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Cooper M, Gemzell-Danielsson K, Kopp-Kallner H, Heikinheimo O, Cameron S. Postpartum contraception provision across Europe: preliminary findings from a multi country survey. EUR J CONTRACEP REPR 2024:1-6. [PMID: 39166711 DOI: 10.1080/13625187.2024.2383953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 06/21/2024] [Accepted: 07/18/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION Looking after a baby and recovering from birth pose barriers to accessing and initiating effective contraception in the postpartum period. Another pregnancy at this time can end in abortion or a short interbirth interval. These are preventable if contraception is provided immediately from maternity settings. Our aim was to survey contraceptive experts across Europe about provision of postpartum contraception (PPC) in their country to develop a greater understanding of availability of and delivery of PPC services within the region. MATERIALS AND METHODS Contraceptive experts across Europe were invited to participate in an anonymous mixed-methods online survey consisting of free text and fixed-response questions focusing on: (1) national guidelines/policy (2) antenatal contraceptive discussion and (3) immediate postpartum provision of methods. Respondents were asked to rate PPC provision in their region and detail perceived facilitators or barriers. RESULTS Experts from 28 countries completed the survey. Fifteen (40%) reported their country had national guidelines for PPC provision, 40% reported that some antenatal contraceptive counselling was offered and 51% reported that contraceptive methods were provided in some (43%) or all (8%) maternity settings. Country-level PPC provision was reported as 'poor' or 'very poor' by 54% of respondents. Reported barriers to PPC provision included: cost, lack of policy/government support, awareness and training of maternity staff. CONCLUSIONS There is significant variation in PPC provision across Europe. Few countries offer antenatal contraceptive counselling or provide contraception from maternity settings. Introduction of supportive PPC policies, funding and training for staff could improve outcomes for mothers and babies.
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Affiliation(s)
| | | | | | - Oskari Heikinheimo
- University of Helsinki & Helsinki University Hospital, Helsinki, Finland
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2
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Singh R, Botfield JR. Postpartum contraception in Australia: opportunities for increasing access in the primary care setting. Aust J Prim Health 2024; 30:NULL. [PMID: 37879299 DOI: 10.1071/py23101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
In Australia, 20% of pregnancies occur within the first year after birth and most are unintended. Both unintended pregnancies and short interpregnancy intervals (<12-18months) can have adverse effects on maternal, infant, and child health. Access to postpartum contraception reduces the risk of unintended pregnancies and short interpregnancy intervals, and supports women in pregnancy planning and birth spacing. In this forum article, we describe how postpartum contraception is currently provided in Australia and highlight opportunities for improving access in the primary care setting.
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Affiliation(s)
- Rhea Singh
- SPHERE NHMRC Centre of Research Excellence, Monash University, Melbourne, Vic., Australia; and
| | - Jessica R Botfield
- SPHERE NHMRC Centre of Research Excellence, Monash University, Melbourne, Vic., Australia; and
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3
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Ollivier R, Aston M, Price S, Sheppard-LeMoine D, Steenbeek A. 'Feeling Ready': A Feminist Poststructural Analysis of Postpartum Sexual Health. QUALITATIVE HEALTH RESEARCH 2024; 34:252-262. [PMID: 37967315 PMCID: PMC10768324 DOI: 10.1177/10497323231209842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
There exists a lack of literature surrounding how postpartum individuals define feeling 'ready' to resume sexual activities after childbirth. Many factors may influence feelings of desire or readiness for sexual activities, such as breastfeeding. Therefore, it is important to understand why and how postpartum individuals understand and make meaning of their experiences surrounding postpartum sexual activities, as well as how those experiences are influenced or negotiated through relations of power. This study was guided by feminist poststructuralism and discourse analysis. Eleven participants who were between 1 and 6 months postpartum and living in Nova Scotia, Canada, were interviewed using semi-structured interviews. Participants challenged certain discourses surrounding sexual activities postpartum, including the social discourse that positions sexual activities as a requirement within romantic relationships and the discourse that positions health care providers as the authority on postpartum sexual health. 'Feeling ready' centered on four main issues: (1) navigating physical recovery; (2) personal knowing and emotional readiness; (3) the 6-week check; and (4) redefining intimacy. This article describes one branch of the findings within the overall study. Choosing to resume sexual activities postpartum, or feeling ready to do so, is individual, fluid, and complex. This research has important implications for practice and policy, specifically as it pertains to postpartum care.
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Affiliation(s)
- Rachel Ollivier
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Sheri Price
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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4
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Florkiewicz-Danel M, Zaręba K, Ciebiera M, Jakiel G. Quality of Life and Sexual Satisfaction in the Early Period of Motherhood-A Cross-Sectional Preliminary Study. J Clin Med 2023; 12:7597. [PMID: 38137665 PMCID: PMC10744264 DOI: 10.3390/jcm12247597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
The aim of the study was to assess the impact of breastfeeding-related fatigue and family support on the sexuality and quality of life of mothers during early motherhood. A cross-sectional preliminary study was conducted between 1 October 2021 and 15 May 2022 in 65 women being in early postpartum period. We used the authors' questionnaire developed for the purposes of the study; the Sexual Satisfaction Scale for Women-SSS-W; the Mell-Krat scale for women; and the General Health Questionnaire-GHQ28. A significant negative correlation was found between the age of the patients and the reduction in somatic symptoms (GHQ28 questionnaire) (r = -0.315, p = 0.011). Women working professionally achieved significantly higher results in the SSS-W contentment category (r = 0.313, p = 0.014). Frequent sexual activity reduced disorders in social functioning (the GHQ28 questionnaire) (r = -0.107, p = 0.283). Women who breastfed up to 5 times a day (p = 0.033) reached significantly higher SSS-W scores in terms of communication. The partner's help significantly contributed to higher sexual satisfaction in the aspect of compatibility (p = 0.004) and the overall level of satisfaction determined with the SSS-W questionnaire (p = 0.016). The presented study suggests that older mothers who are employed and supported by a partner have a higher level of contentment, sexual satisfaction and quality of life.
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Affiliation(s)
- Maria Florkiewicz-Danel
- Department of Nursing, Faculty of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, 00-968 Warszawa, Poland;
| | - Kornelia Zaręba
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain 17666, United Arab Emirates
| | - Michał Ciebiera
- 2nd Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education in Warsaw, 01-809 Warsaw, Poland;
- Warsaw Institute of Women’s Health, 00-189 Warsaw, Poland
| | - Grzegorz Jakiel
- 1st Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education in Warsaw, 01-004 Warsaw, Poland;
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5
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Fanshawe AM, De Jonge A, Ginter N, Takács L, Dahlen HG, Swertz MA, Peters LL. The Impact of Mode of Birth, and Episiotomy, on Postpartum Sexual Function in the Medium- and Longer-Term: An Integrative Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5252. [PMID: 37047868 PMCID: PMC10094321 DOI: 10.3390/ijerph20075252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
(1) Background: Sexual function can be affected up to and beyond 18 months postpartum, with some studies suggesting that spontaneous vaginal birth results in less sexual dysfunction. This review examined the impact of mode of birth on sexual function in the medium- (≥6 months and <12 months postpartum) and longer-term (≥12 months postpartum). (2) Methods: Literature published after January 2000 were identified in PubMed, Embase and CINAHL. Studies that compared at least two modes of birth and used valid sexual function measures were included. Systematic reviews, unpublished articles, protocols and articles not written in English were excluded. Quality was assessed using the Newcastle Ottawa Scale. (3) Results: In the medium-term, assisted vaginal birth and vaginal birth with episiotomy were associated with worse sexual function, compared to caesarean section. In the longer-term, assisted vaginal birth was associated with worse sexual function, compared with spontaneous vaginal birth and caesarean section; and planned caesarean section was associated with worse sexual function in several domains, compared to spontaneous vaginal birth. (4) Conclusions: Sexual function, in the medium- and longer-term, can be affected by mode of birth. Women should be encouraged to seek support should their sexual function be affected after birth.
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Affiliation(s)
- Anne-Marie Fanshawe
- Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, 9713 GL Groningen, The Netherlands
- Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, 9700 AD Groningen, The Netherlands
| | - Ank De Jonge
- Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, 9713 GL Groningen, The Netherlands
- Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
- School of Nursing and Midwifery, Western Sydney University, Blacktown, NSW 2148, Australia
| | - Nicole Ginter
- Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, 9713 GL Groningen, The Netherlands
- Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Lea Takács
- Department of Psychology, Faculty of Arts, Charles University, 128 08 Prague, Czech Republic
| | - Hannah G. Dahlen
- School of Nursing and Midwifery, Western Sydney University, Blacktown, NSW 2148, Australia
| | - Morris A. Swertz
- Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Lilian L. Peters
- Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, 9713 GL Groningen, The Netherlands
- Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
- School of Nursing and Midwifery, Western Sydney University, Blacktown, NSW 2148, Australia
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Mothering Ideology: A Qualitative Exploration of Mothers' Perceptions of Navigating Motherhood Pressures and Partner Relationships. SEX ROLES 2023; 88:101-117. [PMID: 36568897 PMCID: PMC9765384 DOI: 10.1007/s11199-022-01345-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Good mother ideology refers to beliefs that women are only 'good' mothers if they adhere to the tenets of dominant parenting discourse, such as intensive mothering ideology, which prioritizes children's needs and child-raising above all else. Undergirded by this ideology, mothers' attempts to navigate the transition to motherhood are fraught with pressures, and the transition is associated with negative health outcomes for mothers and children; yet existing research gives little attention to the quality or dynamics of the partner relationship as part of this transition. The current study examined motherhood pressure and the impact on partner relationships through individual, semi-structured interviews with 19 mothers living in Australia who were 18 years or older in a heterosexual relationship with at least one child under the age of five. Thematic analysis revealed four key themes: discourses on motherhood: criticisms of mothers and internalised guilt; transformation of identity; entrenchment of gender roles through childrearing; and positive relationship dynamics: supportive fathers and challenging gender roles. This study contributes to the larger body of literature highlighting the complexity of dominant mothering ideology and its entanglement with and impact on partner relationships. Further, this study includes mothers' perceptions of how they navigate these pressures within the relationship with their partner and the family unit. These findings have implications for programs to support mothers and other caregivers, as well as challenge unrealistic standards for motherhood. Supplementary Information The online version contains supplementary material available at 10.1007/s11199-022-01345-7.
