Background <p>Postpartum sexual health is an important yet often under recognized aspect of maternal well-being. The impact of preeclampsia on postpartum sexual quality of life (QoL) in the Sidama Region remains insufficiently understood. This study aimed to assess maternal sexual QoL among women with and without preeclampsia in the Sidama Region, underscoring the need for higher attention to this critical dimension of women’s health in the local context.</p> Methods and Materials <p>A prospective cohort study was conducted from October 1, 2022 to January 31, 2023. Participants were enrolled between ≥ 20 and 37 weeks of gestation and followed into the postpartum period. Sexual QoL was assessed at 6 and 12 weeks postpartum using a context-validated version of the Sexual Quality of Life–Female (SQoL-F) questionnaire. Overall sexual QoL was evaluated based on total SQoL-F scores, with higher scores indicating better sexual QoL. Multivariable linear regression analysis was performed to identify factors associated with sexual QoL, and results were reported using beta coefficients with 95% confidence intervals. A p-value of &lt; 0.05 was considered statistically significant.</p> Results <p>A total of 598 postpartum women, including those with preeclampsia/Eclampsia and normotensive women, were enrolled in the study. Although sexual QoL improved in both groups by 12 weeks postpartum, women with preeclampsia/Eclampsia continued to report significantly lower SQoL-F scores across all domains. Compared with women without severe features of preeclampsia, the persistence of severe features was significantly associated with lower SQoL-F scores (β = -0.10, 95% CI: -0.82 to -0.60). Women who were very dissatisfied had significantly lower SQoL-F scores (β = -2.84, 95% CI: -3.64 to -2.03) compared with women who were very satisfied with their sexual life. Similarly, women who were dissatisfied also had lower SQoL-F scores (β = -3.11, 95% CI: -3.95 to -2.28) compared with women who were very satisfied with their sexual life.</p> Conclusions and recommendations <p>In conclusion, the findings indicate that women affected by preeclampsia/Eclampsia experienced significantly lower sexual QoL scores during the postpartum period, with significant differences observed at both six and twelve weeks postpartum compared with normotensive women. These results highlight the importance of strengthening antenatal and postpartum counseling, with particular emphasis on providing appropriate guidance regarding the timing and resumption of sexual activity.</p>