Sexuality & Breastfeeding: What Do You Know?

Pelvic floor-related sexual functioning in the first 24 months postpartum: Findings of a large cross-sectional study

INTRODUCTION

The pelvic floor is exposed to differing stresses and trauma depending on the mode of birth. At the same time, the pelvic floor plays a crucial role in female sexual functioning (FSF). Whereby FSF encompasses different dimensions, from subjective satisfaction to physiological aspects, such as lack of pain and orgasm ability. The aim of the study presented here is to assess FSF in relationship to postpartum pelvic floor disorder based on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), in a large convenience sample and to identify whether there is an association between mode of birth as well as perineal injuries and FSF of women up to 24 months postpartum.

MATERIAL AND METHODS

We conducted a cross-sectional online survey and recruited via social media women up to 24 months after birth of their last child. FSF was surveyed using the PISQ-IR. Details were also collected on all previous births and birth-related perineal trauma, as well as current breastfeeding, obesity, and socio-demographics. Multivariate models were then calculated to determine a possible association between FSF and birth mode.

RESULTS

The data basis is the responses of 2106 survey participants within the first 24 months postpartum. Even 12-24 months postpartum, 21% of respondents are not sexually active, which burdens almost 44% of these women. With regard to mode of delivery, differences in FSF are only evident in individual dimensions of the PISQ-IR. The dimensions "Condition Impact" and "Condition Specific" were significantly associated with more impairments in sexually active respondents up to 12 months postpartum whose last mode of delivery was forceps or vacuum extraction. If a perineal tear had occurred during last birth, this was significantly associated with a lower PISQ-IR subscore in the "Condition Impact," "Condition-Specific," "Global Quality," "Partner-Related," and "Arousal" models. The low variance explanation shows that further relevant factors on female sexuality may exist.

CONCLUSIONS

The issue of impairments in FSF following childbirth, persisting for an extended period of time, is a significant postpartum concern. Due to the very different dimensions of FSF, the influence of the mode of delivery must be considered in a differentiated way.

Breastfeeding vs. Formula Feeding and Maternal Sexuality among Polish Women: A Preliminary Report

Although postpartum sexual problems are common, there is a poor understanding of the underlying influencing factors and the impact of the infant feeding method on the mother's sexual life. A cross-sectional control study was conducted with a group of 253 women during their postpartum period. This study aimed to investigate the effects of different infant feeding methods on female sexual life after childbirth. The study followed the STROBE guidelines for cross-sectional control analysis. The study design included a questionnaire characterizing sociodemographic, obstetric and breastfeeding variables and the PL-FSFI (Female Sexual Function Index). The authors collected the data in compliance with the CAWI (Computer-Assisted Web Interview) research methodology-an interview conducted via an Internet channel. Each respondent received and completed the survey provided to them via the same online link. This study included women in the postpartum period: 170 breastfeeding women (study group) and 83 formula-feeding women (control group). There were statistically significant difference between the groups that practiced different types of breastfeeding. Out of all the PL-FSFI-assessing domains, the highest average score for the whole group correlated with satisfaction and the lowest score correlated with lubrication use. Our findings indicate that women practicing only breastfeeding are more likely to develop sexual problems. In order to maintain sexual health and promote long-term breastfeeding, extensive and professional counseling is needed for couples about postpartum sexuality and the factors that affect it, such as breastfeeding.

The effect of intra-vaginal oxytocin on sexual function in breastfeeding mothers: a randomized triple-blind placebo-controlled trial

BACKGROUND

Considering the importance of sexual function, high prevalence of sexual dysfunction (especially dyspareunia caused by atrophic vaginitis) in breastfeeding women, and lack of effective interventions, the present research aimed to determine the effect of oxytocin (OXT) vaginal gel on sexual function (primary outcome), sexual satisfaction, and depression (secondary outcomes) in the breastfeeding women.

METHODS

This randomized triple-blind controlled trial was conducted on 64 breastfeeding women who referred to health centers in the city of Tabriz, Iran, in 2020-21. Participants were equally assigned to intervention/control groups using block randomization. 200 IU of OXT vaginal gel was given to the participants in the intervention group daily for eight week and the same protocol was carried out for the control group with placebo. Standard questionnaires of Female Sexual Function Index (FSFI), Edinburgh Postpartum Depression Scale (EPDS) and Sexual satisfaction scale for women (SSSW) were completed at baseline and 8 weeks after intervention. ANCOVA test was used to compare post-intervention mean score of the groups, adjusted for the baseline values.

