8050NRS - Promoting Sexual Health and Wellness Assessment Answer

Executive summary

A complex and multidimensional element of women's well-being, postpartum sexual health is influenced by several contributing and determinant factors. The psychological aspects of sexual fulfilment and desire, such as cultural expectations and postpartum mental health, are significant influences. Furthermore, physical difficulties, including vaginal trauma and hormone changes brought on by nursing, can have a substantial impact on the sexual health of postpartum women. Cultural standards also influence people's views and behaviours. Postpartum sexual health is influenced by various variables such as insufficient postpartum care, inadequate sexual education, the stress of parenting, difficulties with work and personal life, and a lack of support from others. Together, these elements have an effect on women's sexual health, which may result in unresolved problems and long-term effects. The Comprehensive Postpartum Sexual Health Education Programme and Mindfulness-Based Sexual Counselling (MBSC) are two effective methods for enhancing postpartum sexual health. When compared to a control group, the former demonstrated statistically significant improvements in sexual function, satisfaction, and response. The programme presents a sophisticated understanding of postpartum sexual health by addressing risk factors and customised needs. The latter, called MBSC, incorporates a structured counselling programme and mindfulness techniques. It showed that among postpartum women, there had been a notable improvement in views towards sexuality and a decrease in sexual anxiety and body image issues. The report demonstrates five key highlights. 

- Insufficient understanding of psychological and physiological transformations that take place after giving birth leads to misunderstandings, impractical anticipations, and uneasiness while talking about sexual matters thus necessitating proper sexual education.

-The impact of postpartum mental health, body image modifications, and societal expectations on women's sexual satisfaction and desire is substantial which requires addressing cultural standards and providing adequate mental health assistance.

- Postpartum sexual health is impacted by vaginal trauma, hormonal shifts, and inadequate postpartum care, which can cause discomfort, suffering, and changes in libido. There must be open communication between patients and healthcare practitioners to overcome these challenges.

-Key factors affecting postpartum sexual health include the strength of the partner bond, effective communication, and cultural norms. Positive outcomes require supportive environments and candid discussions about postpartum sexuality.

- Women are disproportionately affected by cultural expectations about work commitment and gendered roles, which highlights work-life balance as a significant driver of postpartum sexual health.

Background

According to Johansson et al. (2020), childbirth and the postpartum period that follows represent a momentous life event that has a dramatic impact on parents' and mothers' sexual adjustment. However, not every woman adjusts to the psychological and biological shifts easily; two-thirds of them report a significant reduction in their ability to mate within six months of giving birth (Faisal-Cury et al., 2015). Several causes, such as marital discord, despair, and financial pressures, cause this decline. In the first year following childbirth, sexual desire disorder (81.2%), orgasmic disorders (53.5%), and sexual arousal disorder (52.3%) were the most common issues among 325 Australian postpartum women in Khajehei's (2015) investigation. These findings are consistent with those of Hanafy et al. (2015), who found that orgasmic disorders and desire disorders were equally common in the postpartum period. 626 pregnant women participated in a retrospective cohort research six months after giving birth, and Hajimirzaie et al. (2021) found that women who delivered with an intact perineum were much more likely to have positive sexual results. On the other hand, a study conducted in 2013 by McDonald & Brown with 1,507 nulliparous women found that most of them did not have vaginal sex until after the first six weeks after giving birth. In addition, women who had a caesarean section, an operative vaginal delivery, a perineal tear, or an episiotomy showed a prolonged latency period before engaging in sexual activity again. Studies have shown that pudendal neuropathy, perineal discomfort, dyspareunia, and general maternal health are associated with delayed resumption of sexual life after perineal injuries (Krapf & Tappy, 2020). After vaginal delivery, there is evidence of pudendal nerve damage (Kinter & Newton, 2020). Two to three months after giving birth, 41–67% of women report having dyspareunia (Faisal-Cury et al., 2015). In women with significant obstetric morbidity, poor health outcomes may have an additional effect on sexual function (Yeniel & Petri, 2014). The long-term consequences of perineal laceration and episiotomy on sexual function were examined by Gutzeit et al. ( 2019). Women's sexual lives may be impacted by episiotomy in the second year after giving birth, as there may be more cases of pain and dry vagina during sexual activity (Gutzeit et al., 2019).

