Sexual behaviour in pregnancy, after childbirth and during breast-feeding

Abstract

Sexual and marital relationships change throughout marriage and the transition to parenthood can be seen as a psychosocial crisis. Recent studies do not support the finding of Masters and Johnson (1966) that there is a mid-trimester rise in sexual responsiveness. Sexual behaviour decreases towards the end of pregnancy and a number of studies have found that in the majority of mothers there is only a slow return to pre-pregnancy levels in the first postnatal year. Some of the factors influencing the rate of return are discussed. Breast-feeding is important because of the hormonal changes it produces and it has been said to stimulate sexual feelings in both mother and baby. There is some evidence that breast-feeding has an adverse effect on sexuality in the first postnatal year. It is not clear whether this could be related to differences in hormone levels or differences in feeding behaviour. Fatigue and contraception have largely been ignored in studies of factors influencing postnatal sexual behaviour. Women who went on to breast-feed were found to be very similar on antenatal measures of sexual behaviour to those who went on to bottle-feed. The method of feeding is the major influence on the hormonal status, and the experience of painful intercourse reported by breast-feeding mothers may be related to low oestrogen levels. Breast-feeding persistence is influenced by both social and psychological factors and its effect on sexual behaviour is discussed.

PIP: The birth of the 1st child constitutes a psychosocial crisis for most couples, and significant marital and sexual changes occur during the childbearing years. Most women report a decline in sexual activity and interest as their pregnancy progresses, although an association with prepregnancy sexual behavior is apparent. Prospective studies of sexual behavior in the 1st postnatal year reveal resumption of intercourse by the 6th-8th week after delivery and a slow return to prenatal levels of sexual frequency. Pain and tenderness in the episiotomy scar, fear of another pregnancy, changes in body image, and fatigue all have been cited by women for the avoidance or dislike of sexual intercourse in the postpartum period. There is some evidence that breastfeeding, too, has an adverse effect on sexuality in the 1st year postpartum. Lactating women experience raised levels of prolactin and prolonged hypo-estrogenization. In addition, lactating women with diminished sexual desire have been found to have significantly lower levels of androstenedione and testosterone than their counterparts whose sexual interest was not severely reduced. Unclear is whether the generally negative association between prolonged breastfeeding and resumption of prepregnancy levels of sexual activity reflects hormonal changes linked to lactation or psychosocial characteristics that determine whether a women breastfeeds or bottlefeeds. Marriage counselors have observed that sexual problems often have their origins in the year after the birth of the 1st child. Thus, more research on the association between infant feeding and sexual behavior, mood, and morbidity is needed so clinicians can try to avert the development of marital conflicts.