January 30,2014 —Summary of "Predictors of Postpartum Sexual Activity and Function in a Diverse Population of Women," Lee et al., Journal of Midwifery & Women's Health, Dec. 10, 2013.
There is a lack of definitive research about how mode of birth and other factors might affect when women resume sexual activity after birth or their levels of sexual functioning and satisfaction, according to Lynn Yee, a maternal-fetal medicine fellow at Northwestern University's Feinberg School of Medicine, and colleagues.
The researchers developed a study to determine how mode of birth, breastfeeding, depression and demographic factors potentially predict sexual activity and sexual functioning.
The researchers used data from a larger University of California-San Francisco study conducted from August 2008 to March 2011. The study recruited pregnant women seeking care at UCSF's obstetrics practice. Eligible participants included English-speaking women with singleton gestations.
Participants completed baseline, face-to-face interviews between 24 and 36 weeks of gestation. The researchers also conducted a telephone interview at eight to 10 weeks postpartum and a second face-to-face interview six to eight months postpartum that included questions on sexual activity and function, depression, mode of birth, and breastfeeding.
The main predictor in the study was mode of birth, while the primary outcomes included the resumption of sexual activity -- defined as "the presence or absence of sexual activity, with or without a partner" -- and sexual function -- which "was an assessment of the quality of the sexual activity." To measure sexual function, researchers used a modified version of the Sexual Health Outcomes in Women Questionnaire (SHOW-Q), which is "a validated scale designed to assess the full range of female sexual activity."
During the first postpartum interview, women completed the modified SHOW-Q only if they had resumed sexual activity since giving birth. During the second postpartum interview, women who were sexually active within the last four weeks completed the modified SHOW-Q, while others only answered questions about desire, satisfaction and the effects of postpartum function or discomfort on sexual functioning. The researchers noted that "[i]n all cases, higher [SHOW-Q] scores reflect[ed] better sexual functioning or fewer sexual problems."
Of the 160 women who completed baseline interviews in the study, 129 completed the second postpartum interview. At the first postpartum interview, 60.7% of the women had resumed sexual activity, while 76.7% reported sexual activity in the past four weeks at the second interview.
Seventy-five percent of the participants had a vaginal birth. At the second postpartum interview, 45.2% of participants were breastfeeding, and 25.4% were experiencing symptoms of major or other depression.
Neither rates of reported sexual activity at either interview nor modified SHOW-Q scores differed significantly by mode of birth. In a multivariate analysis, multiparous women "were significantly more likely to have resumed sexual activity, whereas women who were older were less likely to have done so." The study found no relationship between the resumption of sexual activity and mode of birth, depression or breastfeeding.
Among women who had sex within the past four weeks at the time of the second postpartum interviews, the mean global modified SHOW-Q score was 72.8, on a 100-point scale.
In addition, the study found that African-American women on average had higher SHOW-Q scores than the reference population of white women. Breastfeeding and older age were associated with lower SHOW-Q scores. Likewise, women who positively screened for depression tended to have lower scores. While there was no statistically significant relationship between mode of birth and SHOW-Q scores, women who experienced caesarean births tended to have lower average scores than those who experienced a vaginal birth.
Discussion and Clinical Recommendations
The "findings suggest that a majority of women resume sexual activity in the early postpartum period," the researchers wrote. Although mode of birth did not predict resumed sexual activity or sexual function scores, the study showed that "demographic factors, including age and parity, were related to having resumed sexual activity, and that breastfeeding and depression were associated with poorer sexual function and decreased satisfaction with sex," they noted.
This study and prior research "suggest[s] that postpartum sexual functioning is influenced by a number of complex factors," the researchers wrote, noting that mental health issues and exclusive breastfeeding could create "barriers to optimal postpartum sexual satisfaction."
The researchers highlighted "several important clinical implications of [their] findings." First, given the significant portion of women who resumed sexual activity within 10 weeks postpartum, the researchers "recommend that counseling for pregnant and postpartum women include the possibility of early postpartum sexual activity, with appropriate contraception counseling," beginning "in the antenatal period to provide guidance about potential postpartum changes."
Second, they urged health care providers to screen patients for postpartum depression and "offer anticipatory guidance about postpartum depression and actively screen for mood disorders, including recognition of the impact of mood disorders on ... sexual functioning."
Third, the researchers suggest "that counseling on breastfeeding include guidance on coping with its potential impact on sexual health in order to help women successfully combine breastfeeding with a healthy sexual life."
Finally, and "most important[ly]," the researchers "recommend that health care providers caring for postpartum women ask about concerns regarding postpartum sexual functioning and counsel on this issue."