SEXUAL DYSFUNCTION

AFTER DELIVERY
• Sexual dysfunction is a heterogeneous group of disorders, which affects the capacity

for sexual response or sexual pleasure.

• Postpartum period is known as a vulnerable and stressful period for women owing to

intense psychological, physical and social changes that can affect the sexual health of

both parents.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(DSM-5®). American Psychiatric Pub.

Banaei, M., Moridi, A., & Dashti, S. (2018). Sexual Dysfunction and its Associated Factors After
Delivery: Longitudinal Study in Iranian Women. Materia Socio-Medica, 30(3), 198.
Prevelance
•Female sexual dysfunction is considered a public health problem affecting 40.9% of middle-aged
women.

•Postpartum sexual dysfunction(PPSD) is particularly identified in 41–83% of women at 2–3

months Postpartum.

•Moreover, PPSD can persist  in 18-30% of the women till the six month of delivery.

•Furthermore, it was reported in 54.5% of women at the 12th month.

• Convery, K. M., & Spatz, D. L. (2009). Sexuality & breastfeeding: what do you know?. MCN: The American Journal of Maternal/Child
Nursing, 34(4), 218-223.

• Leeman, L. M., & Rogers, R. G. (2012). Sex after childbirth: postpartum sexual function. Obstetrics & Gynecology, 119(3), 647-655.
• Rogers, R. G., Borders, N., Leeman, L. M., & Albers, L. L. (2009). Does spontaneous genital tract trauma impact postpartum sexual
function?. Journal of midwifery & women's health, 54(2), 98-103.

• Williams, A., Herron-Marx, S., & Carolyn, H. (2007). The prevalence of enduring postnatal perineal morbidity and its relationship to
perineal trauma. Midwifery, 23(4), 392-403.
Classification
• PPSD can be classified into four categories:

• Sexual desire dysfunction (Hypoactive sexual desire disorder).

• Sexual pain disorders (Dyspareunia, Vaginismus, Vulvodynia).

• Sexual areusal disorders.

• Female orgasmic disorders.

 Sayasneh, A., & Pandeva, I. (2010). Postpartum Sexual

Dysfunction: A literature review of risk factors and role of mode
of delivery. Bjmp, 3(2), 316.
• Among all domains of sexual problems, pain during

intercourse, sexual dissatisfaction and delay in resuming

intercourse are the most common sexual problems that
negatively affect the quality of life after delivery.

• Fan, D., Li, S., Wang, W., Tian, G., Liu, L., Wu, S., ... & Liu, Z. (2017). Sexual
dysfunction and mode of delivery in Chinese primiparous women: a systematic
review and meta-analysis. BMC pregnancy and childbirth, 17(1), 408.
• Dyspareunia was reported in 41.3% of women during 60-180 days period

after giving birth.

• Dyspareunia can occur as a result of a combination of medical problems

such as a mal-healed perineal or vaginal tear, postpartum infection, cystitis,

arthritis, or haemorrhoids and psychosocial factors as problems in
relationship with the partner, financial crisis, depression, and anxiety.

• Sayasneh, A., & Pandeva, I. (2010). Postpartum Sexual Dysfunction: A literature

review of risk factors and role of mode of delivery. Bjmp, 3(2), 316.

•  Hypoactive sexual desire in the first 6-7 weeks after delivery is
considered normal. However, persistent reduced or absent
desire for sexual activity is abnormal problem causing sexual
distress.

• Sexual desire disorder may be due to the mother being

preoccupied with the neonate or postpartum complications (e.g.
infection, pain, and bleeding).

• Sayasneh, A., & Pandeva, I. (2010). Postpartum Sexual Dysfunction:

A literature review of risk factors and role of mode of
delivery. Bjmp, 3(2), 316.
Risk factors of PPSD
• Several factors can influence the sexual health in the

postpartum period, such as parity, mode of delivery, episiotomy,

breast feeding, stress, fatigue and physical and psychological
problems such as postpartum depression.

• Banaei, M., Torkzahrani, S., Ozgoli, G., Azad, M., Mahmoudikohani,

F., & Pormehr-Yabandeh, A. (2018). Addressing the Sexual Function
of Women During First Six Month After Delivery: Aquasi-Experimental
Study. Materia socio-medica, 30(2), 136.
Mode of delivery-1

• Vaginal delivery, operative vaginal delivery and vaginal delivery

with episiotomy were reported as risk factors for sexual
dysfunction especially dyspareunia.
• Moreover,  operative vaginal delivery was associated with poorer
arousal, lubrication, orgasm, and global sexual functioning 

• Yeniel, A. O., & Petri, E. (2014). Pregnancy, childbirth, and sexual function:
perceptions and facts. International urogynecology journal, 25(1), 5-14.
• Barbara, G., Pifarotti, P., Facchin, F., Cortinovis, I., Dridi, D., Ronchetti, C. et al.
(2016). Impact of mode of delivery on female postpartum sexual functioning:
spontaneous vaginal delivery and operative vaginal delivery vs cesarean
section. The journal of sexual medicine, 13(3), 393-401.
• However, there is no clear evidence that Cesarean delivery is protective from the PPSD.

• Cesarean delivery was associated with an increased prevalence of depressive symptoms

at 3 months and higher pain levels that persisted at 6 months postpartum.

• Yeniel, A. O., & Petri, E. (2014). Pregnancy, childbirth, and sexual function: perceptions
and facts. International urogynecology journal, 25(1), 5-14.