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7
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Hees KA, Speer L, Gozzi P, Berg C, Hellmeyer L, Schlembach D, Wernecke KD, David M. Eine Analyse zur Wiederaufnahme von Geschlechtsverkehr und dem
Auftreten von Dyspareunie post sectionem. Z Geburtshilfe Neonatol 2022; 227:141-146. [PMID: 36368684 DOI: 10.1055/a-1929-1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ZusammenfassungSchwangerschaft und Geburt eines Kindes stellen eine prägende
Erfahrung mit Auswirkungen auf das Körpergefühl und die
Sexualität einer Mutter dar. Dabei wird in der Literatur bereits ein
Einfluss des Geburtsmodus auf die postpartale Sexualität diskutiert.
Ziel dieser Studie ist es nun, die Wiederaufnahme von vaginalem
Geschlechtsverkehr (vag. GV.) und das Auftreten einer Dyspareunie in
Abhängigkeit von primärer vs. sekundärer Sectio zu
untersuchen. Ebenso werden ein möglicher Einfluss des Stillens, der
(Still-)Amenorrhoe und hormoneller Kontrazeptiva auf die Wiederaufnahme des
vag. GV näher evaluiert.
Methodik Von Oktober 2019 bis Juni 2020 wurden 525 Frauen nach
erfolgter Sectio für eine prospektive, multizentrische Studie zur
Erhebung von Häufigkeit und assoziierten Beschwerden bei einer
Isthmozele drei (3 M. pp.) und sechs Monate postpartal (6 M.
pp.) rekrutiert. Im Rahmen dieser Studie wurden die Studienteilnehmerinnen
zudem mittels Fragebögen zur Wiederaufnahme des vag. GV, zum Stillen
und zu potentieller Symptome wie „Dyspareunie“ und
„Unterbauchschmerzen“ befragt. Eingeschlossen wurden Frauen
im Alter zwischen 18 und 40 Jahren, mit Einlings- oder
Geminigravidität, ohne Plazentationsstörung.
Ergebnisse 66,4% der befragten Frauen gaben
3 M. pp. an wieder vag. GV aufgenommen zu haben, zu 6 M. pp.
79,7% (p<0,001). Unter Einbeziehung des Sectio-Modus
(primär vs. sekundär) ergab sich weder ein signifikanter
Unterschied bezüglich der Wiederaufnahme von vag. GV (Aufnahme vag.
GV: 3 M. pp. p=0,843, 6 M. pp. p=0,236) noch
bezüglich einer Dyspareunie (3 M. pp. p=0,645,
6 M. pp. p=0,187). 6 M. pp. litten 41,5% der
Frauen nach primärer Sectio unter einer Dyspareunie und
50,0% nach sekundärer Sectio. Interessanterweise zeigten
sich „Stillen“ und „Ausbleiben der
Regelblutung“ als signifikante Einflussfaktoren auf das Auftreten
einer Dyspareunie 3 und 6 Monate postpartal (Stillen: 3 M. pp.
p<0,001; 6 M. pp. p=0,010; Regelblutung:
3 M. pp. p<0,001; 6 M. pp. p=0,006). So
zeigte sich bei Frauen, die stillten, häufiger eine Dyspareunie.
Ebenfalls häufiger trat eine Dyspareunie bei Frauen auf, die
„Ausbleiben der Regelblutung“ angaben. Die logistische
Regression ergab 3 M. pp. für Frauen, die nicht mehr
stillten, ein geringeres Risiko für eine Dyspareunie
(OR=0,46; 95%-Konfidenzintervall: 0,26–0,83;
p=0,010), sowie ein höheres Risiko für das Auftreten
einer Dyspareunie bei Ausbleiben der Regelblutung (OR=1,98;
95%-Konfidenzintervall: 1,15–3,43, p=0,014). 6
Monate postpartal ergaben sich diese Zusammenhänge in der
logistischen Regression nicht mehr.
Schlussfolgerungen Auch wenn sekundären Sectiones
oftmals verzögerte Geburtsphasen vorangehen und der Eingriff unter
erschwerten Bedingungen durchgeführt werden muss, zeigt sich in
dieser Studie kein Einfluss auf die postpartale Sexualität. Eine
(Still-)Amenorrhö wurde hingegen als Faktor identifiziert, der
vermehrt zu einer Dyspareunie führen kann.
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Affiliation(s)
| | - Lara Speer
- Klinik für Geburtsmedizin,
Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paola Gozzi
- Klinik für Gynäkologie,
Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Carolin Berg
- Klinik für Gynäkologie und Geburtsmedizin, Vivantes
Clinic in Friedrichshain, Berlin, Germany
| | - Lars Hellmeyer
- Klinik für Gynäkologie und Geburtsmedizin, Vivantes
Clinic in Friedrichshain, Berlin, Germany
| | | | - Klaus-Dieter Wernecke
- Institut für Biometrie und Klinische Epidemiologie,
Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias David
- Klinik für Gynäkologie,
Charité-Universitätsmedizin Berlin, Berlin, Germany
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8
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Cooper M, Cameron S. Improving Access to and Quality of Postpartum Contraception Provision. Semin Reprod Med 2022; 40:235-239. [PMID: 36626916 DOI: 10.1055/s-0042-1758114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Sexual activity and fertility can resume shortly after childbirth, but there are barriers to contraceptive access in the postpartum period. Unintended pregnancy and short interpregnancy intervals (of less than one year) can increase the risk of obstetric and neonatal complications. The antenatal period presents an opportunity to discuss contraceptive options, many of which can be safely initiated immediately after childbirth. Successful delivery of a postpartum contraception program requires an adequate number of maternity staff trained to provide the full range of methods.
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Affiliation(s)
- Michelle Cooper
- Department of Gynaecologist, Chalmers Centre, NHS Lothian/University of Edinburgh, Edinburgh, United Kingdom
| | - Sharon Cameron
- Department of Gynaecologist, Chalmers Centre, NHS Lothian/University of Edinburgh, Edinburgh, United Kingdom
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9
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Harrison LN, Neiterman E, MacEachen E, Gibson MF. Navigating return to sex: A qualitative Reddit analysis of parents' perceptions about the timing of resuming sex after a birth. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100782. [PMID: 36179395 DOI: 10.1016/j.srhc.2022.100782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/22/2022] [Accepted: 09/09/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Given the many transitions that occur in the postpartum period as men and women navigate the return to sex after a birth, this study aimed to explore parents' experiences of resuming sexual activity. METHODS This was a qualitative study that used posts from both men and women from the online public forum Reddit. Data were analysed using constructivist grounded theory. RESULTS This study found that the discourse surrounding sexual activity in the postpartum period was dominated by an understanding that medical guidelines prohibited sex prior to six weeks after giving birth. Although some parents disagreed, many Reddit users perceived a high degree of risk in resuming sex prior to six weeks and medical expertise was highly valued as parents negotiated the return to sex. While Reddit users were largely in agreement that penetrative vaginal sex prior to six weeks was a risky activity, there was less consensus as to the risk involved in other sexual activities. CONCLUSION This study recommends that medical practitioners initiate conversations with men and women about returning to sexual activity after a birth, and that these conversations should consider parents' emotional well-being as they resume sex. Further research is needed to establish evidence-based and comprehensive guidelines to facilitate these conversations.
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Affiliation(s)
- Lauren Nicole Harrison
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
| | - Elena Neiterman
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Ellen MacEachen
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Margaret F Gibson
- Social Development Studies, Renison University College, 240 Westmount Rd N, Waterloo, ON N2L 3G4, Canada
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10
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Trajectories of Postpartum Recovery: What is Known and Not Known. Clin Obstet Gynecol 2022; 65:594-610. [PMID: 35797600 DOI: 10.1097/grf.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Women's postpartum health is a public health issue that has lifelong consequences. Timely recognition and treatment of physical and mental health issues can have positive health consequences while lack of access to effective treatments or health care services can lead to long-term health problems. To advance knowledge of priority health symptoms and trajectories of postpartum recovery from women's health perspectives, we share findings from the Maternal health And Maternal Morbidity in Ireland (MAMMI) study. Data from 3047 first-time mothers recruited to a longitudinal maternal health study in Ireland from 2012 to 2017 reveal the trajectories of maternal health and health problems experienced up to 12 months postpartum. Morbidities explored include urinary incontinence, pelvic girdle pain, and sexual and mental health issues. Viewed together, and over time, the scale and persistent nature of many physical and mental health problems become apparent, yet considerable proportions of women were not asked directly about health problems by health care professionals. When women do not know what is and is not normal postpartum, they may suffer in silence and the consequence is that health problems/issues that are preventable, and treatable, are likely to become chronic. To make positive contributions to women's health, maternity care systems must be truly woman-centered and structured in ways that place emphasis on women's own health needs. In systems where women's voices and concerns are acknowledged and central, women are likely to thrive and flourish in motherhood.
