Sexual function in the postpartum period: effects of maternal depression and interpersonal psychotherapy treatment

Do treatments for mental disorders affect relationship satisfaction? A systematic review and meta-analysis

Objective: Psychiatric disorders have been linked to poor social functioning, including deficits in relationship satisfaction. Treatments have shown strong effectiveness in reducing clinical symptoms for a range of disorders, though less is known of the effects disorder-focused treatments have on relationship satisfaction.

Methods: The present study describes a systematic review that was conducted to determine the efficacy of treatments for specific psychiatric disorders in improving relationship satisfaction. Surprisingly, only seventeen studies were identified and included in the review.

Results: We found that a majority of these studies reported modest improvement in relationship satisfaction among people who completed treatment. However, studies were severely hampered by methodological limitations, and all therapy-related improvements could be attributable to placebo effects or the passage of time.

Conclusion: Important gaps in the literature were found that future research should seek to address to maximize treatment outcomes and psychosocial functioning.

Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low- and middle-income countries: A systematic review

Background

Postpartum depression (PPD) is a condition that can affect any woman regardless of ethnicity, age, party, marital status, income, and type of delivery. This condition is highly prevalent worldwide. PPD, if not treated timely, can affect the maternal-child bond and can have a detrimental impact on the future cognitive, emotional, and behavioral development of the child. Interpersonal psychotherapy (IPT) has been reported as an effective treatment of PPD in previous studies as this focuses on relationship and social support issues. Previous reviews conducted in developed nations have reported the superior efficacy of IPT in comparison to other treatment options. There is no systematic review conducted in low to middle-income countries on the efficacy of IPT on PPD. Therefore it was necessary to undertake a systematic review to assess the effectiveness of IPT in reducing the depression among postpartum women in low and middle-income countries (LMICs).

Objectives

The main aim of this systematic review was to assess the effectiveness of IPT alone or in conjunction with pharmacological therapy and/or other psychological and psychosocial interventions, in reducing depressive symptoms among women diagnosed with PPD residing in LMICs.

Search Methods

The systematic search encompassed several prominent databases and grey literature. Furthermore, experts specializing in the field of IPT were consulted to identify any relevant studies conducted in LMICs that fulfilled the predetermined eligibility criteria. The most recent search update was performed in July 2022.

Selection Criteria

The PICOS criteria were meticulously defined for this review as described. Participants: Postpartum women diagnosed with PPD in LMICs were included. Intervention: IPT either as a standalone treatment or in conjunction with pharmacological therapy was included. Comparison: any form of psychological therapy or pharmacological therapy, whether administered individually or in combination, was considered for comparison. Study designs: experimental and quasi-experimental, factorial designs, and quantitative components (experimental, quasi-experimental, factorial designs) of mixed methods designs were eligible to be included. Studies with single-group study designs and qualitative studies were excluded from the review.

Data Collection and Analysis

Two reviewers from our team conducted a rigorous screening process to determine the eligibility of articles for inclusion. This involved an initial evaluation of titles and abstracts, followed by a comprehensive assessment of the full text of selected articles. In instances where discrepancies arose between the two reviewers, resolution was achieved through discussion or consultation with a third author to establish a consensus. Following the screening process, two team members independently extracted pertinent information and data from the studies that met the inclusion criteria. The treatment effect of the intervention, in comparison to the control group, was subsequently analyzed utilizing the fixed effects model taking into account the small number of studies.

