SEXUAL DYSFUNCTION AMONG WOMEN AT FOUR TO SIX MONTHS POSTPARTUM: A STUDY IN A PRIMARY CARE SETTING
Sexual dysfunction in women is a significant health problem that harms marriage stability. Women in the Western countries were reportedly being affected by this condition after childbirth but the magnitude of the problem in our local setting is still unknown. The aim of this cross-sectional study was to determine the prevalence of women with sexual dysfunction at four to six months postpartum and its possible risk factors in an urban primary care setting. The participants were given a set of questionnaire, consisting of three parts; i) sociodemographic and maternal characteristics ii) Malay version of Female Sexual Function Index and iii) Malay DASS-21 questionnaire. Responses from 249 women were analyzed. More than half (57.0%,n=142) were found to have sexual dysfunction. The most prevalent types of sexual dysfunction reported by the affected women were sexual satisfaction disorder (98.6%), followed by arousal disorder (58.5%) and lubrication disorder (28.9%). Three factors were found to be significantly associated with sexual dysfunction; household income of less than RM2000 (adj OR = 0.31, 95% CI 0.14, 0.70), Malay ethnic group (adj OR = 1.93,95% CI 1.02, 3.66) and breastfeeding (adj OR = 2.24,95% CI 1.03, 4.85). In conclusion, the prevalence of sexual dysfunction in the postpartum period was considerably high. Efforts should be made to incorporate sexual health as part of the routine postnatal assessment in primary care practice.
2. Ishak IH, Low WY, Othman S. Prevalence, risk factors, and predictors of female sexual dysfunction in a primary care setting: a survey finding. J Sex Med 2010; 7:3080–7.
3. Hassanin IM, Helmy Y, Fathalla MMF, et al. Prevalence and characteristics of female sexual dysfunction in a sample of women from Upper Egypt. Int J Obs Gynaecol 2010;108(3).
4. Wallwiener CW, Wallwiener LM, Seeger H, et al. Prevalence of sexual dysfunction and impact of contraception in female German medical students. J Sex Med 2010; 7(6):2139–48.
5. Laumann EO, Paik A, Rosen RC, et al. Sexual Dysfunction in the United States. JAMA 1999;281(6):537–45.
6. Sidi H, Abdullah N, Puteh SEW, Midin M. The female sexual function index (FSFI): Validation of the Malay version. J. Sex. Med.2007; 4:1642–54.
7. Abdool Z, Thakar R, Sultan AH. Postpartum female sexual function. Eur. J. Obstet. Gynecol. Reprod. Biol. 2009; 145(2):133–7.
8. Lewis RW, Fugl-Meyer KS, Bosch R, et al. Epidemiology/risk factors of sexual dysfunction. J Sex Med 2004; 1(1):35–9.
9. Khajehei M, Doherty M, Tilley PJM, et al. Prevalence and Risk Factors of Sexual Dysfunction in Postpartum Australian Women. J Sex Med 2015;12(6):1415–26.
10. Barrett G, Pendry E, Peacock J, et al. Women’s sexual health after childbirth. BJOG 2000;107(2):186–95.
11. Pakpour AH, Yekaninejad MS, Zeidi IM, et al. Prevalence and risk factors of the female sexual dysfunction in a sample of infertile Iranian women. Arch Gynecol Obstet 2012; 286(6):1589–96.
12. Shifren JL, Monz BU, Johannes CB, et al. States Women. Obstet Gynecol 2008;112(5):970–8.
13. Abdul Latif R, Muhamad R, Kanagasundram S, et al. Risk and associated factors of female sexual orgasmic disorder in women with hypertension in Malaysia. Asia Pac Psychiatry 2013; 5 Suppl 1:21–6.
14. Acele EÖ, Karaçam Z. Sexual problems in women during the first postpartum year and related conditions. J Clin Nurs 2012;21(7–8):929–37.
15. Song M, Ishii H, Toda M, et al. Association between sexual health and delivery mode. Sex Med 2014;2(4):153–8.
16. Sidi H, Ezat S, Puteh W, Midin M, et al. Female Sexual Dysfunction Among Malaysian Women in A Primary Care Setting: Does The Frequency of Sexual Activity Matter? Med Heal 2007;2(21):48–57.
17. Leeman LM, Rogers RG. Sex after childbirth: postpartum sexual function. Obstet Gynecol 2012;119(3):647–55.
18. Rowland M, Foxcroft L, Hopman WM, et ak. Breastfeeding and sexuality immediately post partum. Can Fam physician Médecin Fam Can 2005;51:1366–7.
19. Avery MD, Duckett L, Frantzich CR. the Experience of Sexuality During Breastfeeding Among Primiparous Women. J Midwifery Womens Health 2000; 45(3): 227-37
20. Basson R, Brotto L, Laan E, Redmon G, Utian W. Assessment and Management of Women’s Sexual Dysfunctions: Problematic Desire and Arousal Rosemary. J Sex Med 2005; 2:291–300.
21. Yelland J, Sutherland G, Brown SJ. Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women. BMC Public Health 2010;10(1):771.
22. Ramli M, AbdullRamli M, Abdullah A, et al. Determinants of Early Postpartum Psychological Reaction among Mothers in Kuala Lumpur Hospital. Int Med J 2010; 9(1):37–42.
23. Dion MR. Healthy marriage programs: Learning what works. Futur Child 2005; 15(2):139–56.
24. Susan P. Couples and the first baby: responding to new parents’ sexual and relationship problems. Sex Relatsh Ther 2004; 19(3):223–46.
