Content written by Rachel N. Pauls MD

The postpartum period is a time when many women notice changes in their sexual function. These may result from a variety of factors such as hormonal fluctuations, low body image, stress of a newborn and healing of perineal trauma. Anxiety about these changes is common during pregnancy. A recent survey of pregnant women suggested levels of concern for their sexual function; with greatest apprehension in women that had never delivered before.

Several studies have documented declining sexual function after delivery, particularly with respect to sexual satisfaction, lubrication, ability to achieve orgasm, and pain with intercourse. Vaginal delivery may be responsible for some impact- mechanisms include injury to the nerves that supply the pelvic organs and stretching or laxity of the vaginal introitus. Most significantly, vaginal tearing or episiotomy could lead to discomfort with resumption of sexual activity, especially when suturing is required. However, it is reassuring that in the majority of cases, painful intercourse generally resolves within three to six months postpartum.

Preventative factors for sexual problems after childbirth include a controlled vaginal delivery to minimize rapid labor or lacerations. Avoiding episiotomy is beneficial to several long-term outcomes. Perineal massage or progressive dilation during pregnancy may gently stretch the vaginal opening and reduce spontaneous tearing. Pelvic floor physical therapy after delivery minimizes pelvic floor muscle spasm, improves vaginal tone and nerve deficits, as well as aids in scar tissue mobilization. Finally, physician and patient awareness and open conversations about these issues may lead to earlier identification of problems and better outcomes.

While it has been suggested that cesarean delivery could be associated with less sexual impact, the available literature is not conclusive in supporting this. Sexual function is highly complex, and a myriad of factors play a role in the postpartum period.