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11
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Huber M, Tunón K, Lindqvist M. "From hell to healed" - A qualitative study on women's experience of recovery, relationships and sexuality after severe obstetric perineal injury. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100736. [PMID: 35640528 DOI: 10.1016/j.srhc.2022.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 05/03/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Few studies have investigated women's experiences of daily life after childbirth complicated by obstetric anal sphincter injury (OASI). The aim of the present study was to explore experiences related to recovery, sexual function, relationships and coping strategies among women affected by OASI. METHODS In-depth interviews were conducted using a purposive sample of 11 women affected by OASI. Women were interviewed 1-2 years after their first childbirth. Inductive qualitative content analysis was applied. RESULTS The theme "From hell to healed" illustrates women's experiences of recovery, relationships and sexual function after OASI. Three categories addressing women's perceptions emerged: "Challenged to the core", "At the mercy of the care provider" and "For better or for worse". Support from partners and family and comprehensive care were important elements for the experiences of coping and healing from OASI. Elements that negatively influenced women's experiences were the pain and physical symptoms of pelvic floor dysfunction, normalization of symptoms by heath care providers, and unrealistic expectations about how this period in life should be experienced. CONCLUSION OASI greatly affects women's experiences of their first years with their newborn child, relationships, social context and sexuality. For some women, OASI negatively affects everyday life for a long period after childbirth. However, others heal and cope quite quickly. Health care professionals need to identify and pay attention to women with persisting problems after OASI so that they can be directed to the right level of care.
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Affiliation(s)
- Malin Huber
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
| | - Katarina Tunón
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Maria Lindqvist
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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12
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Naigino R, Makumbi F, Mukose A, Buregyeya E, Arinaitwe J, Musinguzi J, Kiene SM, Wanyenze RK. Resumption of Sexual Intercourse Among Postnatal Women Enrolled on Lifelong Antiretroviral Therapy in Uganda. AIDS Behav 2022; 26:1684-1694. [PMID: 34714435 DOI: 10.1007/s10461-021-03520-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/26/2022]
Abstract
The postnatal period is critical to the delivery of interventions aimed at improving maternal health outcomes. This study examined the timing to resumption of sexual intercourse and associated factors among postnatal women living with HIV (WLWH) in Uganda. A sample of 385 women was drawn from a larger prospective cohort study conducted between 2013 and 2015. We used survival analysis to estimate the postpartum time periods during which women had a higher risk of sexual intercourse resumption within 6 months after childbirth. Cox proportional hazards regression was used to examine associated factors with sexual intercourse resumption. The cumulative probability of sexual intercourse resumption was lowest (6.2%) in the sub-acute postpartum period (1-45 days since delivery) and highest (88.2%) in the delayed postpartum period (151-183 days since delivery). Having a live-term baby (adjusted HR 0.52, 95% CI 0.31-0.85, p = 0.01) and an advanced education (adjusted HR 0.63, 95% CI 0.40-0.98, p = 0.04) were associated with a lower risk of sexual intercourse resumption. Desire for another child (adjusted HR 1.36, 95% CI 1.08-1.73, p = 0.01), having a sexual partner (adjusted HR 5.97, 95% CI 3.10-11.47, p < 0.001) and contraceptive use (adjusted HR 2.21, 95% CI 1.65-2.95, p < 0.001) were associated with a greater risk of sexual intercourse resumption. However, only 1 in 4 women who resumed sexual intercourse by the 90th day after childbirth, reported currently using contraception. HIV programs should focus on supporting postnatal women to align the timing of sexual intercourse resumption with their return to contraceptive use. Interventions aimed at improving contraceptive uptake among postnatal WLWH should target the delayed postpartum period.
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Affiliation(s)
- Rose Naigino
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Aggrey Mukose
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Esther Buregyeya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Susan M Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, USA
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Lichtenstein Liljeblad K, Kopp Kallner H, Brynhildsen J. Effectiveness, safety and overall satisfaction of early postpartum placement of hormonal IUD compared with standard procedure: An open-label, randomized, multicenter study. Acta Obstet Gynecol Scand 2022; 101:424-430. [PMID: 35141886 PMCID: PMC9564423 DOI: 10.1111/aogs.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In this open-label, randomized controlled, non-inferiority, multicenter study we aimed to study the risk of termination of pregnancy within 1 year postpartum, the safety profile and patient acceptability after early postpartum insertion of a hormonal intrauterine device (LNG-IUS, Mirena®) compared with standard placement 6-8 weeks postpartum. MATERIAL AND METHODS April 2018 to January 2020 women with uncomplicated vaginal delivery at four urban birth centers in Sweden, were randomized to either early placement within 48 h after delivery (early group) or standard placement 6-8 weeks postpartum (standard group) of a hormonal intrauterine device. The main outcome measure was the proportion of terminations of pregnancies in each group during the first year after placement of the intrauterine device. Registration EudraCT database no. 2017-001945-29. RESULTS The study was prematurely stopped according to the protocol due to an expulsion rate >20% in the early group. No pregnancies occurred. Fifty-two women were randomized to early and 49 women to standard insertion. In the early group, 23/52 (44.2%) of the intrauterine devices were expelled. After expulsion, 10 women chose to have another hormonal intrauterine device placed but still significantly fewer women (39/52, 75%, p = 0.22) in the early group used the hormonal intrauterine device method at study completion. No expulsions occurred in the standard group, but 5/49 (10.2%) requested removal and 41/49 (83.7%, p = 0.22) had used the hormonal intrauterine device method continuously for 1 year. CONCLUSIONS Early hormonal intrauterine device insertion after vaginal delivery is associated with high expulsion rates. Despite this, a high continuation rate of the hormonal intrauterine device method is seen among women once choosing the method. In the light of high continuation rates, the advantages of early insertion could balance the risk of expulsion for well-informed women.
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Affiliation(s)
- Karin Lichtenstein Liljeblad
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Linköping, Sweden
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Cooper M, Free CJ, Cameron S. Contraception after childbirth in the UK: beyond the COVID-19 pandemic. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:82-84. [PMID: 34750187 DOI: 10.1136/bmjsrh-2021-201310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/31/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Caroline J Free
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sharon Cameron
- Chalmers Sexual Health Centre, Edinburgh, UK
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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FitzPatrick KM, Brown S, Hegarty K, Mensah F, Gartland D. Physical and Emotional Intimate Partner Violence and Women's Health in the First Year After Childbirth: An Australian Pregnancy Cohort Study. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP2147-NP2176. [PMID: 32608316 DOI: 10.1177/0886260520934426] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Intimate partner violence (IPV) can comprise physical, sexual, and emotional abuse, and is a widespread public health concern. Despite increasing recognition that women experience different types of IPV, the majority of research has focused on physical IPV. The present study aims to examine associations between different types of IPV (physical, emotional, physical, and emotional) and women's mental, physical, and sexual health by analyzing longitudinal data from a prospective pregnancy cohort of 1,507 first-time mothers in Melbourne, Australia. Questionnaires included validated measures of physical and mental health (Short Form Health Survey, Edinburgh Postnatal Depression Scale) and IPV (Composite Abuse Scale). Emotional IPV alone was the most commonly reported type of IPV (n = 128, 9.5%), followed by both physical and emotional IPV (n = 76, 5.7%), and then physical IPV alone (n = 30, 2.2%). Women reporting emotional IPV or physical and emotional IPV had increased odds of poor health compared with women reporting no IPV. Experience of physical and emotional IPV was most strongly associated with mental health issues, including depressive symptoms (adjusted odds ratio [OR] 4.6, 95% confidence interval [CI] = [2.9, 7.1]) and self-reported anxiety (adjusted OR 2.9, 95% CI = [1.9, 4.4]). Experience of emotional IPV alone was associated with poor mental health as well as physical factors, including poor general physical health (adjusted OR 1.9, 95% CI = [1.2, 3.1]), and pain during sex (adjusted OR 1.8, 95% CI = [1.2, 2.7]). Increased odds of poor body image were also observed for women reporting emotional IPV alone and physical and emotional IPV. These findings highlight the need for greater awareness of the diversity in women's experiences of IPV among health care providers. This includes understanding the prevalence of emotional IPV among new mothers, and the range of health problems that are more common for women experiencing IPV.
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Affiliation(s)
- Kelly M FitzPatrick
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Melbourne, Victoria, Australia
| | - Stephanie Brown
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Melbourne, Victoria, Australia
| | - Kelsey Hegarty
- University of Melbourne, Victoria, Australia
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Deirdre Gartland
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Delgado-Pérez E, Rodríguez-Costa I, Vergara-Pérez F, Blanco-Morales M, Torres-Lacomba M. Recovering Sexuality after Childbirth. What Strategies Do Women Adopt? A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020950. [PMID: 35055771 PMCID: PMC8775547 DOI: 10.3390/ijerph19020950] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 01/15/2023]
Abstract
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.