RESULTS

After intervention, there was no statistically significant difference between groups in terms of mean total score of FSFI (Adjusted Mean Difference (AMD): 1.14; 95% Confidence Interval (95% CI): -1.28 to 9.16; P= 0.349) and sexual satisfaction (AMD: 5.01; 95% CI: -0.53 to 10.56; P= 0.075). However, there was statistically significant difference between the groups in terms of mean scores of sexual contentment (AMD: 1.56; 95% CI: 0.29 to 2.83; P = 0.017) and depression (AMD: -1.90; 95% CI: -1.27 to -2.54; P < 0.001). One participant in the OXT group and one participant in the placebo group reported mild uterine contraction and one person in the placebo group reported vaginal burning sensations.

CONCLUSIONS

No evidence was found for the effects of OXT gel in the improvement of FSFI, even though, OXT significantly improved sexual satisfaction in the domain of contentment, and improved the symptoms of depression in comparison to the placebo group. However, a definite conclusion requires more research in this regard.

TRIAL REGISTRATION

the Iranian Registry of Clinical Trials (IRCT), code: IRCT20120718010324N55 , Date of registration: 27/05/2020, URL: https://en.irct.ir/user/trial/44986/view .

Sexual dysfunction among women of reproductive age: A systematic review and meta-analysis

Background

Available statistics show a high prevalence of sexual dysfunction (SD) among women worldwide. Various factors affect SD among women of reproductive age.

Objective

To evaluate studies on the prevalence and determinants of SD in different parts of the world.

Materials and Methods

MEDLINE, EMBASE, Web of Science, Scopus and ProQuest databases were systematically reviewed during 2000–2019. All original articles were reviewed. The STROBE checklist was used to evaluate the quality of the papers. I2 was calculated to determine heterogeneity. Fixed effects and/or random-effects models were applied to estimate the pooled prevalence. Meta-regression analysis was also performed to identify the sources of heterogeneity.

Results

Based on the results of the meta-analysis (21 eligible studies), the pooled prevalence with 95% confidence interval of SD was estimated at 50.75% (41.73–59.78). The prevalence of pain and disorders in arousal, sexual desire, lubrication, orgasm, and sexual satisfaction were calculated (39.08%, 48.21%, 50.70%, 37.60%, 40.16%, and 35.02%, respectively). Also, age, depression, low education level, increased duration of the marriage, and the presence of chronic diseases were the highest risk factors for SD.

Conclusion

The prevalence of SD in women of reproductive age varies in different countries. Considering the importance of female SD, further studies are needed to facilitate the development of relevant educational interventions.

The Association Between Infant Feeding Methods and Female Sexual Dysfunctions

Background: Although postpartum sexual problems are common, the impact of the infant feeding method on sexual life is still unclear. The aim of this study was to investigate the effects of different infant feeding methods and other influencing factors on female sexual life 3 months postpartum. Materials and Methods: Three hundred women from three obstetrical institutes were enrolled in this cross-sectional study. An online questionnaire was administered 3 months postpartum. Women were categorized into three groups: exclusive breastfeeding (n = 180), mixed feeding (n = 75), and formula-feeding (n = 45) groups. The infant feeding method was assessed by self-constructed questions. Sexual dysfunctions were evaluated by the Hungarian version of the Female Sexual Function Index (FSFI). Results: Of the women, 50.55% reported sexual dysfunction in the exclusive breastfeeding group, 42.66% in the mixed feeding group, and 31.11% in the formula-feeding group. Lack of sexual desire was the most prevalent dysfunction regardless of the infant feeding method. Significantly lower median scores were found in the exclusive breastfeeding group compared with the formula-feeding group for the total FSFI score (p = 0.002), arousal (p = 0.034), lubrication (p = 0.020), orgasm (p = 0.015), and pain (p = 0.021) subgroups. Breastfeeding (p = 0.032) and the quality of prepregnancy sexual life (p < 0.001) were significant factors, whereas prepregnancy dyspareunia, parity, age, income, and educational level did not predict women's postpartum sexual function. Conclusions: Our findings indicate that exclusive breastfeeding women have an increased likelihood of sexual problems 3 months postpartum. Extensive and professional counseling is needed for couples about postpartum sexuality and influencing factors such as breastfeeding to maintain sexual health and promote long-term breastfeeding.

