Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study)

Abstract

BackgroundMany women are not prepared for changes to their sexual health after childbirth. The aim of this paper is to report on the prevalence of and the potential risk factors (pre-pregnancy dyspareunia, mode of birth, perineal trauma and breastfeeding) for sexual health issues (dyspareunia, lack of vaginal lubrication and a loss of interest in sexual activity) at 6 and 12 months postpartum.MethodsA longitudinal cohort study of 832 first-time mothers who were recruited in early pregnancy and returned postnatal surveys at 3, 6, 9 and 12 months postpartum were assessed for sexual health issues and associated risk factors.ResultsNearly half of the women (46.3%) reported a lack of interest in sexual activity, 43% experienced a lack of vaginal lubrication and 37.5% of included women had dyspareunia 6 months after birth. On univariate analysis, vacuum-assisted birth, 2nd degree perineal tears, 3rd degree perineal tears and episiotomy were all associated with dyspareunia 6 months postpartum, but, of these only 3rd degree tears, in association with breastfeeding and pre-existing dyspareunia, remained significant on multivariable analysis. Breastfeeding, in combination, with other significant factors, was associated with dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity 6 months postpartum, and, dissatisfaction with body image emerged as a significant factor associated with lack of interest in sexual activity at 12 months postpartum. Pre-pregnancy dyspareunia and breastfeeding emerged as common factors associated with all three outcomes of dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity at 6 months postpartum.ConclusionBreastfeeding and pre-existing dyspareunia are associated with sexual health issues at 6 months postpartum. Pre-existing dyspareunia is associated with a lack of vaginal lubrication at 12 months postpartum and breastfeeding is associated with dissatisfaction with body image. Preparing women and their partners during the antenatal period and advising on simple measures, such as use of lubrication to avoid or minimise sexual health issues, could potentially remove stress, anxiety and fears regarding intimacy after birth. Introducing the topic of pre-existing sexual health issues antenatally may facilitate appropriate support, treatment or counselling for women.

Stop, think, reflect, realize—first‐time mothers’ views on taking part in longitudinal maternal health research

“…For others, they helped them realize they had a health problem, and prompted them to take better care of themselves or seek professional help, even up to 12 months postpartum. Contrary to previously held beliefs that women's bodies return to their pre‐pregnant state within 6 weeks postpartum, findings from this and other studies show that some health problems are present before women's first pregnancy, that considerable proportions of women experience persistent and long‐term morbidities and that some women's health can deteriorate during the year after giving birth. A systematic review of morbidities experienced by women who had a postpartum haemorrhage found that women who suffered problems such as coagulopathy [a disorder affecting the blood's ability to clot] (1.74 %), post‐traumatic stress disorder (3%), or required readmission to hospital 1‐3 months postpartum (3.6 %) described their health as “much worse than 1 year ago” (6%) .…”

Economic burden of maternal morbidity – A systematic review of cost-of-illness studies

“…The reported incidence does not include many other health problems that are common during pregnancy and postpartum, such as depression, incontinence, sexual health issues, and pelvic girdle pain. [2][3][4][5][6] These types of health problems are frequently underreported and undertreated, due to their sensitive nature, or a belief that they are normal, selflimiting symptoms of pregnancy and birth. [7][8][9] There is a growing body of research describing their prevalence, which indicates that almost all women (94%) experience at least one major health problem in the first year after having a baby, with up to one in five (20%) reporting depressive symptoms and almost half (47%) reporting urinary incontinence.…”

The meaning of postpartum sexual health for women living in Spain: A phenomenological inquiry.

“…Although the women did not feel rejected by their partners, their dissatisfaction with their physical appearance resulted in them feeling less intimate and less confident about returning to sexual activity. Similarly, O'Malley et al [56] found positive selfimage improves sexual health, including the woman's satisfaction with intercourse in the postpartum.…”

“…[8] For women in varied contexts, unique cultures and different countries, dynamic changes in the postpartum negatively impact their sexual desire as well as satisfaction [32][33][34][35][36][37][38][39][40][41][42][43][44], and even stimulates fear. [45] Researchers, primarily from economically developed countries, have reported a variety of issues that impact the overall experience of women when returning to sexual activity, including: dyspareunia [22,32,35,37,41,[46][47][48][49][50][51][52], decreased libido [51,[53][54][55], problems achieving orgasm [11,46,48,56], negative body image [33,53,54], fatigue and sleep deprivation [53][54][55]57], relationship satisfaction [43,57], household responsibilities [54], and concerns about satisfying partner.…”

“…[35,46,55,57,62] These sexual health issues are reported to persist for 12 months and longer following birth. [11,32,39,41,56] While some women reluctantly engage their healthcare providers in discussions about sexual health [40,47], other women, such as reported in Spain [34], lack the prerequisite knowledge about sexual health to seek help during the postpartum. Even when women do seek help, Herron-Marx et al [63] found women perceive the healthcare providers considered their concerns are trivial, or the information they receive is not helpful.…”