Dyspareunia may also result from a history of pain and other obstetrical causes. One year following the first delivery, 377 nulliparous women participated in a study to evaluate the factors impacting sexual activity and satisfaction. They found that compared to women with an intact perineum, those with a third or fourth-degree anal sphincter rupture had a five-fold lower likelihood of engaging in sexual activity (Leeman et al., 2016; Huber et al., 2021). The Breech Trial showed that, as compared to planned vaginal delivery, planned caesarean sections did not significantly impact a woman's ability to have sex two years after giving birth (Wängberg Nordborg et al., 2022). An additional investigation comprising 276 pairs of identical twins demonstrated a correlation between childbirth and reduced sexual function in parous twins. The study's findings suggest that childbirth affects sexual function long after giving birth, mainly because of psychological factors rather than physical ones (Yeniel & Petri, 2014; Faisal-Cury et al., 2015).

Priority populations

Sexual and reproductive health after childbirth is a complex and multifaceted domain influenced by various determinants and contributing factors. Understanding these elements is essential for developing targeted interventions and support systems, particularly when considering a priority population group.

Determinants of Sexual Health and Wellness:

Psychological factors such as postpartum mental health play a pivotal role in shaping sexual well-being (Molgora & Accordini, 2020). Conditions such as postpartum depression and anxiety, coupled with changes in body image, can significantly impact a woman's sexual satisfaction and desire (Hartley et al., 2017). The emotional toll of childbirth and the adjustments to new motherhood create a complex interplay between psychological well-being and sexual health. The physical aftermath of childbirth, including vaginal trauma, perineal tears, and hormonal fluctuations during breastfeeding, can have profound effects on postpartum sexual health (McBride & Kwee, 2017). Women may experience discomfort, pain, or changes in libido, influencing their desire and ability to engage in sexual activities. The quality of the partner relationship , effective communication, and emotional connection are pivotal determinants of postpartum sexual health. The adjustment to parenthood can strain couples, and emotional intimacy becomes intertwined with sexual satisfaction (Serrano Drozdowskyj et al., 2020). The lack of a supportive and communicative environment may hinder couples from addressing challenges and seeking solutions collaboratively, affecting both emotional and sexual intimacy (Prager, 2013). Cultural and societal norms influence perceptions of modesty, openness about sexuality, and the degree of acceptance of postpartum sexual exploration. Societal expectations can create barriers to open conversations about postpartum sexuality, leaving individuals feeling isolated or hesitant to seek support when needed (Fortenberry & Hensel, 2022).

Contributing Factors to Postpartum Sexual Health:

The absence of comprehensive sexual education exacerbates challenges related to postpartum sexual health. Inadequate knowledge about the physical and emotional changes that occur postpartum can contribute to misconceptions, unrealistic expectations, and discomfort in discussing sexual issues(Fortenberry & Hensel, 2022). Contributing to this lack of education are factors such as societal discomfort with discussing postpartum sexuality, shame or stigma associated with it, limited access to accurate information, and insufficient emphasis on comprehensive sexual education during prenatal and postnatal care (O'Malley et al., 2022). As a result, individuals may navigate the postpartum period with unmet needs and concerns, impacting their sexual well-being. Inadequate postpartum care is a significant contributing factor to unaddressed sexual health concerns. Insufficient attention to gynaecological follow-ups and discussions about sexual health during postpartum care can lead to unresolved issues and discomfort (Lobel & M. Ibrahim, 2018). Contributing to this inadequacy are factors such as a lack of emphasis on postpartum sexual health in healthcare systems, limited time allocated for postpartum appointments, and societal discomfort with discussing intimate issues openly. Parenting demands, sleep deprivation, and role adjustments contribute to fatigue, impacting sexual desire. Challenges in finding time for intimacy stem from societal expectations of perfect parenting, limited support systems, and the belief that prioritising self-care, including sexual well-being, is secondary (Tavares et al., 2019). Balancing responsibilities may strain relationships, diminishing interest in sexual activity. The challenges of balancing work and family responsibilities contribute to increased stress and fatigue, which, in turn, impact sexual desire and satisfaction. Couples facing these challenges may struggle to find quality time for each other, affecting overall relationship and sexual well-being (Leavitt et al., 2016). Inadequate or lack of comprehensive postpartum support systems , including family and community resources, exacerbates challenges. Insufficient emotional support, coupled with societal expectations romanticising the postpartum period and a general reluctance to discuss intimacy issues, leaves individuals feeling isolated, impacting mental and sexual well-being (Corrigan et al., 2015).

