The Relationship Between Body Image, Female Genital Self-Image, and Sexual Function Among First-Time Mothers

The effect of genital self-image on sexual satisfaction and stress in women after vaginal delivery

OBJECTIVE

Pregnancy, childbirth, and postpartum periods bring along biological, psychological, and social changes that could affect women's sexual health. The aim of this study was to evaluate the effect of genital self-image on sexual satisfaction and stress in women who had a vaginal delivery.

METHODS

This descriptive and cross-sectional study was conducted online between June and September 2023 by using snowball sampling and the data collection forms prepared in the GoogleDocs program. Women who had a normal vaginal delivery were included, were within 6 weeks to 1 year postpartum, were able to use at least one of the social media networks (e-mail, WhatsApp, Facebook, and Instagram), and volunteered to participate in the research. Data were collected through the Personal Information Form, the "Female Genital Self-Image Scale," the "Golombok-Rust Inventory of Sexual Satisfaction," and the "Female Sexual Distress Scale-Revised."

RESULTS

The average age of the participating women was 30.54±5.83 years (n=235). The participants' mean scores were 18.94±2.92 for the Female Genital Self-Image Scale, 40.07±15.51 for the Golombok-Rust Inventory of Sexual Satisfaction, and 8.85±8.50 for the Female Sexual Distress Scale-Revised total. A statistically significant and negative relationship was found between Female Genital Self-Image Scale and Golombok-Rust Inventory of Sexual Satisfaction and Female Sexual Distress Scale-Revised total scores (r=-0.183, p<0.01; r=-0.387, p<0.01). Regression analysis (forward) was performed, and genital self-image was found to be the predictive factor affecting sexual satisfaction and stress.

CONCLUSION

This study found that women had a medium level of genital self-image and sexual satisfaction and a low level of sexual distress.

Attitudes toward mothers as sexual beings and the sexual functioning of parents

BACKGROUND

Research has shown that negative sexual attitudes are associated with lower levels of sexual functioning among men and women, however, little is known about how attitudes about mothers as sexual beings are associated with sexual functioning for parents.

AIM

The aim of the current study was to examine how attitudes toward mothers as sexual beings (ATMSB) were associated with sexual functioning for women and partners of women among parents with young children.

METHODS

Cross-sectional retrospective data were collected online via Qualtrics Panels from 475 women and men (partnered to women) who reported having their first child within the last 5 years.Outcomes: The Revised Female Sexual Function Index and revised Expanded Prostate Cancer Index Composite-Short Form were used to measure sexual function in women and men, respectively.

RESULTS

Results indicated that after controlling for age and relationship length, more positive ATMSB predicted higher levels of sexual functioning (and multiple domains of functioning) for men and women.Clinical Implications: These findings indicate that sexual functioning, especially in parents, is linked to the attitudes held toward seeing mothers as inherently sexual (or not).

STRENGTHS AND LIMITATIONS

This is the first study to examine how attitudes toward mothers as sexual beings can impact sexual functioning, though the cis heterosexual mostly white sample is a notable limitation.

CONCLUSION

ATMSB may need to be examined and challenged in the context of treating sexual dysfunction during this transitional period for mothers and those partnered to mothers.

Association of Body Image and Genital Self-Image with Female Sexual Function: A Systematic Review

The aim of this study was to identify, through a systematic review, how perceptions of genital and body self-image can influence the sexual function of young adult women. A systematic review was performed in which 704 studies were selected. After analyzing the articles, only 10 articles were included, from which the data for this research were extracted. The studies showed that there is an association between body and genital image and sexual function. However, those perceptions carry independent and distinct values depending on the associated condition and the audience being evaluated.

Genital self-image and sexual function in Iranian women from pregnancy to postpartum: a cohort study

BACKGROUND

Genital self-image is among the factors affecting women's sexual function.

AIM

The present study aimed to determine changes in the genital self-image and its relationship with women's sexual function in the third trimester of pregnancy and postpartum.

METHODS

The participants of this prospective cohort study included 301 eligible pregnant women chosen through stratified random sampling with proportional allocation from comprehensive health centers in Gorgan, Iran. The Persian version of the 7-item Female Genital Self-Image Scale, the 6-item Female Sexual Function Index, and Depression Anxiety and Stress Scale 21 were filled in a self-report manner on 2 occasions: (1) 30 to 37 weeks of pregnancy and (2) 12 to 16 weeks (± 2 weeks) postpartum. Finally, the data were analyzed using SPSS 24 software.

OUTCOMES

Outcomes included Female Genital Self-Image Scale and Female Sexual Function Index changes from pregnancy to postpartum according to the childbirth mode.

RESULTS

The mean age of participants was 29.66 ± 5.27 years. These values for the genital self-image scores of women during pregnancy (19.18 ± 3.25) and postpartum (19.43 ± 3.57) were not significantly different (P = .30). Also, this difference was not statistically significant regarding the mode of delivery in 2 groups of women with vaginal birth (P = .62) and cesarean section (P = .14). The mean Female Sexual Function Index scores during pregnancy (15.15 ± 6.73) and postpartum (17.52 ± 6.46) were significantly different (P = .001). In addition, this difference was significant in women with vaginal birth (P = .004) and cesarean section (P = .001).

