Does Severe Maternal Morbidity Affect Female Sexual Activity and Function? Evidence from a Brazilian Cohort Study

Abstract

Objectiveto assess Female Sexual Function Index (FSFI) scores and delay to resume sexual activity associated with a previous severe maternal morbidity.MethodThis was a multidimensional retrospective cohort study. Women who gave birth at a Brazilian tertiary maternity between 2008 and 2012 were included, with data extraction from the hospital information system. Those with potentially life-threatening conditions and maternal near miss episodes (severe maternal morbidity) were considered the exposed group. The control group was a random sample of women who had had uncomplicated pregnancy. Female sexual function was evaluated through FSFI questionnaire, and general and reproductive aspects were addressed through specific questions. Statistical analyses were performed using Mann-Whitney and Pearson´s Chi-square for bivariate analyses. Logistic regression was used to identify variables independently associated with lower FSFI scores.Results638 women were included (315 at exposed and 323 at not exposed groups). The majority of women were under 30 years-old in the control group and between 30 and 46 years-old in the exposed group (p = 0.003). Women who experienced severe maternal morbidity (SMM) had statistically significant differences regarding cesarean section (82.4% versus 47.1% among deliveries without complications, p<0.001), and some previous pathological conditions. FSFI mean scores were similar among groups ranging from 24.39 to 24.42. It took longer for exposed women to resume sexual activity after index pregnancy (mean 84 days after SMM and 65 days for control group, p = 0.01). Multiple analyses showed no significant association of FSFI below cut-off value with any predictor.ConclusionFSFI scores were not different in both groups. However, they were lower than expected. SMM delayed resumption of sexual activity after delivery, beyond postpartum period. However, the proportion of women in both groups having sex at 3 months after delivery was similar. Altered sexual response may be evaluated as one of possible long-term consequences after SMM episodes. Further studies on the growing population of women surviving severe maternal conditions might be worth for improvement of care for women.

Reference ranges of the WHO Disability Assessment Schedule (WHODAS 2.0) score and diagnostic validity of its 12-item version in identifying altered functioning in healthy postpartum women

“…On the other hand, when comparing across the three groups, Domain 4 scores remained constant. This is in agreement with the findings of Andreucci et al., who applied the Female Sexual Function Index to a Brazilian cohort of women with and without SMM, and found similar mean scores in the population studied . These issues may be inherent to the pregnancy and postpartum period regardless of the presence or absence of any morbidity.…”

“…25On the other hand, when comparing across the three groups, Domain 4 scores remained constant. This is in agreement with the findings of Andreucci et al,12 who applied the Female Sexual Function T A B L E 3 Values of percentiles 90, 95, and 97.5 for WHODAS-36 total and domain scores, and for WHODAS-12 total scores, among women with no morbidity (n=127 a ).…”

“…Index to a Brazilian cohort of women with and without SMM, and found similar mean scores in the population studied. 12 These issues may be inherent to the pregnancy and postpartum period regardless of the presence or absence of any morbidity.…”

“…8 These concerns-which are not only dependent on the presence or diagnosis of morbidity, but also on the inadequate assessment of such issues or even their misinterpretation-may contribute to the deterioration of maternal and newborn health. 9 The occurrence of severe maternal morbidity (SMM), defined as having a potentially life-threatening condition (PLTC) and/or maternal near miss (MNM), has been studied over the past decade: impacts on maternal and child health are unquestionable, [10][11][12] as are their effects on women's functionality (her ability to perform everyday tasks, including social and economic responsibilities). 13 Non-life-threatening or nonsevere maternal morbidity (non-SMM) is also a theme of concern and is currently defined as "any health condition attributed to and/or complicating pregnancy and childbirth that has a negative impact on the woman's well-being and/or functioning".…”

Saúde sexual e reprodutiva de mulheres seis meses após a vivência de um episódio de morbidade materna grave

“…Apesar das suposições de vários autores sobre como a MMG afeta a qualidade de vida das mulheres e de suas famílias (CECATTI et al, 2009;PACAGNELLA et al, 2010), há poucas informações sobre as consequências destas complicações, como por exemplo, sobre a saúde sexual da mulher e a saúde reprodutiva (ANDREUCCI et al, 2015;GANABA et al, 2010). Da mesma forma, também não existem estudos que abordam qual o tempo estimado para a retomada da atividade sexual feminina no pós-parto após algum tipo de complicação no ciclo grávido-puerperal (ANDREUCCI et al, 2015).…”