Materials and Methods
Using the Qualtrics platform we administered electronic surveys to 540 women in Ohio, Pennsylvania, and Michigan evaluating the primary domains of female sexual function before and after birth; additional information collected included demographic characteristics, as well as pregnancy and post-partum related variables such as duration of peripartum complications and duration of breastfeeding. Respondents were stratified into controls, those who did not report sexual dysfunction, those with dysfunction seeking care, and those with dysfunction not seeking care. Chi-squared and multivariate logistic regression analyses were used to evaluate variables associated with seeking care for sexual dysfunction.
540 women responded to the survey in completion, with 449 (83.1%) reporting some form of PPSD. The most common reported symptom was decreased desire, 64.3%, followed by decreased arousal 56.3%, pelvic pain, 34.1%, and decreased orgasm, 25.5%. Out of these, 56.5% resumed sex within 3 months of birth, 33.9% resumed sex between 4-12 months, and 5.3% resumed sex between 12-24%. The remainder did not resume sex at the time of the survey. Only 72 (16.0%), sought care for sexual dysfunction. Multivariable regression variables associated with care seeking for PPSD were difficulty with perineal healing (aOR=4.53, 95%CI: 1.54-13.38), transfusion after delivery (aOR=3.71, 95%CI: 1.44-9.56), reporting decreased desire (aOR=8.52, 95%CI: 2.72-26.76), bothered by decreased desire (aOR=7.13, 95%CI: 2.65-19.12), current dyspareunia (aOR=3.41, 95%CI: 1.31-8.87), reporting medication or substance abuse as cause of decreased desire (aOR=7.95, 95%CI: 3.63-17.42). Factors associated with decreased probability of seeking care were number of kids under 18 years in the home (aOR=0.61, 95%CI: 0.43-0.88 per child), number of cesarean deliveries (aOR=0.46, 95%CI: 0.29-0.74, per delivery), lower decreased sexual desire index score (aOR=0.57, 95%CI: 0.42-0.78, per 1.0 unit increase).
Predictors for health care seeking behaviors for sexual dysfunction after childbirth include not only degree of sexual dysfunction, but perceived bother of dysfunction. Identifiable variables were a difficult or complicated birthing experience. Though a majority of women experience new or worsening sexual dysfunction postpartum, few seek care. This study highlights the need for a more comprehensive and longer term approach to providing postpartum care that addresses sexual dysfunction beyond the traditional six week visit.