Postpartum sexual problems are similar for depressed and nondepressed women, but prevalence differs.

Within six months after giving birth at a London hospital, nine in 10 women answering survey questions about their sexual and mental health had resumed intercourse, but two-thirds of those who had said that sex was less frequent and four in 10 said that it was less satisfying than it had been before they became pregnant. (1) Twelve percent of women suffered postpartum depression; these women were less likely than others to report having resumed intercourse and were more likely to say that they had started having sex too soon after delivering. The proportions of women reporting sexual problems such as pain during intercourse were elevated three months after delivery; they were lower, but remained above prepregnancy levels, at six months postpartum. This pattern was the same regardless of whether women were depressed, although problems were more common among women with postpartum depression.

Respondents to the mailed survey were first-time mothers who delivered in the second half of 1997. Analyses of the sexual health of women with and without depression were based on data for 468 respondents who answered questions that permitted the investigators to assess their scores on a standard postpartum depression scale.

Overall, 12% of women had postpartum depression. Obstetric records revealed that these women were significantly less likely than others to have been born in the United Kingdom (61% vs. 76%), to be white (58% vs. 75%), to be employed (63% vs. 80%) and to have a permanent residence (81% vs. 93%). In other respects that could be related to postpartum mental and sexual health, women with depression were statistically indistinguishable from those without: In each group, 50-60% were younger than 30 and were married; about half had had an unassisted vaginal delivery, and one-quarter a cesarean. Depressed and nondepressed women were equally likely to have had perineal damage and to be currently breast-feeding.

Eighty-seven percent of women had resumed intercourse by the survey date, and another 2% had attempted to do so; the proportion who had at least attempted to start having sex again was significantly greater among women without depression than among those who were depressed (90% vs. 77%). Among those who had resumed or attempted to resume sexual relations, similar proportions of depressed and nondepressed women said that they were having sex less often than they had before becoming pregnant (68% and 69%, respectively), that their sex life was not as satisfying as it had been (43% and 38%) and that their partner was dissatisfied with the couple's sex life (21-26%). However, those suffering depression were more likely than others to say that their partner had initiated the resumption of intercourse (35% vs. 20%) and that they had resumed having sex too soon (28% vs. 9%).

Regardless of women's depression status, when those who had a partner but had not attempted to resume intercourse were asked the reason, they most frequently cited loss of libido, lack of interest, fatigue, physical problems and feelings of unattractiveness. Those without depression added that they feared conceiving again, they needed contraception, their partner was away or ill, and they were spending time with their child.

Significantly greater proportions of women reported having sexual problems--vaginal dryness, looseness or tightness; pain during intercourse, penetration or orgasm; difficulty achieving orgasm; or bleeding or irritation after intercourse--three months after delivery than before conception. The proportions declined between three and six months postpartum, but not to prepregnancy levels. Although this pattern was the same for nondepressed and depressed women, problems were consistently more common among the latter; the median number of sexual problems six months postpartum was two for depressed women and one for others. Sixty percent of women with a postpartum sexual problem had not discussed it with anyone, 33% had talked to their partner about it and 12% had discussed it with a doctor; these proportions did not differ by women's depression stares.

The researchers stress that their findings do not indicate a causal relationship between sexual problems after childbirth and postpartum depression. However, they conclude, their study "provides a basis for clinicians to provide information to women, depressed or not, on the problems they are likely to encounter, which of those may resolve, and when to seek further health care."

REFERENCE

(1.) Morof D et al., Postnatal depression and sexual health after childbirth, Obstetrics & Gynecology, 2003, 102(6): 1318-1325.