CLINICAL IMPLICATIONS

Clinicians should inform women/couples about changes in female sexual function and address genital self-image as a factor involved in female sexual function during pregnancy and postpartum.Strengths and Limitations: Because the participants of this study were women in the third trimester of pregnancy, the obtained results may not be generalized to pregnant women in the first and second trimesters of pregnancy or even to different postpartum periods (ie, midterm and long term).

CONCLUSION

The results showed that the female genital self-image is not significantly different during pregnancy and postpartum, or with the mode of delivery. However, the female sexual function score in postpartum is higher than in pregnancy, regardless of the mode of delivery.

Female genital self-image and body appreciation in Turkish women: a mixed methods study

The study investigated negative genital self-image in women and determined the effect of education on natural/normal female genital appearance diversity on the change in women's genital self-image. The type of research is a mixed method descriptive study. The participants were 259 women living in Turkey. In the first stage of the study, female genital self-image levels and body appreciation levels were evaluated. In the second stage of the study, women were interviewed thoroughly about negative female genital self-image, and then, visual education presentation was made on natural/normal female genital diversity. One week after the presentation, the women's genital self-image levels were re-evaluated. In the first phase of the study, the mean Female Genital Self-Image Scale (FGSIS) total score was 22.07 ± 4.07 and the mean Body Appreciation Scale (BAS) total score was 42.40 ± 8.13 of the women. Higher FGSIS and BAS scores showed an increase in women's positive genital self-image and body appreciation. The relationship between the FGSIS and the BAS scale scores of the women was found to be significantly correlated (r = 0.401, p < 0.001). In the second stage of the study, four main themes were examined as "positive thoughts," "size and image," "metaphors related to genital organs," and "negative thoughts." In conclusion, in the first phase, it was determined that women's feeling of discomfort with their sexual organs during sexual intercourse, comparing their genital organs with other women's genital organs, thinking of genital organ aesthetic surgery, and BAS scores were associated with FGSIS scores. In the second phase, women's positive or negative feelings and thoughts about their genital self-image were revealed.

The relationship between women's mode of delivery, body image, self-respect, and genital self-image

INTRODUCTION AND HYPOTHESIS

Many factors affect women's genital self-image. This study was conducted to investigate the relationship between women's mode of delivery, body image, self-esteem, and genital self-image.

METHODS

The research was carried out in two public hospitals between 15 January 2022 and 30 June 2022. The study sample consisted of a total of 197 multiparous women in the early postpartum period. They were asked to fill out a Personal Information Form, the Rosenberg Self-Esteem Scale (RSES), the Body-Esteem Scale (BES), and the Female Genital Self-Image Scale (FGSIS), based on self-report. The Chi-squared, Pearson's correlation, and multiple linear regression analysis were used.

RESULTS

Of the participants, 49.50% had a vaginal delivery, and 50.50% had a cesarean section. Their mean scores were 0.64 ± 0.62 on the RSES, 155.01 ± 24.40 on the BIS, and 20.97 ± 4.39 on the FGSIS. As the women's age increased, their mean FGSIS score also increased. There was negative correlation between women's mean RSES and FGSIS scores. A positive, significant correlation was found between the mean FGSIS and BES scores of the women. Of the variables included in the multiple linear regression model, age, self-esteem, and body image were statistically significant predictors 19.5% of the FGSIS score (p < 0.005).

CONCLUSIONS

Mode of delivery was not a predictor of female genital self-image in the early postpartum period. Women with high self-esteem had a positive body image and genital self-image. Age, self-esteem, and body image were influential on female genital self-image. On the other hand, age, self-esteem, and body image predicted about 19.5% of female genital self-image according to multiple linear regression.

The strength of correlation between female genital self-image and sexual function: a systematic review and meta-analysis

BACKGROUND

Mounting evidence indicates that female genital aesthetic complaints impact sexual relationships.

AIM

The study sought to determine the strength of the correlation between genital self-image and sexual function.

METHODS

Electronic databases were comprehensively searched including PubMed, Web of Science, Scopus, PsycINFO, Embase, and the Cochrane Library from January 2000 to December 2022. After duplicate removal, 146 articles were retrieved by searching keywords in titles and abstracts.

OUTCOMES

A positive correlation is noted between genital self-image and sexual function; the strength of this correlation was 0.375.

RESULTS

By omitting irrelevant articles according to the eligibility criteria, 16 articles remained for a total of 13 505 participants. All but 1 of them indicated a statistically significant positive correlation between genital self-image and sexual function. For a more accurate result, a meta-analysis was conducted noting a considerable heterogeneity.

CLINICAL IMPLICATIONS

The results of this study may be used in counseling women with sexual dysfunction who are dissatisfied with their genital appearance.

STRENGTHS AND LIMITATIONS

This study is the first systematic review to reveal the strength of the correlation between genital self-image and sexual function. The most important limitation of this study is the heterogeneity of the studies reported.

CONCLUSION

This systematic review indicates a positive correlation between genital self-image and sexual function. The results are restricted by inconsistency of the articles considered. Using different tools in different cultural contexts without considering confounding factors leads to a wide range of correlation sizes and significant heterogeneity is evident.

