You, Me, and Baby Makes Three: Female Sexual Health after Childbirth

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Have you ever heard a new parent say that if they had to choose between sleep and sex, they would choose sleep? This statement can be shocking to hear, especially for those who don't have infants or young children in the home. Tons of things change when little ones come into your life—everything from sleep, mood, relationship dynamic, vehicle choices, and of course, your sex life can be impacted in some way.

A woman’s sexual desire can ebb and flow throughout her lifetime. For women who have given birth, the pregnancy and postpartum periods in particular can be a time of change in terms of one’s level of sexual desire. During pregnancy it is extremely common for women to experience fluctuating levels of sexual desire, so the amount of sexual activity that a woman and her partner engage in during pregnancy tends to vary from couple to couple. However, there seems to be a steep drop in sexual interest and activity after childbirth, for both the birthmother and her partner. In fact, research has shown that 86% of women and 88% of men report having sexual problems after the birth of a child.

During childbirth, there are many physical changes that happen to a woman’s body, and these changes may be responsible for some of the sexual problems couples experience after the birth of a child. For example, women who give birth vaginally are at risk of experiencing genital tearing, having an episiotomy (surgically planned incision on the perineum during labour), or having an assisted birth that requires instruments like a vacuum extractor or forceps to help pull the baby out. These factors can cause injury to the genital area (genital trauma), which is associated with painful intercourse (dyspareunia) in the first few months postpartum. Women who experience genital trauma during childbirth also tend to wait longer after childbirth to start having penetrative sexual activities again.

In the Sexual Health Research Lab (SexLab), we are aware that “sex” is way more than just penis-in-vagina intercourse; but unfortunately, most of the research on postpartum sexuality focuses on penis-in-vagina sex and the pain that it might cause.  That said, genital trauma can still affect all sorts of aspects of sexual function, like sexual satisfaction, desire, and orgasmic ability. Given all of these potential negative effects that a vaginal birth can have on a woman’s – and her partner’s – sex life, one might assume that having a Caesarean section (C-section) would prevent any sexual problems in the postpartum. In fact, recent surveys of Canadian women and men have found that a common reason for preferring a C-section over a vaginal birth is the belief that C-sections are better for a couple’s future sex life. Another recent study found that many women believe that having vaginal birth makes a woman’s vagina “loose” or “used”.

Okay, so it seems as though the general public opinion is that having a vaginal birth will lead to sexual problems. So, if women are concerned about their future sex life, then they should all have C-sections, right? Well let’s hold our horses – before we start writing off vaginal births all together, let’s see what the research actually tells us, shall we?

Drum roll please…. most studies that examine many different aspects of sexual function (e.g., sexual desire, sexual satisfaction, dyspareunia, etc.) have not found a difference in the self-reported sexual functioning between women who have had a vaginal birth and women who have had a C-section. These studies usually give questionnaires to women asking about their sex lives and interest in sex. In SexLab, we can objectively measure sexual function using some neat equipment, in addition to questionnaires. One way that we can measure sexual function is to look at sensitivity in the genito-pelvic region. There is some research to suggest that women who are more sensitive to touch and heat in those regions have better sexual function than those who are less sensitive to touch and heat. We can also measure sexual arousal by using special equipment to measure blood flow to the genitals while participants watch erotic films.

So, why does SexLab care about postpartum sexual function and whether it’s better or worse or the same after a vaginal birth or a C-section? Well, we believe that it is important to understand how different modes of delivery can potentially impact a couple’s sex life given that the rate of C-sections are increasing worldwide, with rates in Canada (26.9%) almost doubling the World Health Organization (WHO) recommended rate of 15%. In fact, in some South American countries, the rates of C-sections are as high as almost 50% of all births! Although it is unclear why this trend is occurring, some people suggest that this is because more women than ever are specifically requesting to have a C-section. It is possible that one of the reasons some women are requesting C-sections is because they are worried about the impact that having a vaginal birth will have on their future sex life. Granted, most people feel that sex is an important aspect of their lives, which means it is equally as important for women to know all of the facts (or at least what the research tells us thus far) when it comes to sex and childbirth.

To answer all these questions, the SexLab is conducting two studies to examine postpartum sexuality. The first is an online study for women who have not given birth to find out about perceptions of and preferences for pregnancy and childbirth, specifically as they relate to female sexuality. If you are a woman (18+) who has not given birth and are interested in completing this online survey, please click here: https://queensu.fluidsurveys.com/s/childbirthperceptions/. Please note that while we welcome all sexual orientations and gender identities, at this time we are only recruiting DFAB individuals (i.e., designated female at birth). Individuals who participate in the survey can be entered into a prize draw for an Amazon gift card.

The second study compares sexual function among women who have had a vaginal birth, women who have had a C-section, and women who have never given birth, by measuring things like genital sensitivity and genital blood flow. If you are a new mother (i.e., you had your first child within the last 2 years) in the Kingston, Ontario area and would like to participate in our study, please contact SexLab (email: sex.lab@queensu.ca or telephone: 613-533-3276).

Jackie Cappell, M.Sc. Ph.D. Candidate, Clinical Psychology, Queen's University

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