Women's Postpartum Sexual Health Program: A Collaborative and Integrated Approach to Restoring Sexual Health in the Postpartum Period

Development of an educational guide for postpartum sexual health promotion: The Delphi method

BACKGROUND

The Promotion of sexual health has been emphasized in Sustainable Development Goals (SDGs). As a primary prevention strategy, the promotion of sexual knowledge can reduce the incidence of postnatal sexual disorders. This study aimed to develop an educational guide for postpartum sexual health promotion.

MATERIALS AND METHODS

This qualitative study was conducted in 2021 in Tehran. The steps of developing the educational guide were based on the model of the National Institute for Health and Clinical Excellence (NICE). First, the related guidelines, books, booklets, and original articles were comprehensively reviewed. Based on the scientific evidence, the educational content was compiled. Then, the quality of this content was evaluated using the Delphi method; It was performed using expert opinions with the Appraisal of Guidelines for Research and Evaluation (AGREE) tool.

RESULTS

The educational content was developed in three chapters as follows: basic sexual education, postpartum changes and prevalent sexual problems of this period, and strategies for solving or adapting to postpartum sexual problems. This guide was developed in two separate sections for healthcare providers and mothers. The content was of excellent quality in all 6 domains of the AGREE tool (>90%); and evaluated to be optimal in terms of scientificity, significance, and feasibility with the consensus of experts (>95%).

CONCLUSIONS

In this research, the steps of developing a comprehensive evidence-based educational guide for sexual health services in postpartum care were described, and its content was presented. The validity of the compiled content was also confirmed.

Risk of sexual dysfunctions in breastfeeding females: protocol for a systematic review and meta-analysis

BACKGROUND

Epidemiological studies do not provide accurate statistics on the percentage of breastfeeding women experiencing sexual dysfunctions and restraining from sexual activity. The data vary between 40% and 83% in the first group and 20-50% in the second one. Despite excessive studies on contributors to intimacy changes, breast feeding received little attention from researchers. The relationship between lactation and postpartum sexual dysfunctions remains unclear. This systematic review and meta-analysis will synthesise available data and establish the link between breast feeding and sexuality problems.

METHODS AND ANALYSIS

A comprehensive literature search will be performed in biomedical databases PubMed/Medline, Scopus, Web of Science, EMBASE and CINAHL. We will extract peer-reviewed original studies written in English, Arabic or Polish from 2000 to June 2023. We will also search for reports from international health organisations and local health authorities. The preliminary search was performed on 04 April 2023. The studies must provide data on dysfunction prevalence/incidence and the strength of the relationship between breast feeding and sexuality in generally healthy women. The Covidence software will be used to perform literature screening, data extraction and quality assessment of individual studies. We will use a random-effects model meta-analysis to calculate pooled weighted frequency measures and effect size. Between-study heterogeneity will be assessed with the I2 test.

ETHICS AND DISSEMINATION

This meta-analysis does not require ethical approval because it synthesises data from previously published original studies. The final work will be published in a peer-reviewed journal and presented at scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42023411053.

Breastfeeding Sexual Lives of First-Time Mothers: A Qualitative Explorative Study

Background: Problems with sexuality are experienced in the first 6 months at the most, and often in the first 12 months after birth. Although there are studies reporting negative effects of breastfeeding on sexuality, the evidence is limited. Objective: This study was conducted with the aim of exploring the breastfeeding sexual lives of first-time mothers. Materials and Methods: The research was carried out in Turkey between October 2020 and December 2021. The study was conducted with 41 women who met the inclusion criteria. Participants were selected by the "snowball" sampling procedure among nonprobability sampling methods. A qualitative approach was used to gather data through semistructured interviews. Content analysis was used for data analysis as described by Graneheim and Lundman. Data analysis was performed using NVivo software (Version 11). Results: According to the results of the content analysis, three themes were created: factors affecting sexuality in the breastfeeding process, sexual interaction with the spouse during the breastfeeding process, and understood expectations. The theme, titled factors affecting sexuality in the breastfeeding process, consists of five categories: physical, psychological, sociocultural, infant-related, and health professionals-related factors. The theme of "understood expectations" consists of desires for improving sexual satisfaction and satisfaction during lactation, and sexual communication categories. The contact of sexual interaction with spouse during breastfeeding consists of positive interaction and negative interaction categories. Conclusions: It has been concluded that the sexual intercourse of women is adversely affected during the breastfeeding period and that women have expectations to increase their sexual satisfaction. Sexual problems during the breastfeeding process cause problems in the spousal relationship.