Romantic Attachment and Sexual Satisfaction Trajectories Among Couples Transitioning to Parenthood

The transition to parenthood (TTP) is an exciting yet destabilizing time for couples. First-time parents may experience changes in their sexual satisfaction during the TTP, but little is known about the factors associated with these changes. Romantic attachment might help understand why some new parents experience a decrease in sexual satisfaction while others do not. This prospective and dyadic study aimed to examine new parents' sexual satisfaction trajectories through the moderator role of prenatal attachment anxiety and avoidance in these trajectories. A total of 221 primiparous Canadian couples completed four online questionnaires from the second trimester of pregnancy to 12 months postpartum. Dyadic latent growth curve analyses revealed that although pregnant people present lower prenatal sexual satisfaction than their partners, both parents show an increase in their sexual satisfaction from pregnancy to 12 months postpartum. For both parents, partners' attachment anxiety was related to one's own steeper increase in sexual satisfaction from pregnancy to 12 months postpartum. Finally, both parents' attachment avoidance was related to their own lower sexual satisfaction during pregnancy. These findings will help educate and support expectant parents about anticipated fluctuations in sexual satisfaction.

What to Expect When You're Expecting: Perinatal Sexual Education Is Linked with Couples' Sexual Well-Being in Pregnancy and the Postpartum

Up to 88% of expectant and new parents report problems with their sexual well-being, yet less than 30% of individuals receive information about potential sexual problems from health-care professionals. Lack of information may contribute to difficulty adjusting to sexual challenges, and in turn, to poorer sexual well-being. The current study examined the following: 1) the amount of perinatal sexual health information individuals receive/access; 2) gaps between desired and received information; 3) barriers to accessing information; and 4) links between the quantity of information received/accessed and sexual well-being outcomes in one sample of pregnant couples (N = 102) and another sample of couples in the postpartum (N = 102). Results revealed that most participants reported receiving/accessing little-to-no sexual health information, despite most participants wanting to receive a variety of information related to their perinatal sexuality. On average, expectant and new parents were indifferent regarding how easy/comfortable they felt discussing their sexuality with health-care professionals. Overall, when gestational parents received/accessed more pregnancy-related sexual health information and when either parent received/accessed more postpartum-related sexual health information, both members of the couples reported greater sexual well-being. Access to information might not only address couples' needs and concerns but may also bolster sexual well-being during a vulnerable period.

Associations between Genital Self-Image and Individuals' Own and Perceived Partner Sexual Satisfaction

Negative genital self-image is linked with lower sexual satisfaction, but no research has examined its association with perceptions of partners' sexual satisfaction. In two studies (N = 475, N = 234), we examined links between genital self-image and own and individuals' perceived partner sexual satisfaction. In the second study, we tested whether a mindfulness intervention moderated these associations. In both studies, more negative genital self-image was significantly associated with individuals' lower own and perceived partner sexual satisfaction concurrently and over a two-week period. Mindfulness intervention exposure did not moderate associations. Findings support negative genital self-image as a risk factor for sexual dissatisfaction.

Restrictions and distress in daily, social, and sexual functioning, and intimate relationships in women with pelvic floor complaints: A mixed-method study

Women with pelvic floor complaints experience restrictions and distress in their daily, social, and sexual functioning, and their intimate relationships. We interviewed forty-eight women to unravel differences between women receiving and not receiving pelvic physical therapy and between pregnant, parous, and nulliparous women in preparation for theory development. We analyzed data in a mixed-method design using NVivo and Leximancer. Sexual dysfunction, relationship dynamics, the nature and severity of restrictions and distress, and coping strategies appear to vary between women receiving and not receiving therapy. Specific combinations of restrictions and distress are present in pregnant, parous, and nulliparous women, and might influence women's decision to seek help.

Pregorexia: a systematic review and meta-analysis on the constructs of body image dissatisfaction and eating disturbances by gestational age in the peripartum

PURPOSE

Pregorexia is a phenomenon posited to occur in the peripartum, characterized by an attempt to counter pregnancy's physiological changes in body shape through reduced calorie intake or increased physical activity.

METHODS

In this pre-registered systematic review and meta-analysis, body image dissatisfaction and eating psychopathology in the peripartum according to gestational age were formally assessed. PubMed was searched up to May 2023. Selection criteria were represented by studies on body image concerns or eating psychopathology in the peripartum (up to 1 year after delivery). The population needed to include women from the general population or among patients with a history of (or current) eating disorder. For the meta-analysis, 17 studies were included: 10 for body image dissatisfaction (2625 individuals overall), 7 for eating behaviors (2551 individuals overall). The interplay between body image and the following themes was examined in depth: the adoption of breastfeeding, peripartum depression, sociocultural influences on body image, sexual disturbances, experiencing or reporting an altered food intake.

RESULTS

Progressive dissatisfaction with body image during pregnancy by gestational age was observed, stably elevated for at least 12 months postpartum. Eating psychopathology was observed as elevated only at 12 months in the postpartum, but not during pregnancy.

DISCUSSION

The current work offers normative values of body image satisfaction and eating psychopathology in the peripartum by gestational age. The relevance of current results was discussed, in order to inform both current clinical practice and future public policies.

LEVEL OF EVIDENCE

Level I-Evidence obtained from: systematic reviews and meta-analyses.

Preferred mode of delivery association with the body image and genital image in pregnant women - a cross-sectional study

BACKGROUND

Pregnant women experience several changes in their appearance, body shape and body image. In some studies, there has been a relationship between these changes and the type of delivery. This study aimed to investigate the relationship of the prenatal body image and genital image with the mode of delivery preferred by pregnant women in Gorgan in 2020.