The Effect of Sexual Health Counseling Based on REDI Model on Sexual Function of Lactating Women with Decreased Sexual Desire

Introduction: Sexual problems have significant effects on individual sexual function. The aim of this study was to determine the effect of counseling on sexual function of lactating women with decreased sexual desire. Methods: This is a quasi-case research. The sample consisted of 104 lactating mothers with sexual desire disorder from 2 to 6 months after childbirth. Samples were randomly selected and divided into two control and case groups. Data were collected using questionnaires, including the decreased sexual desire scale, sociodemographic characteristics, and midwifery questionnaire, and female sexual function index (FSFI). Sexual function was measured before and 4 weeks after consultation based on the rapport building, exploration, decision making, and implementing the decision (REDI) model. The results were analyzed by using SPSS-24 software and a significant level of <5%. Results: The mean age of participants was 30.71 ± 6.23 years and 29.65 ± 5.66 years in the case and control group, respectively (p = 0.380), ∼50% had a diploma degree or more, 100% were living in urban areas, and 95.90% of women were housewives. Both case and control groups were homogeneous in terms of demographic and midwifery variables (p > 0.05). There was a highly significant difference between study and control groups regarding mean FSFI domains except for orgasm, as well as in the total FSFI score 4 weeks after the intervention (p < 0.001). The results of the linear mixed effects model for assessing the trend of mean total FSFI score present that the mean of total FSFI score in the case group was increased 2.26 in comparison with the control group. Estimated slopes for female indicate that the mean of total FSFI score was increased 3.44 for 1 month. Conclusions: The results of this study show that supporting lactating women with decreased sexual desire through sexual counseling based on the REDI model can make a significant difference in their sexual function.

Ten-Year Systematic Review of Sexuality and Breastfeeding in Medicine, Psychology, and Gender Studies

OBJECTIVE

To shed light on the current literature surrounding sexuality and breastfeeding from several domains (gender studies, psychology, and medicine), providing a discourse for discussions of sexuality, breastfeeding, and their interface while acknowledging the intersections of race and sexual orientation.

DATA SOURCES

A systematic search of the literature was conducted using search terms breastfeeding and sexual activity with the electronic databases PubMed, PsycINFO, and GenderWatch.

STUDY SELECTION

Eligible studies were in English and were published from January 2008 through March 2019. The search resulted in 171 articles, and an additional article was identified by an expert in the field; 12 were used for review. Exclusion criteria included articles that were focused on a specific culture, feminist theory, HIV/disease transmission, historical perspective, mode of child birth, and education. Only articles that discussed relationships between breastfeeding and sexuality were included. The 12 remaining articles were compared on the basis of purpose, design, sample and setting, and results and implications.

DATA EXTRACTION

One author extracted the data from the full-text articles and organized them into a table of evidence. Because study design and outcome measures varied, the data were synthesized narratively.

DATA SYNTHESIS

Themes that emerged from the synthesis were Breastfeeding influences one's relationship with their body and identity; When breasts are perceived as sexual, appearance influences breastfeeding decisions; and People have a concern with embarrassment, discomfort in public, and potential sexual implications of breastfeeding.

CONCLUSION

Clinicians should initiate conversations aimed at normalizing the coexistence of the characteristics of sexuality and nurturing in parents, potentially using the Sexual Perceptions of Breastfeeding Scale as a guide, while providing information about the potential for breastfeeding-related sexual dysfunction and its remedies.

A comparison of sexual function in primiparous and multiparous women

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

What are the prevalence and factors associated with sexual dysfunction in breastfeeding women? A Brazilian cross-sectional analytical study

OBJECTIVE

This study determined the prevalence and factors associated with sexual dysfunction in breastfeeding women.

DESIGN

Cross-sectional analytical study.

SETTING

Population-based study of individuals living in the northeast region of São Paulo state, Brazil.

