Sexual Dysfunction After Childbirth

For most women, sexuality is affected at some point in the peripartum. Sexual function declines in pregnancy, reaching a nadir in the third trimester, and for some women sexual function continues to be compromised for more than a year and a half after birth. These changes in sexual function become dysfunction, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), when they result in personal distress. There are many established risk factors contributing to the development of sexual dysfunction postpartum and include operative vaginal birth, higher order perineal lacerations, breastfeeding and depression. Other contributing factors include waning pregnancy hormones, disrupted sleep, stress, body image changes, relationship factors, sequelae from birth, and concurrent pelvic floor dysfunction. It is important for an obstetric provider to offer anticipatory guidance on changing sexual function antepartum and revisit sexual function postpartum, as patients may not voluntarily disclose their concerns otherwise. When sexual dysfunction and/or dyspareunia are identified, a patient-centered approach to discussing the natural history, individualized goals, and tailored therapies is essential to helping women achieve healthy, satisfying sexual relationships.