METHODS

In this cross-sectional study, 334 pregnant women were selected by stratified sampling. The Prenatal Body Image Questionnaire (PBIQ), Female Genital Self-Image Scale (FGSIS), pregnant women's preferences for mode of delivery questionnaire (PPMDQ) and DASS-21 were completed on line. The data was analyzed using Spearman test and linear regression.

RESULTS

The average score of PBIQ, FGSIS, and PPMDQ was 68.24 (standard deviation = 17.71), 19.25 (standard deviation = 3.3), and 63.12 (standard deviation = 3.3) respectively. Vaginal delivery as a preferred mode of delivery was inversely correlated with dissatisfaction with body image (r=-0.32, P < 0.001), and directly correlated with satisfaction with the genital image (r = 0.19, P < 0.001). There was a significant inverse correlation between prenatal body image dissatisfaction and genital image satisfaction (r=-0.32, P < 0.001). While FGSIS score could not predict PPMDQ, PBIQ score could.

CONCLUSIONS

Satisfaction with the prenatal body image or genital image is associated with the choice of vaginal delivery. These results can be the basis for prenatal care and childbirth counselling.

Algorithm for Trim and Wedge Labiaplasties

In the last decade labiaplasty procedures have been on the rise in the United States. The trim and the wedge are among the most commonly used techniques. The purpose of this paper is to provide a trim-wedge algorithm to guide the surgeon based on the qualities of the individual patient. The choice of technique should be based on the reasonable labiaplasty candidate's goals, her nicotine/cocaine usage, and the physical characteristics of her labia, including edge quality, texture, pigmentation, symmetry, morphology of protrusion, and labial length. By considering these individual patient factors, the trim-wedge algorithm may improve labiaplasty outcomes and increase patient satisfaction. Some surgeons perform only the wedge or only the trim, and no algorithm should alter that. After all, the best technique is always the one the surgeon performs comfortably and safely.

LEVEL OF EVIDENCE: 4

Genital Self-Image and Esthetic Genital Surgery

Genital self-image describes the perception of one's genital appearance as being "normal" or "abnormal," and a disharmonious image leads to an increasing number of women seeking esthetic genital surgery each year. The concept of what constitutes "normal" is strongly influenced by the media, cultural norms, and sexual relations. In reality, the extent of normalcy is highly variable and overall patient education regarding extremes of size and shape should be provided to all patients considering surgery. When performed with appropriate training, expertise, and attention to detail in a properly selected patient, esthetic genital surgery is associated with minimal complications or sequelae.

Communication changes the effects of sexual pain on sexual frequency in the pregnancy to postpartum transition

PURPOSE

To evaluate how sexual pain influences changes in sexual frequency from the pregnancy to postpartum transition, and to examine how couple's sexual communication interacts with sexual pain during pregnancy.

METHODS

We explored data following 159 mixed-sex couples across the transition from pregnancy to 6 months postpartum. Couples completed the Relationship Quality Interview and the Marital Satisfaction Inventory-Revised, which assessed their sexual communication, pain and other sexual problems during pregnancy, and frequency of intercourse at pregnancy and postpartum.

RESULTS

Overall, couples reported a decline in sexual activity from pregnancy to postpartum. Women's sexual pain during pregnancy influenced changes in sexual frequency only among couples who reported poorer communication about sex. Among couples reporting sexual pain and good communication, pain did not impact changes in sexual frequency (i.e. they experienced significant declines in sexual activity into the postpartum period, as expected). In contrast, among couples with poor communication, sexual frequency did not significantly decline.

CONCLUSION

Our findings suggest that sexual communication alters the effects of sexual pain on postpartum sexual activity. Future research should examine if sexual communication training during pregnancy improves postpartum sexual wellbeing.

Body image self-consciousness, sexting, and sexual satisfaction among midlife Canadians

Life circumstances at midlife are often different than those for younger adults (e.g., relationship type and duration, physical health, experience of sexual problems), and these circumstances impact experiences of sexuality and sexual behaviour. Past research on sexual behaviours like sexting, which has been primarily conducted on young people, may not generalize to middle-aged adults. Sexting may be a beneficial activity for midlife adults in long-term relationships who are seeking private and convenient ways to communicate sexual interest. Furthermore, as in younger samples, sexting may be associated with body image and sexual satisfaction. A cross-sectional study with a sample of 640 midlife (40–59 years old) married Canadians was conducted to address these suppositions. Structural equation modelling was used to test the factorial validity of a body image self-consciousness (BISC) scale and to investigate the connections between BISC, sexting frequency (to communicate sexual interest, to initiate sexual activity, and that include a picture), and sexual satisfaction. Almost one-half of participants (43%) reported sexting to communicate sexual interest, 37% sexted to initiate sexual activity, and 18% sexted sexy pictures of themselves. Women with lower levels of BISC were more likely to sext (communicate, initiate, and pictures), and men with lower levels of BISC were more likely to send sexts with pictures. Both men and women with lower levels of BISC and those who engaged in sexting to communicate sexual interest had higher levels of sexual satisfaction. Sexting may be an opportunity for busy marital partners to engage in technology-mediated sexual activity when apart. The current results indicate that technology-mediated sexual communication has similar psychological mechanisms to face-to-face interactions and that sexting may be a beneficial behaviour for sexual satisfaction within midlife marriages.

