A Clinical Perspective On Sexuality With Pregnancy and Postpartum

Abstract

In taking a comprehensive psycho-sexual-relational history it is very common to hear that "sex was great until the birth of the first child". Therefore, it is very important to address sexual health in a way that prevents detrimental changes in women's and couples sexual lives. Proactive intervention through open discussion of normal sexuality and sexual concerns during this phase with provision of education and effective strategies is preferable to the unhappiness, pain and disruption that can result through denial of possible consequences. Not all women and couples experience negative sexual consequences as some women experience increased ease of orgasm, desire and general confidence with the birth of the child. However, almost all individuals benefit from affirmation that they are 'normal'. Good communication and co-operation around parenting can significantly increase the intimacy and valence of the relationship with flow on to sexuality and family wellbeing.Sexuality is often not discussed during pre-and postpartum care. Often, the assumption is that a couple has adequate knowledge about sex and that it is enjoyable or good enough because a pregnancy has been achieved, that they will raise any problems, that someone else will address the sexuality component etc. Pregnancy and sexuality are both considered 'natural'. Yes, the instinct and performance of intercourse are largely natural but the enjoyable artistry of lovemaking is a learnt behaviour. Not many cultures actively teach creative lovemaking or educate about how to manage sexuality when changes occur.Pregnancy and childbirth lead to many changes for the mother and father. Both individuals and the couple need to be considered and included in the management of their sex lives. Sexual problems during pregnancy and postpartum that are unresolved can trigger ongoing patterns of discord with detrimental consequences for the man, woman, couple, child and society. This is important because of the relationships between low sexual desire, low sexual activity frequency, relationship satisfaction, domestic violence and relationship and family stability. The postpartum period is often associated with a decline in couple's relationship satisfaction [1]. Relationship satisfaction drops for over 60% of couples in the first 3 years after a child is born [2,3]. Intimacy which is the depth of exchange, both verbal and non-verbal, which implies a deep form of acceptance of the other as well as commitment to the relationship [4] is extremely important as a buffer for changes in sexual function. Low relationship satisfaction is highly correlated with low total relationship intimacy and poor sexual relationship [5]. Transition to parenthood can be both extremely pleasurable and extremely stressful and holistic proactive care should be given. Prevalence of Female Sexual Dysfunction (FSD) PostpartumThe prevalence of FSD is generally reported as being between 10-40% [6,7]. With the first pregnancy 40-70% of couples experience a drop in marital quality with marital conflict in...