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Affiliation(s)
- Esther Delgado-Pérez
- Physiotherapy Department, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (E.D.-P.); (M.B.-M.)
| | - Isabel Rodríguez-Costa
- Humanization in the Intervention of Physiotherapy for the Integral Attention to the People (HIPATIA) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain
- Correspondence:
| | - Fernando Vergara-Pérez
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (F.V.-P.); (M.T.-L.)
| | - María Blanco-Morales
- Physiotherapy Department, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (E.D.-P.); (M.B.-M.)
| | - María Torres-Lacomba
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (F.V.-P.); (M.T.-L.)
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Complications after interval postpartum intrauterine device insertion. Am J Obstet Gynecol 2022; 226:95.e1-95.e8. [PMID: 34461075 PMCID: PMC8940222 DOI: 10.1016/j.ajog.2021.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/06/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND: In the United States, up to 57% of women report resumption of sexual activity by the 6 week postpartum visit. Effective contraception should be addressed and provided at that time, to avoid unintended pregnancies and optimize interpregnancy intervals. Long-acting reversible contraceptives are the most effective forms of reversible contraception and are increasingly popular during the postpartum period. However, timing of postpartum intrauterine device (IUD) placement varies among providers and many delay insertion due to concerns for uterine perforation or expulsion of the IUD. OBJECTIVE: This study aimed to evaluate uterine perforation and expulsion rates with IUD insertion at 4–8 weeks postpartum vs 9–36 weeks postpartum. STUDY DESIGN: We performed a retrospective cohort study using the Kaiser Permanente Southern California electronic medical record from 2010 to 2016. We calculated the proportion of perforations and expulsions with IUD insertion at 4–8 weeks vs 9–36 weeks postpartum. Our primary outcome was the perforation rate. Secondarily, we evaluated the expulsion rate. For our minimum sample size calculation, to detect a difference of 0.5% in the perforation rate, with a baseline perforation rate of 0.5% for the 9–36 week postpartum IUD placement group, 80% power, and 5% alpha error rate, we would need at least 4221 participants per group, 8442 in total. RESULTS: A total of 24,959 patients met inclusion criteria (n=13,180 in the 4–8 week group, n=11,777 in the 9–36 week group). Of 430 patients with a confirmed complication, 157 uterine perforations and 273 IUD expulsions were identified. Perforation rates were significantly higher with placement at 4–8 weeks than at 9–36 weeks (0.78% vs 0.46%; P=.001). After adjusting for race and ethnicity, breastfeeding, IUD type, provider type, parity, most recent delivery, and body mass index, the odds of perforation remained higher with placement at 4–8 weeks than at 9–36 weeks (adjusted odds ratio, 1.92; 95% confidence interval, 1.28–2.89). Our Kaplan-Meier survival curve showed that the risk of uterine perforation remained elevated until approximately 22–23 weeks postpartum. Expulsion rates were similar between the 2 groups (1.02 vs 1.17; P=.52). CONCLUSION: Uterine perforation after interval postpartum IUD insertion is greater at 4–8 weeks than at 9–36 weeks, although perforation rates remain low at <1%. Expulsion rates did not differ between the groups. Because overall rates of uterine perforation are low, women can safely be offered IUDs at any interval beyond 4 weeks with minimal concern for perforation.
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18
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Feasibility, acceptability and sustainability of postpartum contraceptive implant provision by midwives in NSW public hospitals. Women Birth 2021; 35:e439-e445. [PMID: 34836756 DOI: 10.1016/j.wombi.2021.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Repeat pregnancy in the first year after a birth is common. Many of these conceptions are unintended and may be prevented by providing access to contraception in the immediate postpartum period. Midwives in the hospital setting could potentially play a greater role in improving postnatal contraception information and provision. AIM We sought to implement and examine the success of a program training hospital-based midwives in immediate postpartum implant insertion. METHODS This mixed methods study in two hospitals in New South Wales sought to explore the feasibility, acceptability and sustainability of a program that provided competency-based implant insertion training for midwives. The study documented training completion, implant insertion numbers and experience, and conducted end of study interviews with midwives and stakeholders. FINDINGS Twenty-seven midwives undertook training and inserted 265 implants during the study period. Interviews with 13 midwives and 11 stakeholders concluded the program to be feasible and acceptable with midwives reporting high satisfaction from their involvement. All interviewees felt that midwives were well placed to insert implants, and reported that challenges around workload and opportunities for practice were generally manageable. It was recognised that sustainability of the program would require supportive policy and regular insertion opportunities. CONCLUSIONS Midwives successfully upskilled in implant insertions and there was widespread support for the program with expectations it would be sustained. Provision of contraceptive information and implant insertion by midwives in the immediate postpartum period is likely to increase contraceptive choice and access for women and contribute to reducing rapid repeat pregnancies.
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Fan X, Zhou F, Li Y, Xia W, Che Y. Factors associated with postpartum resumption of sexual intercourse among women in China: A retrospective multicenter study. J Obstet Gynaecol Res 2021; 48:230-238. [PMID: 34788897 DOI: 10.1111/jog.15088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/16/2021] [Accepted: 10/22/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the prevalence and factors associated with early resumption of sexual intercourse among postnatal women in China. METHOD We conducted a retrospective multicenter study of 15 834 postpartum women from 60 hospitals in 15 different locations across China. Data were obtained from questionnaires administered to the participants. All dates were analyzed using a one-way ANOVA and two-level Cox multiple linear regression models. RESULTS More than half of the participating women (55.9%) resumed sexual intercourse by 3 months postpartum. The independent variables associated with the postpartum resumption of sexual intercourse included sociodemographic characteristics (age, geographic location, educational attainment) and medical histories, including the previous abortion (incorporate with spontaneous and voluntary abortion) frequency, menstrual recovery, exclusive breastfeeding, and number of living children (p < 0.05). CONCLUSION More than half of the women in this study resumed sexual intercourse within 3 months postpartum. Women with a lower educational attainment and from the western regions of China were more likely to resume sexual intercourse earlier. Increasing age, delayed recovery of menses, and exclusive breastfeeding were associated with a delayed resumption of sexual intercourse. Women who had greater experience with abortion or the number of living children resumed sexual intercourse earlier than their counterparts.
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Affiliation(s)
- Xiaorong Fan
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Zhou
- Reproductive Medicine Department, Hubei Maternal and Child Health Hospital, Wuhan, China
| | - Yuyan Li
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Wei Xia
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Che
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China.,NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
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20
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O’Malley D, Higgins A, Smith V. Exploring the Complexities of Postpartum Sexual Health. CURRENT SEXUAL HEALTH REPORTS 2021. [DOI: 10.1007/s11930-021-00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
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.
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21
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Knutson AJ, Boyd SS, Long JB, Kjerulff KH. Early Resumption of Sexual Intercourse after First Childbirth and Unintended Pregnancy within Six Months. Womens Health Issues 2021; 32:51-56. [PMID: 34602327 DOI: 10.1016/j.whi.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We aimed to evaluate factors associated with early resumption of sexual intercourse after first childbirth and assess whether early intercourse is associated with unprotected intercourse, subsequent pregnancy, and unintended pregnancy over 6 months. METHODS This secondary analysis used data from the First Baby Study, a prospective study of women aged 18-35 years with singleton pregnancies who delivered at 76 hospitals in Pennsylvania. At 1 and 6 months postpartum, women were asked about intercourse and the use of birth control since childbirth. We compared women who resumed intercourse in the first month after childbirth (early resumption) with those who resumed intercourse later, via multivariable logistic regression models. RESULTS In our cohort, 261 of 2,643 women (9.9%) reported first intercourse within the first postpartum month (7-31 days). Women who resumed intercourse early were less educated, younger, and less likely to breastfeed, have had a perineal laceration, or have had an episiotomy than those who resumed intercourse later. In addition, they were more likely to have unprotected intercourse in at least one of the first 6 months after first childbirth (adjusted odds ratio [aOR], 2.33; 95% confidence interval [CI], 1.76-3.09); to be pregnant by 6 months postpartum (aOR, 3.03; 95% CI, 1.48-6.20); and to report that pregnancy as unintended (aOR, 3.32; 95% CI, 1.50-7.36). CONCLUSIONS Nearly 10% of women resumed intercourse in the first month after childbirth. Because early resumption of intercourse was associated with a greater likelihood of unprotected intercourse and unintended pregnancy within 6 months of first childbirth, clinicians should focus efforts on comprehensive family planning and contraception counseling beginning in the prenatal period.
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Affiliation(s)
- Alex J Knutson
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Sarah S Boyd
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jaime B Long
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Kristen H Kjerulff
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania.
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Pardell-Dominguez L, Palmieri PA, Dominguez-Cancino KA, Camacho-Rodriguez DE, Edwards JE, Watson J, Leyva-Moral JM. The meaning of postpartum sexual health for women living in Spain: a phenomenological inquiry. BMC Pregnancy Childbirth 2021; 21:92. [PMID: 33509133 PMCID: PMC7844957 DOI: 10.1186/s12884-021-03578-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/20/2021] [Indexed: 02/08/2023] Open
Abstract
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.