PARTICIPANTS

From May to August 2017, 372 women aged ≥18 years were selected who gave exclusive, predominant or complementary breast feeding up to 23 months postpartum, and who did not have contraindications for the resumption of intercourse. Pregnant women, those diagnosed with mental health problems, users of medications that affect sexual function (antihypertensives, antidepressants or antipsychotics) and women unable to read or understand the instructions for the study were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

The breastfeeding women completed the Female Sexual Function Index, the EUROHIS-QOL 8-item index and a questionnaire to collect participants' sociodemographic, clinical and interpersonal data. A bivariate analysis was performed, and variables with p values<0.20 were analysed by multivariate logistic regression.

RESULTS

Sexual dysfunction was present in 58.3% of the study population. Factors significantly associated with female sexual dysfunction (FSD) included placing a low importance on sexual intercourse (adjusted OR [AOR]=2.49, 95% CI=1.22 to 5.09), limited communication with the partner (AOR=2.64, 95% CI=1.43 to 4.86), decreased frequency of sexual intercourse (AOR=2.17, 95% CI=1.30 to 3.61) and low quality of life (AOR=2.23, 95% CI=1.33 to 3.74).

CONCLUSIONS

The prevalence of FSD appears with a great magnitude in breastfeeding women. The risk factors for sexual dysfunction are biopsychosocial and these findings may lead to improved counselling for prenatal and postnatal care.

Determinants of Female Sexual Function in Breastfeeding Women

Knowledge about the determinants of female sexual function in breastfeeding women is limited. A total of 355 breastfeeding women completed the Female Sexual Function Index (FSFI) and the Qol-8 quality of life questionnaire. FSFI scores decreased in the first six months of breast feeding. There was a positive relationship between FSFI scores and the importance of sex, level of communication, income, quality of life, and receiving brief sexual counseling.

Breastfeeding and Female Sexuality

This paper explores the apparent reluctance in the world to recognizing the sexuality of breastfeeding. It demonstrates the ways in which the experience of breastfeeding is desexualized and attempts an understanding of why this occurs. Breastfeeding is looked at from a psychobiological perspective and situates it within the complexity of female sexuality. Female sexuality is understood to have both maternal and erotic components. Maternal and erotic sexuality is examined from a hormonal, neurological, and anatomical perspective, in order to demonstrate the similarities. Resistances to experiencing breastfeeding as sexual are looked at from both an oedipal and preoedipal perspective. An attempt is made to understand the biochemical processes underlying the transformation of breastfeeding from its potentially erotic sexual position to a position of maternal sexuality. Maternal sexuality is looked at as a maturational achievement, perhaps an additional psychosexual stage following genital sexuality.

What are the factors that contribute to the development of sexual dysfunction in breastfeeding women? A systematic scoping review protocol

INTRODUCTION

Female sexual dysfunction is a public health problem. Evidence suggests that the population of nursing women is more vulnerable to the phenomenon due to breast feeding. Thus, this protocol was developed to explore the factors that contribute to the development of sexual dysfunction in breastfeeding women.

METHODS AND ANALYSIS

The systematic scoping review will be conducted in six stages, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. The databases used will be: PubMed, Excerpta Medica Database, Cumulative Index for Nursing and Allied Health Literature, PsycINFO, Science Direct, Web of Science and Google Scholar. The searches were made until 1 June 2018, and no retrospective time limit was used. For the organisation of the literature retrieved from the databases, the EndNote Basic manager will be used. The Cochrane model will be used for the data extraction. The analysis of the quantitative data will be carried out through descriptive statistics and the qualitative data will be submitted to thematic analysis. The methodological quality of the empirical studies will be evaluated using the Mixed Methods Appraisal Tool.

ETHICS AND DISSEMINATION

As it will be a review study, without human involvement, there will be no need for ethical approval. The results will be disseminated in a scientific journal, as well as in various media, such as: conferences, seminars, congresses or symposia.

Effectiveness of an Online Natural Family Planning Program for Breastfeeding Women

OBJECTIVE

To analyze the effectiveness of an online, nurse-managed natural family planning (NFP) program among breastfeeding women and subgroups of these women.

DESIGN

Longitudinal comparative cohort study.

SETTING

A university-based online NFP education program and menstrual cycle charting system.

PARTICIPANTS

Women (N = 816) with a mean age of 30.3 years (standard deviation = 4.5) who registered to use the online NFP system and indicated they were breastfeeding.

