Postpartum Sexual Activity Analysis

Sexuality is a phenomenon not to be neglected, as similar to other instinctive desires of mankind, it has existed since birth and has evolved in accordance with human development. [1] Sexual function is an important component of women’s lives and has an essential role in the marriage stability and is recognized as a multidimensional phenomenon, which can be influenced by multi bio psychosocial factors. [2,3]
Women's sexual activity changes at various stages of life and is affected by numerous factors, one of them includes childbirth and maternity that deserves a closer analysis, as it promotes significant changes in women’s, husband's and family lives. Factors affecting sexual activity after childbirth include fatigue, fear of subsequent pregnancy, concern about pain during intercourse, mode of delivery, parity and tenderness of breasts which can have different results because of different culture. [4]
Postpartum sexual function is affected by changes in anatomy, hormonal milieu, family structure, and husband relationships that accompany childbirth. Although the intimacy of beginning a family and
supporting a newborn may enrich many couples’ sexual experience many postpartum obstacles may adversely influence sexual health. [5] There is a need to adapt to the demands of the newborn and the parental role may adversely affect the intimacy of the couple, as well as changes in body image and the desexualized figure of woman, cultivated by society. [6]
Women with episiotomy or perineal tears show higher pain intensity, less sexual satisfaction, lower levels of sexual arousal, lubrication, greater changes regarding the orgasm’s intensity and duration, and total sexual function, than women with intact perineum and the Cesarean Section (CS) group. [7] in addition women who were breastfeeding had lower lubrication, more dyspareunia, and longer time to resume sexual activity. [8]
The rate of cesarean delivery has raised dramatically worldwide in the last decades particularly in high- and middle income countries. The explanations for this increase are multifactorial and not well-defined. Increasing malpractice pressure, changes in maternal characteristics and professional practice styles, as well as organizational, economic, cultural and social factors have all been associated in concern. [9, 10 ] It seems that the majority of women choices CS due to the ability to retain a successful and satisfying sex after delivery. [11]
Postpartum female sexual dysfunction is a behaviour resulting from a combination of psychological, biological, social and cultural factors, which makes a total or partial blockage of the sexual response of subjects related to desire, arousal and orgasm. It is a serious morbidity and may lead to a variety of physical, social and adverse effects on the patient. Moreover, the consequent cycle of fear might compound the initial sexual disorder and makes it more difficult to treat. [12] It has been increasingly recognized as an important public health issue with impact on the health, well-being and quality of life of women. [13, 14] So, early diagnosis and treatment is crucial to avoid later sequalae on sexual and reproductive life. However, early diagnosis may be challenged by many factors, where many patients will be embarrassed of talking about sexual matters or preoccupied by the newborn after delivery, which makes it very important for the midwifery, medical, or nursing staff to raise the issue at the postnatal care settings. [13]
Sexual quality of life (SQOL) is an important issue for assessing short- and log-term outcomes due to sexual problems. [15] Sex has a fundamental role in reproductive life, that integrates physical, emotional and psychological factors and affects quality of life. [16,17] The sexual quality of life-female questionnaire is a short tool that assesses the relationship between female sexual dysfunction and quality of life. It has good psychometric properties with beneficial role to evaluate the female SQOL in maternity care settings. [18]
Improve the nurses awareness about the importance of patient's healthy sexual function for good quality of life and full sexual and psychological evaluation of patients will allow for early interventions and will promote positive patient outcomes and compliance with treatment pathways. [19] Healthcare professionals should evaluate women in terms of their sexual functions during both pregnancy and postpartum period. Health education, referral services for early diagnosis and treatment might contribute to the protection and improvement of the sexual health of women during the postpartum period. [20]
Nurses play a key role in the prevention, evaluation, and treatment of postpartum sexual concerns during postpartum period.
They should discuss perineal pain, dyspareunia, and initiation of postpartum sexual activity before hospital discharge, assess sexual function and address concerns, including considering the use of a brief sexual function screening questionnaire, assess perineal repair if dyspareunia is present, assess urinary and fecal incontinence symptoms, encourage vaginal lubricants, particularly in breast-feeding women with a physiologic hypo-estrogenic state, consider alternative positions, and assess for postpartum mood changes, adequate rest, and time for intimacy. Postpartum sexual counselling should be a part of antenatal and postnatal follow-up that enhancing women to disclose their sexual complains and fears in order to improve their sexual QOL.
[5]
1.1. Significance of the Study
During the postpartum period, women encounter numerous physical, psychological and socio cultural factors that negatively affect both sexual function and quality of life causing postpartum sexual problems. [20] It has been reported that decrease sexual function adversely affects women’s quality of life and interpersonal relationships. [21]
Postpartum sexual dysfunction can influence physical, mental, and social aspects of individuals’ life with a prevalence of 20- 73% in women. [12] Research shows that the integrity of care in women is neglected, since most of the orientations of healthcare team about postpartum sexuality are limited to recommend the resumption period of sexual activity, without addressing the aspects of the quality and the strategies to deal with the changes resulting from pregnancy-puerperal cycle. [22]
It is unclear whether or not CS is protective of postpartum sexual complaints. Because CS avoids genital tract trauma, it has often been assumed to protect postpartum sexual function. [23] Several studies confirmed the relationship between sexual function and mode of delivery, episiotomy, and laceration. [8, 24] Whereas other studies found no association between sexual function and delivery mode. [25, 26] These inconsistent findings require numerous studies to fill the research gap in this respect. Also, Eniel and Petri [27] indicated the need for more adequately powered studies based on validated tools to answer the question of effects of mode of delivery on sexual function.
1.2. Aim of the Study
The aim of this study was to evaluate the effect of mode of delivery on postpartum sexual function and sexual quality of life in primiparous women through:
1.2.1. Comparing post-partum sexual function between vaginal delivery and caesarean section.
1.2.2. Comparing SQOL between vaginal delivery and cesarean section.
1.3. Research Questions
1.3.1. Is there a difference between vaginal delivery and cesarean section groups regarding postpartum sexual function?
1.3.2. Is there a difference between vaginal delivery and cesarean section groups regarding SQOL after delivery?
1.3.3. Is there a relationship between the studied subjects' postpartum sexual function and their SQOL?