Main Results

A total of 17,588 studies were identified from various databases, and 6493 duplicate studies were removed. Subsequently, 9380 studies underwent independent title and abstract screening resulting in the exclusion of 9040 studies. 345 full texts were thoroughly assessed leading to the exclusion of 341 studies, finally including 4 studies for review. The four included trials were randomized trials and comprised a total sample size of 188 women diagnosed with PPD residing in LMICs. Among these studies, three compared IPT with usual treatment, while one study compared IPT with antidepressant medications (ADMs). In terms of the providers of IPT, in one study, IPT was administered by nurses, while psychologists delivered IPT in another study. In one study, community health workers were responsible for providing IPT. However, in one study, information regarding the specific providers of IPT was not available or reported. The primary outcome measure reported in all four studies was depression, assessed using the Edinburgh Postnatal Depression Scale (EPDS). The geographical distribution of the studies included; one conducted in Zambia, one in Kenya, one in Pakistan, and one in Iran. Out of the four studies, three were included in the meta-analysis, as missing data from one study could not be obtained. Based on the overall treatment effect, it was found that depression scores decreased significantly more in the IPT group compared to other interventions (usual treatment or ADMs) (standardized mean difference [SMD] -0.62, 95% confidence interval [CI] (-1.01, -0.23), Z = 3.13 (p = 0.002), χ 2 = 49.49; df = 2; p < 0.00001; I 2 = 96%; 3 studies, n = 136). Out of the three studies, two studies compared the effectiveness of IPT in reducing depression scores specifically when compared to the usual treatment, and in both studies, depression scores were reduced significantly in the IPT group as compared to the usual treatment group. Only one study directly compared the effectiveness of IPT with ADM, reporting that IPT was more effective than ADM in reducing depression scores among postpartum women. Regarding adverse outcomes, only one study reported suicidal ideation with one participant in the IPT group and two in the ADM group (RR 0.50, 95% CI (0.05, 5.30), p = 0.56, n = 78). The same study reported seven participants in the ADM group had adverse drug reactions as compared to none in the IPT group (RR 15.0, 95% CI (0.89, 254), p = 0.06, n = 78).

Authors' Conclusions

Our comprehensive search yielded a limited number of four studies conducted in such settings. Despite the scarcity of available evidence, the findings collectively suggest that IPT is indeed an effective treatment for reducing PPD when compared to usual treatment and pharmacological therapy. However given the low certainty of evidence, there is a need for further research in the form of well-designed randomized controlled trials with larger sample sizes and a reduced risk of bias. Such studies would greatly contribute to enhancing the strength and reliability of the evidence base regarding the effectiveness of IPT in the context of PPD in LMICs. The knowledge generated from future research endeavors would be highly valuable in guiding the development of more affordable and cost-effective treatment approaches for PPD in resource-limited settings.

Multilevel analysis of early resumption of sexual intercourse among postpartum women in sub-Saharan Africa: evidence from Demographic and Health Survey Data

BACKGROUND

Resuming sexual activity early after childbirth can cause reproductive health problems such as unwanted pregnancy, unsafe abortion, and short birth intervals, especially if contraception is not used. However, it is uncommon for healthcare providers to discuss postpartum sexual practices during prenatal and postnatal care. Therefore, this study aimed to assess early resumption of sexual intercourse and associated factors among postpartum women in sub-Saharan Africa.

METHODS

Secondary data analysis from the most recent Demographic and Health Surveys data from the period of 2014 to 2019/2020 of 23 countries in sub-Saharan Africa were used. A total weighted sample of 118,371 women who gave birth in the three years before the surveys were used. We analyzed the data using Stata version 14. A multilevel mixed-effect logistic regression model was fitted to identify factors associated with early resumption of sexual intercourse. Variables with a p-value < 0.05 in the multilevel mixed-effect logistic regression model were declared significant factors associated with the outcome variables.

RESULTS

The magnitude of early resumption of sexual intercourse among postpartum women was 67.97% (95% CI: 67.60, 68.34). Urban resident (AOR = 1.91; 95% CI: 1.83, 2.06), women with primary education 1.11 (AOR = 1.11; 95% CI: 1.07 to 1.31) and secondary education and above level 1.17 (AOR = 1.17; 95% CI: 1.09 to 1.29), husbands with primary education 1.32 (AOR = 1.32; 95% CI: 1.27, 1.38) and secondary education and above level 1.15 (AOR = 1.15; 95% CI: 1.11 to 1.25), family planning use (AOR = 95%; CI: 1.77, 1.91), fertility intention wanted then 1.24 (AOR = 1.24; 95%; CI: 1.19, 1.32) and wanted later 1.27 (AOR = 1.27; 95%; CI: 1.22, 1.46), religion (AOR = 2.08; 95%CI: 1.97, 2.17), and place of delivery (AOR = 1.51; 95%CI = 1.36, 1.65) were significantly associated with early resumption of sexual intercourse.

