Sexual function and associated factors at 24 months postpartum: a cohort study / Função sexual e fatores associados aos 24 meses de pós-parto: um estudo de coorte

Ana Laura Warmling Rovaris, Fabiana Flores Sperandio, Ingridy Kammers, Julia Sperandio Baron


The aim of this study was primarily to investigate the rates of indicative sexual dysfunction (SD) in the last gestational month and at 24 months postpartum. As a secondary objective, we sought to identify the main factors associated with SD at 24 months. The study sample included 131 women who gave birth in maternity wards at two public hospitals in southern Brazil between the period of October 2018 and April 2019. In the first stage (T1), an interview was carried out while the participants were hospitalized, during the immediate postpartum period, based on a clinical record and on the female sexual function questionnaire (Female Sexual Function Index – FSFI). In the second stage (T2), assessments were made via telephone, given the restrictions of the Covid-19 pandemic, 24 months after the initial data collection. At this stage, an updated clinical record was used, followed by the FSFI questionnaire. The final sample consisted of 82 women. Data analysis was performed using descriptive statistics. Data normality was verified using the Kolmogorov-Smirnov test. The chi-square test was used to compare categorical variables in two stages. The Wilcoxon test was used to compare the FSFI score and its domains, both in the last gestational month and at 24 months postpartum. To analyze the correlation of factors associated with the FSFI score, Spearman's test was used. As for sexual function (SF), of the women who were sexually active in the last four weeks of pregnancy (n=33), 39.4% (n=13) indicated SD, while at 24 months postpartum, the percentage was reduced to 20.7% (n=17). There was no statistically significant difference between the total FSFI scores for the two periods observed; however, the analysis of the FSFI domains showed a significant improvement in sexual desire (p=0.01) and a reduction in pain during intercourse (p=0.04) at the 24-month postpartum follow-up. Thus, indications of SD, both in the last month of pregnancy and at 24 months postpartum, can be considered moderate. Furthermore, it was possible to identify factors associated positively, as well as negatively, with SF at 24 months postpartum.


postpartum, sexual dysfunction, associated factors.

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. WEIRAN, L. et al. Sexual dysfunction and health condition in Chinese doctor: prevalence and risk factors. Scientific Reports, v.10, n.1, p.1-9, 16 Dec. 2020.

BANAEI, N. et al. Prevalence of postpartum dyspareunia: a systematic review and meta-analysis. International Journal Gynecology and Obstetrics, v.153, n.1, p. 14-24, 27 Apr. 2021.

PAULS, R.N.; OCCHINO, J.A.; DRYFHOUT, V.L. Effects of pregnancy on female sexual function and body image: a prospective study. Journal of Sexual Medicine, v.5, n.8, p.1915-1922, Aug. 2008.

BARRETT, G. et al. Women’s sexual health after childbirth. BJOG: An International Journal of Obstetric and Gynaecology, v.107, n.2, p.186-195, 2000.

GUTZEIT, O.; LEVY, G. and LOWENSTEIN, L. Postpartum female sexual function: risk factors for postpartum sexual dysfunction. Sexual Medicine, v.8, n.1. p.8-13, 2020.

GLAZENER, C.M.A. Sexual function after childbirth: women’s experiences, persistent morbidity and lack of professional recognition. BJOG: An International Journal Obstetrics Gynaecology, v.104, n.3, p.330-335, Mar. 1997.

SIGNORELLO, L.B.; HARLOW, B.L.; CHEKOS, A.K. and REPKE, J.T. Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. American Journal of Obstetrics Gynecology, v.184, n.5, p.881-890, 2001.

MC DONALD, E.; WOOLHOUSE, H. and BROWN, S.J. Sexual pleasure and emotional satisfaction in the first 18 months after childbirth. Midwifery, v.55, p.60-66, 6 Sep. 2017.

REVITAL, A. et al. Delivery in patients with dyspareunia - a prospective study. European Journal Obstetrics of Gynecology Reproductive Biology, v.237, p.131-136, 18 Apr. 2019.

BUHLING, K.J. et al. Rate of dyspareunia after delivery in primiparae according to mode of delivery. European Journal of Obstetrics Gynecology and Reproductive Biolology, v.124, n.1, p.42-46, 2006.

SAFARINEJAD, M.R.; HOSSEINI, L. and KOLAHI, A. 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, v.6, n.6, p.1645-1667, 2009.

MC DONALD, E.; GARTLAN, D.; SMALL, R. and BROWN, S.J. Dyspareunia and childbirth: a prospective cohort study. BJOG: An International Journal of Obstetrics and Gynaecology, v.122, n.5, p.672-679, 21 Jan. 2015.

QIAN, R.; CHEN, Z.; TANG, L. and ZHANG, W. Postpartum adverse effects and sexual satisfaction following cesarean delivery in Beijing. International Journal of Gynecology and Obstetetrics, v.132, n.2, p.200-205, 2016.

LAMARRE, A.; PATERSON, L. and GORZALKA, B. Breastfeeding and postpartum maternal sexual functioning: a review. The Canadian Journal of Human Sexuality, v.12, p.151-168, 2003.

MATTHIES, L.M. et al. The influence of partnership quality and breastfeeding on postpartum female sexual function. Archives of Gynecology and Obstetrics, v.299, n.1, p.69-77, 2019.

