Sexual problems equally common after C-section, natural birth

After giving birth, women often struggle with reduced sexual desire and arousal, but how they delivered – by cesarean or vaginally – is not to blame, a small study suggests.

Women in the study were just as likely to report sexual problems 12 weeks after delivery, regardless of how they gave birth, although complaints did differ somewhat between the C-section and vaginal-delivery groups.

“The message for pregnant women is that sexual dysfunction in some aspects or domains is expected and is not permanent,” said senior author Dr. Taymour Mostafa, a professor of andrology and sexology at Cairo University in Egypt.

Pregnancy and delivery can cause physical changes that often cause pain during sex, reduced desire, difficulty achieving orgasm and fatigue, Mostafa and his colleagues write in the International Journal of Impotence Research.

Many women with these problems don’t ask for help from doctors, even though they want to, the authors note.

The researchers surveyed 200 women six weeks after giving birth, and again at 12 weeks. The average age was 25 to 30; most were highly educated and living in urban areas. Forty-five percent delivered vaginally; 55 percent had a C-section.

Six weeks after delivery, 43 percent of the women noticed a difference in sex, with 70 percent feeling pain and 30 percent fatigue. By 12 weeks, however, 38 percent said their sex lives were improved because of more intimacy and less pain.

Overall, the risk of problems was similar for both delivery modes. But those who delivered vaginally felt much less desire, arousal and lubrication than the C-section group, though not much difference in ability to have an orgasm, satisfaction or pain. The women who had a C-section only noticed a significant difference in their level of desire after 12 weeks.

“Many women are afraid (to resume sexual intercourse), so I think fear plays into that part of desire,” said Sandi Tenfelde, a women’s health nurse practitioner and researcher at the Marcella Niehoff School of Nursing, Loyola University Chicago.

“If you are concerned about the changes that happen in your body and you’re nervous about what it’s going to feel like, that fear can reduce the desire,” she said.

“Women can also have pelvic pain or perineal (between vagina and rectum) pain, depending on their mode of giving birth, that may also impact not only their desire but their arousal,” Tenfelde said.

Tenfelde praised the researchers for doing a study on a subject that needed more answers.

Women who return for their six-week postpartum check "are reassured that everything is normal and healing, but many women recognize that their body has changed during pregnancy and after birth and they are wondering how they will recover from the physical changes that happen with pregnancy and birth,” she told Reuters Health.

“Until we can start asking those questions, it’s hard for us to give that anticipatory guidance to help women recover and heal and understand what is expected,” Tenfelde said.

Mostafa and colleagues say the new father’s state of mind can also affect sex after giving birth.

“The role of the male partner is highly important for good understanding of these changes, support, encouragement and avoiding criticisms,” Mostafa told Reuters Health.

Tenfelde said couples could have a “desire discrepancy,” where the typical six weeks of waiting for sex after a birth was long and frustrating for a partner but a woman still felt apprehensive. But, Tenfelde said, couples could find other ways to be intimate.

“There are lots of ways to be intimate with your partner after the birth of a baby (hand holding, cuddling, massage and genital stimulation without vaginal penetration). Finding alternate ways of being intimate without vaginal penetration can be very therapeutic for the couple,” Tenfelde said.