• Chang, S. R., Chen, K. H., Ho, H. N., Lai, Y. H., Lin, M. I., Lee, C. N., & Lin, W. A. (2015).
Depressive symptoms, pain, and sexual dysfunction over the first year following vaginal
or cesarean delivery: a prospective longitudinal study. International journal of nursing
studies, 52(9), 1433-1444.
Breast feeding -2
• Breast feeding women may have a higher risk of sexual dysfunction.

• Hyperprolactinaemia, hypo-oestrogenism and the demand for infant care may increase

sexual dysfunction in this period.

•  In addition, breastfeeding is associated with lower lubrication, more pain at intercourse, and

longer time to resumption of sexual activity

• Fuentealba-Torres, M., Cartagena-Ramos, D., Sierra, J. C., Lara, L. A., Okano, S. P., Berra, T. Z., et al.
(2018). What are the factors that contribute to the development of sexual dysfunction in breastfeeding
women? A systematic scoping review protocol. BMJ open, 8(8), e022863.
• Chang, S. R., Chen, K. H., Ho, H. N., Lai, Y. H., Lin, M. I., Lee, C. N., & Lin, W. A. (2015). Depressive
symptoms, pain, and sexual dysfunction over the first year following vaginal or cesarean delivery: a
prospective longitudinal study. International journal of nursing studies, 52(9), 1433-1444.
• However, an increase in sexual desire over pre pregnancy

levels and increased eroticism have also been reported.

• This can be explained by the larger breast size, increased

sensitivity and direct stimulation by suckling.

• Abdool, Z., Thakar, R., & Sultan, A. H. (2009). Postpartum female sexual

function. European Journal of Obstetrics & Gynecology and Reproductive

Biology, 145(2), 133-137.
Postpartum depression -3
• PPSD is also common in women experiencing postpartum
depression.
• Depression has been found to be associated with decreased
frequency and interest in sexual intercourse at 8–12 weeks and
decreased sexual desire at 6 months postpartum.
• Antidepressants can also affect all aspects of sexual response.

• Leeman, L. M., & Rogers, R. G. (2012). Sex after childbirth: postpartum sexual
function. Obstetrics & Gynecology, 119(3), 647-655.
 Management
• PPSD is a disorder that relies on self report for both diagnosis
and treatment.

• So, valid and reliable questionnaires that screen for sexual

dysfunction may aid in both the diagnosis and treatment since
patients may feel more comfortable reporting problems by
questionnaires than direct interview.

• Leeman, L. M., & Rogers, R. G. (2012). Sex after

childbirth: postpartum sexual function. Obstetrics &
Gynecology, 119(3), 647-655.
• Elements of good postpartum sexual health include; sexual desire, resumption of

sexual intercourse after birth, pain free sex and orgasm. 

• So, a practical approach for the prevention, evaluation, and treatment of postpartum

sexual dysfunction should be considered.

• O'Malley, D., Higgins, A., Begley, C., Daly, D., & Smith, V. (2018). 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). BMC pregnancy and childbirth, 18(1), 196. doi:10.1186/s12884-018-1838-6.

• Leeman, L. M., & Rogers, R. G. (2012). Sex after childbirth: postpartum sexual function.  Obstetrics &
Gynecology, 119(3), 647-655.
Prenatal Care

• Determination whether sexual dysfunctions or depression were

present before pregnancy.

• Discussion of changes in anatomy, physiology, and sexual

function that commonly occur during pregnancy.

• Advice for perineal massage to minimize perineal trauma and

postpartum pain.

• Leeman, L. M., & Rogers, R. G. (2012). Sex after childbirth: postpartum sexual
function. Obstetrics & Gynecology, 119(3), 647-655.
Intrapartum

• Careful use of operative vaginal delivery and selection of

vacuum rather than forceps to decrease the incidence of
anal sphincter lacerations.
• Limitation of episiotomy .
• Careful postpartum examination to increase the detection
and repair of anal sphincter lacerations.

• Leeman, L. M., & Rogers, R. G. (2012). Sex after childbirth: postpartum sexual
function. Obstetrics & Gynecology, 119(3), 647-655.
Intrapartum
• Repairing of perineal lacerations with synthetic
absorbable suture.
• Discussion of perineal pain, dyspareunia, and initiation of
postpartum sexual activity before hospital discharge.

• Leeman, L. M., & Rogers, R. G. (2012). Sex after childbirth: postpartum

sexual function. Obstetrics & Gynecology, 119(3), 647-655.
Postpartum

• Assessment of sexual function using screening

questionnaire.

• Assessment of perineal repair if dyspareunia is present.

• Assessment for presence of urinary and anal

incontinence symptoms.

• Leeman, L. M., & Rogers, R. G. (2012). Sex after childbirth: postpartum sexual function. Obstetrics
& Gynecology, 119(3), 647-655
Postpartum
• Encourage vaginal lubricants, particularly in breastfeeding
women.

• Advice for alternative positions.

• • Assessment for postpartum mood changes, adequate

rest, and time for intimacy

• Leeman, L. M., & Rogers, R. G. (2012). Sex after childbirth: postpartum sexual function. Obstetrics
& Gynecology, 119(3), 647-655
In summary
• PPSD is a common problem that should be concerned by health care
providers.

• Preparing women and their partners during the antenatal period and

advising on simple measures, as the use of lubrication to avoid or
minimise sexual health issues, can remove stress, anxiety and fears
regarding intimacy after birth.

• O’Malley, D., Higgins, A., Begley, C., Daly, D., & Smith, V. (2018). 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). BMC pregnancy and childbirth, 18(1),
196.