CONCLUSION

The study revealed that more than two-thirds of the women had resumed sexual intercourse early after childbirth. Hence, the concerned bodies should strengthen the integration of postpartum education on sexual resumption with maternal, neonatal, and child health care services to reduce the early resumption of sexual intercourse. In addition, healthcare providers providing counseling on the resumption of postpartum sexual intercourse should focus on these factors to ensure a more effective outcome.

Randomized controlled trial of Sunnyside: Individual versus group-based online interventions to prevent postpartum depression

BACKGROUND

Postpartum depression (PPD) is a serious mental health problem that has a prevalence rate of nearly 20% in the first three months after delivery. The purpose of this study was to evaluate the benefit of Sunnyside, an internet-based cognitive-behavioral intervention, delivered in a group format compared to the same intervention delivered individually for the prevention of PPD.

METHOD

210 people between 20- and 28-weeks gestation and who scored between 5 and 14 on the PHQ-8 and who did not meet criteria for major depression were recruited online. The Inventory of Depression and Anxiety Symptoms (IDAS), the Hamilton Rating Scale for Depression (HAMD), and the depression and anxiety modules of the MINI were obtained at baseline, post-treatment, and 12-weeks postpartum. Intervention adherence was measured by site usage.

RESULTS

Across self-report and interview measures of depression there were no significant differences in outcome between the group and the individual versions of the program. Rates of major depression and generalized anxiety disorder in the postpartum period were low and adherence to the conditions was similarly high. Participants in the individual condition were significantly more satisfied than participants in the group condition (p < 0.05).

LIMITATIONS

The sample was predominantly white (85%) and recruited online, which may limit generalizability.

CONCLUSIONS

The group intervention was not more effective than the individual intervention. However, ignoring groups, many measures improved over time. The results of this study provide evidence that mood symptoms improve when participating in an online preventive intervention for postpartum depression.

Longitudinal Associations between Depressive Symptoms and Postpartum Sexual Concerns Among First-time Parent Couples

Most first-time parents experience novel concerns about their sexuality such as worries about the effects of labor and delivery on their sex lives. The link between postpartum depressive symptoms and problems with sexual function is bidirectional; however, associations with postpartum sexual concerns (i.e., worries about one's sexuality that are not necessarily related to sexual function) have not been examined. First-time parent couples (N = 99) completed measures assessing their postpartum sexual concerns and depressive symptoms at 3, 6, and 12 months postpartum. Dyadic latent growth curve modeling revealed that mothers' and partners' initial frequencies of postpartum sexual concerns were positively associated, with significant declines in the frequency of these concerns over time for both partners. Mothers' and partners' initial depressive symptoms were also positively associated; however, mothers' depressive symptoms did not change over time whereas partner's depressive symptoms worsened. Mothers' and partners' higher initial depressive symptoms were associated with partners' higher frequency of postpartum sexual concerns. Mothers' depressive symptoms at 3 months postpartum and the degree to which these symptoms changed over time were associated with a steeper decline in partners' postpartum sexual concerns over time. Results provide preliminary support for depressive symptoms as a risk factor for partners' postpartum sexual concerns.

Exploring the Complexities of Postpartum Sexual Health

Purpose of Review

This paper explores the complexities of postpartum sexual health. It answers the question on what should be considered normal sexual health after birth and what should be considered abnormal.

Recent Findings

Many women experience physical sexual health issues in the months after birth, such as dyspareunia, lack of vaginal lubrication and a loss of sexual desire. For some women, these issues can persist 12 and 18 months after birth. Mode of birth is not associated with long-term dyspareunia 6 and 12 months after birth. There is conflict seen in the literature with regard to the association between perineal trauma and short-and long-term sexual health. Breastfeeding and the existence of pre-existing sexual health issues are strongly predictive of sexual health issues at 6 and 12 months after birth. Women have described a discordance in their sexual desire to that of their partner, for some this caused distress but for couples who communicated their feelings of sexual desire, concern over baby’s well-being and adapting to parenthood distress was not experienced. Resuming sexual intercourse after birth was not spontaneous, women considered their mode of birth, the presence of perineal trauma and their physical and emotional recovery from birth. One fifth of women had not resumed sexual intercourse 12 weeks after birth.

