The sexual function of women during puerperium: a qualitative study

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.

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.

Emotion-focused group therapy among women with premenstrual dysphoric disorder: A randomized clinical trial

OBJECTIVE

Premenstrual Dysphoric Disorder (PMDD) contributes to couple burnout, reduced quality of life, sexual dysfunction, and social isolation. The present study aimed to investigate the effectiveness of emotion-focused group therapy (EFGT) in pain perception, self-compassion, sexual function, and couple burnout in women with PMDD. Method: Among married females with PMDD, 72 participants were selected and randomly assigned to experimental and waitlist control groups. EFGT was performed in 10 sessions for the subjects in the experimental groups. The McGill Pain Questionnaire, Self-Compassion Scale, Female Sexual Function Index and Couple Burnout Measure were used to collect data in the pre-test and post-test. To analyze the data, an analysis of covariance test was applied. Results: The findings demonstrated that EFGT was effective in pain perception (p < .001, η²=.80), self-compassion (p < .001, η²= .86), sexual function (p < .001, η²= .38), and couple burnout (p < .001, η²= .70). Participants of EFGT improved well, were satisfied with treatment, and had a good therapeutic relationship. Conclusion: Implementing EFGT increased the components of self-compassion and sexual function, and reduced the components of pain perception and couple burnout. It seems that EFGT could be effective in women with PMDD.

Postpartum Urinary Incontinence: A Qualitative Study on Sexuality and Life Experiences of Muslim Turkish Women

OBJECTIVES

The study was planned to identify the sexuality and life experiences of Muslim Turkish women with urinary incontinence (UI) within 12 months postpartum.

METHODS

A qualitative study was conducted using a semistructured interview. Data were collected between July and December 2019 via an in-depth, face-to-face interview technique using an interview form. The qualitative data obtained in this study were analyzed with the content analysis technique.

RESULTS

The main themes related to sexuality and life experiences of the women with UI in the postpartum period were identified as "problems in daily life," "emotional effects," "baby-related effects," and "spouse's and family's attitudes."

CONCLUSIONS

As a result, it was found that women in the postpartum period were affected by UI in terms of behavioral, emotional, and social aspects.

Sexual educational needs of Jordanian women after giving birth

BACKGROUND

Pregnancy and birth entail many bodily changes, including changes in sexual activity. The postpartum period is a time of considerable recovery and adaptation for women, yet women do not always receive adequate information, especially in countries where such topics may be considered taboo. The purpose of this project was to explore the sexual educational needs of Jordanian women after giving birth.

METHODS

A qualitative, phenomenological approach was used. A purposive sample of 25 women were recruited from two health care centers. Semi-structured, in-depth interviews were conducted in person in Arabic between August and November 2015. Transcripts were independently analyzed and coded by each researcher.

RESULTS

Two major themes with six subthemes emerged. Theme 1, sexual education, included discussions about the women's needs for scientific information and the husband's involvement, and their psychological needs. Theme 2, professional approaches, involved discussions about the most appropriate person to deliver education, preferred place and time for education, and effective educational approaches to be used.

DISCUSSION

Congruent with previous studies, findings indicated that issues related to sexuality are often ignored in this population.

CONCLUSIONS

Jordanian women have many unmet educational needs with respect to sexuality after giving birth. More efforts are needed from health care professionals and other stakeholders to help improve Jordanian women's sexual health education after giving birth. These should include greater access to classes, websites with scientific information, and informational handouts that target husbands, and postpartum women themselves.

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.

A phenomenological study of Jordanian women's experience of sexual intercourse after giving birth

AIM

to explore the sexual experiences of Jordanian women on the first occasion after giving birth.

METHODS

phenomenological qualitative research. Twenty-five Jordanian women were purposively recruited from two maternal health centres and interviewed.

FINDINGS

four themes emerged: "culture and religion v/s health professionals in resumption of sexual intercourse"; "enduring physical and psychological discomforts"; "husbands' role in resumption of sexual intercourse"; and "newborn babies' role in the experience of sexual intercourse".

CONCLUSION

health professionals need to adopt appropriate maternal clinical guidelines to meet women's needs. There is a need to give greater emphasis on sexual health care provided to women during pregnancy and after giving birth.

What matters to women in the postnatal period: A meta-synthesis of qualitative studies

INTRODUCTION

The postnatal period is an underserved aspect of maternity care. Guidelines for postnatal care are not usually informed by what matters to the women who use it. This qualitative systematic review was undertaken to identify what matters to women in the postnatal period, to inform the scope of a new World Health Organization (WHO) postnatal guideline.

METHODS

We searched MEDLINE, CINAHL, PsycINFO, POPLINE, Global Index Medicus, EMBASE, LILACS, AJOL, and reference lists of eligible studies published January 2000-July 2019, reporting qualitative data on women's beliefs, expectations, and values relating to the postnatal period.

DATA COLLECTION AND ANALYSIS

Author findings were extracted, coded and synthesised using techniques derived from thematic synthesis. Confidence in the quality, coherence, relevance and adequacy of data underpinning the resulting findings was assessed using GRADE-CERQual.

RESULTS

We included 36 studies from 15 countries, representing the views of more than 800 women. Confidence in most results was moderate to high. What mattered to women was a positive postnatal experience where they were able to adapt to their new self-identity and develop a sense of confidence and competence as a mother; adjust to changes in their intimate and family relationships, including their relationship to their baby; navigate ordinary physical and emotional challenges; and experience the dynamic achievement of personal growth as they adjust to the 'new normal' of motherhood and parenting in their own cultural context.

CONCLUSION

This review provides evidence that what matters to women in the postnatal period is achieving positive motherhood (including maternal self-esteem, competence, and autonomy), as well as fulfilling adaptation to changed intimate and family relationships, and (re)gaining health and wellbeing for both their baby, and themselves. Where this process is optimal, it also results in joy, self-confidence, and an enhanced capacity to thrive in the new integrated identity of 'woman and mother'.

Coital resumption after delivery among OASIS patients: differences between instrumental and spontaneous delivery

BACKGROUND

Obstetric anal sphincter injuries (OASIS) are associated with sexual dysfunction and a lower likelihood of sexual activity in the postpartum period. The aim of the present study was to compare coital resumption and the variables influencing this activity after delivery in women with and without a history of obstetric anal sphincter injury (OASIS) and according to the mode of delivery.

METHODS

A prospective, observational, case-control study was performed at 6 months postpartum in 318 women: 140 with a history of primary repaired OASIS and 178 women without OASIS. Demographic and obstetric data, breastfeeding, and symptoms of urinary and anal incontinence were collected. Patients were asked about coital resumption and completed the validated specific Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12). Continuous and non-continuous variables were compared using ANOVA and the Fisher exact tests, respectively. A multivariate logistic regression model and a multiple regression analysis were constructed to assess the impact of demographic and clinical variables on the percentage of coital resumption and on the PISQ-12 score, respectively.

RESULTS

After a spontaneous delivery (SD), patients without OASIS showed a higher percentage of coital resumption than those with OASIS (98% vs. 77%; p = 0.003), and the PISQ-12 score was also higher (p < 0.001). PISQ-12 score was better in women with SD compared to those with operative vaginal delivery (OVD)(p < 0.001), independently of the history of OASIS. Current breastfeeding, a higher Wexner score and OVD negatively influenced the PISQ-12 score.

CONCLUSIONS

After SD, women with OASIS resumed coital activity later than women without OASIS. Women with OVD resumed coital activity later, and had a lower PISQ-12 score than women with SD.

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.