Impact of delivery type on female sexual function explored

In primiparas, route of delivery does not have a long-term effect on female sexual dysfunction, according to Iranian research published in Electronic Physician. This is contrary to popular belief among women that vaginal delivery can be expected to hamper sexual function more than does cesarean delivery.

Pregnancy and childbirth are known to be important factors affecting female sexual function, and the advent of sexual dysfunction can negatively impact a woman’s quality of life and intimate relationships. Pregnancy itself, hormonal changes, and the mechanical force and pressure of the labor process during vaginal delivery can damage the pelvic floor, which in turn can precipitate urinary or fecal incontinence, and female reproductive organ prolapse.

The authors noted that the elective cesarean rate in their country is growing due to fear of pain and injury during childbirth and the perceived risk of complications of normal vaginal delivery among women. They also stated that approximately 62% of healthy women in their region of Iran suffer from sexual dysfunction. These trends led them to investigate whether vaginal vs. cesarean delivery in first-time mothers had different effects on long-term sexual function.

Study population

The researchers enrolled 177 primiparas who were randomly selected from all primaparas who had delivered in Sabzevar Hospitals over a 2-year period. Subjects were included if they had not had any physical or mental illnesses in the 2 years prior to the study and had not taken any medications for longer than a month in that time. Exclusions included preterm or post-term labor, non-elective cesarean section, instrumental vaginal delivery, and women with multiple partners.

Mean age of the women was 31.81 +6.31 years and mean duration of marriage was 11.7+ 6.15 years. Of the women studied, 69.5% had vaginal delivery and 30.5% had caesarean section.

Participants were asked to complete a demographic questionnaire. In addition, a validated Persian version of the Female Sexual Function Index (FSFI) consisting of 19 questions in six domains of sexual function-sexual desire, lubrication, sexual satisfaction, sexual arousal, orgasm, and sexual pain-was self-administered. Scores on each domain could range from a low of 0 to a high of 5; score cut-off points used in the study to diagnose dysfunction are listed in the Table.

Table 1. FSFI Score Cut-Offs Used in the Study

Results of the cross-sectional study revealed that women in the cesarean delivery group had significantly higher sexual arousal scores than women in the vaginal delivery group (P = 004), but no other significant differences were found in FSFI scores between the two groups (P = 0.23). There was also no association between delivery method and either urinary (P = 0.07) or fecal (P = 0.6) incontinence. However, among women with urinary and/or fecal incontinence (found in 22.6% and 0.6% of the subjects, respectively), sexual dysfunction was prominent (P = 0.015 and P = 0.018, respectively). 

Counseling essential

Sexual function is known to fluctuate for 6 months after delivery, but it gradually improves over time. According to the study authors, that is an essential counseling point, along with the lack of difference in impact on sexual function among delivery methods as identified in this study, and healthcare practitioners should use this information to dissuade women from choosing elective surgical delivery. “The results of this study can be used by healthcare professionals, especially midwives, to design and develop effective counseling programs and appropriate education about sexual function after delivery and the effect of delivery on sexual function,” stated the authors.