Sexual function after childbirth: Women's experiences, persistent morbidity and lack of professional recognition

Objective To describe the sexual behaviour of postnatal women, including time of restarting intercourse, problems encountered, use of contraception and related use of available services. Design Longitudinal survey using postal questionnaires following discharge from hospital, and at eight weeks and twelve to eighteen months postnatally. Setting The questionnaires referred to postnatal care received in a teaching hospital and general practitioner delivery units, and in the community. Population Randomly selected one in five sample of women who were delivered in the Grampian Region of Scotland over a 12-month period. Main outcome measures Times to restarting intercourse and contraception; problems related to intercourse and their relation to perineal pain, tiredness and method of infant feeding; and perceived need for and adequacy of help. Results The median times to restarting intercourse and contraception were each six weeks. Problems with intercourse were reported by 569/1075 (53%, 95% CI 50-56) of women in the first eight weeks after delivery, and by 215/435 (49%, 95% CI 45-54) in the subsequent year. Women who reported perineal pain, depression or tiredness experienced problems related to intercourse more often than those who did not. Women who breastfed their infants were significantly less interested in intercourse than those who bottlefed, irrespective of tiredness or depression, but this effect did not persist in the long term. The need for help with problems was expressed by 7% to 13% of women, but a quarter of these had not sought it. Conclusions Postnatal sexual problems are common. Health professionals ought to educate and prepare patients antenatally; be trained to identify problems; and be competent to deal with them openly and sympathetically.