METHODS

Participants tracked their fertile times with an electronic hormone fertility monitor (EHFM), cervical mucus monitoring, or both. All unintended pregnancies were evaluated by professional nurses.

RESULTS

The correct use pregnancy rates were 3 per 100 users over 12 cycles of use, and typical rates were 14 per 100 at 12 cycles of use. At 12 cycles of use, total pregnancy rates were 16 per 100 for electronic hormone fertility monitor users (n = 380), 81 per 100 among mucus-only users (n = 45), and 14 per 100 for electronic hormone fertility monitor plus mucus users (n = 391).

CONCLUSION

Use of a nurse-managed online NFP program for women can be effective to help women avoid pregnancy while breastfeeding, especially with correct and consistent use.

An update on sexual function and dysfunction in women

Sexual function of women can be affected by many factors resulting in female sexual dysfunction (FSD). Sexual dysfunction is a common problem among women of all ages and has negative effects not only on their quality of lives but also on the sexual function and quality of life of their partners. It can also affect mental health of the entire family and society. Regarding the multidimensional nature of female sexual dysfunction and considering its consequences, this condition needs to be recognised in its early stages in order to prevent future consequences and impacts. This article discusses biopsychosocial aspect of female sexual function, classifications and risk factors of female sexual dysfunction and investigates current approaches to identify and treat this problem.

[Sexuality and breastfeeding: concepts and approaches of primary health care nurses]

The objective of this study is to identify the primary health care nurses' concepts about sexuality, and how this theme is integrated within the health care practices of these professionals when working with breastfeeding women. This qualitative, exploratory and descriptive study was performed with eight nurses from three primary health care units in a city in the north region of Rio Grande do Sul state. Data collection was performed through semi-structured interviews. Thematic content analysis revealed three themes: ideation about sexuality; sexuality and breastfeeding; and sexuality and nursing practices aimed at the breastfeeding woman. The study revealed that nursing professionals understand the broad meaning that sexuality represents and the relationship it has with breastfeeding, but they do not approach this theme in the care provided to women engaged in the breastfeeding process, thus their practices are grounded in the biomedical approach.

Getting BETTER: breaking the ice and warming to the inclusion of sexuality in mental health nursing care

Discussing sexual issues with consumers is considered a nursing role, yet it is commonly avoided. Research suggests that sexual issues and difficulties are particularly evident in mental health settings, and failure to address these issues represents a significant gap in care and treatment. Specific models for raising sexual issues have been used in oncology and cardiac care settings to assist clinicians. A descriptive, exploratory study was conducted with mental health nurses from Queensland, Australia. The aim of this research was to explore whether a specific model, the BETTER model (bring up, explain, tell, time, educate, record) was useful in assisting mental health nurses in raising the topic of sexuality with consumers. In-depth interviews explored participants' attitudes and experiences of discussing sexuality. Participants were introduced to the BETTER model, and were asked to trial the approach with consumers. They were then interviewed a second time. Two main themes emerged: greater awareness and becoming part of practice. Participants described a transformation of their practice from one of avoiding issues of sexuality with consumers, to a position of inclusion, which became embedded within practice. Participants did not tend to use the model in a structured way, and it appears that knowledge and awareness were more useful than the model itself.

Sexualidade de puérperas com bebês de risco

OBJETIVO: Identificar possíveis alterações na sexualidade de mulheres que experienciaram o puerpério com bebês de risco. MÉTODOS: Estudo do tipo coorte realizado com 193 puérperas que tiveram filhos nascidos entre maio e outubro de 2008 e incluídos no Programa de Vigilância ao Recém-nascido de Risco de Maringá-PR. Os dados foram coletados por meio de entrevista semi-struturada em duas visitas domiciliares, aos 45 dias e seis meses pós-parto. RESULTADOS: Entre as puérperas participantes 45,8% e 26,3% afirmaram que sua sexualidade estava pior do que antes da gravidez, respectivamente, aos 45 dias e seis meses após o parto. Não foi observada associação estatística entre sexualidade e qualquer variável aos 45 dias, mas o foi aos seis meses, após o parto em relação às intercorrências na gravidez (p=0,0259) e convívio com o companheiro (p=0,0093). CONCLUSÃO: Mães de recém-nascidos de risco, em especial, as que apresentaram intercorrência gestacional, necessitam de acompanhamento multidisciplinar e a longo prazo