Evaluation of existing sexual health and wellness strategies for postpartum women

Comprehensive Postpartum Sexual Health Education Program

The Comprehensive Postpartum Sexual Health Education Program by Evcili et al. (2020) is a promising intervention designed to address the sexual health needs of postpartum women (Evcili et al., 2020). The program's alignment with Levine's conservation model showcases a thoughtful, evidence-based, and theory-driven approach to program development. Using validated assessment tools, such as The Index of Female Sexual Function, Arizona Sexual Experience Scale, and Golombok–Rust Inventory of Sexual Satisfaction, enhances the program's methodological rigour (Evcili et al., 2020). Moreover, the intervention group's exposure to the structured postpartum sexual health education program resulted in statistically significant improvements in sexual function, satisfaction, and response compared to the control group, indicating its benefits. This outcome suggests that the program contributes to reducing the negative effects commonly associated with postpartum sexual health (Evcili et al., 2020). A comprehensive evaluation should consider financial resources, time commitment, and scalability that make the program cost-effective and viable. The program's significance is underscored by its positive impact on key outcomes, including sexual function, satisfaction, and response (Darooneh et al., 2022). Identifying factors influencing postpartum sexual health, such as breastfeeding frequency and communication with healthcare professionals, adds depth to the program's significance by addressing individualised needs (Navidian et al., 2020). The study's emphasis on the reduction of the risk of sexual dysfunction and deterioration of sexual function/quality of sexual intercourse is noteworthy (Evcili et al., 2020). By targeting specific risk factors, the program demonstrates a nuanced understanding of postpartum sexual health, potentially enhancing its long-term impact and indicating its sustainability.

Mindfulness-Based Sexual Counseling (MBSC)

The MBSC strategy for postpartum women by Sıdıka Özlem Cengizhan & Tuba Uçar (2023) draws on the principles of mindfulness meditation, an ancient Eastern practice with origins in Buddhist traditions, fostering present-moment, nonjudgmental awareness (Stephenson & Kerth, 2017). It utilises an intervention consisting of a 4-week, 8-session counselling program based on mindfulness and is well-structured. The incorporation of validated outcome measures, including the Female Sexual Distress Scale-Revised, Attitude Scale toward Sexuality during Pregnancy, and Body Image Concerns during Pregnancy Scale, adds rigour to the program's quality (Sıdıka Özlem Cengizhan & Tuba Uçar, 2023). The study results indicate a significant decrease in sexual distress, body image concerns, and improvement in attitudes toward sexuality in the mindfulness group compared to the control group, thus indicating its usefulness for postpartum women who suffer from anxiety, depression, and body image issues which affect their sexuality. The benefits include enhanced psychological and physical well-being, increased self-confidence, and improved self-compassion. While the implementation of MBSC involves costs associated with counselling sessions, the long-term value lies in the potential prevention of negative psychological outcomes, contributing to the overall mental health of postpartum women (Jaderek & Lew-Starowicz, 2019). The sustainability of MBSC is supported by its evidence-based nature and alignment with the principles of mindfulness meditation. As mindfulness tools and skills promote psychological and physical well-being, the strategy may have enduring positive effects on sexual functioning and overall mental health (Sıdıka Özlem Cengizhan & Tuba Uçar, 2023).