25. Sydow K Von. Sexuality during pregnancy and after childbirth: a meta-analysis of 59 studies. J Psychomatic Res 2000; 8(15):27–49.
26. Orbuch TL, Thornton A, Cancio J. The Impact of Marital Quality, Divorce, and Remarriage on the Relationships Between Parents and Their Children. Marriage Fam Rev 2000; 29(4):221–46.
27. Johnson CE. Sexual health during pregnancy and the postpartum. J Sex Med 2011; 8(5):1267–84.
28. Bailey RA, Kish L. Statistical Design for Research. Biometrics 1988; 44(2):625.
29. Musa R, Fadzil MA, Zain Z. Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales ( DASS ). Asean J. Psychiatry 2007;8(2):82–9.
30. Bursac Z, Gauss LH, Williams DK, et al. Purposeful selection of variables in logistic regression. Source Code for Biology and Medicine 2008; 3(17): 1-8
31. Farnam F, Pakgohar M, Mir-Mohammadali M. Effect of Pre-Marriage Counseling on Marital Satisfaction of Iranian Newlywed Couples: A Randomized Controlled Trial. Sex Cult 2011; 15(2):141–52.
32. Signorello LB, Harlow BL, Chekos AK, et al. Postpartum sexual functioning and its relationship to perineal trauma: A retrospective cohort study of primiparous women. Am J Obstet Gynecol 2001; 184(5):881–90.
33. De Lima Holanda JB, Vieira Abuchaim EDS, Coca KP, et al. Sexual dysfunction and associated factors reported in the postpartum period. ACTA Paul Enferm 2014; 27(6):573–8.
34. Gungor S, Baser I, Ceyhan S, et al. Mode of delivery and subsequent long-term sexual function of primiparous women. Int J Impot Res 2007;19(4):358–65.
35. Rosen NO, Mooney K, Muise A. Dyadic empathy predicts sexual and relationship well-being in couples transitioning to parenthood. J Sex Marital Ther 2017; 43 (6): 543-559.
36. Rao TSS, Nagaraj AKM. Female sexuality. Indian J Psychiatry 2015;57(Suppl 2):S296-302.
37. MoreiraJr ED, Hartmann U, Glasser D, et al. A Population Survey of Sexual Activity, Sexual Dysfunction and Associated Help - Seeking Behaviour in Middle - Aged and Older. Eur J Med Res 2005; 10(10): 434–43.
38. Akhavan-Taghavi MH, Asghari-Moghaddam MA, Froutan SK, et al. Vaginismus in Iran: A Single Center Report of 7 Years Experience. Nephrourol Mon 2015; 7(6):e30077.
39. Khajehei M. Prevalence and Risk Factors of Relationship Dissatisfaction in Women During the First Year After Childbirth: Implications for Family and Relationship Counseling. J Sex Marital Ther 2015;0715:1–10.
40. Kahneman D, Deaton A. High income improves evaluation of life but not emotional well-being. Psychological and Cognitive Sciences (PNAS) 2010; 107(38):16489-16493
41. Tehrani FR, Farahmand M, Simbar M, et al. Factors Associated with Sexual Dysfunction; A population based study in Iranian Reproductive Age Women. Arch Iran Med 2014; 17(10): 679-684
42. Campara JP, Vieira KM, Potrich ACG. Overall Life Satisfaction and Financial Well-Being: Revealing the Perceptions of the Beneficiaries of the Bolsa Familia Program. Brazilian Journal of Public Administration 2017; 51(2):182-200
43. Sungur MZ, Bez Y. Cultural Factors in the Treatment of Sexual Dysfunction in Muslim Clients. Curr Sex Heal Reports 2016;8(2):57–63.
44. De Judicibus MA, McCabe MP. Psychological Factors and the Sexuality of Pregnant and Postpartum Women. J Sex Res 2010; 39(2):94–103.
45. Alder EM, Cook A, Davidson D, West C, Bancroft J. Hormones, mood and sexuality in lactating women. Br J Psychiatry 1986 [cited 2016 May 3];148(1):74–9.
46. Lurie S, Aizenberg M, Sulema V, et al. Sexual function after childbirth by the mode of delivery: A prospective study. Arch Gynecol Obstet 2013; 288(4):785–92.
47. MacDonald C, Pinion SB, MacLeod UM. Scottish female obstetricians’ views on elective caesarean section and personal choice for delivery. J Obstet Gynaecol 2002;22(6):586–9.
48. Woranitat Taneepanichskul SW. Sexual function during the postpartum period. J Med Assoc Thail 2007; 90(9):1744–8.
49. Andrews V, Thakar R, Sultan AH, et al. Evaluation of postpartum perineal pain and dyspareunia-A prospective study. Eur J Obstet Gynecol Reprod Biol 2008; 137(2):152–6.
50. Bener A, Gerber LM, Sheikh J. Prevalence of psychiatric disorders and associated risk factors in women during their postpartum period: A major public health problem and global comparison. Int J Womens Health 2012; 4(1):191–200.
51. Miller RL, Pallant JF, Negri LM. Anxiety and stress in the postpartum: Is there more to postnatal distress than depression? BMC Psychiatry 2006;6(1):12.
52. Morof D, Barrett G, Peacock J, et al. Postnatal depression and sexual health after childbirth. Obstet. Gynecol.2003; 102:1318–25.
53. Glazener CMA. Sexual function after childbirth: women’s experiences, persistent morbidity and lack of professional recognition. Br J Obstet Gynaecol 1997; 104(3):330–5.
54. Brown S, Lumley J. Physical health problems after childbirth and maternal depression at six to seven months postpartum. BJOG 2000; 107(October):1194–201.