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Affiliation(s)
- Lidia Pardell-Dominguez
- Department d'Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213. Campus de la UAB, 08193, Bellaterra, (Cerdanyola del Vallès), Barcelona, Spain
| | - Patrick A Palmieri
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Av. Arequipa 444, 15046, Lima, Peru. .,College of Graduate Health Studies, A. T. Still University, 800 West Jefferson Street, Kirksville, MO, 63501, USA. .,Center for Global Nursing, Texas Woman's University, 6700 Fannin Street, Houston, TX, 77030, USA. .,Center for Qualitative Research, EBHC South America: A Joanna Briggs Institute Affiliated Group, Calle Cartavio 402, 15023, Lima, Peru.
| | - Karen A Dominguez-Cancino
- Center for Qualitative Research, EBHC South America: A Joanna Briggs Institute Affiliated Group, Calle Cartavio 402, 15023, Lima, Peru.,Universidad Científica del Sur, Carr. Panamericana Sur 19, Villa EL Salvador, 15067, Lima, Peru.,Escuela de Salud Pública, Universidad de Chile, Independencia 939, Independencia, 8380453, Santiago de Chile, Chile
| | - Doriam E Camacho-Rodriguez
- Center for Qualitative Research, EBHC South America: A Joanna Briggs Institute Affiliated Group, Calle Cartavio 402, 15023, Lima, Peru.,School of Nursing, Universidad Cooperativa de Colombia, Calle 30, Santa Marta, Magdalena, Colombia
| | - Joan E Edwards
- Center for Global Nursing, Texas Woman's University, 6700 Fannin Street, Houston, TX, 77030, USA.,Nelda C. Stark College of Nursing, Texas Woman's University, 6700 Fannin St, Houston, TX, 77030, USA
| | - Jean Watson
- Watson Caring Science Institute, 4450 Arapahoe Avenue, Suite 100, Boulder, CO, 80304, USA.,College of Nursing, Anschutz Medical Campus University of Colorado, 13120 East 19th Avenue, Aurora, CO, 80045, USA
| | - Juan M Leyva-Moral
- Department d'Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213. Campus de la UAB, 08193, Bellaterra, (Cerdanyola del Vallès), Barcelona, Spain.,Center for Global Nursing, Texas Woman's University, 6700 Fannin Street, Houston, TX, 77030, USA.,Center for Qualitative Research, EBHC South America: A Joanna Briggs Institute Affiliated Group, Calle Cartavio 402, 15023, Lima, Peru
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Zgliczynska M, Zasztowt-Sternicka M, Kosinska-Kaczynska K, Szymusik I, Pazdzior D, Durmaj A, Szlachta M, Bartnik P, Wielgos M. Impact of childbirth on women's sexuality in the first year after the delivery. J Obstet Gynaecol Res 2020; 47:882-892. [PMID: 33372310 DOI: 10.1111/jog.14583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/16/2020] [Accepted: 11/15/2020] [Indexed: 12/14/2022]
Abstract
AIM The aim was to compare the quality of sexual life before pregnancy and after delivery and to find out whether and how selected factors affect women's sexuality during this period. METHODS The study group consisted of 433 women who completed the survey containing basic demographic questions and two Female Sexual Function Index (FSFI) questionnaires: a retrospective one, regarding time before pregnancy and the current period. The inclusion criteria: time between 10 weeks and 1 year after delivery, vaginal intercourses before pregnancy and the resumption of vaginal intercourses after delivery. RESULTS We observed the negative impact of labor on the total FSFI score, regardless of the time that had passed since birth and the delivery mode. The decrease by at least 10% of the initial FSFI score was noticed in 44.3% of the participants. FSD (Female Sexual Dysfunction) occurred statistically more commonly after delivery than before pregnancy (45.3% vs 17.1%; P < 0.001). The following factors had an impact on the risk of post-partum FSD: pre-pregnancy FSD (adjusted odds ratio [aOR] = 4.17 [95% confidence interval [CI] 2.38-7.31]) and nulliparity (aOR = 1.67 [95% CI 1.09-2.53]). CONCLUSION Childbirth has an undeniable impact on women's sexuality. The prevention and treatment of sexual dysfunctions is very important, especially in this crucial period of life.
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Affiliation(s)
- Magdalena Zgliczynska
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Monika Zasztowt-Sternicka
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | | | - Iwona Szymusik
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Dominika Pazdzior
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Durmaj
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Szlachta
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Bartnik
- Second Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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Chiruvella M, Schaffir J, Benedict JA, Tedesco C, Loftus T, Henderson A, Yudovich M, Hade EM, Lynch CD. Is provision of contraception at discharge following delivery associated with postpartum visit attendance? Contraception 2020; 103:103-106. [PMID: 33098849 DOI: 10.1016/j.contraception.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We examined whether provision of contraception at discharge following delivery was associated with lower rates of postpartum visit (PPV) attendance. METHODS We conducted a retrospective cohort study of women who received pregnancy care at a Midwestern medical center in 2013. Attendance at the postpartum visit was compared for women with sterilization, contraception initiated prior to discharge (depot medroxyprogesterone acetate or etonogestrel implant), hormonal contraception prescription, or no contraception provided at postpartum discharge. Poisson regression models with robust standard errors were used to estimate the relative risk of postpartum visit attendance controlling for age, race, and parity, insurance status, and histories of both depression and drug abuse. RESULTS Of the 1015 women who met inclusion criteria, 55% had been prescribed contraception, had initiated contraception prior to discharge, or were sterilized at the time of discharge following delivery. After adjustment for confounders, there was no association between receiving contraception and PPV attendance (relative risk for prescribed contraception = 1.09 [95% CI 0.85, 1.39], for contraception initiated prior to discharge = 0.83 [95% CI 0.67, 1.03], for sterilization = 0.86 [95% CI 0.63, 1.17] compared to no contraception). CONCLUSIONS We found no evidence that prescribing or administering contraception post-delivery was associated with lower rates of return for postpartum follow up. IMPLICATIONS This single site study suggests that providing effective contraception at discharge following delivery does not appear to impact PPV attendance.
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Affiliation(s)
- M Chiruvella
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, 395 12th Avenue, 5th Floor, Columbus, OH 43210, USA
| | - J Schaffir
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, 395 12th Avenue, 5th Floor, Columbus, OH 43210, USA.
| | - J A Benedict
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Dr, 250 Lincoln Tower, Columbus, OH 43210, USA
| | - C Tedesco
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, 395 12th Avenue, 5th Floor, Columbus, OH 43210, USA
| | - T Loftus
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, 395 12th Avenue, 5th Floor, Columbus, OH 43210, USA
| | - A Henderson
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, 395 12th Avenue, 5th Floor, Columbus, OH 43210, USA
| | - M Yudovich
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, 395 12th Avenue, 5th Floor, Columbus, OH 43210, USA
| | - E M Hade
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, 395 12th Avenue, 5th Floor, Columbus, OH 43210, USA; Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Dr, 250 Lincoln Tower, Columbus, OH 43210, USA
| | - C D Lynch
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, 395 12th Avenue, 5th Floor, Columbus, OH 43210, USA; Division of Epidemiology, The Ohio State University College of Public Health, Cunz Hall, 1841 Neil Ave, Columbus, OH 43210, USA
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A Comparison of the Sexual Well-Being of New Parents With Community Couples. J Sex Med 2020; 17:2156-2167. [PMID: 32943374 DOI: 10.1016/j.jsxm.2020.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 11/20/2022]
Abstract
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.
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Lichtenstein Liljeblad K, Kopp Kallner H, Brynhildsen J. Risk of abortion within 1-2 years after childbirth in relation to contraceptive choice: a retrospective cohort study. EUR J CONTRACEP REPR 2020; 25:141-146. [PMID: 32083501 DOI: 10.1080/13625187.2020.1718091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The primary objective of the study was to investigate whether the choice of long-acting reversible contraception (LARC) was associated with the risk of abortion over a period of 24 months postpartum. The secondary objective was to analyse whether other significant factors were affecting the risk of abortion during this period.Methods: In this retrospective cohort study, we analysed 11,066 women who had delivered in three Swedish cities during 2013 and 2014. Demographic and medical variables were obtained from medical records. Attendance at the postpartum visit, choice of postpartum contraception and history of abortion was noted. Logistic regression analysis was performed to assess factors associated with the risk of abortion. The main outcome measure was the proportion of women with abortion up to 24 months postpartum.Results: Data from 11,066 women were included in the final analysis. Within 12-24 months after delivery 2.5% of women had an abortion. The choice of LARC after childbirth reduced the risk of subsequent abortion (odds ratio 0.74; 95% confidence interval [CI] 0.60, 0.91; p = .005). Smoking, age <25 years and have had a previous abortion significantly increased the risk of abortion during follow-up, whereas exclusive breastfeeding decreased the risk.Conclusions: Increasing the proportion of women who choose LARC postpartum could decrease the risk of abortion for up to 2 years after childbirth.
