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

Tweet 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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Cai, L., Zhang, B., Lin, H., Xing, W., & Chen, J. (2014). Does vaginal delivery affect postnatal coitus? International Journal of Impotence Research, 26(1), 24-27. doi: 10.1038/ijir.2013.25

Fehniger, J. E., Brown, J. S., Creasman, J. M., Van Den Eeden, S. K., Thom, D. H., Subak, L. L., & Huang, A. J. (2013). Childbirth and female sexual function later in life. Obstetrics & Gynecology, 122(5), 988-997. doi:10.1097/AOG.0b013e3182a7f3fc

Gibbons, L., Belizan, J. M., Lauer, J. A., Betran, A. P., Merialdi, M., & Althabe, F. (2012). Inequities in the use of cesarean section deliveries in the world. American Journal of Obstetrics & Gynecology, 206(4), 331 e331-319. doi: 10.1016/j.ajog.2012.02.026

Gungor, S., Baser, I., Ceyhan, T., Karasahin, E., Kilic, S. (2008). Does mode of delivery affect sexual functioning of the man partner? Journal of Sexual Medicine, 5, 155-163. doi: 10.1111/j.1743-6109.2007.00479.x

Hosseini, L., Iran-Pour, E., & Safarinejad, M. R. (2012). Sexual function of primiparous women after elective cesarean section and normal vaginal delivery. Journal of Urology, 9(2), 498-504.

Kelly, S., Sprague, A., Fell, D. B., Murphy, P., Aelicks, N., Guo, Y., . . . Walker, M. (2013). Examining caesarean section rates in Canada using the Robson classification system. Journal of Obstetrics and Gynaecology Canada, 35(3), 206-214.

Klein, K., Worda, C., Leipold, H., Gruber, C., Husslein, P., & Wenzl, R. (2009). Does the mode of delivery influence sexual function after childbirth? Journal of Womens Health, 18(8), 1227-1231. doi: 10.1089/jwh.2008.1198

Lurie, S., Aizenberg, M., Sulema, V., Boaz, M., Kovo, M., Golan, A., & Sadan, O. (2013). Sexual function after childbirth by the mode of delivery: a prospective study. Archives of  Gynecology and Obstetrics, 288(4), 785-792.

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Safarinejad, M. R., Kolahi, A. A., & Hosseini, L. (2009). The effect of the mode of delivery on the quality of life, sexual function, and sexual satisfaction in primiparous women and their husbands. Journal of Sexual Medicine, 6, 1645-1667. doi: 10.1111/j.1743-6109.2009.01232.x

Signorello, L. B., Harlow, B. L., Chekos, A. K., & Repke, J. T. (2001). Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. American Journal of Obstetrics & Gynecology, 184, 881-888; discussion 888-890. doi: 10.1067/mob.2001.113855

Stoll, K., Fairbrother, N., Carty, E., Jordan, N., Miceli, C., Vostrcil, Y., & Willihnganz, L. (2009). “It’s all the rage these days”: University students’ attitudes toward vaginal and Cesarean birth. Birth, 36, 133-140. doi: 10.1111/j.1523-536X.2009.00310.x.

Stoll, K., Hall, W., Janssen, P., & Carty, E. (2014). Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian university students, Midwifery, 30, 220-226. doi: 10.1016/j.midw.2013.07.017.

van Anders, S. M., Hipp, L. E., & Kane Low, L. (2013). Exploring co-parent experiences of sexuality in the first 3 months after birth. Journal of Sexual Medicine, 10, 1988-1999. doi: 10.1111/jsm.12194

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We Make too Big of a Deal Out of the Big O!

Tweet Orgasms! They are wonderful things. But contrary to popular belief, they are not the “be all and end all” of sexual intercourse. Really, they aren’t. Or they shouldn't be. Then why do Cabrera and Menard (2013) state “according to the Western sexual script, orgasm for both partners is the ultimate goal of every sexual interaction and the most important marker of normal, healthy sexuality”—what is this all about????

We don’t like anything about this rigid script, especially the word “normal”—there is no such thing! To make things worse, orgasms portrayed by the media are supposed to happen easily, consistently, and quickly. Certainly, if we base our expectation of an orgasm on Fifty Shades of Grey, for example, we would probably be quite disappointed: a virginal Anastasia has her first ever, mind-blowing, black-out-from-so-much-pleasure orgasm from ... nipple stimulation! In the movies, women always appear to orgasm, and these orgasms almost always come about via penile-vaginal intercourse. However, in reality, most women cannot achieve an orgasm via penetration alone; clitoral stimulation is usually needed. In these same movies, men are portrayed as highly skilled, “always ready” sexual beasts who can go all night with their orgasms signalling the end of intercourse. Ah, what has Hollywood done to our sex lives?