Conceptualization and Inventory of the Sexual and Psychological Burden of Women With Pelvic Floor Complaints; A Mixed-Method Study

Introduction

Despite the fact that the literature reports various restrictions and types of distress in women with pelvic floor complaints, a comprehensive overview of women's sexual and psychological burden emerging from these complaints is lacking, which compromises our ability to assess and grasp the impact to women.

Aim

This study was performed to conceptualize women's sexual and psychological burden and create a more comprehensive overview on this topic from both women's and health care providers’ perspectives. Furthermore, this research intended to identify items to populate a to-be-developed instrument to assess sexual and psychological burden.

Methods

In Group Concept Mapping, 125 statements were used about restrictions and distress that women with pelvic floor complaints experienced. Women with, and health care providers with and without pelvic floor complaints (13 women and 3 men) sorted the statements into comprehensive self-labeled clusters and rated their nature and severity. Multidimensional scaling and hierarchical cluster analyses were performed to identify a conceptual model of coherent clusters of statements. Item-total correlations of severity scores were calculated to identify statements that can be used in future research to represent women's sexual and psychological burden.

Main Outcome Measure

A conceptual model emerged, and outcomes of item-total correlations were then examined again using the conceptual model.

Results

Seven distress clusters were identified, namely, loss of control, sexual distress, feeling insecure, feeling wronged, feeling helpless, feeling angry, and feeling disappointed. Feeling insecure appeared more pervasive than other distresses. Furthermore, 33 statements were identified that can be used in future research to develop an instrument to assess sexual and psychological burden representing both women's and health care providers’ perspectives.

Conclusion

The conceptual model and list of statements may concisely represent the sexual and psychological burden of women with pelvic floor complaints from both women's and health care providers’ perspectives on this topic.

Brand AM, Rosas S, Waterink W, et al. Conceptualization and Inventory of the Sexual and Psychological Burden of Women With Pelvic Floor Complaints; A Mixed-Method Study. Sex Med 2022;10:100504.

Relationship Between the Genital Self-Image and the Sexual Quality of Life of Primiparous Women in the Postpartum Period in Heterosexual Couples

Objectives: This study was planned to investigate the relationship between the genital self-image of primiparae and their sexual quality of life in the postpartum period in heterosexual couples. Method: In this cross-sectional and correlational study, the data were collected through face-to-face interviews in the eastern part of Turkey. Results: The results demonstrated that the relationship between the genital self-image and sexual quality of life of the participants who were sexually active after birth was moderate (r = 0.52, p <.001). Both the genital self-image and sexual quality of life of the participating women were affected by the romantic relationship between them and their partners after birth (p <.01). Conclusions: Healthcare professionals should encourage and support couples to look over their relationship and problems they experience in their romantic relationship after birth.

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.

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.

Knowledge of Vulvar Anatomy and Self-examination in a Sample of Italian Women

OBJECTIVE

The aim of the study was to investigate the knowledge of vulvar anatomy and vulvar self-examination (VSE) in a sample of Italian women attending a gynecology clinic.

METHODS

For this original research from May to July 2019, 512 women attending the Lower Genital Tract Clinic at the Department of Surgical Sciences of the University of Torino were invited to participate in a 29-question survey about vulvar anatomy, VSE, and sociodemographic details. Data were analyzed using descriptive statistics.

RESULTS

Of 512 patients, 500 completed the questionnaire (98% response rate). The mean age of respondents was 41 years (range = 17-77 years). Education level was evenly distributed between elementary, high school, and university graduates. Only 15% of interviewed women were able correctly sketching vulvar anatomy. Seventy-six percent of the women had not heard about VSE, and 61% of the women approach their genitalia with feelings of shame and embarrassment. Only 23% of the women would seek medical advice after identification of possible abnormalities during VSE. A majority (69%) of the women would like to have more information about VSE and vulvar health through educational videos and social media.

CONCLUSIONS

Education about VSE may lead to earlier diagnosis of vulvar cancers and other pathologies. Further efforts are needed to disperse information about normal external female genital anatomy and VSE to achieve self-confidence among women.

Factors influencing stress, anxiety, and depression among Iranian pregnant women: the role of sexual distress and genital self-image

Background

Pregnancy is a unique period with the increased likelihood of psychological changes and emotional disturbances such as depression, anxiety, and stress. In this study, we investigated the factors influencing depression, anxiety, and stress in pregnancy and identify their associations with Sexual Distress (SD) and Genital Self-Image (GSI).

Methods

This was a descriptive, correlational, cross-sectional study performed using the two-stage cluster sampling method between September 2019 and January 2020. Overall, 295 pregnant women completed a demographics and obstetric information checklist, Depression Anxiety and Stress Scale-21 (DASS-21), Female Genital Self-Image Scale (FGSI), and Female Sexual Distress Scale-Revised (FSDS-R).

