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

Abstract

Background Sexual health is a multidimensional phenomenon constructed by personal, social, and cultural factors but continues to be studied with a biomedical approach. During the postpartum period, a woman transitions to mother, as well as partner-to-parent and couple-to-family. There are new realities in life in the postpartum period, including household changes and new responsibilities that can impact the quality of sexual health. This phenomenon is understudied especially in the context of Spain. The purpose of this study was to describe the lived experience of postpartum sexual health among primiparous women giving birth in Catalonia (Spain). Methods This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi’s seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis. Results Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model. Conclusion Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.

Exploring the Complexities of Postpartum Sexual Health

“…The factors that emerged were, extreme tiredness, changed lifestyle, emotional connection to the baby, changes to the sexual and intimate relationship and changed view of sexuality. This corresponds with findings from a phenomenological study involving ten postpartum women who described how their new reality at home impacted on their sexual health [45]. Women talked about the changed family roles, sharing responsibility for childcare and the shift in relationship priorities; some women feared losing their womanhood as baby care took priority.…”

“…It is noteworthy that in studies using qualitative designs, women described how they waited until they had physically recovered from the birth when planning to resuming sexual activity. Women reported waiting for abdominal and perineal wounds to heal and lochia to cease in advance of resuming sexual activity [37,45], which suggest that short-term physical recovery from birth is an important consideration for postpartum sexual health. Additionally, it is likely that some women were advised by their maternity healthcare provider to wait until 6 weeks had passed and they were assessed by their general practitioner or obstetrician before resuming sexual intercourse.…”

“…There is an emerging trend of qualitative study designs being utilised to give voice to women's views and experiences of their postpartum sexual health [15,37,45,48,49]. A common theme from these studies is that of a discordance of sexual desire between women and their partners in the months following birth, which for many, causes feelings of guilt and failure that they are not living up to their own expectation of sexual activity postpartum [15,37,45,50,51]. Incorporated in this is women's awareness of their partner's sexual desire, with women reporting that they did not want to 'hurt their partner's feelings' by regularly refusing their partners sexual advances.…”

“…Women talked about the changed family roles, sharing responsibility for childcare and the shift in relationship priorities; some women feared losing their womanhood as baby care took priority. Women have expressed a need for personal space away from the baby and their partner in order to rest, sleep or read a book or magazine [37,45].…”

“…Women's perception of their body image has featured as a theme when considering postpartum sexual health. While body image is an issue that impacts many women, postpartum body image is also impacted by scars, changed abdomen shape and size, enlarged breasts, stretch marks and changing body weight [37,45,51,55]. A prospective cohort study in Ireland (n = 832) demonstrated that women who were 'never satisfied' with their body image were more likely to selfreport a loss of interest in sex at 6 and 12 month postpartum (AOR 2.8 and 3.6, respectively) [12•].…”