Psychological Factors and the Sexuality of Pregnant and Postpartum Women

continued

At 6 months after childbirth, women continued to report significantly decreased sexual desire, frequency of intercourse, and sexual satisfaction compared to their levels prior to conception satisfaction (Fischman et al., 1986; Pertot, 1981). The most marked reduction was in level of sexual desire.

By the time babies are 6 months old, their presence and aspects of women's mother role have a considerable impact on the sex lives of their parents. Many women have greater difficulty with the mother role at 6 months postpartum than at 12 weeks postpartum, due to their infants' more difficult behaviors (Koester, 1991; Mercer, 1985). Babies are well into the process of attachment, usually preferring to be cared for by their mothers; most can move around by crawling or sliding, and need considerable attention. In the cross-sectional analyses, mother-role quality was the strongest predictor of each of the sexual measures. Women with higher mother-role quality also had higher relationship satisfaction and less depression and fatigue at 6 months postpartum. This is consistent with research which has shown various associations between mother-role quality, infant difficulty, lower marital satisfaction, fatigue, and postnatal depression (Belsky & Rovine, 1990; Milligan, Lenz, Parks, Pugh & Kitzman, 1996). It may be that by 6 months postpartum the interaction between infant temperament and the parental relationship has been amplified.

Depression appeared to exert an unexpected positive influence on women's sexual desire at 6 months postpartum. These findings differ from those of Hyde et al. (1998), who found that depression was a highly significant predictor of loss of sexual desire of employed women at 4 months postpartum. This discrepancy may be due to problems with the sample in this wave of our study. The low rate of postnatal depression suggests a lower response rate in this study from women who may have become depressed after childbirth. The distribution of sexual desire by depression scores at 6 months postpartum was unusual, in that there was a cluster of women who were very low in both depression and sexual desire, and this cluster may have unduly influenced results for the sample as a whole.

Dyspareunia continued to have a strong influence on women's sexuality at 6 months postpartum, although the average level of dyspareunia at the later period was less than at 3 months earlier. It is possible that by this stage the expectation of pain with sexual intercourse for some women may have started a cycle in which they become less aroused sexually, which perpetuates vaginal dryness and discomfort with intercourse. Although dyspareunia may commence as a physical factor, it may be maintained by psychological factors. This relationship needs to be explored further in future research.

A major limitation of the current study is that only women were surveyed, and not their partners. An additional limitation is that before-conception measures required retrospective recall, and that prepregnancy and pregnancy measures were collected at the same time. It would have been preferable to take baseline measures earlier in the pregnancy. Ideally, baseline measures would be taken before conception. Further there was some attrition in participants throughout the study (25% between time 1 and time 2, and a further 26% between time 2 and time 3). This may have limited the generalizability of the findings.

In addition, the sample in the current study appeared to be biased to better educated women of higher professional status, like samples in many previous studies (e.g., Bustan et al., 1996; Glazener, 1997; Pertot, 1981). This is a problem which is not easily overcome, although multidisciplinary collaboration between gynaecological and mental health professionals may assist (Sydow, 1999).

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The findings from the current study have important implications for the well-being of women, their partners, and the family. It is clear that a range of factors influence sexual responses during pregnancy and postpartum, and that these factors vary at different stages of the process of adjusting to childbirth. Fatigue is a constant factor influencing sexual responses during pregnancy and at 12 weeks and 6 months postpartum. Other variables assume significance at different stages of the pregnancy and postpartum periods. Providing couples with information about what sexual changes they may expect, the duration of those changes, and the possible influences on those changes, may help couples avoid making unfounded harmful assumptions about their relationship.

Last reviewed: 11/05

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