Sexual problems in obstetrics and gynaecology
Osborn, M.F.
British Journal of Hospital Medicine 30(4): 264-266; 268
1983
ISSN/ISBN: 0007-1064 PMID: 6685551 Document Number: 401126
Some efforts have been made to investigate sexual functioning in obstetric patients, and these are considered in 3 areas: pregnancy, the postpartum period, and the sequelae of episiotomy. Most research in the area of pregnancy suggests that sexual activity and libido decline steadily during pregnancy, but some studies such as that of Masters and Johnson (1966) report that sexual functioning varies during pregnancy. In this study, 101 North American women were interviewed in each trimester of pregnancy and again 3 months after delivery. In primiparous women there was, compared with preconception levels, a marked reduction of sexual activity and libido during the 1st and 3rd trimesters of pregnancy, but an increase during the 2nd trimester. Multiparous women showed a similar pattern. The finding of an improvement in sexual performance during the 2nd trimester has not been supported by subsequent research. Studies in which sexual functioning was assessed during pregnancy and retrospectively during the puerperium have reported a steady decline in libido and coital frequency throughout the 3 trimesters. Childbirth appears to be associated with diminished frequency and enjoyment of sexual intercourse for at least a year after delivery, but there is a gradual improvement in sexual functioning during this period. The level of sexual functioning before conception appears to determine sexual behavior in the year after delivery. Available findings cannot provide a basis for determining whether episiotomy is a specific cause of dyspareunia, but Beischer's (1967) findings suggest that there is little relation between the anatomical results of episiotomy and subsequent development of pain on intercourse. Sexual problems encountered in gynecology may be of 2 main types: those accompanying gynecological disorders and those arising from gynecological treatments. Research has focused mainly on sexual problems in 2 gynecological conditions--the menopause and infertility. In contrast to previous findings, recent studies have suggested that there is little sexual disturbance at the time of menopause. It seems likely that the loss of libido and orgasmic dysfunction are not specifically associated with the menopause, but vaginal dryness is not an uncommon feature of ovarian failure and may give rise to dyspareunia. Infertility is reported to be associated with a substantial prevalence of sexual dysfunction, some of which may be a direct cause of the failure to conceive. Certain sexual problems have no etiological relation to infertility but are nevertheless distressing to the patients involved. Sexual dysfunction has been studied in relation to surgical procedures and oral contraceptive use.