, Anna Redaelli1, Ilaria Baini1 and Massimo Candiani1
(1)
Department of Obstetrics & Gynecology, San Raffaele University, Milan, Italy
Few studies have been carried out on post-partum sexual function; in fact, little is known concerning postnatal sexual dysfunctions related to childbirth in various ways and/or obstetric risk factors. Sexual dysfunction is a multifaceted disorder that occurs frequently and concerns various aspects of sexuality:
Sexual desire disorders that are often related to the hypo efficiency of the pelvic floor, which occurs post-partum
Sexual arousal disorders due to the vaginal dryness and poor lubrication typical of breastfeeding women
Orgasmic disorders related to hypotonia due to childbirth which causes pain and inability to reach orgasm
Superficial dyspareunia (pain during penetration)
In general, the prevalence of post-partum sexual dysfunction ranges between 22 and 50 %. In a study carried out by Odar et al., at a 6-month post-partum follow-up, 22.2 % reported having sexual problems due to vaginal pain (18.8 % due to lacerations) or blood loss (15.6 %) [1]. According to Barrett et al., only 15 % of women suffering from post-partum sexual dysfunctions report the problem to their doctor [2].
Pelvic floor traumas are often related to sexual dysfunction and are associated with the following risk factors: advanced maternal age, low BMI with operative delivery, prolonged second stage of labour, foetal head circumference and episiotomy.
8.1 Time Required for Resuming Sexual Intercourse
The time required for resuming sexual intercourse after childbirth varies from woman to woman and is influenced by many factors. Signorello et al. studied the time required for resuming sexual intercourse following childbirth for a cohort of 626 women who had vaginal delivery with or without episiotomy and vaginal tears. After 6 months all women included in the study had resumed having sexual intercourse regardless of the level of laceration. Women with lower grades of laceration (grades I and II) had resumed having sexual intercourse on average 7.1 weeks post-partum while women with higher grades of lacerations (grades III and IV) had resumed sexual intercourse on average 9.3 months post-partum. Moreover patients aged ≥35 years of age resumed having sexual intercourse on average 2.5 weeks later than women aged <25 years of age. Black women resumed having sexual intercourse on average 1.2 weeks earlier than white women. Breastfeeding women resumed having sexual intercourse 0.8 weeks earlier than non-breastfeeding women [3].
In the study by Brubaker et al., the percentage of women who began having sexual intercourse at 6 months post-partum was approximately 90 %. The resumption of sexual intercourse was slightly longer for women with 3rd and 4th degree perineal tears and women who underwent caesarean sections than women with vaginal delivery [4].
8.2 Dyspareunia
Dyspareunia post-partum is a fairly common problem. In a study carried out by Odal et al. approximately 62 % of women who resumed having sexual intercourse 6 month after childbirth reported pain [1].
The study by Basksu et al. shows that women who undergo a paramedian episiotomy have an increase in the level of pain at 6 months post-partum compared to women who have elective caesarean sections [5]. The same result is reported by Safarinejad et al. [6].
This finding is in agreement with the study by Klein et al. which showed that the first-time mothers who had elective caesarean sections had better-toned pelvic floors than women who had a delivery. This leads many women to prefer giving birth by caesarean section than vaginal delivery. Besides the pain, it appears to have a predominant effect on the total FSFI score [7] as well as on sexual satisfaction.
Among women who had a delivery, the women with 3rd and 4th grade vaginal tears reported feeling more pain than the patients with intact perineum which decreased at 3 and 6 months post-partum in both cases [3]. Moreover, women who underwent episiotomy reported feeling more pain at their first sexual intercourse after childbirth than women who with a spontaneous perineal lacerations.
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