Results

Analysis of Variance (ANOVA) showed significant differences in the mean scores of SD between the groups with varying degrees of depression, anxiety, and stress (P <  0.001) and in the mean score of GSI between the groups with varying degrees of depression (P = 0.01) and anxiety (P <  0.001). In multivariate linear regression analysis, higher (worse) depression, anxiety, and stress scores were found in women with more advanced age and higher SD scores; however, these scores were lower (better) in those with increased gestational age. Lower depression and anxiety scores were associated with moderate satisfaction with income, moderate satisfaction with BI in pregnancy, and lower stress and depression scores were linked to planned pregnancy. Higher (better) GSI score was a predictor of lower depression score, complication in a previous pregnancy was a predictor of higher stress score, and finally, fear of fetal abortion and being a housewife were predictors of a higher anxiety score.

Conclusion

Various factors contribute to the development of antenatal depression, anxiety, and stress. A positive correlation was found between SD and the severity of depression, anxiety, and stress, while a negative correlation was noted between GSI and the severity of depression and anxiety. Therefore, raising awareness regarding SD and GSI through screening and counseling sessions can have beneficial effects for mothers and their fetuses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03575-1.

Roles of Genital Self-Image, Distraction, and Anxiety in Women's Sexual Pleasure: A Preregistered Study

Women with negative genital self-image are more likely to experience sexual dysfunction , but the processes underlying this association are unknown. We theorized that this association is mediated by distraction from the arousing sexual cues that foster pleasure and orgasm . In a sample of 1,619 women who had sex in the previous four weeks, women with negative genital self-image were more likely to be distracted by self-critical concerns (i.e., appearance- and performance-based distraction and embarrassment) during sex, and in turn, experienced less sexual pleasure and worse sexual function. Additionally, this indirect effect via appearance-based distraction was strongest among women with trait-level anxiousness and social anxiety. We found a similar pattern of results when investigating the indirect effect of genital self-image on sexual function. Implications for understanding sexual function and therapeutic approaches are discussed.

Sexual function in Chinese women from pregnancy to postpartum: a multicenter longitudinal prospective study

Background

The aims of our research were as follows: First, to estimate the prevalence of female sexual dysfunction in early, middle, late stages of pregnancy, and postpartum 6 months after delivery. Second, to discuss relevant factors associated with female sexual dysfunction among women in 6 months after delivery in Nanjing, Yangzhou and Huaian Main, China.

Methods

Our multicenter longitudinal study was carried out from September 2017 to March 2019, with participants recruited from Southeast China: Nanjing, Yangzhou and Huaian. Participants were recruited when they built their Record of Prenatal Care in community hospitals. The online questionnaires included a set of validated tools, sociodemographic information as wells as medical history data. In the meantime, qualitative interviews were conducted during different periods of pregnancy (from the first trimester to the third trimester of pregnancy and following up to six-month postpartum) respectively. All participants have obtained written informed consent.

Results

By qualitative interview, the vast majority of the participants were inactive in having sex from pregnancy to postpartum. There were negative aspects of sexual experiences, emotional responses closely related to self-attitudes toward sexual behavior during this period. Through quantitative analysis, pre pregnancy BMI (OR = 1.15, P = 0.012), postpartum weight gain (OR = 1.057, P = 0.033) and partnership quality (OR = 1.181, P = 0.04) were associated with postpartum sexual dysfunction 6 months after delivery.

Conclusions

Women are at the risk of significantly different FSD with regard to pre-pregnancy BMI, postpartum weight gain and partnership quality. The impaired sexual function from pregnancy to postpartum period indicated the requirement for further survey as well as extensive investigation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03546-6.

#postbabyhankypanky: An Empirically Based Knowledge Sharing Initiative About Sex and the Transition to Parenthood

Despite the many sexual concerns experienced by new parents, and their reported desire for more information on this topic, both parents and healthcare providers remain reticent to broach the subject. The goal of this project was to disseminate evidence-based knowledge from our prior research in a way that was accessible, engaging, and would spark further interest and communication for both new parents and healthcare providers. We convened a multidisciplinary advisory group that also involved community parents who provided feedback at all phases of this project. We developed five brief YouTube videos, each featuring a core research finding. Following an empirically supported strategic knowledge translation plan, we disseminated the videos to our target audiences (i.e., expectant and new parents, healthcare providers, educators, and other stakeholders) using social media from February 2018 to November 2019. Data were collected using YouTube analytics and an online survey (convenience sample: N = 225 parents; N = 161 healthcare providers). From the date of the launch, the videos had a reach of 91,766 views from 14 countries, with viewers watching an average of 90% of a video. Overall, quantitative and qualitative survey results suggested that the videos were acceptable and appropriate, and respondents were more confident and comfortable discussing sexual issues (with their partner/with their patients) and would like more information about postpartum sexuality after watching the videos. YouTube videos are an acceptable and effective way to disseminate evidence aimed at raising awareness of factors affecting sexuality in the transition to parenthood.

Genital self-image as predictor of sexual dysfunction in women with pelvic organ prolapse in Indonesia

Background:

The incidence of sexual dysfunction increases in women with pelvic organ prolapse. In addition to physical factors, other important components that influence each other in sexual dysfunction are psychological aspects and genital self-image. Sociocultural factors also affect individual sexuality and sexual behavior. Until now, there are no data and the relationship between genital self-image and sexual dysfunction in pelvic organ prolapse is not known in Indonesia.

Objective:

This study aims to analyze the correlation of genital self-image with sexual dysfunction in women with pelvic organ prolapse.