Summary

A discussion is presented on the challenges associated with viewing postpartum sexual health from a physical perspective only, and why prevalence studies alone do not capture the nuances of postpartum sexual health. Future research needs to take account of the psychosocial and relational dimensions of postpartum sexual health as well as physical dimensions.

Partner relationship quality predicts later postpartum depression independently of the chronicity of depressive symptoms

OBJECTIVE

Given the lifelong implications of extended postpartum depression (PPD), research is needed to examine the social factors implicated in its development (such as relationship quality) and associated predictors. This study sought to examine the association of partner relationship quality (PRQ) and decline of sexual life (DSL) with maternal PPD at 12-15 months after childbirth.

METHODS

Prospective study of 294 low-income postpartum women. A structured questionnaire and the Patient Health Questionnaire-9 (PHQ-9) captured responses for the main outcome variable and covariates.

RESULTS

The prevalence of the main outcome (PPD at 12-15 months) was 19.1%. Using logistic regression models, low PRQ (risk ratio [RR] = 1.58, 95%CI 1.01-2.49) and DSL (RR = 1.97, 95%CI 1.23-3.15) were associated with PPD at 12-15 months even after controlling for perinatal depression.

CONCLUSIONS

Late PPD (12 to 15 months after giving birth) is very common among low-income women, and is independently associated with different aspects of the couple's relationship. Improving PRQ may prevent late PPD. Future investigations are warranted.

Interpersonal Psychotherapy to Reduce Psychological Distress in Perinatal Women: A Systematic Review

BACKGROUND

Interpersonal psychotherapy (IPT) is a psychological intervention with established efficacy in the prevention and treatment of depressive disorders. Previous systematic reviews have not evaluated the effectiveness of IPT on symptoms of stress, anxiety, depression, quality of life, relationship satisfaction/quality, social supports, and an improved psychological sense of wellbeing. There is limited information regarding moderating and mediating factors that impact the effectiveness of IPT such as the timing of the intervention or the mode of delivery of IPT intervention. The overall objective of this systematic review was to evaluate the effectiveness of IPT interventions to treat perinatal (from pregnancy up to 12 months postpartum) psychological distress.

METHODS

MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (OVID), CINAHL with Full Text (Ebsco), Social Work Abstracts (Ebsco), SocINDEX with Full Text (Ebsco), Academic Search Complete (Ebsco), Family & Society Studies Worldwide (Ebsco), Family Studies Abstracts (Ebsco), and Scopus databases were searched from inception until 31 January 2019. Two researchers independently screened articles for eligibility. Of the 685 screened articles, 43 met the inclusion criteria. The search was re-run on 11 May 2020. An additional 204 articles were screened and two met the inclusion criteria, resulting in a total of 45 studies included in this review. There were 25 Randomized Controlled Trials, 10 Quasi-experimental studies, eight Open Trials, and two Single Case Studies. All included studies were critically appraised for quality.

RESULTS

In most studies (n = 24, 53%), the IPT intervention was delivered individually; in 17 (38%) studies IPT was delivered in a group setting and two (4%) studies delivered the intervention as a combination of group and individual IPT. Most interventions were initiated during pregnancy (n = 27, 60%), with the remaining 18 (40%) studies initiating interventions during the postpartum period.

LIMITATIONS

This review included only English-language articles and peer-reviewed literature. It excluded government reports, dissertations, conference papers, and reviews. This limited the access to grassroots or community-based recruitment and retention strategies that may have been used to target smaller or marginalized groups of perinatal women.

CONCLUSIONS

IPT is an effective intervention for the prevention and treatment of psychological distress in women during their pregnancy and postpartum period. As a treatment intervention, IPT is effective in significantly reducing symptoms of depression and anxiety as well as improving social support, relationship quality/satisfaction, and adjustment. Systematic Review Registration: PROSPERO CRD42019114292.