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Affiliation(s)
- Karin Lichtenstein Liljeblad
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics & Gynaecology, Department of Clinical & Experimental Medicine, Linköping University, Linköping, Sweden
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Omona K, Namuli W. Factors influencing utilization of intra-uterine device among postpartum mothers at Gombe Hospital, Butambala disrtict, Uganda. COGENT MEDICINE 2020. [DOI: 10.1080/2331205x.2020.1846264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Affiliation(s)
- Adam D Jakes
- Guy's & St Thomas' Hospital NHS Trust, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George's University of London, London, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry UK
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Lévesque S, Bisson V, Fernet M, Charton L. A study of the transition to parenthood: new parents’ perspectives on their sexual intimacy during the perinatal period. SEXUAL AND RELATIONSHIP THERAPY 2019. [DOI: 10.1080/14681994.2019.1675870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sylvie Lévesque
- Department of Sexology, Universite du Quebec a Montreal, Montreal, Quebec, Canada
| | - Véronique Bisson
- Department of Sexology, Universite du Quebec a Montreal, Montreal, Quebec, Canada
| | - Mylène Fernet
- Department of Sexology, Universite du Quebec a Montreal, Montreal, Quebec, Canada
| | - Laurence Charton
- INRS Urbanization, Culture, and Society Center, Montreal, Quebec, Canada
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DeMaria AL, Delay C, Sundstrom B, Wakefield AL, Avina A, Meier S. Understanding women's postpartum sexual experiences. CULTURE, HEALTH & SEXUALITY 2019; 21:1162-1176. [PMID: 30624136 DOI: 10.1080/13691058.2018.1543802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Andrea L DeMaria
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Cara Delay
- Department of History, College of Charleston, Charleston, SC, USA
| | - Beth Sundstrom
- Department of Communication, College of Charleston, Charleston, SC, USA
| | - Audrey L Wakefield
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Angel Avina
- Department of Consumer Science, Purdue University, West Lafayette, IN, USA
| | - Stephanie Meier
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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Postabortion and Postpartum Intrauterine Device Provision for Adolescents and Young Adults. J Pediatr Adolesc Gynecol 2019; 32:S30-S35. [PMID: 31585616 DOI: 10.1016/j.jpag.2019.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/24/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022]
Abstract
Adolescents are at high risk for unintended pregnancy and rapid repeat pregnancy, both of which can be associated with negative health and social outcomes. Intrauterine device (IUD) use has been shown to decrease unintended pregnancy and rapid repeat pregnancy. Evidence supports IUD insertion postabortion and postpartum as safe and practical for nearly all women, including adolescent and young adult women. Providers of adolescent gynecology can play an important role in decreasing repeat and unintended pregnancy among adolescents by increasing access to IUDs, reducing barriers to care, and providing IUDs immediately postabortion and postpartum.
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32
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Serrano Drozdowskyj E, Gimeno Castro E, Trigo López E, Bárcenas Taland I, Chiclana Actis C. Factors Influencing Couples' Sexuality in the Puerperium: A Systematic Review. Sex Med Rev 2019; 8:38-47. [PMID: 31447412 DOI: 10.1016/j.sxmr.2019.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Elena Serrano Drozdowskyj
- Perinatal Mental Health Unit, Consulta Dr Carlos Chiclana, Madrid, Spain; Universidad Pontificia de Comillas, Madrid, Spain
| | | | - Elena Trigo López
- Perinatal Mental Health Unit, Consulta Dr Carlos Chiclana, Madrid, Spain
| | - Inés Bárcenas Taland
- Perinatal Mental Health Unit, Consulta Dr Carlos Chiclana, Madrid, Spain; Universidad Francisco de Victoria, Madrid, Spain
| | - Carlos Chiclana Actis
- Perinatal Mental Health Unit, Consulta Dr Carlos Chiclana, Madrid, Spain; Universidad San Pablo CEU, Madrid, Spain
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Zhuang C, Li T, Li L. Resumption of sexual intercourse post partum and the utilisation of contraceptive methods in China: a cross-sectional study. BMJ Open 2019; 9:e026132. [PMID: 30862636 PMCID: PMC6429937 DOI: 10.1136/bmjopen-2018-026132] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This is a cross-sectional study that aimed to examine the resumption of sexual intercourse post partum, the utilisation of contraceptive methods and the influencing factors among Chinese women at a tertiary teaching hospital. DESIGN This is a questionnaire survey by written and online interview for participants. PARTICIPANTS Based on medical records, we sent online questionnaires about postpartum sexual intercourse and contraception plans to 550 eligible women. MAIN OUTCOME MEASURES Potential factors affecting postpartum sexual intercourse and utilisation of contraception were determined by analysis of epidemiological and clinical factors and sexual experiences during and after pregnancy. RESULTS Of 550 eligible participants, 406 women (73.8%) with a postpartum period of 8.5 months (range 6-10) completed the questionnaires; 146 of 406 (36.0%) resumed sexual intercourse within 3 months, and 259 of 279 (92.8%) used contraceptive methods. In univariate and multivariate analyses, sexual intercourse during pregnancy (adjusted OR 4.4, 95% CI 2.8 to 6.9) and resumption of menstruation (adjusted OR 2.5, 95% CI 1.5 to 4.3) were significant influencing factors in resumption of sexual intercourse within 3 months after childbirth. No factor was found to be associated with using contraceptive methods or the general resumption of sexual intercourse post partum. The questionnaire had good reliability and validity. CONCLUSIONS Having sexual intercourse during pregnancy and resuming menstruation earlier were independent factors for resumption of sexual intercourse within 3 months after delivery. Almost all women who had postpartum sexual intercourse used various contraceptive methods.
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Affiliation(s)
- Caixia Zhuang
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Ting Li
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Lei Li
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
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McDonald EA, Gartland D, Woolhouse H, Brown SJ. Resumption of sex after a second birth: An Australian prospective cohort. Birth 2019; 46:173-181. [PMID: 29907972 DOI: 10.1111/birt.12363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few longitudinal studies have examined women's experiences of sex after childbirth. Much of the advice given to couples about what to expect in relation to sex after childbirth is based on cross-sectional studies. OBJECTIVE To investigate timing of resumption of sex after a second birth and assess associations with obstetric factors (method of birth and perineal trauma) and time interval between first and second births. METHOD Prospective cohort of 1507 nulliparous women recruited before 25 weeks' gestation in Melbourne, Australia followed up at 3, 6, 9, and 12 months after first births, and 6 and 12 months after second births. Measures include: obstetric factors and resumption of vaginal sex after first and second births. RESULTS By 8 weeks after their second birth, 56% of women had resumed vaginal sex, compared with 65% after their first birth. Women were more likely to resume sex later than 8 weeks postpartum if they had a spontaneous vaginal birth with episiotomy or sutured perineal tear (aOR: 2.21, 95% CI: 1.5-3.2), operative vaginal birth (aOR: 2.60, 95% CI: 1.3-5.3) or cesarean delivery (aOR: 2.15, 95% CI: 1.4-3.3) compared with a vaginal birth with minimal or no perineal trauma. There was no association between timing of resumption of sex and the time interval between births. CONCLUSION For almost half of the cohort, sex was not resumed until at least 8 weeks after the second birth. Timing of resumption of sex was influenced by obstetric factors, but not the time interval between births.
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Affiliation(s)
- Ellie A McDonald
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Deirdre Gartland
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Hannah Woolhouse
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Stephanie J Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, Vic., Australia.,Departments of Paediatrics and General Practice, The University of Melbourne, Parkville, Vic., Australia
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Cooper M, Cameron S. Successful implementation of immediate postpartum intrauterine contraception services in Edinburgh and framework for wider dissemination. Int J Gynaecol Obstet 2018; 143 Suppl 1:56-61. [PMID: 30225868 DOI: 10.1002/ijgo.12606] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Provision of immediate postpartum intrauterine device (PPIUD) insertion within maternity settings can overcome many of the barriers faced by women in accessing this method after childbirth. Uptake of PPIUD can help reduce the risk of a subsequent unintended pregnancy and improve spacing between births. PPIUD insertion is not yet routinely available in the UK and evidence to support the practical implementation of the service in this setting is lacking. Shared learning and experience of providers may assist in the wider availability of PPIUD. A routine PPIUD service has been successfully established within a public maternity setting in Edinburgh (UK) and this article utilizes an implementation framework to discuss the approach.
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36
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Holden EC, Lai E, Morelli SS, Alderson D, Schulkin J, Castleberry NM, McGovern PG. Ongoing barriers to immediate postpartum long-acting reversible contraception: a physician survey. Contracept Reprod Med 2018; 3:23. [PMID: 30455978 PMCID: PMC6222995 DOI: 10.1186/s40834-018-0078-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Postpartum women are at risk for unintended pregnancy. Access to immediate long-acting reversible contraception (LARC) may help decrease this risk, but it is unclear how many providers in the United States routinely offer this to their patients and what obstacles they face. Our primary objective was to determine the proportion of United States obstetric providers that offer immediate postpartum LARC to their obstetric patients. Methods We surveyed practicing Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (ACOG) about their use of immediate postpartum LARC. These members are demographically representative of ACOG members as a whole and represent all of the ACOG districts. Half of these Fellows were also part of the Collaborative Ambulatory Research Network (CARN), a group of ACOG members who voluntarily participate in research. We asked about their experience with and barriers to immediate placement of intrauterine devices and contraceptive implants after delivery. Results There were a total of 108 out of 600 responses (18%). Participants practiced in a total of 36 states and/or US territories and their median age was 52 years. Only 26.9% of providers surveyed offered their patients immediate postpartum LARC, and of these providers, 60.7% work in a university-based practice. There was a statistically significant association between offering immediate postpartum LARC and practice type, with the majority of providers working at a university-based practice (p < 0.001). Multiple obstacles were identified, including cost or reimbursement, device availability, and provider training on device placement in the immediate postpartum period. Conclusion The majority of obstetricians surveyed do not offer immediate postpartum long-acting reversible contraception to patients in the United States. This is secondary to multiple obstacles faced by providers.
