Dyspareunia — pain during sex — is relatively common after childbirth, and recent research sheds light on how psychological and biomedical factors relate to this condition. Interestingly, mode of delivery, may have less of an effect on sexual well-being than some people suspect. Despite a perception that caesarean delivery might affect sexual function less than vaginal delivery, how mothers delivered did not affect how often they had sex postpartum or the amount of enjoyment they got from it, according to research published in BJOG.
The researchers had data about pain during sex at 11 years, sexual enjoyment and frequency at 33 months, 5 years, 12 years, and 18 years after delivery. The results suggest that caesarean delivery may not help protect against sexual dysfunction, as previously thought.
Other studies have likewise found that different modes of delivery generally lead to similar outcomes of sexual well-being and have shown limited associations between mode of delivery and various aspects of sexual well-being including sexual satisfaction, sexual function, and sexual desire.
For some parents, resuming sexual intimacy after having a baby is a top priority. For others not so much, when the demands of the newborn infant act as such an effective contraceptive!
The results suggest that cesarean delivery "may not help protect against sexual dysfunction, as previously thought," Flo Martin, a PhD student in epidemiology at the University of Bristol, United Kingdom, and lead author of the study, said in a news release.
For their study, Martin and her colleagues analyzed data from more than 10,300 participants in the Avon Longitudinal Study of Parents and Children, which recruited women in the United Kingdom who were pregnant in 1991 and 1992.
The researchers had data about pain during sex at 11 years. They had data about sexual enjoyment and frequency at 33 months, 5 years, 12 years, and 18 years after delivery.
If women experienced pain during sex years after cesarean delivery, uterine scarring might have been a cause, Martin and colleagues suggested. Alternatively, women with dyspareunia before delivery may be more likely to have cesarean surgery, which also could explain the association.
Other studies have likewise found that different modes of delivery generally lead to similar outcomes of sexual well-being after birth.
"Several of my own longitudinal studies have shown limited associations between mode of delivery and various aspects of sexual well-being including sexual satisfaction, sexual function, and sexual desire," said Natalie O. Rosen, PhD, director of the Couples and Sexual Health Laboratory at Dalhousie University, Halifax, Nova Scotia, Canada.
"There are many causes of ovulatory disorders that are not related to ovarian function. This is one message. Another is that ovulatory disorders are not binary. They occur on a spectrum. These range from transient instances of delayed or failed ovulation to chronic anovulation," he said.
The new system is " a welcome update," according to Mark P. Trolice, MD, director of the IVF Centre and professor of obstetrics and gynaecology at the University of Central Florida, both in Orlando.
Trolice pointed to the clinical value of placing PCOS in a separate category. He noted that it affects 8%-13% of women, making it the most common single cause of ovulatory dysfunction.
"Another area that required clarification from prior WHO classifications was hyperprolactinemia, which is now placed in the type II category," Trolice said in an interview.
Better terminology can help address a complex set of disorders with multiple causes and variable manifestations.
"In the evaluation of ovulation dysfunction, it is important to remember that regular menstrual intervals do not ensure ovulation," Trolice pointed out. Even though a serum progesterone level of higher than 3 ng/mL is one of the simplest laboratory markers for ovulation, this level, he noted, "can vary through the luteal phase and even throughout the day."
The proposed classification system, while providing a framework for describing ovulatory disorders, is designed to be adaptable, permitting advances in the understanding of the causes of ovulatory dysfunction, in the diagnosis of the causes, and in the treatments to be incorporated.
"No system should be considered permanent," according to Munro and his co-authors. "Review and careful modification and revision should be carried out regularly."
