Sexual health is a multidimensional basic need for  a human’s well-being, which as affected by many mental, emotional, biological and physical changes across a person’s lifespan (1). Pregnancy and delivery affect sexual health of women and can lead to sexual dysfunction (2). The aims of the Early Intervention of Pelvic Floor Disorder After Delivery trial (E-PAD) were to investigate the prevalence of pelvic floor dysfunctions postpartum through a first prospective study design in Germany. We also analyzed sexual function until 12 months postpartum identify significant risk factors for the development of sexual dysfunction after delivery and to address this taboo topic in the care of women’s health.

This is the first prospective cohort study in Germany of primi- and multiparous women using standardized questionnaire to assess pelvic floor dysfunctions. 409 women who delivered at the Cologne University Hospital from 2021 to 2022 were recruited for the trial. Symptoms of pelvic floor disorders were assessed by using the validated German Pelvic Floor Questionnaire: prevalence and intensity of bladder, bowel, prolapse, and sexual symptoms, along with the resulting subjective impact on the quality of daily life. We asked them about symptoms before pregnancy and subsequently interviews at three timepoints (3, 6 and 12 months postpartum) were conducted. Data were analyzed using IBM Statistical Package for Social Sciences (SPSS) Version 29 (NewYork, NY, USA). Besides a descriptive analysis, we conducted statistical analyses to figure out relevant factors sexual health.

261 women answered the questionnaire 3 months postpartum, after 12 months we were able to interview 136 patients. Sexual inactivity was most prevalent 3 months postpartum (30.9 %), 12 months postpartum 14 % of our patients continued to be sexually inactive. 28% of patients were bothered by a problem with their sexuality before their pregnancy, 12 months postpartum the percentage increased to 38.5 % of our patients.
Risk for sexual dysfunction was higher for women who gave birth to a premature baby (OR 4.9, p=0.007). Patients who suffered from prolapse symptoms of a vaginal foreign body sensation also mentioned sexual dysfunction such as discomfort or feeling of loose vagina, which lead to subjectively bothersome symptoms of sexual dysfunction.
Whereas injuries after vaginal delivery 3 months postpartum were correlated with pain and discomfort, no correlation could be calculated 12 months postpartum. Episiotomy could be shown to be  a risk factor for the vaginal feeling of being too tight (OR 4.226, p=0.04).
Primiparous women reported significantly more symptoms of discomfort or dyspareunia in comparison to multiparous women (OR 8.9, p=0.003).

Sexual inactivity increased comparing timepoint 3 months and 12 months postpartum. While discomfort and dyspareunia were described most by patients 3 months postpartum, subjectively bothersome sexual dysfunction increased from timepoint before pregnancy until 12 months postpartum. Patients who suffer from pelvic floor disorders, such as urinary incontinence or pelvic organ prolapse are also affected by sexual dysfunction. Pelvic floor disorders after deliveries are prevalent and relevant in our German collective. Significant risk factors are concordant with previous international studies (2). Nevertheless, these results are the first of this kind in Germany.

Sexual health is a multifaceted and not well-defined part of becoming a mother. Addressing this intimate topic should be a routine part of peripartal maternal health care. More qualitative studies are needed to understand the influence of pregnancy, motherhood and partnership on peripartal women´s sexual health.

World Health Organization W. (2017). Sexual health, human rights and the law. Share-Net Int.
Leeman LM, Rogers RG. (2012). Sex after childbirth: Postpartum sexual function. Obstet Gynecol.119(3):647–55.

Continence 12S (2024) 101656
DOI: 10.1016/j.cont.2024.101656