A comparison of sexual function in primiparous and multiparous women

Childbirth is one of the most important influencing factors for sexual function. Therefore, this study was conducted with the aim of comparing sexual function in primiparous and multiparous women. This cross-sectional analytical study was performed using systematic random sampling on 420 women in the postpartum period who referred to Bandar Abbas health Centres in 2018. The data were collected using an interview method which consisted of a Female Sexual Function Index questionnaire and a demographic questionnaire. The data analysis was performed using the SPSS Version 23 software. The results showed that sexual dysfunction was lower in multiparous women compared to primiparous women (p = .006). Low sexual activity in primiparous women can be due to less privacy and more time and energy loss. Several factors including housing situation, monthly income, episiotomy incision, and the education level of the couple were influential in the sexual function of the primiparous women (p < .05). Sexual function differs between primiparous and multiparous women in postpartum period and the number of deliveries can affect sexual performance.IMPACT STATEMENTWhat is already known on this subject? Sexual function in humans is affected by a complexity of interactions. Childbirth is among the most one of the important factors that influences sexual function. Pregnancy and childbirth affect all organs of the female body, especially the genital tract, and the resulting changes may cause problems in sexual intercourse. Negative childbirth experiences from previous deliveries can affect sexual performance.What do the results of this study add? Regarding the high prevalence of sexual problems during the postpartum period and the direct impact of this on spousal relationship, and also given the controversial data on the relationship between parity and sexual dysfunction, the present study was conducted to compare postpartum sexual function between primiparous and multiparous women.What are the implications of these findings for clinical practice and/or further research? The sexual and emotional intimacy of couples may be affected due to the changes in women's sexual function as the result of physiological and anatomical changes during pregnancy and postpartum. Therefore, to improve the quality of sexual relations, screening and counselling for sexual disorders should not be limited to pregnancy and postpartum periods, but should also be included in pre-pregnancy counselling centres.

Factors Influencing Couples' Sexuality in the Puerperium: A Systematic Review

INTRODUCTION

The puerperium is a period of adaptation in which various transformations take place in the lives of women and men on their way to becoming mothers and fathers. These changes can also have repercussions on their sexual relations. How the couple deals with this transition is crucial to the well-being of the couple and affects how parents relate to the baby.

AIM

This study aimed to explore the factors that influence sexuality in both women and men during postpartum.

METHODS

We conducted a bibliographic review of 236 articles found on the PubMed database and published from 2008 to January 2019.

MAIN OUTCOME MEASURE

The main outcome measure was the impact of various physical, psychological, and sociocultural factors on couples' sexual functioning during postpartum.

RESULTS

The main problems that couples face after childbirth can be classified as (i) psychological changes, such as loss of a sense of self, transitioning to parenthood, taking on the new roles of mother and father, and feelings of abandonment among men; (ii) body changes in women that affect their self-image and perineal trauma; (iii) hormonal changes in women and men that can lead to reduced sexual desire in both and vaginal dryness or dyspareunia in women; (iv) changes in the marital relationship, including changes in each other's roles, taking time for intimacy, and initiating sexual intercourse; (v) sociocultural influences, such as social support, culturally expected roles, and beliefs regarding when to resume sex; and (vi) lifestyle changes, especially with regard to baby care.

CONCLUSION

Sexuality during postpartum is influenced by multiple factors: physical, psychological, and sociocultural. Our findings offer a deeper understanding of how the transition to parenthood affects sexual relationships during the postpartum period. Implications regarding caring for and promoting the sexual health of individuals and couples after childbirth are discussed, and some medical recommendations for parents are offered. Serrano Drozdowskyj E, Gimeno Castro E, Trigo López E, et al. Factors Influencing Couples' Sexuality in the Puerperium: A Systematic Review. Sex Med Rev 2020;8:38-47.

Sexualidad en embarazo y postparto: la necesidad de educación afectivo-sexual

El estudio de la sexualidad femenina durante el embarazo y tras el parto ha sido infravalorado hasta la fecha. Sin embargo, son numerosos los factores biopsicosocioculturales asociados a estos acontecimientos que influyen en la vivencia de la sexualidad, la intimidad y el placer de las mujeres, y la de sus parejas. Por ello, por medio del presente trabajo se pretende visibilizar dichas condiciones especiales de la maternidad y poner en valor la educación afectivo-sexual como estrategia de acompañamiento a estos desafíos vitales.  

