gms | German Medical Science

Introduction: Sexual health and functioning and the associated well-being of women after childbirth is an area that hitherto far has not been addressed enough scientifically. Limitations in sexual functioning (SF) can be attributed to birth injuries. Concurrently, women may suffer from postpartum pelvic floor disorders, which can be accompanied by urinary or fecal incontinency. The aim of the study was to explore the complexity of the relationships between mode of delivery, birth injuries, pelvic floor disorders, and the occurrence of SF and its impact on well-being from the perspective of women within the first five years postpartum (PP).

Methods: An anonymous online survey (via LimeSurvey) was conducted, which was distributed via social media (Instagram and Facebook). When possible, validated instruments were employed to assess SF (PISQ-IR), incontinence (ICIQ), and general well-being (WHO5).

Population Studied: The survey explicitly addressed mothers with and without pelvic floor disorders five years PP (inclusion criteria).

Results: Principal Findings: In total, the data of 2.930 women were analyzed. The mean age was 32.9 years (18–49, SD 4.2) and on average 1.5 children have been delivered (1–6, SD 0.7). Twenty-five percent of women surveyed reported that they were not sexually active (neither with partner nor alone), with the mean time PP being 13.3 months (SD 11.5) for sexually inactive women and 17.2 months (SD 13.2) for sexually active women (p < 0.0001, sig. diff. Wilcoxon rank-sum test). Reasons given for lack of sexual activity were "no interest" by 83.6 percent, "pain" by 36.8 percent, "health problems" by 24.8 percent, and "fear of urinary or fecal leakage, lowering of the pelvic floor" by 12.5 percent. Pain during sexual intercourse (Dyspareunia) was reported "sometimes" by 22.9 percent, "often" by 9.8 percent, and "always" by 2.9 percent. According to the Pearson correlation coefficient, SF is significantly correlated with the frequency of reported pain during intercourse (Chi2 = -0.47; p = 0.000). Overall, nearly 64 percent have a critical WHO-5 score below 51 points. Maternal well-being is significantly associated with SF (coef: 12.37, p = 0.000), incontinence (coef: -0.33, p = 0.003), as well as number of births (coef. -2.321, p = 0.000) in the multivariate linear model. A total of 11.59 percent of the adjusted variance is being explained by the model, with 10.2 percent of the variance being explained alone by SF. Therefore, a higher impairment of SF (lower score) is associated with significantly lower well-being.

Conclusion: Beside lack of interest in sexual activities, pain during sexual intercourse seems to be the principal issue for mothers in the first five years PP, which is associated with general well-being.

Implications for Practice: The topic of maternal health, and here explicitly the topic of SF, is relevant. Target points here could be, for example, education on measures, such as pelvic floor training or the utilization of lubricants to avoid pain during sexual intercourse.