Methods:

In this cross-sectional study, 113 consecutive women with pelvic organ prolapse were selected in urogynecology referral centers in Jakarta. Demographic data, physical examination, and guided interviews were filled in to complete the Female Sexual Function Index and Female Genital Self-Image Scale-7 questionnaires. Preliminary research has been carried out in the form of language translation and cultural validation of the Indonesian version of the Female Genital Self-Image Scale-7 questionnaires.

Results:

There is a significant correlation between genital self-image and sexual dysfunction, where the lower Female Genital Self-Image Scale-7 score significantly predicts the lower Female Sexual Function Index score (p < 0.000; odds ratio: 14.17).

Conclusion:

Genital self-image is the main variable that affects sexual function in women with pelvic organ prolapse. It is necessary to evaluate and treat genital self-image because sexual function is an integrated component of quality of life.

A Comparison of the Sexual Well-Being of New Parents With Community Couples

BACKGROUND

Changes in sexual well-being are common for new mothers and their partners after the birth of a baby. However, most research has sampled mothers not couples, assessed only one aspect of sexual well-being, and has not included a control sample of couples.

AIM

This study aimed to compare the sexual well-being (ie, sexual frequency, sexual satisfaction, sexual desire, sexual distress) of first-time mothers and their partners in the transition to parenthood (first 12-month postpartum) to community couples who are not actively in this transition. We also compared the sexual well-being within couples (eg, mothers to their partners).

METHODS

Couples in the transition to parenthood (n = 99) completed measures of sexual satisfaction, sexual desire, sexual distress, and sexual frequency at 3, 6, and 12 months postpartum, and community couples (n = 104) completed the measures at a single time point.

OUTCOMES

Measures included the following: (i) Global Measure of Sexual Satisfaction Scale; (ii) Female Sexual Function Index and International Index of Erectile Function sexual desire subscale; (iii) Female Sexual Distress Scale-Revised; and (iv) checklist of sexual behaviors.

RESULTS

Compared with community controls, new parents reported lower sexual satisfaction, lower sexual desire, and higher sexual distress at all time-points; however, these group differences became less pronounced by 12 months postpartum. By 6 months postpartum, there was no difference in sexual frequency between postpartum couples and the control group. Mothers experienced persistently lower sexual desire relative to their partners throughout the 12 months postpartum. Between 39% and 59% of mothers reported clinically low sexual desire, and 47-57% reported significant sexual distress at all time points. There were no significant differences reported in sexual satisfaction, sexual desire, or sexual distress between women and their partners in the community sample.

CLINICAL IMPLICATIONS

Clinicians should be aware that sexual well-being may be compromised in new parents, and some of these challenges are still present for new parents at 12 months postpartum. Findings can be used to educate new parents regarding their expectations about postpartum sexual well-being.

STRENGTHS & LIMITATIONS

The strengths of the present study are the dyadic approach, assessing multiple aspects of sexual well-being in new parents over time, and the comparison with a community sample. An important limitation is that the control sample was not followed up over time.

CONCLUSION

Education regarding postpartum sexual well-being should be incorporated in routine perinatal and postnatal healthcare practices to support new parents in developing realistic expectations about changes during the transition to parenthood, potentially preventing undue distress. Schwenck GC, Dawson SJ, Muise A, et al. A Comparison of the Sexual Well-Being of New Parents With Community Couples. J Sex Med 2020;17:2156-2167.

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.

Breastfeeding and Sexual Activity and Sexual Quality in Postpartum Women

Background: Breastfeeding is the ideal source of nutrition for infants. Breastfeeding can affect sexual activity and sexual quality of women in the postpartum period. Objective: The present study was carried out to determine the effect of breastfeeding on sexual activity and sexual quality in postpartum women. Materials and Methods: The sample of the study consisted of 161 breastfeeding and 176 nonbreastfeeding women who were cared for in the Family Health Centers utilizing the Descriptive Information Form and Sexual Quality of Life-Female (SQOL-F) questionnaire. Results: Half of the breastfeeding and nonbreastfeeding women included in the study had cesarean delivery and the women in both groups reported changes in their sexual life (having less sexual intercourse, and suffering from dyspareunia) during the postpartum period. In the present study, 68.3% of the breastfeeding women and 47.7% of the nonbreastfeeding women experienced dyspareunia, and the difference between them was statistically significant (p < 0.05). There was also a statistical difference between the breastfeeding women and nonbreastfeeding women in terms of the types of changes experienced in sexual life (p < 0.05). The rate of the women who enjoyed sexual satisfaction more was higher in the nonbreastfeeding women (15.9%) than in the breastfeeding women (1.2%). The SQOL-F scale total mean score was 60.07 ± 9.88 in the breastfeeding women and 62.81 ± 9.66 in the nonbreastfeeding women, but the difference between the groups was not statistically significant (p > 0.05). Conclusions: In the present study, the sexual life quality mean scores between the breastfeeding and nonbreastfeeding women were moderate and similar to each other. The fact was that the reported sexual life quality was similar in the breastfeeding and nonbreastfeeding women despite the association of a lower sexual desire and frequency of intercourse in the breastfeeding group, suggesting that breastfeeding may serve as a sexual alternative for nursing mothers.