These sexual scripts and stereotypes need to be challenged because they create unachievable standards for orgasm and for sex in general. These standards are difficult to achieve for typically functioning individuals, but what are these messages communicating to those with orgasmic disorders? When you are being bombarded with the message that an orgasm is essentially the goal and meaning of sex, what does sex mean when you simply cannot orgasm? Most people will have times when they cannot orgasm for whatever reason (like stress, fatigue, drunkenness, etc.) and some people cannot orgasm at all (due to having a medical condition, or sustaining a serious injury). Is the “sex” they are having meaningless – does it count less because orgasms are not happening consistently, or at all? Absolutely not!!!

According to Breuer (2013), “we need to focus a lot more on the journey rather than the destination. If you’ve had an amazing sexual experience where you and your partner(s) have really focused on sharing as much sexual pleasure as possible, why should it matter if orgasm was reached or not?” The media makes orgasms look like a piece of cake, but in reality, a relatively large portion of the population struggle with orgasm difficulties, be it they take too long (as in the case of orgasmic disorder or delayed ejaculation), they don’t take long enough (as in the case of premature [early] orgasm which is a disorder for males, but certainly some women complain that they orgasm too fast sometimes/often), they don’t have orgasms (for many reasons, some of which are short-term and some of which are longer term), or they don't have them in the “right” way (some people can only orgasm via masturbation and not partnered sex). These difficulties can be very distressing to the individuals who experience them, and the media’s fixation on “good sex = orgasm” perpetuates this distress. Therefore, it is important to talk about unrealistic standards for sex that we may have.

As a society, there are a few things we must become more aware of: (a) Orgasmic disorders are more prevalent than many people may think – because nobody talks about them! (b) Orgasmic disorders can be treated successfully. (c) Orgasmic disorders do not necessarily severely impact a romantic relationship, and dysfunction and dissatisfaction do not always go hand-in-hand. (d) Your level of dysfunction depends on the level of distress you feel in regards to it.

Contrary to the media’s overwhelming emphasis on orgasm as the key to sexual and relationship satisfaction, early research done by Frank, Anderson, and Rubinstein (1978) showed that, although 63% of women reported arousal and orgasmic dysfunction and 40% of men reported erection and ejaculatory dysfunction, 86% of women and 85% of men reported that their sexual relations were moderate to very satisfying. Even more surprisingly, sexual difficulties (not sexual dysfunctions), which were considered to be things like “lack of interest” and “inability to relax”, were more strongly related to sexual dissatisfaction than actual sexual dysfunctions were. The overall message of these researchers was that “it is not the quality of sexual performance but the affective tone of the marriage that determines how most couples perceive the quality of their sexual relations”. A couple dealing with an orgasmic disorder could have a far better sex life than a couple with no sexual dysfunction.

It is important to remember that a sexual “dysfunction” is only a problem to the point that it causes clinically significant levels of distress – if it doesn’t bother you, it’s not a dysfunction. The aforementioned unachievable standards put forth by the media contribute greatly to this distress and perhaps with more information and more realistic portrayals of sex and orgasm, this distress could be alleviated—or even prevented. Those experiencing difficulties with orgasm should know that they are not alone, and that these difficulties do not define their sex life – they do.

Sex is so much more than physiology – it’s about two (or more) people connecting. Those struggling to meet the standards for sex that the media has created should take comfort in the fact that they are not alone and that society has the problem, not them. Don’t get me wrong, orgasms are great and all, but instead of making them the grand finale, they should be viewed as a part of sexual activity, whether they are at the beginning, the end, or somewhere in the middle—if they happen at all.

Amber Hart, BAH student studying Psychology at Queen’s University

(Edited by Caroline Pukall, Ph.D., C.Psych.)

References

Breuer, R. (2013). Fixation on Orgasm. The Science of Sex. Retrieved from http://www.standardinnovation.com/scienceofsex/fixation-on-orgasm/

Cabrera, C., & Menard, A. D. (2013). "She exploded into a million pieces": a qualitative and quantitative analysis of orgasms in contemporary romance novels. Sexuality and Culture, 17(2), 193+. Retrieved from http://link.springer.com/content/pdf/10.1007%2Fs12119-012-9147-0.pdf

Frank, E., Anderson, C., & Rubinstein, D. (1978). Frequency of sexual dysfunction in normal couples. The New England Journal of Medicine. pp 111-115. DOI: 10.1056/NEJM197807202990302