Prevalence and Risk Factors of Relationship Dissatisfaction in Women During the First Year After Childbirth: Implications for Family and Relationship Counseling

The aim of this study was to investigate the rate of relationship dissatisfaction among Australian women during the first year after childbirth and to uncover factors affecting their relationships. Postnatal women who had given birth during the previous 12 months were invited to participate in a cross-sectional online study. A comprehensive, multisection questionnaire, as well as the Relationship Assessment Scale (RAS), Female Sexual Function Index (FSFI), and Patient Health Questionnaire - 8 (PHQ-8), were used to collect data. Responses were analyzed using SPSS for Windows. Results showed that 37.2% of the participants experienced relationship dissatisfaction. Results of the multiple logistic regression revealed that the following were significant risk factors for relationship dissatisfaction during the first postpartum year: annual income of less than AU$50,000, sexual dysfunction, and a clinical diagnosis of depression and having symptoms of depression according to the PHQ-8 scores (p < 0.05). Compared to women in a heterosexual relationship, women who were in a same-sex relationship were less likely to have relationship dissatisfaction. In addition, in the period six to 12 months postpartum, women were less likely to have relationship dissatisfaction compared to the period 5 months or less postpartum (p < 0.05).

Factors Associated With Timing of Return to Intercourse After Obstetric Anal Sphincter Injuries

INTRODUCTION

The impact of obstetric perineal trauma on timing of return to intercourse is unclear, although sexual desire is clearly decreased in these women. In addition, studies examining timing of return to intercourse are cross-sectional and therefore cannot delineate potential reasons that patients might delay return to intercourse.

AIM

To identify factors associated with delayed return to intercourse after obstetric anal sphincter injuries.

METHODS

This was a planned secondary analysis of a prospective cohort study of women sustaining obstetric anal sphincter injuries during delivery of a full-term singleton infant. Patients completed the Fecal Incontinence Severity Index at every postpartum visit (1, 2, 6, and 12 weeks) and the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12 once resuming vaginal intercourse. Intercourse was considered "delayed" if patients did not resume intercourse by the 12-week visit. This cutoff was chosen because it was subsequent to the 6-week visit, when patients were instructed to return to normal pelvic activity. Continuous variables were compared using the Student t-test (parametric) or Mann-Whitney U-test (non-parametric). The χ(2) test was used for categorical variables. Statistical significance was assigned with a P value less than .05.

MAIN OUTCOME MEASURES

Primary outcome measurements were differences in pelvic floor symptoms on validated surveys between the "delayed" and "not-delayed" groups at the first postpartum visit and at the time the subjects returned to intercourse. We used the Patient Health Questionnaire-9 for depression, the Urinary Distress Inventory-6 and Incontinence Impact Questionnaire-7 for urinary symptoms, the visual analog scale for pain, the Fecal Incontinence Severity Index for bowel symptoms, and the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12 at the return to intercourse visit only.

RESULTS

One hundred ninety-nine women were included in this analysis. Most were Caucasian (77%) and primiparous (86%). One hundred nineteen women (60%) did not resume vaginal intercourse until after the 12-week visit and were deemed "delayed." Patients who delayed intercourse scored higher on the Fecal Incontinence Severity Index (more anal incontinence) than those who resumed intercourse before 12 weeks (15.4 ± 12.3 vs 12.0 ± 12.8, P = .02). The delayed group also had worse sexual function, shown as lower Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12 scores (35.4 ± 5.9 vs 38.4 ± 4.1, P ≤ .001) and persistently higher Fecal Incontinence Severity Index scores (4.1 ± 7.3 vs 1.6 ± 4.4, P = .001), at the first visit after returning to intercourse.

CONCLUSION

Patients with obstetric anal sphincter injuries who do not resume intercourse by 12 weeks postpartum report more severe anal incontinence symptoms and worse sexual function after return to coitus.

