couple during the pre-natal consultation, so that there may be opportunities for reflection and dialog prior to the critical time itself.Descriptors: Postpartum Períod; Sexual Behavior; Women's Health; Contraception. IntroductionThe puerperium is understood as the period which begins straight after birth and ends when the local and general modifications determined by the gestation in the maternal organism return to normal conditions (1) . Some complex physiological and behavioral adaptations occur in women in this period, characterized by involutive phenomena, by the establishment of lactation, by the mother's psychological adaptation, and by the establishment of mother-child and family relationships.The post-natal period is associated generally with a reduction in biological, psychological, marital and family well-being, often entailing a restructuring of the couple's family life as they seek to adapt to this new condition. The changes resulting from the pregnancy and the birth, present in the puerperium, are expressed as pain or abdominal discomfort in the perineal region, pain in the breasts, and muscle pain, which may also entail difficulties in self-care and in care of the baby (2) .Changes in patterns of sexual activity and reduction in desire and sexual pleasure are observed after the birth of the baby, and may persist long after the end of conventional post-natal care. The post-natal period presents reduced or absent sexual activity, especially in relation to coitus, for the majority of women, whose reasons range from the tiredness inherent to pregnancy and to birth itself, to concern with maternal responsibilities, including the time period necessary for the genital apparatus to recover from the birth, particularly in the occurrence of an episiotomy or tear. At the same time, the low levels of estrogen tend to reduce vaginal lubrication, making coitus uncomfortable (3) .Even having overcome the fears and recovered from the physical vulnerability, other obstacles to a satisfactory sexuality may remain, such as ...

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