BASSON, R. The Female Sexual Response: a different model. Journal of Sex & Marital Therapy, v.26, n.1, p.51-65, 2000.

SYDOW, K.V. Sexuality during pregnancy and after childbirth: a meta-analysis of 59 studies. Reproductive Health Matters, v.8, n.15, p.183, 2000.

MARTÍNEZ-GALIANO, J.M. et al. Women’s quality of life at 6 weeks postpartum: influence of the discomfort present in the puerperium. International Journal of Environmental Research and Public Health, v.16, n.2, p.1-9, 17 Jan. 2019.

FIELD, A. Descobrindo a estatística usando o SPSS. Aletheia, 200-205, 2009.

LEMOS, A. Fisioterapia obstétrica baseada em evidências. Editora Científica Ltda, 2014.

FAUL, F. et al. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical. Journal of Materials and Environmental Science, v.2, p.175-191, 2007.

CHAYACHINDA, C.; TITAPANT, V. and UNGKANUNGDECHA, A. Dyspareunia and sexual dysfunction after vaginal delivery in thai primiparous women with episiotomy. The Journal of Sexual Medicine, v.12, n.5, p.1275-1282, May 2015.

ROSEN, R. et al. The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of Female Sexual Function. Journal of Sex & Marital Therapy, v.26, p.191-208, 2000.

PACAGNELLA, R.C; MARTINEZ, E.Z. and VIEIRA, E.M. Construct validity of a portuguese version of the Female Sexual Function Index. Cadernos de Saúde Pública, v.25, n.11, p,2333-2344, Nov. 2009.

WOLPE, R.E. et al. Reliability and validity of the Female Sexual Function Index administered via telephone in brazilian women. Manual Therapy, Posturology & Rehabilitation Journal, v.55, p.1-6, Jul. 2020.

WIEGEL, M.; MESTON, C. and ROSEN, R. The Female Sexual Function Index (FSFI): cross-validation and development of clinical cutoff scores. Journal of Sex & Marital Therapy, v.1, p.1-20, 2005.

WALLWIENER, S. et al. Sexual activity and sexual dysfunction of women in the perinatal period: a longitudinal study. Archives of Gynecology and Obstetrics, v.296, n.4, p.873-883, Jan. 2017.

SALIM, N.; ARAÚJO, N. and GUALDA, D. Body and Sexuality: Puerperas’ Experiences. Revista Latino Americana de Enfermagem, v.18, p.732-739, 2010.

HOLANDA, J.B.D.L; ABUCHAIM, E.D.S.V; COCA, K.P. and ABRÃO, A.C.F.D.V. Sexual dysfunction and associated factors reported in the postpartum period. ACTA Paulista de Enfermagem, v.27, n.6, p.573-578, 2014.

GHARE, N. et al. Postpartum female sexual dysfunction and related factors in Iranian women: A systematic review and meta-analysis. Journal of Isfahan Medical School, v.153, p. 14-24, 2019.

FUENTEALBA-TORRES, M. et al. What are the prevalence and factors associated with sexual dysfunction in breastfeeding women? A Brazilian cross-sectional analytical study. BMJ Open, v.9, n.4, p.1-9 2019.

CHANG, S. et al. Sexual dysfunction predicts depressive symptoms during the first 2 years postpartum. Women and Birth, v.31, n.6, p.403-411, Jan. 2018.

BANAEI, M.; MORIDI, A. and DASHTI, S. Sexual Dysfunction and its associated factors after delivery: longitudinal study in iranian women. Materia Socio Medica, v.30, n.2, p.198-203, 20 Aug. 2018.

MOLLAIOLI, D. et al. Lifestyles and sexuality in men and women: the gender perspective in sexual medicine. Reproductive Biology and Endocrinology, v.18, n.1, p.1-11, 2020.

VOLKOVICH, E.; BAR-KALIFA, E.; MEIRI, G. and TIKOTZKY, L. Mother-infant sleep patterns and parental functioning of room-sharing and solitary sleeping families: a longitudinal study from 3 to 18 months. Sleep, v.41, n.2, p. 1-31, 2017.

AKSU, A. and YILMAZ, D.V. The relationship of postpartum sleep quality and breastfeeding self-efficacy of turkish mothers. Scandinavian Journal of Caring Sciences, v.33, n.4, p.833-839, Feb. 2019.

CARREGA, J. et al. Impact of the quality of postpartum sleep and its health determinants on human milk volume. MCN. The American Journal of Maternal Child Nursing, v.45, n.5, p.289-295, Oct. 2020.

HOLT, L.L.; CHUNG, Y.B.; JANSSEN, E. and PETERSON, Z.D. Female Sexual satisfaction and sexual identity. Journal of Sex Research, p.1-11, 09 Jul. 2020.

O’MALLEY, D. et al. Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum: a longitudinal prospective cohort study (the MAMMI study). BMC Pregnancy and Childbirth, v.18, n.1, p.1-13, 2018.

LAGAERT, L.; WEYERS, S.; KERREBROECK, H.V. and ELAUT, E. Postpartum dyspareunia and sexual functioning: a prospective cohort study. Euroepan Journal of Contraception and Reproductive Health Care, v.22, n.3, p. 200-206, 27 Apr. 2017.