Psychological Factors and the Sexuality of Pregnant and Postpartum Women

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Sexual desire scale. Nine items asking about level of sexual desire were drawn from an earlier version of the Sexual Function Scale (SFS) (McCabe, 1998a). Desire is defined as "interest in or wish for sexual activity." Items referred to frequency of desire for sexual activity, frequency of sexual thoughts, strength of desire in different situations, the importance of fulfilling sexual desire through activity with a partner, and desire for masturbation. Three items asking about frequency of desire provided for a range of responses from 0 (Not at all) to 7 (More than ... or Many times a day). Six items sought a response on a 9-point Likert Scale, ranging from 0 to 8. Item scores were summed to provide a score ranging from 0 to 69. On the first administration, participants were asked to recall how items applied before conception and "now, during pregnancy." No previous psychometric data were available on the scale: however, the questions have face validity, and in the current study had an acceptable coefficient alpha of .74 at baseline, .87 during pregnancy, .85 at 12 weeks postpartum, and .89 at 6 months postpartum.

Frequency of sexual intercourse. In the first administration, respondents were asked to recall how often they typically had intercourse before conception (not just when they were trying to conceive), and during pregnancy and at 12 weeks and 6 months postpartum they were asked "How often do you typically have intercourse?". Respondents chose one of six fixed categories: rarely, not often (1-6 times a year), now and then (once per month), once a week, several times a week, or daily or more.

Sexual satisfaction scale. Nine items relating to female sexual satisfaction drawn from the Sexual Dysfunction Scale (McCabe, 1998b) were administered at each wave of data collection. Baseline required retrospective recall of how items applied before conception. Items included how often sexual activity with the partner was enjoyable, the partner's sensitivity as a lover, and the woman's own sexual responses. Items were measured on 6-point Likert Scale ranging from 0 (Never) to 5 (Always). Five items were reverse scored. Responses on these nine items were summed to provide a score which ranged from 0 to 45. The items all had face validity; however, no data were available on reliability for this subscale. In the current study, the scale had a coefficient alpha of .81 at baseline, .80 during pregnancy, .81 at 12 weeks postpartum, and .83 at 6 months postpartum.

Procedure

Written permission was obtained from four Melbourne metropolitan hospitals and one independent childbirth educator to recruit women attending antenatal classes to participate in the study. The study was approved by the Ethics Committees of each of the hospitals. In an endeavour to obtain a sample from a diverse socioeconomic group, a large public hospital group with a number of different childbirth education sites and three smaller private sector hospitals were included.

The researcher briefly addressed the classes, explained the purpose and requirements of the study, handed out a printed outline of the study, and answered questions about the study. The criteria for inclusion in the study were that each woman be over the age of 18, expecting her first child, and cohabiting with a male partner. Those who wished to participate were provided with a questionnaire package in an unsealed envelope. Return postage was prepaid and responses were anonymous. Informed Consent forms were sent back in the separate self-addressed envelopes provided. Informed Consent forms sought the names and addresses of participants and the anticipated dates of the babies' births, so that follow-up questionnaires could be sent out at approximately 2 and 5 months after the birth. Responses to the later questionnaires were matched by the dates of birth of women and their partners, which were included in each wave of data collection.

At approximately 2 months after the expected date of birth, questionnaires were mailed requesting completion of the questionnaires at 12 weeks after the birth. Responses were received from 104 women, a response rate of 75%. The periods since birth of the completed questionnaires ranged from 9 weeks to 16 weeks, mean = 12.2 weeks, SD = .13.

At 5 months postpartum, questionnaires were sent to 95 of the 138 women who participated in the first wave of data collection, and who met the criteria for inclusion in the postpartum studies. The remainder were omitted because at the time limit for collection of data for the current study they had not reached 6 months postpartum. Responses were received from 70 women, a response rate of 74%. Multivariate analyses of variance indicated that there were no significant differences between responders and nonresponders on any of the demographic variables at 12 weeks and 6 months postpartum, nor on the dependent or independent variables assessed at both prepregnancy and during pregnancy.

RESULTS

To determine whether women reported significant decreases in sexual desire, frequency of sexual intercourse, relationship satisfaction, and sexual satisfaction during pregnancy and at 12 weeks and 6 months postpartum compared to their recalled prepregnancy levels, a series of repeated measures MANOVA analyses were conducted with levels of time (prepregnancy, pregnancy, 12 weeks postpartum, and 6 months postpartum) as the independent variable, and sexual desire, frequency of sexual intercourse, sexual satisfaction, and relationship satisfaction as the dependent variables.

Comparing prepregancy to pregnancy (n = 131), there was a significant effect for time, F (4,127) = 52.41, p < .001. Univariate tests revealed significant differences for sexual desire [t(1,130) = - 8.60, p < .001], frequency of sexual intercourse [t(1,130) = - 12.31, p < .001], and sexual satisfaction [t(1,130) = - 6.31, p < .001]. In each of these variables, there were decreases from prepregnancy. However, for relationship satisfaction, there was a significant increase [t(1,130) = 3.90, p < .001] from prepregnancy to pregnancy.

Data from women who had not resumed sexual intercourse following childbirth were excluded from the postpartum analyses. At 12 weeks postpartum, the overall effect of time was significant, F(4,86) = 1290.04, p < .001. Univariate planned contrasts revealed that at 12 weeks postpartum compared with prepregnancy, women reported decreased sexual desire [t(1,79) = -8.98, p < .001], frequency of sexual intercourse [t(1,79) = - 6.47, p < .001], sexual satisfaction [t(1,79) = -3.99, p < .001], and relationship satisfaction [t(1,79) = 2.81, p < .01]. At 12 weeks postpartum compared with pregnancy, sexual desire [t(1,79) = 2.36, p < .05] and relationship satisfaction [t(1,79) = - 5.09, p < .001] were reduced, but frequency [t(1,79) = 5.58, p < .001] and sexual satisfaction [t(1,79) = 3.13, p < .01] had increased.

At 6 months postpartum, the overall effect of time was significant, F(4,47) = 744.45, p < .001. Comparing 6 months postpartum with prepregnancy, women reported decreased sexual desire [t(1,50) = -6.86, p < .001], frequency of sexual intercourse [t(1,50) = -2.77, p < .01], and sexual satisfaction [t(1,50) = -3.69, p < .001]. There was no difference in relationship satisfaction, [t(1,50) = .81, p > .05]. Comparing 6 months postpartum with 12 weeks postpartum, frequency of sexual intercourse had increased [t(1,50) = -2.18, p < .05], whereas there were no significant changes in sexual desire [t(1,50) = -1.26, p > .05], sexual satisfaction [t(1,50) = .91, p > .05], or relationship satisfaction [t(1,50) = -.82, p > .05]. The mean scores of the sexual and predictor variables are provided in Table 1.

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To test the prediction that psychological and relationship variables would account for women's sexual functioning during pregnancy and at 12 weeks and 6 months postpartum, a series of nine standard regressions (sexual desire, frequency of sexual intercourse, and sexual satisfaction at pregnancy, 12 weeks and 6 months postpartum as the dependent variables) were performed with role-quality, relationship satisfaction, depression, and fatigue as the independent variables.

For sexual desire during pregnancy, [R.sup.2] = .08, F(5,128) = 2.19, p > .05. For frequency of sexual intercourse during pregnancy, [R.sup.2] = .10, F(5,128) = 2.97, p < .05, with the major predictor being fatigue. For sexual satisfaction during pregnancy, [R.sup.2] = .21, F(5,128) = 6.99, p < 001, with the major predictor being relationship satisfaction (see Table 2).

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Last reviewed: 11/05

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