Management of postpartum loss of libido: midwives, health visitors and GPs are key in counselling and reassuring women about sexual problems after childbirth, as Dr Henrietta Hughes explains

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Date: Aug. 2008
From: Journal of Family Health Care(Vol. 18, Issue 4)
Publisher: Pavilion Publishing and Media Ltd.
Document Type: Clinical report
Length: 2,246 words
Lexile Measure: 1340L

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ABSTRACT

Following the birth of a child many physical, emotional and hormonal changes occur which can all have an impact. These include painful sex due to healing stitches or infection, low mood and depression and physiological changes due to breast-feeding or contraception. These can all affect the woman's sexual needs and impact on her relationship with her partner. Surveys of women postnatally suggest that there is an unmet need for discussing these issues and offering sensitive help and advice.

Journal of Family Health Care 2008; 18(4): 123-125

Key words:

libido; postpartum

Background

Libido is the medical term for sexual desire. After having a baby, loss of libido is a widespread but hidden problem for a woman. Hormonal changes and physical and emotional changes can all affect desire and lead to problems with the relationship with her partner (1). Studies have identified a variety of sexual problems including vaginal dryness, painful penetration, pain during sexual intercourse, pain on orgasm, vaginal tightness, vaginal looseness, bleeding or irritation after sex, and loss of sexual desire (2).

Sex is less common towards the end of pregnancy and for most mothers there is only a slow return to prepregnancy levels in the first year after giving birth (3). In one study, the median (average) time for restarting sex and contraception was six weeks (2) but problems with sex were reported by nearly half of women over the next year. One in eight women wanted help with sexual problems but not all had discussed these with their doctor or midwife. Of first-time mothers, 83% reported experiencing sexual problems three months after delivery, but only 15% of women discussed this with a health professional (3).

Women reported that conversations with their health professional in the postnatal period focused mainly on contraception (3). Women with pain in the perineum (the lower part of the vagina), depression or tiredness experienced more problems related to sex. Women who breast-fed their babies were significantly less interested in sex than those who bottle-fed (2). The problems described above may be due to underlying medical and psychological reasons for decreased libido, and the following diagnoses need to be considered.

Underlying medical disorders

In the postnatal period, underlying medical conditions need to be borne in mind. Tiredness may be due to anaemia or an underactive thyroid. Vaginal thrush, bacterial vaginosis and low oestrogen levels due to breast-feeding or contraception can all lead to painful sex. Inflammation and infection of vaginal stitches, retained products of conception and infection of the lining of the uterus also need to be checked.

Taking a careful history by listening to the patient is extremely important. Concerns about medical problems should be referred to the general practitioner (GP) or obstetrician for examination, vaginal swabs or blood tests and appropriate treatment.

Postnatal depression

Postnatal depression is a major public health problem. It is a distressing disorder, more prolonged than the "blues" which occur in the first week after delivery but less severe than puerperal psychosis. Studies have shown that postnatal depression...

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Gale Document Number: GALE|A184134171