Psychological Factors and the Sexuality of Pregnant and Postpartum Women

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Fatigue is one of the most common problems women experience during pregnancy and the postpartum (Bick & MacArthur, 1995; Striegel-Moore, Goldman, Garvin, & Rodin, 1996). Fatigue or tiredness and weakness are almost universally given by women as reasons for loss of sexual desire during late pregnancy and in the postpartum (Glazener, 1997; Lumley, 1978). Similarly, at approximately 3 to 4 months postpartum, fatigue was frequently cited as a reason for infrequent sexual activity or sexual enjoyment (Fischman et al., 1986; Kumar et al., 1981; Lumley, 1978). Hyde et al. (1998) found that fatigue accounted for considerable variance in postpartum women's decreased sexual desire, although at 4 months postpartum fatigue did not significantly add to the prediction of decreased desire after depression had been first entered into regression analysis.

The physical changes associated with birth and the postpartum may influence women's sexuality. During childbirth, many women experience tearing or episiotomy and perineal pain, particularly when they have had an assisted vaginal delivery (Glazener, 1997). Following childbirth, dramatic hormonal changes cause the vaginal wall to become thinner and to lubricate poorly. This commonly causes vaginal soreness during intercourse (Bancroft, 1989; Cunningham, MacDonald, Leveno, Gant, & Gistrap, 1993). Dyspareunia may persist for many months after childbirth (Glazener, 1997). Perineal pain and dyspareunia due to childbirth morbidity and vaginal dryness have been shown to be related to women's loss of sexual desire (Fischman et al., 1986; Glazener, 1997; Lumley, 1978). Experiencing pain or discomfort with sexual intercourse is likely to discourage women from desiring sexual intercourse on subsequent occasions, and to reduce their sexual satisfaction.

Strong evidence indicates that breastfeeding reduces women's sexual desire and frequency of intercourse in the early postpartum period (Forster, Abraham, Taylor, & Llewellyn-Jones, 1994: Glazener, 1997; Hyde et al., 1996). In lactating women, high levels of prolactin, maintained by the baby's suckling, suppress ovarian oestrogen production, which results in reduced vaginal lubrication in response to sexual stimulation.

The principal aim of this study was to examine influences of psychological factors on changes from prepregnancy levels of women's sexual desire, frequency of intercourse, and sexual satisfaction during pregnancy and at 12 weeks and 6 months postpartum.

It was expected that during pregnancy and at 12 weeks and 6 months postpartum women would report a significant decrease in sexual desire, frequency of sexual intercourse, and sexual satisfaction compared to their prepregnancy levels. It was expected that women's reported relationship satisfaction would not change during pregnancy, but would decrease at 12 weeks and 6 months postpartum compared to their prepregnancy levels. Lower role quality and relationship satisfaction and higher levels of fatigue and depression were expected to predict changes to women's levels of sexual desire, frequency of sexual intercourse, and sexual satisfaction during pregnancy and at 12 weeks and 6 months postpartum. Dyspareunia and breastfeeding were also expected to have a negative influence on women's sexuality in the postpartum.

METHOD

Participants

One hundred and thirty eight primigravidae who were recruited at antenatal classes at five sites participated in the study. The participants' ages ranged from 22 to 40 years (M = 30.07 years). The partners of the women were aged from 21 to 53 years (M = 32.43 years). Data from four women were excluded from the analyses during pregnancy, as they were not yet in the third trimester. Responses were received from 104 women from this original group at 12 weeks postpartum, and 70 women at 6 months postpartum. It is unknown why there was a decline in response rate over the course of the study, but given the demands of caring for a young baby, it is likely that a substantial level of the attrition was related to a preoccupation with this task.

Materials

Participants completed a questionnaire package in the third trimester of pregnancy, and at 12 weeks and 6 months postpartum, which elicited the following information.

Demographic data. Date of birth, country of birth, occupation of both women and partners, the women's education level, and date of completion of the questionnaire were collected on the first questionnaire. The first questionnaire asked the expected date of the birth of the child. The second questionnaire asked the actual date of birth, and whether the mother experienced tearing or episiotomy. The second and third questionnaires asked whether sexual intercourse had been resumed following the birth. Participants who had resumed intercourse were asked "Are you currently experiencing physical discomfort with sexual intercourse which was not present before the birth?" Response choices ranged from 0 (None) to 10 (Severe). The second and third questionnaires asked whether the woman was currently breastfeeding.

Role quality scales. Work-role and Mother-role scales developed by Baruch and Barnett (1986) were used to determine role quality. Several questions on Baruch and Barnett's Mother-role scale were adjusted from those used for midlife women to make the scale more relevant to the anticipated role and actual role as the mother of an infant. Each scale lists an equal number of reward and concern items. The Work-role reward and concern subscales each contained 19 items, and the Mother-role subscales each contained 10 items. Participants used a 4-point scale (from Not at all to Very) to indicate to what extent items were rewarding or a concern. Each participant received three scores per role: a mean reward score, a mean concern score, and a balance score that was calculated by subtracting the mean concern score from the mean reward score. The balance score indicated role quality. The alpha coefficients for the six scales were reported to range from .71 to .94. In the current study, the alpha coefficients for the Work-role scale were .90 during pregnancy, .89 at 12 weeks postpartum, and .95 at 6 months postpartum. The alpha coefficients for the Mother-role scale were .82 during pregnancy, .83 at 12 weeks postpartum, and .86 at 6 months postpartum.

Depression scale. The 10-item Edinburgh Postnatal Depression Scale (EPDS) (Cox, Holden, & Sagovsky, 1987) is widely used as a community screening tool for postpartum depression. Each item is scored on a 4-point scale according to severity of symptoms, with a potential range from 0 to 30. The EPDS has been validated for antenatal use (Murray & Cox, 1990). The EPDS has increasingly been used for research as a linear indicator of dysphoria or distress (Green & Murray, 1994). The alpha coefficients for the EPDS in the current study were .83 during pregnancy, .84 at 12 weeks postpartum, and .86 at 6 months postpartum.

Fatigue scale. The 11-item self-rating Fatigue Scale was developed by Chalder et al. (1993) to measure the severity of subjective perceptions of fatigue. Respondents choose one of four responses to each item: better than usual, no more than usual, worse than usual, and much worse than usual. Scale scores potentially range from 11 to 44. In the current study, the scale had a coefficient alpha of .84 during pregnancy, .78 at 12 weeks postpartum, and .90 at 6 months postpartum.

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Relationship satisfaction scale. Nine items from the 12-item Quality of Relationship subscale from the Sexual Function Scale (McCabe, 1998a) were administered for each wave of data collection. On the first administration, participants were asked to recall how items applied before conception, and also "now, during pregnancy." Items were measured on a 6-point Likert Scale ranging from 0 (Never) to 5 (Always). The 12-item Quality of Relationship subscale is reported to have a test-retest reliability of .98, and a coefficient alpha of .80 (McCabe, 1998a). In the current study, the scale had a coefficient alpha of .75 for baseline (before conception) and .79 during pregnancy, .78 at 12 weeks postpartum, and .83 at 6 months postpartum.

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Last reviewed: 11/05

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