[What do we know about perinatal sexuality? A scoping review on sexoperinatality - Part 2]

The intimate and sexual dimension of future and new parenting couples' relationship is the most affected and the most vulnerable during the transition to parenthood. The purpose of this scoping review is to present the portrait of perinatal sexuality through 123 empirical articles published in the last 15 years. This second article in a series of two is about sexuality during labor and birth, during the postpartum, and in relation to breastfeeding. A total of 29 sexual variables were analyzed. Sexuality during the intrapartal and postnatal periods is very diversified. Some recurring items, however, can be identified: a period of non-sexuality in the first postnatal months, followed by a gradual return of sexuality from 3 to 6 months postpartum and continuing until 12 months or more. Sexuality during the intrapartum is considered taboo and couples' experiences can be at opposite ends: some couples' experiences are sensual and erotic during childbirth, while others experience birth trauma with a negative sexual impact postnatally. Sexuality during breastfeeding is also taboo with a negative impact on women's sexuality. In all of these circumstances, women's and men's sexuality are affected and a multitude of simultaneous physiological and psychological factors affect their experiences. Fluctuations in the intimate and sexual dimensions of the conjugal relationship are considered as a natural phenomenon but temporary. Sexoperinatal interventions should be part of holistic perinatal health care in order to help couples maintain a positive intimate and sexual relationship.

Modifiable partner factors associated with perinatal depression and anxiety: a systematic review and meta-analysis

BACKGROUND

Perinatal distress is a significant public health problem that adversely impacts the individual and their family. The primary objective of this systematic review and meta-analysis was to identify factors that partners can modify to protect each other from developing perinatal depression and anxiety.

METHOD

In accordance with the PRISMA statement, we reviewed the risk and protective factors associated with perinatal depression and anxiety symptoms that partners can potentially modify without professional assistance (PROSPERO reference CRD42014007524). Participants were new or expectant parents aged 16 years or older. The partner factors were sub-grouped into themes (e.g., instrumental support) based on a content analysis of the scale items and measure descriptions. A series of meta-analyses were conducted to estimate the pooled effect sizes of associations.

RESULTS

We included 120 publications, reporting 245 associations with depression and 44 with anxiety. Partner factors with sound evidence that they protect against both perinatal depression and anxiety are: emotional closeness and global support. Partner factors with a sound evidence base for depression only are communication, conflict, emotional and instrumental support, and relationship satisfaction.

LIMITATIONS

This review is limited by the lack of generalizability to single parents and the inability to systematically review moderators and mediators, or control for baseline symptoms.

CONCLUSION

The findings suggest that future prevention programs targeting perinatal depression and anxiety should aim to enhance relationship satisfaction, communication, and emotional closeness, facilitate instrumental and emotional support, and minimize conflict between partners.

Postpartum sexual health: a principle-based concept analysis

AIM

The aim of this study is to report an analysis of the concept of postpartum sexual health.

BACKGROUND

Postpartum sexual health is a minimally understood concept, most often framed within physical/biological dimensions or as a 'checklist' task in postpartum information provision. This has the potential to leave women unprepared to manage transient or normative sexual health changes after childbirth. For meaningful discussions, clarity and understanding of postpartum sexual health is required.

DESIGN

A principle-based method of concept analysis.

DATA SOURCES

The databases of PubMed, CINAHL, Maternity and Infant Care, PsychInfo, Web of Science, EMBASE, SCOPUS and Social Science Index were systematically searched, from their earliest dates, using a combination of key terms, including; 'sexual health', 'sexual function', 'dyspareunia', 'sexuality', 'sexual desire', 'sexual dysfunction', 'postnatal' and 'postpartum', resulting in a final included dataset of 91 studies.

METHODS

Using the principle-based approach, postpartum sexual health was analysed under the four philosophical principles of epistemological, pragmatic, linguistic and logical.

RESULTS

Philosophically, postpartum sexual health is underdeveloped as a concept. A precise theoretical definition remains elusive and, presently, postpartum sexual health cannot be separated theoretically from sexuality and sexual function. Identified antecedents include an instrument free birth, an intact perineum and avoidance of episiotomy. Attributes include sexual arousal, desire, orgasm, sexual satisfaction and resumption of sexual intercourse. Outcomes are sexual satisfaction and a satisfying intimate relationship with one's partner.