References

‌Corrigan, C. P., Kwasky, A. N., & Groh, C. J. (2015). Social support, postpartum depression, and professional assistance: A survey of mothers in the midwestern United States. The Journal of Perinatal Education , 24 (1), 48–60. https://doi.org/10.1891/1058-1243.24.1.48

‌Darooneh, T., Ozgoli, G., Keshavarz, Z., & Nasiri, M. (2022). Educational programs and counseling models for improving postpartum sexual health: a narrative review. Sexual and Relationship Therapy , 1–17. https://doi.org/10.1080/14681994.2022.2085250

‌Evcili, F., Demirel, G., Bekar, M., & Guler, H. (2020). Effectiveness of postpartum sexual health education programme structured according to Levine’s conservation model: An interventional study. International Journal of Nursing Practice , 26 (3). https://doi.org/10.1111/ijn.12855

‌Faisal-Cury, A., Menezes, P. R., Quayle, J., Matijasevich, A., & Diniz, S. G. (2015). The Relationship between mode of delivery and sexual health outcomes after childbirth. The Journal of Sexual Medicine , 12 (5), 1212–1220. https://doi.org/10.1111/jsm.12883

‌Fortenberry, J. D., & Hensel, D. J. (2022). Sexual modesty in sexual expression and experience: A scoping review, 2000 - 2021. The Journal of Sex Research , 59 (8), 1000–1014. https://doi.org/10.1080/00224499.2021.2016571

‌Fortenberry, J. D., & Hensel, D. J. (2022). Sexual Modesty in Sexual Expression and Experience: A Scoping Review, 2000 - 2021. The Journal of Sex Research , 59 (8), 1000–1014. https://doi.org/10.1080/00224499.2021.2016571

‌Gutzeit, O., Levy, G., & Lowenstein, L. (2019). Postpartum female sexual function: Risk factors for postpartum sexual dysfunction. Sexual Medicine , 8 (1). https://doi.org/10.1016/j.esxm.2019.10.005

‌Hajimirzaie, S. S., Tehranian, N., Razavinia, F., Khosravi, A., Keramat, A., Haseli, A., Mirzaii, M., & Mousavi, S. A. (2021). Evaluation of couple’s sexual function after childbirth with the biopsychosocial model: A systematic review of systematic reviews and meta-analysis. Iranian Journal of Nursing and Midwifery Research , 26 (6), 469–478. https://doi.org/10.4103/ijnmr.IJNMR_426_20

‌Hanafy, S., & El-Esawy, F. (2015). Female sexual dysfunction during the postpartum period. Human Andrology , 5 (4), 71–81. https://doi.org/10.1097/01.xha.0000475197.51922.f5

‌Hartley, E., Hill, B., McPhie, S., & Skouteris, H. (2017). The associations between depressive and anxiety symptoms, body image, and weight in the first year postpartum: a rapid systematic review. Journal of Reproductive and Infant Psychology , 36 (1), 81–101. https://doi.org/10.1080/02646838.2017.1396301

Huber, M., Malers, E., & Tunón, K. (2021). Pelvic floor dysfunction one year after first childbirth in relation to perineal tear severity. Scientific Reports , 11 (1). https://doi.org/10.1038/s41598-021-91799-8

Jaderek, I., & Lew-Starowicz, M. (2019). A systematic review on mindfulness meditation-based interventions for sexual dysfunctions. The Journal of Sexual Medicine , 16 (10), 1581–1596. https://doi.org/10.1016/j.jsxm.2019.07.019

‌Johansson, M., Benderix, Y., & Svensson, I. (2020). Mothers’ and fathers’ lived experiences of postpartum depression and parental stress after childbirth: a qualitative study. International Journal of Qualitative Studies on Health and Well-Being , 15 (1), 1722564. https://doi.org/10.1080/17482631.2020.1722564

‌Khajehei, M., Doherty, M., Tilley, P. J. M., & Sauer, K. (2015). Prevalence and risk factors of sexual dysfunction in postpartum Australian women. The Journal of Sexual Medicine , 12 (6), 1415–1426. https://doi.org/10.1111/jsm.1290

‌Kinter, K. J., & Newton, B. W. (2020). In Anatomy, abdomen and pelvis, pudendal nerve. StatPearls Publishing, Treasure Island (FL)

Krapf, J. M., & Tappy, E. (2020). Postpartum genito‐pelvic pain. Female Sexual Pain Disorders , 323–331. https://doi.org/10.1002/9781119482598.ch36