The effectiveness of "Women's Postpartum Sexual Health Program (WPSHP)" on Iranian women's postpartum sexual health: A randomized clinical trial

In this study, we examined the effectiveness of Women's Postpartum Sexual Health Program (WPSHP) on Iranian women's sexual health in the postpartum period. A single-blinded randomized clinical trial was conducted in 2016 on 80 postnatal women in Iran. We used the Female Sexual Function Index, Sexual Quality of Life - Female questionnaire and Female Sexual Distress Scale. The intervention group received counseling based on WPSHP. After 28 weeks, the mean score of the Female Sexual Function Index and Female Sexual Quality of Life significantly increased in the WPSH group (p < 0.001, p < 0.001), while the mean score of the Female Sexual Distress significantly decreased in the WPSH group (p < 0.001). We concluded that Women's Postpartum Sexual Health Program could promote postnatal women's sexual function and female sexual quality of life and reduces female sexual distress in women suffering from sexual problems in the postpartum period.

Recovering Sexuality after Childbirth. What Strategies Do Women Adopt? A Qualitative Study

This study aimed to determine the strategies used by women to adapt to the changes that affect the first sexual relations after childbirth. A qualitative study with a phenomenological approach used three data collection techniques (in-depth interviews, discussion groups, and online forums). Thirty-six women in the first six months postpartum participated in the study, from physiotherapy centers with maternal child specialties in several locations in Spain. Women with different types of delivery, presence or absence of perineal trauma during delivery, previous deliveries, and different types of breastfeeding were included. Among the strategies, closeness support and understanding were the ones that women used to adjust to the new situation, in order to improve the couple's relationship, intimacy, and cope with the significant changes that appear in the first six months postpartum. Changes and adaptations in sexual practices become a tool for coping with a new sexuality, especially if it is affected by the presence of pain or discomfort associated with physical changes. Personal time facilitates emotional management and improvement of emotional changes related to the demands of motherhood. Accepting the changes that motherhood brings is critical to dealing with the new situation. Strategies used by postpartum women focus on acceptance, self-care, partner, couple time, personal time, and adapting encounters. The findings of this study are of interest to health professionals as they provide insight into how women cope with the changes that appear in the first six months postpartum. In this way, the findings will be able to transmit to couples the alternatives they can adopt before the resumption of sexual relations to improve satisfaction both as a couple and in terms of sexuality after childbirth.

The meaning of postpartum sexual health for women living in Spain: a phenomenological inquiry

BACKGROUND

Sexual health is a multidimensional phenomenon constructed by personal, social, and cultural factors but continues to be studied with a biomedical approach. During the postpartum period, a woman transitions to mother, as well as partner-to-parent and couple-to-family. There are new realities in life in the postpartum period, including household changes and new responsibilities that can impact the quality of sexual health. This phenomenon is understudied especially in the context of Spain. The purpose of this study was to describe the lived experience of postpartum sexual health among primiparous women giving birth in Catalonia (Spain).

METHODS

This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi's seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis.

RESULTS

Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.

CONCLUSION

Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.

Effectiveness of postpartum sexual health education programme structured according to Levine's conservation model: An interventional study

AIM

This study aimed to determine the effects of a postpartum sexual health education programme structured according to Levine's conservation model on postpartum women.

METHODS

The interventional study was completed with 67 postpartum women. The intervention group was given the postpartum sexual health education programme structured according to Levine's conservation model. The control group received routine discharge training. The data were collected using a personal information form, The Index of Female Sexual Function, Arizona Sexual Experience Scale and Golombok-Rust Inventory of Sexual Satisfaction.

RESULTS

It has been determined that the decrease in sexual arousal and desire is the first among postpartum sexual problems experienced by women. This study demonstrated that sexual function, sexual satisfaction and sexual response were higher in nonbreastfeeding women, women who had sexual intercourse one to three times a week and women who could talk to health care professionals on sexual matters. After the programme, the intervention group had more adequate sexual function, and they developed a strong, easy and satisfactory sexual response than the control group (p < 0.05).

CONCLUSION

This programme was effective in increasing the sexual functions and satisfaction of the postpartum women. Models provide guidance to nurses for provision of care in a systematic manner.