The Relationship of Close Marital Affairs to Healthy Women's Sexual Function: A Cross-Sectional Retrospective Study in Egypt

Introduction

Some marriage-related factors may be associated with women’s sexuality, but this topic has not been sufficiently investigated in developing countries. Indeed, these marital factors can be well planned and/or managed to achieve desirable outcomes; for instance, the legal age of marriage can be increased to 21 years. However, how this will reflect on women’s sexuality should be clarified before any laws are changed.

Aim

The purpose of this study was to investigate the associations of the age of marriage, number of children, educational level, duration of marriage, and aging with female sexual function among groups of Egyptian women.

Methods

We analyzed the recorded sociodemographic data and scores of the 19-item Female Sexual Function Index (FSFI) among 270 apparently healthy women aged 21−45 years. According to the studied variables, the data were divided into various subgroups.

Main Outcome Measure

The sociodemographic data and scores of the FSFI.

Results

Marriage, before or after 21 years, was not correlated with sexual function. FSFI scores were significantly lower among women with ≥3 children and women who had been married for ≥10 years. FSFI scores were significantly lowest in women with the lowest educational level and those aged ≥40 years.

Conclusion

It is important to ensure that people are equipped with accurate information. Sound knowledge can serve as the basis for informed decisions regarding the age of marriage and number of children desired. Furthermore, everyone, not just women, should be aware of the adverse sexual effects associated with long marriages and the age-related declines in sexual activity. Accordingly, women can achieve better sexual satisfaction.

Hassanin AM, Kaddah AN, El-Amir MY. The Relationship of Close Marital Affairs to Healthy Women’s Sexual Function: A Cross-Sectional Retrospective Study in Egypt. Sex Med 2019;7:498–504.

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.

Female genital image: is there a relationship with body image?

OBJECTIVE

Dissatisfaction with body image may extend to the genital region, and the most dissatisfied with their bodies are women. To analyze the relation between body image and genital image in female, and to verify demographic and/or clinical factors related to body image and genital image.

MATERIALS AND METHODS

This is a cross-sectional study in 421 women. The Body Shape Questionnaire-34 (BSQ-34) was used to evaluate body image perception; scores ≤110 indicate no dissatisfaction. Also, the female genital self-image scale-7 (FGSIS-7) was used to evaluate genital self-image; scores range between 7 and 28, with higher values considered to indicate a more positive genital self-image. The relation between body image and genital image was determined using the Pearson Correlation test, as well as the relation of these with body mass index (BMI) and age. The relation between these data and genital image was determined by using the ANOVA test or the independent t-test (statistical difference was accepted as p<0.05). In order to verify predictors of dissatisfaction with body image, variables with p<0.10 were inserted into the logistic regression model and checked if they remained significant (p<0.05).

RESULTS

Three hundred eighty-nine women were analyzed. The mean age was 34.7±10.2 years. The mean BMI was 24.1±3.6 kg/m², 49% were single, and the mean BSQ-34 and FGSIS scores were 83.2±30.8 and 23.8±3.4, respectively. The correlation (r=-0.24) was found between body image and genital image (p<0.001). A total of 315 women indicated to be satisfied with their body and presented an FGSIS-7 score of 24±3.3. Participants who were dissatisfied with their body had an average FGSIS-7 score of 22.6±3.3.

CONCLUSION

Genital image, age, and BMI influence body image. Change in the perception of body image seems to have low correlation with genital self-image in women.

Genital Self-Image: Associations with Other Domains of Body Image and Sexual Response

Genital self-image is an emerging aspect of body image relevant to sexual functioning and sexual satisfaction. The aims of the present study were to (1) examine the association between body image and genital self-image with a broad range of sexuality-related outcomes; (2) explore whether genital self-image is a more salient influence on sexual satisfaction and functioning than body image and (3) determine whether this would hold true for both men and women. The analytic sample (6,228 cis-gendered, heterosexual men and women between the ages of 18 and 40) was recruited from reddit.com online communities. Participants completed a survey that assessed genital self-image, body image, sexual satisfaction, and sexual functioning. Among women and men, positive genital self-image was associated with positive feelings about one's body overall and reduced body-related concerns specific to sexual encounters (e.g., sexual performance). In female respondents, as genital self-image increased, so did sexual satisfaction. Although genital self-image did not significantly predict sexual satisfaction among men, exploratory analysis indicated a mediating relationship with body image concerns. Findings from the current study may inform interventions to facilitate the development of a healthy sexual self-concept as well as a more positive outlook on genital appearance among men and women.

Personality and Postpartum Sexual Functioning in Israeli Women: The Mediating Role of Body Image

In this study, we aimed to measure the association between the postpartum personality and sexual functioning. This association was examined in light of the possible mediation effect of body image measures, that is, body satisfaction and body exposure during sexual activity. This cross-sectional study employed a web-based questionnaire for women who had given birth in the previous year ( N = 382). Key outcome measures included sexual functioning after birth, body image satisfaction, neuroticism, and extraversion personality dimensions. Among the key findings, increased anxiety regarding body exposure during sexual activity and lower body satisfaction were associated with lower postpartum sexual functioning. Higher neuroticism, but not extraversion, was associated with lower postpartum sexual functioning; however, this association was mediated by the body image measures. Given this mediation by body image variables, it may be beneficial to address body image issues when treating women with postpartum sexual difficulties.