Leavitt, C. E., McDaniel, B. T., Maas, M. K., & Feinberg, M. E. (2016). Parenting stress and sexual satisfaction among first-time parents: A dyadic approach. Sex Roles , 76 (5-6), 346–355. https://doi.org/10.1007/s11199-016-0623-0

 Leeman, L., Rogers, R., Borders, N., Teaf, D., & Qualls, C. (2016). The effect of perineal lacerations on pelvic floor function and anatomy at 6 months postpartum in a prospective cohort of nulliparous women. Birth , 43 (4), 293–302. https://doi.org/10.1111/birt.12258

‌Lobel, M., & M. Ibrahim, S. (2018). Emotions and mental health during pregnancy and postpartum. Women’s Reproductive Health , 5 (1), 13–19. https://doi.org/10.1080/23293691.2018.1429378

McDonald, E., & Brown, S. (2013). Does method of birth make a difference to when women resume sex after childbirth? BJOG: An International Journal of Obstetrics & Gynaecology , 120 (7), 823–830. https://doi.org/10.1111/1471-0528.12166

‌McBride, H. L., & Kwee, J. L. (2017). Sex after baby: Women’s sexual function in the postpartum period. Current Sexual Health Reports , 9 (3), 142–149. https://doi.org/10.1007/s11930-017-0116-3

‌‌Molgora, S., & Accordini, M. (2020). Motherhood in the time of coronavirus: The impact of the pandemic emergency on expectant and postpartum women’s psychological well-being. Frontiers in Psychology , 11 . https://doi.org/10.3389/fpsyg.2020.567155

Navidian, A., Sheikhi, Z., & Rigi, M. (2020). Effect of sexual health education on sexual function and resumption of sexual intercourse after childbirth in primiparous women. Journal of Education and Health Promotion , 9 (1), 87. https://doi.org/10.4103/jehp.jehp_591_19

‌O’Malley, D., Smith, V., & Higgins, A. (2022). Sexual health issues postpartum–A mixed methods study of women’s help-seeking behavior after the birth of their first baby. Midwifery , 104 , 103196. https://doi.org/10.1016/j.midw.2021.103196

‌‌Prager, K. J. (2013). The intimacy dilemma: A guide for couples therapists. In Intimate Couple (pp. 109-157). Routledge.

‌‌Serrano Drozdowskyj, E., Gimeno Castro, E., Trigo López, E., Bárcenas Taland, I., & Chiclana Actis, C. (2020). Factors influencing couples’ sexuality in the puerperium: A systematic review. Sexual Medicine Reviews , 8 (1), 38–47. https://doi.org/10.1016/j.sxmr.2019.07.002

‌‌Sıdıka Özlem Cengizhan, & Tuba Uçar. (2023). The effect of mindfulness‐based sexual counseling on sexual distress, attitude toward sexuality, and body image concerns in pregnant women: A randomized controlled trial. Journal of Midwifery & Women’s Health , 68 (5), 611–618. https://doi.org/10.1111/jmwh.13518

‌Stephenson, K. R., & Kerth, J. (2017). Effects of mindfulness-based therapies for female sexual dysfunction: A meta-analytic review. The Journal of Sex Research , 54 (7), 832–849. https://doi.org/10.1080/00224499.2017.1331199

‌Tavares, I. M., Schlagintweit, H. E., Nobre, P. J., & Rosen, N. O. (2019). Sexual well-being and perceived stress in couples transitioning to parenthood: A dyadic analysis. International Journal of Clinical and Health Psychology , 19 (3), 198–208. https://doi.org/10.1016/j.ijchp.2019.07.004

‌Wängberg Nordborg, J., Svanberg, T., Strandell, A., & Carlsson, Y. (2022). Term breech presentation—Intended cesarean section versus intended vaginal delivery—A systematic review and meta‐analysis. Acta Obstetricia et Gynecologica Scandinavica , 101 (6), 564–576. https://doi.org/10.1111/aogs.14333

‌Yeniel, A. O., & Petri, E. (2014). Pregnancy, childbirth, and sexual function: perceptions and facts. International Urogynecology Journal , 25 (1), 5–14. https://doi.org/10.1007/s00192-013-2118-7

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