A woman’s sexuality can change over the course of her life as a result of different life phases and/or life events. Pregnancy and childbirth have been shown to have a big impact on a woman’s sexual function. Research indicates that sexual function declines during pregnancy and typically does not fully recover to pre-pregnancy levels until about 12 months postpartum (Chayachinda, 2015).

Past studies suggest that trauma to the perineum (region between the vagina and anus), hormonal changes while breastfeeding, pain related to the episiotomy, and psychological factors may all play a role in decreased sexual function during the postpartum period. Because operative vaginal delivery (a delivery involving a tool like forceps, spatulas, or a vacuum extractor) has been associated with increased risk of perineal trauma, it is worth investigating whether mode of vaginal delivery has an impact on a woman’s sexual function.

Over 300 women who had given birth at the Department of Obstetrics and Gynecology of Hospital de Braga (Portugal) between February and October 2018 were approached to participate in a study regarding postpartum sexual function and mode of vaginal delivery. The women were asked to specify their type of vaginal delivery and complete the Female Sexual Function Index (FSFI) at 3, 6, and 12 months postpartum. In the end, 211 women completed at least one questionnaire.

• In this study, the ratio of women with operative vaginal deliveries to those with spontaneous vaginal deliveries was 2:1.
• Women who were less than 18 years old, had pre- or post-term births, gave birth to twins, or had cesarean deliveries were excluded from the study. Because forceps were only used in 4 deliveries, the women with forceps-assisted deliveries were excluded from the study as well. Finally, 11 women were excluded because they had not resumed sexual activity at the time of the study.
• In total, 196 women were included in the study (131 with operative vaginal deliveries and 65 with spontaneous vaginal deliveries).
• The median age of the participants was 32 years old for both operative and spontaneous vaginal delivery modes.
• A total FSFI score of 26.55 or below was used as the cut-off for sexual dysfunction.

This study, which was developed as a part of the Maternal-neonatal Outcomes in Operative Vaginal Delivery Prospective Study (MOODS), has helped illuminate some of the potential effects of vaginal delivery mode on sexual function.

• The participants’ overall rate of sexual dysfunction was 62%, 43%, and 48% at 3, 6, and 12 months postpartum.
• At the 3-month point, there was a significant difference in the FSFI scores of the spontaneous vaginal delivery group and the operative vaginal delivery group. Those in the operative vaginal delivery group had lower total FSFI scores (mean+/-SD = 21.3+/-8.6) than the women in the other group (mean+/-SD = 24.9+/-7.9), meaning that they experienced worse sexual functioning. At this time, 44% of the women in the spontaneous vaginal delivery group were classified as having sexual dysfunction, compared to 70% of the women in the operative vaginal delivery group.
• There were no significant differences found in the FSFI scores of the two groups at 6 or 12 months postpartum, but the women in the operative vaginal delivery group had lower scores in the sexual pain domain at 12 months.
• The type of tool used in operative vaginal deliveries (spatulas or a vacuum extractor) did not result in significant differences in FSFI scores.

Women may experience changes in their sexual function during pregnancy and after childbirth, regardless of the mode of vaginal delivery. Pregnancy and postpartum sexual function are multifaceted experiences, and many variables may influence a woman’s health outcomes. However, the results of this study suggest that women who have an operative vaginal delivery may be at greater risk of sexual dysfunction, at least in the short term. Supporting women as they navigate the changes in their sexuality during pregnancy and the postpartum period may help ease their concerns and enhance their overall sexual well-being.

Resources:

• Chayachinda, C., Titapant, V., & Ungkanungdecha, A. (2015). Dyspareunia and Sexual Dysfunction after Vaginal Delivery in Thai Primiparous Women with Episiotomy. The Journal of Sexual Medicine, 12(5), 1275-1282. DOI: https://doi.org/10.1111/jsm.12860.
  
  
• de Sousa, N.Q., Borges, A.C., Sarabando, R., Bivar, L., Viana, J., Cerqueira, M., Miranda, A., Reis, I., & Nogueira-Silva, C. (2021). The Role of Operative Vaginal Delivery in Postpartum Sexual Dysfunction: MOODS - A Prospective Study. The Journal of Sexual Medicine, 18(6), 1075-1082. DOI: https://doi.org/10.1016/j.jsxm.2021.04.002.