Sexuality during pregnancy and the year postpartum

BACKGROUND. There have been a few studies conducted on couples' sexual behavior during pregnancy and the year postpartum, but those studies contain sampling bias resulting from recruiting volunteers for sex research. The sample for the current research was recruited for a far less sensitive study, and includes data from both mothers and fathers.

METHODS. A total of 570 pregnant women and 550 of their husbands or partners were recruited and were interviewed on four occasions: (1) at the fifth month of pregnancy (T1); (2) at 1 month postpartum (T2); (3) at 4 months postpartum (T3); and (4) at 12 months postpartum (T4).

RESULTS. Although approximately 90% of couples engaged in sexual intercourse at T1, T3, and T4, only approximately 19% did at T2. On average, couples resumed intercourse at 7 weeks postpartum. At T2 and T3, women who were breastfeeding showed significantly less sexual activity and less sexual satisfaction than women who were not. There were few differences between women who gave birth vaginally and those who were delivered by cesarean section, except that the latter resumed intercourse somewhat earlier.

CONCLUSIONS. Practitioners providing family-centered maternity care need to counsel couples about typical patterns of sexuality during pregnancy and postpartum, and about usual patterns during breastfeeding. Accurate information can help couples feel more comfortable during the transition periods before and after childbirth. A discussion of expected changes in sexuality should be routinely introduced by the physician during prenatal care.

KEY WORDS. Sex counseling; postnatal care; libido; psychosexual development; pregnancy trimester, second. (J Fam Pract 1998; 47:305-308)

Pregnancy, childbirth, and the postpartum period represent a major life transition that usually has a substantial impact on the sexual adjustment of both mothers and fathers. Yet there are remarkably little empirical data on these issues. We report data on the largest sample of couples that has been studied on this important topic.

Researchers have reported a decrease in sexual desire and coital frequency from the first to the third trimester.[1-2] A variety of reasons have been suggested for this decrease. Early in pregnancy some women report fears that intercourse will cause miscarriage; during the third trimester, both mothers and fathers report fears that intercourse or orgasm may harm the fetus.[3] However, there is currently no strong research evidence of increased risk of infection from sex during pregnancy.[4] Other reasons for decreased coital frequency include physical discomfort associated with intercourse, particularly in the man-on-top position, and loss of interest in sex.

There is little agreement in the findings of research on the resumption of sexual activity following childbirth.[5] One study[6] found that, at 5 to 7 weeks postpartum, only 50% of women had resumed intercourse.

Numerous reasons have been suggested for the delay in resumption of vaginal intercourse after childbirth.[5] The principal ones are: pain related to an episiotomy; vaginal bleeding or discharge; fatigue; and discomfort related to inadequate lubrication of the vagina due to low levels of estrogen in the postpartum period. Yet, according to one authoritative text, "Following an uncomplicated delivery, a 6-week...