Understanding women's postpartum sexual experiences

This study aimed to understand women's sexual health experiences, specifically knowledge, attitudes and norms related to sexual behaviour resumption during the postpartum period. Semi-structured, reproductive health-focused interviews (N = 70) were conducted among women aged 18 years or older (range: 19-78) residing in South Carolina. Findings demonstrated that women identified clinicians as most influential concerning when they should and could resume sexual activity. Some women noted returning to sex earlier than anticipated due to personal and partner desire and indicated achieving considerable sexual satisfaction during the postpartum period. However, other participants noted difficulties resuming sexual activity, including pain and exhaustion from caring for a new baby. Findings provide practical recommendations for health professionals to further develop tailored, timely health messaging related to safe and healthy postpartum sexual behaviours. We discuss recommendations for health professionals to bring further awareness to varied postpartum sexual experiences.

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.

Sexual well-being and perceived stress in couples transitioning to parenthood: A dyadic analysis

Background/Objective

The transition to parenthood encompasses several psychological and relational changes that might contribute to couples’ high levels of stress postpartum. Although common across the postpartum, couples’ sexual changes are frequently overlooked.

Method

We surveyed 255 mixed-sex new parent couples to examine the associations between sexual well-being—sexual satisfaction, desire, and postpartum sexual concerns—and perceived stress postpartum. Couples completed self-report questionnaires assessing perceived stress and sexual well-being.

Results

For both mothers and fathers, greater sexual satisfaction was associated with their partners’ lower perceived stress and, for fathers, this was also associated with their own lower perceived stress. For mothers, greater partner-focused sexual desire was associated with their own lower perceived stress whereas, for fathers, greater partner-focused sexual desire was associated with their partners’ higher perceived stress. In addition, greater solitary sexual desire and postpartum sexual concerns were associated with both parents’ own higher perceived stress.

Conclusions

This study highlights the association between sexual well-being and couples’ postpartum stress, suggesting that more positive sexual experiences are linked to lower perceptions of stress across this vulnerable period. Couples’ sexual well-being may be an important target for interventions aimed at helping postpartum couples cope with stress.

The effect of sexual health counseling on women's sexual satisfaction in postpartum period: A randomized clinical trial

Background

Many couples experience decreasing sexual satisfaction in postpartum period. Various sexual health counseling approaches have been designed for postpartum women to address their common sexual concerns and problems.

Objective

This study aimed to investigate the effectiveness of Women's Postpartum Sexual Health Program (WPSHP) on women's sexual satisfaction in postpartum period.

Materials and Methods

The study was a single blind randomized clinical trial on 75 postpartum women aged 18-35 yr with low sexual satisfaction who attended urban health-care centres in Mashhad, Iran in 2016. Data were collected using a demographic questionnaire, the Depression Anxiety Stress Scales-21, and the Larson Sexual Satisfaction Questionnaire. The intervention group received counselling based on the WPSHP, a four-session, group- and couples-based program. The control group just received postpartum routine care.

Results

Both the intervention and control groups were homogeneous for demographic variables. According to the Mann-Whitney test, sexual satisfaction score in the intervention group was significantly higher than the control group 8 weeks after the intervention (p < 0.001). According to the Wilcoxon test, there was a significant difference in the mean score of sexual satisfaction before and after intervention in the intervention group (p < 0.001).

Conclusion

WPSHP caused higher levels of sexual satisfaction. It is therefore recommended to use this program in women during the postpartum period to promote their sexual satisfaction.

Musculoskeletal Pelvic Pain and Sexual Function in the First Year After Childbirth

OBJECTIVE

To characterize sexual function in women with and without musculoskeletal pelvic pain during the first year after childbirth.

DESIGN

Cross-sectional descriptive study.

SETTING

Outpatient women's health clinic in a Midwestern U.S. academic medical center.

PARTICIPANTS

Women who gave birth to singleton infants within the past year.

METHODS

Women were recruited from various outpatient settings. We obtained baseline demographic variables and used selected components from the Wilson and Cleary Health-Related Quality of Life model. Participants completed questionnaires related to sexual health, pain symptoms, and general quality of life. They were asked to indicate their pain on a pain diagram and to quantify it with the use of a numeric rating scale (NRS). Examiners used validated examination techniques to assess pelvic floor muscle tenderness, strength, and pelvic girdle pain. Participants who reported pelvic pain and had at least one positive physical examination finding were classified in the pain group.

RESULTS

Forty-five participants completed the study, and 20 participants were in the pain group. Most participants with pain had pelvic girdle pain (n = 15) and pelvic floor myofascial pain (n = 20). Participants with pain reported less sexual satisfaction (t[43] = 2.84, p = .007) and reduced quality of life (t[36] = 5.25, p < .001) compared with participants without pain.

CONCLUSION

Participants who experienced musculoskeletal pelvic pain in the first year after childbirth were significantly more likely to report problems with sexual function compared with their counterparts without pain.