From the Delivery Room to the Bedroom How does mode of childbirth affect a couple's sex life?

By Matthew Hutson, published on June 04, 2008 - last reviewed on June 16, 2008 Childbirth can wreak havoc on a couple's intimate relations. Everything that happens during this euphoric yet agonizing event in the delivery room can have lasting effects in the bedroom. To the degree that a woman has any control over the situation, should anticipation of postpartum sexual functioning play a role in her selecting a mode of delivery? Cesarean sections now make up 30 percent of deliveries in the US, and that number is increasing. Lisa Pastore, an epidemiologist in the University of Virginia's obstetrics and genecology department who recently published a study of postpartum sexuality concerns among first-time parents, says most people who ask for C-sections ask because of scheduling issues or for more control over the situation. But a lot of people don't want to discuss matters of sexuality with their health-care providers. Further, they might not even stop to think that various styles of delivery might have different sexual side effects. In two surveys of obstetricians, a third of doctors say they would choose cesarean sections for themselves. One of their biggest concerns: sex after delivery. Do they know something we don't? The C-Section A number of studies in recent years have looked at C-sections and sexual health. One Canadian study published in 2005 showed that three months after childbirth, first-time mothers who had a vaginal birth noted greater sexual dissatisfaction than those who'd had a C-section70 percent compared with 55 percent. A 2006 study found similar results in women two full years after birth. Another study published in 2005 found long-term differences in the strength of new mothers' pelvic floorsthe pelvic muscles and connective tissue supporting the bladder, intestines, and reproductive organs that contract involuntarily duringorgasm and can intensify orgasm when contracted voluntarily. More than two years after giving birth, women who'd delivered vaginally had significantly lower pelvic floor muscle strength than those who'd delivered by cesarean section. A Note on Kegels There are no studies showing that increasing pelvic floor strength directly improves sex because "sexual function is such a complex thing," says Linda Brubaker, a urogynecologist at Loyola University. But we know that pelvic floor exercises such as Kegels decrease incontinence, and we know that women with less incontinence, particularly coital incontinence (leaking of urine during intercourse), have better sex lives. "Feeling comfortable with yourself is key to feeling comfortable within a sexual relationship," Brubaker says, "and fear of incontinence can be a devastating thing for a woman." Further, Brubaker recently finished a study showing that women completing a pelvic fitness course reported improved sexual function, including better

orgasm. She says we can't be sure the mediating factor isn't improved social support ("the girls night out effect") instead of stronger muscles or better muscle control, but benefits persisted a year after the end of classes. Episiotomy One factor that complicates many of the studies comparing vaginal birth with cesarean section is that some women have episiotomiesincisions through the perineum to expand the vaginal opening. This procedure prevents rips, which are hard to repair, and limits stretching of the pelvic floor. In the US, about 30 percent of vaginal births occur with episiotomy. A 2005 JAMA survey of studies found little evidence that women who'd had episiotomies had better pelvic floor function in the months after childbirth. And they took longer to resume intercourse and suffered more pain during sex. How permanent are the effects? In 2008, Swedish scientists reported a study of women's sex lives 12 to 18 months after delivering a first child: Episiotomy-assisted childbirth didn't affect arousal, orgasm, or satisfaction, but did increase the incidence of painful intercourse and dryness. Countering some of the warnings about vaginal birth, the previously mentioned 2005 Canadian study found that women who'd given birth vaginally with an intact perineum actually had less pain during sex than the C-section group after three months. The general consensus is that a safety snip usually causes more harm than it's worth. Assisted Delivery Another factor is the use of obstetric instruments such as forceps and vacuum. (Again, this is not always up to the mother.) A survey of studies published between 1990 and 2003 concluded that assisted delivery led to painful intercourse, perineal pain, and delays in the resumption of sex. Men's Concerns Because sexual dysfunction affects both people in a relationship, men should at least be part of these discussions. There are stories of the "husband's knot" an extra stitch after an episiotomy to create a tighter fit, which benefited the man at the expense of the womanbut this is not currently common practice. However, men may share women's concerns about sex after vaginal birth, as they can feel tension in a their partners' pelvic floor muscles during vaginal intercourse.