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Affiliation(s)
- Emily C Holden
- 1Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, 185 South Orange Avenue, E-level, Newark, NJ 07103 USA
| | - Erica Lai
- 1Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, 185 South Orange Avenue, E-level, Newark, NJ 07103 USA
| | - Sara S Morelli
- 1Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, 185 South Orange Avenue, E-level, Newark, NJ 07103 USA.,2Reproductive Endocrinology and Infertility, University Reproductive Associates, 214 Terrace Avenue, Hasbrouck Heights, NJ 07604 USA
| | - Donald Alderson
- 3Rutgers University Biostatistics and Epidemiology Services Center, Rutgers University, 65 Bergen St, Newark, NJ 07103 USA
| | - Jay Schulkin
- 4Department of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195-6460 USA
| | - Neko M Castleberry
- 5American College of Obstetricians and Gynecologists, 409 12th Street, SW, Washington, DC 2002420024-9998 USA
| | - Peter G McGovern
- 1Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, 185 South Orange Avenue, E-level, Newark, NJ 07103 USA.,2Reproductive Endocrinology and Infertility, University Reproductive Associates, 214 Terrace Avenue, Hasbrouck Heights, NJ 07604 USA
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Eser A, Unal C, Albayrak B, Wildemeersch D. Clinical experience with a novel anchored, frameless copper-releasing contraceptive device for intra-caesarean insertion. EUR J CONTRACEP REPR 2018; 23:255-259. [DOI: 10.1080/13625187.2018.1491027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ahmet Eser
- University of Health Sciences, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Ceren Unal
- University of Health Sciences, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Betül Albayrak
- University of Health Sciences, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Dirk Wildemeersch
- Gynaecology Outpatient Clinic and IUD Training Centre, Ghent, Belgium
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Goldthwaite LM, Cahill EP, Voedisch AJ, Blumenthal PD. Postpartum intrauterine devices: clinical and programmatic review. Am J Obstet Gynecol 2018; 219:235-241. [PMID: 30031750 DOI: 10.1016/j.ajog.2018.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/05/2018] [Accepted: 07/08/2018] [Indexed: 10/28/2022]
Abstract
The immediate postpartum period is a critical moment for contraceptive access and an opportunity to initiate long-acting reversible contraception, which includes the insertion of an intrauterine device. The use of the intrauterine device in the postpartum period is a safe practice with few contraindications and many benefits. Although an intrauterine device placed during the postpartum period is more likely to expel compared with one placed at the postpartum visit, women who initiate intrauterine devices at the time of delivery are also more likely to continue to use an intrauterine device compared with women who plan to follow up for an interval intrauterine device insertion. This review will focus on the most recent clinical and programmatic updates on postpartum intrauterine device practice. We discuss postpartum intrauterine device expulsion and continuation, eligibility criteria and contraindications, safety in regards to breastfeeding, and barriers to access. Our aim is to summarize evidence related to postpartum intrauterine devices and encourage those involved in the healthcare system to remove barriers to this worthwhile practice.
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Pereira TRC, Dottori EH, Mendonça FMDAF, Beleza ACS. Assessment of female sexual function in remote postpatum period: a cross-sectional study. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2018. [DOI: 10.1590/1806-93042018000200003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: (i) to evaluate female sexual function in remote postpartum period within Brazilian women and (ii) to compare female sexual dysfunction in relation to the mode of delivery. Methods: in this cross-sectional study, two groups of remote postpartum women, who underwent vaginal delivery (n=30) and cesarean (n=48), were studied. The sexual function of participants was assessed through an online Brazilian version of FSFI between 45 and 180 days after delivery. Data were analyzed by descriptive and inferential statistics using Fisher exact test, and Student t test. Results: based on the data of 78 women who completed the online questionnaire, 78% (n=61) showed sexual dysfunction on remote postpartum period being that the FSFI mean score for vaginal postpartum was 22.17 and for cesarean postpartum, 21.12 (p=0.443). Conclusions: the majority of remote postpartum women showed sexual dysfunction. There was no significant difference found on female sexual function between modes of delivery.
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O’Malley D, Higgins A, Begley C, Daly D, Smith V. Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study). BMC Pregnancy Childbirth 2018; 18:196. [PMID: 29855357 PMCID: PMC5984394 DOI: 10.1186/s12884-018-1838-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Many women are not prepared for changes to their sexual health after childbirth. The aim of this paper is to report on the prevalence of and the potential risk factors (pre-pregnancy dyspareunia, mode of birth, perineal trauma and breastfeeding) for sexual health issues (dyspareunia, lack of vaginal lubrication and a loss of interest in sexual activity) at 6 and 12 months postpartum. METHODS A longitudinal cohort study of 832 first-time mothers who were recruited in early pregnancy and returned postnatal surveys at 3, 6, 9 and 12 months postpartum were assessed for sexual health issues and associated risk factors. RESULTS Nearly half of the women (46.3%) reported a lack of interest in sexual activity, 43% experienced a lack of vaginal lubrication and 37.5% of included women had dyspareunia 6 months after birth. On univariate analysis, vacuum-assisted birth, 2nd degree perineal tears, 3rd degree perineal tears and episiotomy were all associated with dyspareunia 6 months postpartum, but, of these only 3rd degree tears, in association with breastfeeding and pre-existing dyspareunia, remained significant on multivariable analysis. Breastfeeding, in combination, with other significant factors, was associated with dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity 6 months postpartum, and, dissatisfaction with body image emerged as a significant factor associated with lack of interest in sexual activity at 12 months postpartum. Pre-pregnancy dyspareunia and breastfeeding emerged as common factors associated with all three outcomes of dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity at 6 months postpartum. CONCLUSION Breastfeeding and pre-existing dyspareunia are associated with sexual health issues at 6 months postpartum. Pre-existing dyspareunia is associated with a lack of vaginal lubrication at 12 months postpartum and breastfeeding is associated with dissatisfaction with body image. Preparing women and their partners during the antenatal period and advising on simple measures, such as use of lubrication to avoid or minimise sexual health issues, could potentially remove stress, anxiety and fears regarding intimacy after birth. Introducing the topic of pre-existing sexual health issues antenatally may facilitate appropriate support, treatment or counselling for women.
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Affiliation(s)
- Deirdre O’Malley
- Health Research Board, Research Fellow, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Cwiak C, Cordes S. Postpartum intrauterine device placement: a patient-friendly option. Contracept Reprod Med 2018; 3:3. [PMID: 29686886 PMCID: PMC5899832 DOI: 10.1186/s40834-018-0057-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
Women in the United States are increasingly choosing an intrauterine device (IUD) for contraception. Since the postpartum period is an important time to consider a patient's need for contraception, offering postpartum IUD placement is considered best practice. Effective implementation of postpartum IUD placement occurs within a context of shared decision making wherein patients are given full information about all options and guided to methods that best fit their lifestyle. Within this context, both the non-hormonal and hormonal IUDs are safe, highly effective, well tolerated, and convenient options. National guidelines support the placement of IUDs, whether immediate (within 10 min of placental delivery) or early postpartum (after 10 min and before 4 weeks after placental delivery), for breastfeeding or non-breastfeeding women. Studies have noted increased IUD expulsion rates, but equivalent IUD usage rates with immediate or early postpartum placement. Postpartum placement requires additional skills that can be easily taught. Finally, successful implementation of a postpartum IUD placement program can be accomplished in hospitals using a team-based approach.
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Affiliation(s)
- Carrie Cwiak
- Division of Family Planning, Department of Gynecology and Obstetrics, 49 Jesse Hill Jr. Drive SE, Atlanta, GA 30303 USA
| | - Sarah Cordes
- Division of Family Planning, Department of Gynecology and Obstetrics, 49 Jesse Hill Jr. Drive SE, Atlanta, GA 30303 USA
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Vanya M, Devosa I, Barabás K, Bártfai G, Kozinszky Z. Choice of contraception at 6-8 weeks postpartum in south-eastern Hungary. EUR J CONTRACEP REPR 2018; 23:52-57. [PMID: 29393708 DOI: 10.1080/13625187.2017.1422238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aims of the study were to describe the sociodemographic determinants, breastfeeding- and sexual life-related predictive factors of contraceptive use at 6-8 weeks postpartum. METHODS A prospective, web-based questionnaire survey was carried out by distributing an access code to women immediately after delivery at the Department of Obstetrics and Gynaecology, the University of Szeged, Szeged, Hungary, between 1 September 2013 and 1 May 2015. RESULTS In total, 1875 women were invited to participate in the study, 632 of whom refused or were excluded and 644 were not sexually active. The remaining sexually active women (n = 599) completed the questionnaire. At 6-8 weeks postpartum, 22.5% were using an effective contraceptive method and 40.2% were relying on lactational amenorrhoea (LAM). We found a significant direct association between the educational level of a woman's partner and her use of an effective contraceptive method (p < .001) (adjusted odds ratio [AOR]: 1.9) or LAM (AOR: 1.49). Use of an effective contraceptive method before pregnancy increased the likelihood of using the same method after delivery (AOR: 3.16) and decreased the likelihood of LAM use at weeks 6-8 (AOR: 0.31). The AOR for effective contraceptive use was 2.23 times higher in women who had sexual intercourse once or more a week compared with those who had sexual intercourse less frequently. CONCLUSIONS Concerted efforts to promote the use of long-acting reversible contraception (LARC) are required, particularly among women who would like future childbearing. Further research is needed on the factors contributing to the low uptake of LARC in this population.
