Women’s sexual health after childbirth

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the Mother and Child Health Research, School of Nursing and Midwifery, Faculty of Health Sciences, La Trobe University, Bundoora.

Objective: To investigate women’s sexual health in the 12 months after the birth of their first baby, with a view to expanding and clarifying current knowledge around the timing of resumption of vaginal sex; the natural history of postpartum dyspareunia and other sexual difficulties, and women’s experience of physical sexual pleasure and emotional satisfaction in their relationship. In addition, the association of social characteristics, obstetric factors and postnatal factors to sexual health is assessed. Design: Prospective pregnancy cohort study of nulliparous women. Sample: A total of 1507 nulliparous women recruited in early pregnancy (≤ 24 weeks). Method: Women were recruited from six metropolitan public hospitals in Melbourne, Australia. Included in analyses were data from women who completed all four questionnaires: early pregnancy, three, six and 12 months postpartum (n=1305). Descriptive data, univariable analyses and multivariable logistic models are presented throughout the thesis. Main outcome measures: Resumption of sexual activity and vaginal sex after childbirth, pain during sex (dyspareunia) on first vaginal sex and subsequent vaginal sex, pattern of pain during sex over time, other sexual difficulties (lack of interest in sex, lack of lubrication, difficulty reaching orgasm, vaginal tightness, vaginal looseness and bleeding or irritation after sex) and sexual pleasure. Results: Forty-one percent of women had resumed vaginal sex by six weeks postpartum, with 78% resuming by three months postpartum. Method of birth and perineal trauma were associated with delays in resumption. Eighty-five percent of women experienced dyspareunia during the first vaginal sex after childbirth. Almost half continued to experience dyspareunia on subsequent sex at three and six months postpartum, reducing to one in four by 12 months postpartum. Perineal trauma and method of birth were associated with dyspareunia. There was no evidence in multivariable analyses that caesarean birth was protective against postnatal dyspareunia. Sexual pleasure and emotional satisfaction were closely associated at all timepoints. Conclusions: Data from this thesis will highlight the postnatal sexual health issues women and their partners may face and should inform the care and preparation of women throughout their pregnancy and postnatally by midwives, obstetricians and general practitioners.