CONCLUSION

Postpartum sexual health is conceptually immature with limited applicability in current midwifery practice.

Prevalence and risk factors of sexual dysfunction in postpartum Australian women

INTRODUCTION

Female sexual dysfunction is highly prevalent and reportedly has adverse impacts on quality of life. Although it is prevalent after childbirth, women rarely seek advice or treatment from health care professionals.

AIM

The aim of this study was to assess the sexual functioning of Australian women during the first year after childbirth.

METHODS

Postpartum women who had given birth during the previous 12 months were invited to participate in this cross-sectional study. A multidimensional online questionnaire was designed for this study. This questionnaire included a background section, the Female Sexual Function Index, the Patient Health Questionnaire (PHQ-8), and the Relationship Assessment Scale. Responses from 325 women were analyzed.

RESULTS

Almost two-thirds of women (64.3%) reported that they had experienced sexual dysfunction during the first year after childbirth, and almost three-quarters reported they experienced sexual dissatisfaction (70.5 %). The most prevalent types of sexual dysfunction reported by the affected women were sexual desire disorder (81.2%), orgasmic problems (53.5%), and sexual arousal disorder (52.3%). The following were significant risk factors for sexual dysfunction: fortnightly or less frequent sexual activity, not being the initiator of sexual activity with a partner, late resumption of postnatal sexual activity (at 9 or more weeks), the first 5 months after childbirth, primiparity, depression, and relationship dissatisfaction.

CONCLUSION

Sexual satisfaction is important for maintaining quality of life for postpartum women. Health care providers and postpartum women need to be encouraged to include sexual problems in their discussions.

The relationship between depressive/anxiety symptoms during pregnancy/postpartum and sexual life decline after delivery

INTRODUCTION

Several factors have been found to be independently associated with decline in sexual activity after delivery. However, the association between depression in pregnancy/postpartum and sexual problems is less clear.

AIM

To prospectively evaluate the relationship between depressive/anxiety symptoms (DAS) during the perinatal period and sexual life in the postpartum period.

METHODS

A prospective cohort study conducted between May 2005 and March 2007 included 831 pregnant women recruited from primary care clinics of the public sector in São Paulo, Brazil. Four groups with DAS during antenatal and postpartum periods were identified using the Self Report Questionnaire (SRQ-20): absence of both antenatal and postpartum DAS; presence of antenatal DAS only; presence of postpartum DAS only; and presence of both antenatal and postpartum DAS. The primary outcome was perception of sexual life decline (SLD) before and after pregnancy/delivery. Crude and adjusted risk ratios (RR), with 95% confidence intervals (95% CI), were calculated using Poisson regression to examine the associations between DAS and SLD.

MAIN OUTCOME MEASURE

The main outcome measure of this study is the perception of SLD before and after pregnancy/delivery.

RESULTS

SLD occurred in 21.1% of the cohort. In the multivariable analysis, the following variables were independently associated with SLD: DAS during both pregnancy and postpartum (RR: 3.17 [95% CI: 2.18-4.59]); DAS during only the postpartum period (RR: 3.45 [95% CI: 2.39-4.98]); a previous miscarriage (RR: 1.54 [95% CI: 1.06-2.23]); and maternal age (RR: 2.11 [95% CI: 1.22-3.65]).

CONCLUSIONS

Postpartum women with DAS have an increased likelihood for SLD up to 18 months after delivery. Efforts to improve the rates of recognition and treatment of perinatal depression/anxiety in primary care settings have the potential to preserve sexual functioning for low-income mothers.

When she says "no" to medication: psychotherapy for antepartum depression

Many women suffering from major depressive disorder during pregnancy are hesitant to initiate or continue antidepressant treatment during preconception planning, conception, pregnancy, and lactation (perinatal period). Over the past few decades, various psychotherapeutic approaches have been found to be efficacious for depression in general population research. Several observational and quasi-experimental studies also suggest that psychotherapy can be a safe first-line treatment for perinatal women with mild to moderate depression. This article summarizes findings to date regarding the use of psychotherapy for depression occurring during pregnancy and describes the adaptations made to tailor the treatment to the unique needs of women in the perinatal period.