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Affiliation(s)
- Melinda Vanya
- a Health Research and Health Promotion Research Group, Teacher Training Faculty , Pallas Athena University , Kecskemét , Hungary.,b MEDITEAM Szeged Co. Ltd. , Szeged , Hungary.,c Department of Obstetrics and Gynaecology , Pándy Kálmán Hospital , Gyula , Hungary
| | - Iván Devosa
- a Health Research and Health Promotion Research Group, Teacher Training Faculty , Pallas Athena University , Kecskemét , Hungary.,d Hungarian Academy of Sciences , Academic Committee of Szeged, Education Committee on Theoretical Education , Szeged , Hungary
| | - Katalin Barabás
- e Department of Behavioural Sciences, Faculty of General Medicine , Albert Szent-Györgyi Health Centre, University of Szeged , Szeged , Hungary
| | - György Bártfai
- f Department of Obstetrics and Gynaecology, Faculty of General Medicine , Albert Szent-Györgyi Health Centre, University of Szeged , Szeged , Hungary
| | - Zoltan Kozinszky
- a Health Research and Health Promotion Research Group, Teacher Training Faculty , Pallas Athena University , Kecskemét , Hungary.,g Department of Obstetrics and Gynaecology , Blekinge Hospital , Karlskrona , Sweden
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McDonald E, Woolhouse H, Brown SJ. Sexual pleasure and emotional satisfaction in the first 18 months after childbirth. Midwifery 2017; 55:60-66. [DOI: 10.1016/j.midw.2017.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 07/24/2017] [Accepted: 09/06/2017] [Indexed: 11/26/2022]
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Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstet Gynecol 2017; 130:e251-e269. [PMID: 29064972 DOI: 10.1097/aog.0000000000002400] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intrauterine devices and contraceptive implants, also called long-acting reversible contraceptives (LARC), are the most effective reversible contraceptive methods. The major advantage of LARC compared with other reversible contraceptive methods is that they do not require ongoing effort on the part of the patient for long-term and effective use. In addition, after the device is removed, the return of fertility is rapid (1, 2). The purpose of this Practice Bulletin is to provide information for appropriate patient selection and evidence-based recommendations for LARC initiation and management. The management of clinical challenges associated with LARC use is beyond the scope of this document and is addressed in Committee Opinion No. 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods (3).
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Triviño-Juárez JM, Romero-Ayuso D, Nieto-Pereda B, Forjaz MJ, Oliver-Barrecheguren C, Mellizo-Díaz S, Avilés-Gámez B, Arruti-Sevilla B, Criado-Álvarez JJ, Soto-Lucía C, Plá-Mestre R. Resumption of intercourse, self-reported decline in sexual intercourse and dyspareunia in women by mode of birth: A prospective follow-up study. J Adv Nurs 2017; 74:637-650. [DOI: 10.1111/jan.13468] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 01/23/2023]
Affiliation(s)
| | - Dulce Romero-Ayuso
- Department of Physical Therapy; Faculty of Health Science; University of Granada (UGR); Granada Spain
| | - Beatriz Nieto-Pereda
- Preventive Medicine Service; Hospital General Universitario Gregorio Marañón; Gregorio Marañón Health Research Institute (IiSGM); Madrid Spain
| | - Maria João Forjaz
- National School of Public Health; Carlos III Institute of Health and REDISSEC; Carlos III Institute of Health; Madrid Spain
| | - Cristina Oliver-Barrecheguren
- Obstetrics and Gynecology Service; Hospital General Universitario Gregorio Marañon; Gregorio Marañon Health Research Institute (IiSGM); Madrid Spain
| | - Sonia Mellizo-Díaz
- Obstetrics and Gynecology Service; Hospital General Universitario Gregorio Marañon; Gregorio Marañon Health Research Institute (IiSGM); Madrid Spain
| | | | | | | | - Consuelo Soto-Lucía
- Obstetrics and Gynecology Service; Hospital General Universitario Gregorio Marañon; Gregorio Marañon Health Research Institute (IiSGM); Madrid Spain
| | - Rosa Plá-Mestre
- Preventive Medicine Service; Hospital General Universitario Gregorio Marañón; Gregorio Marañón Health Research Institute (IiSGM); Madrid Spain
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McBride HL, Kwee JL. Sex After Baby: Women’s Sexual Function in the Postpartum Period. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0116-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Sexual function and postpartum depression 6 months after attempted operative vaginal delivery according to fetal head station: A prospective population-based cohort study. PLoS One 2017; 12:e0178915. [PMID: 28591209 PMCID: PMC5462380 DOI: 10.1371/journal.pone.0178915] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 05/21/2017] [Indexed: 01/24/2023] Open
Abstract
Objective To evaluate the effect of the fetal head station at attempted operative vaginal delivery (aOVD), and specifically midpelvic or low aOVD, on female and male sexual function and symptoms of postpartum depression (PPD) at 6 months. Design Prospective population-based cohort study. Setting 1,941 women with singleton term fetuses in vertex presentation with midpelvic or low aOVD between 2008 and 2013 in a tertiary care university hospital. Methods Symptoms of female sexual dysfunction using the Pelvic Organ Prolapse/Urinary Incontinence/Sexual Function Short Form Questionnaire (PISQ-12), symptoms of PPD using the Edinburgh Postnatal Depression Scale (EPDS) score, symptoms of male sexual dysfunction using the International Index of Erectile Function (IIEF-15) and perineal pain were assessed 6 months after aOVD. We measured the association between midpelvic or low aOVD and symptoms of female and male sexual function and symptoms of PPD at 6 months using multiple regression and adjusting for demographics, and risk factors of sexual dysfunction, symptoms of PPD and perineal pain with adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). Results The study included 907 women (46.7%) who responded to the questionnaire; 18.4% (167/907) had midpelvic aOVD, and 81.6% (740/907) low. Most women (873/907 [96.3%]) of those with partners reported sexual activity at 6 months. No significant difference was observed for PISQ-12, EPDS, IIEF-15 scores and perineal pain between mid and low pelvic groups. Compared with low pelvic aOVD, midpelvic aOVD was not significantly associated with either female or male sexual dysfunction (p = 0.89 and p = 0.76, respectively), or maternal symptoms of PPD (p = 0.83). Perineal pain significantly increased the risk of male and female sexual dysfunction and maternal symptoms of PPD at 6 months (p = 0.02, p = 0.006, and p = 0.02, respectively). Conclusion Midpelvic compared with low pelvic aOVD was not associated with an increase in sexual dysfunction, nor with symptoms of PPD at 6 months.
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Cameron ST, Craig A, Sim J, Gallimore A, Cowan S, Dundas K, Heller R, Milne D, Lakha F. Feasibility and acceptability of introducing routine antenatal contraceptive counselling and provision of contraception after delivery: the APPLES pilot evaluation. BJOG 2017; 124:2009-2015. [DOI: 10.1111/1471-0528.14674] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- ST Cameron
- Chalmers Sexual Health Clinic; NHS Lothian; Edinburgh UK
- Simpson Centre for Reproductive Health; NHS Lothian; Royal Infirmary of Edinburgh; UK
| | - A Craig
- Chalmers Sexual Health Clinic; NHS Lothian; Edinburgh UK
| | - J Sim
- Public Health; NHS Lothian Waverley Gate; Edinburgh UK
| | - A Gallimore
- Public Health; NHS Lothian Waverley Gate; Edinburgh UK
| | - S Cowan
- Simpson Centre for Reproductive Health; NHS Lothian; Royal Infirmary of Edinburgh; UK
| | - K Dundas
- Simpson Centre for Reproductive Health; NHS Lothian; Royal Infirmary of Edinburgh; UK
| | - R Heller
- Chalmers Sexual Health Clinic; NHS Lothian; Edinburgh UK
| | - D Milne
- Public Health; NHS Lothian Waverley Gate; Edinburgh UK
| | - F Lakha
- Public Health; NHS Lothian Waverley Gate; Edinburgh UK
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Jawed-Wessel S, Sevick E. The Impact of Pregnancy and Childbirth on Sexual Behaviors: A Systematic Review. JOURNAL OF SEX RESEARCH 2017; 54:411-423. [PMID: 28166416 DOI: 10.1080/00224499.2016.1274715] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The purpose of this review was to examine and synthesize the available quality evidence to provide researchers, educators, and clinicians an overview of what is known about sexual behaviors during pregnancy and the year after childbirth. Search engines were used to identify peer-reviewed, English-language articles that met the inclusion criteria. A total of 56 prospective, retrospective, and qualitative studies published after 1996 were reviewed. A gradual decline in vaginal intercourse from prepregnancy to first trimester to third trimester was found. Most couples resume vaginal intercourse by eight weeks after childbirth, but this behavior does not occur at prepregnancy frequencies until closer to 12 months postchildbirth. Future studies should consider assessing sexual behaviors beyond vaginal intercourse and increase efforts in recruitment of diverse samples including non-White, nonheterosexual pregnant individuals, and partners of pregnant individuals.
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Affiliation(s)
| | - Emily Sevick
- a School of Health and Kinesiology, University of Nebraska at Omaha
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