الفهرس 
Biopsychosocial Aspect of Female SexualityOnly 14 pages are availabe for public view
Abstract
S
exual health is an important part of the quality of life of women. Although female sexual dysfunction is common, it is under diagnosed and undertreated. Sexual health after childbirth is a relatively new research interest. There is inconsistent evidence about the role of mode of delivery on sexual health outcomes. Data on the relationship between mode of delivery and postpartum sexual dysfunction are very heterogenic and unsatisfying. Caesarean section rates increasing for the last two decades in the world due to the perception that it might be protective to good sexual function.
The aim of our study was to assess the impact of mode of delivery on postpartum female sexual functions, furthermore to determine the frequency of sexual dysfunctions among a sample of postpartum female subjects and the degree of sexual distress, Also to compare sexual dysfunctions domains among females with different socio-demographic and clinical variables such as those who had genital mutilation or were breastfeeding at time of study.
This was done through a comparative cross-sectional study done on 105 female subjects who underwent a single mode of delivery and following up in birth control outpatient clinics, Ain Shams Maternity Hospitals over two years from the beginning of august 2017 till august 2019.
All participants were subjected to clinical assessment, personal history (that included the duration of marriage, number of children, mode of delivery, the use of contraception, lactation status, menstrual regularity), presence of any post-partum complications, presence of genital mutilation and were divided into group according to these different variables. Furthermore, the Arabic version of Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) to exclude psychiatric disorders as well as the Arabic version of female sexual function index (FSFI) to assess dimensions of sexual function and sexual dysfunction in Egyptian women. Furthermore, female sexual distress scale-revised version which was translated and validated throughout the current study was used to determine the degree of sexual distress among females with sexual dysfunction.
The study results showed that 75.2 % of the sample of females in the study suffered from sexual dysfunction, and 60% suffered from sexual distress.
People with lower education level tended to deliver more vaginally, furthermore people who delivered vaginally tended to report a sense of vaginal laxity during coitus which occurred further wards after delivery.
Female subjects who had sexual dysfunction tended to have a slightly lesser body mass index, reported a change in their sexual activity after giving birth
And were more subjected to negative comments from their husbands on their overall sexual performance and were more sexually distressed compared to females with no sexual dysfunction.
Sexual distress was more common among elder females, females with large number of parities, also females who reported a change in their sexual activity after giving birth and females who were more subjected to negative comments from their husbands on their overall sexual performance.
As regards sexual function domains included in female sexual function index questionnaire, it was found that females with adequate income had better arousal, satisfaction, less pain and better overall sexual functioning compared to females with inadequate income.
Females with episiotomy scar had less arousal, orgasm, satisfaction, overall sexual functioning compared to females with no episiotomy scar, yet there was no statistically significant difference between different type of episiotomy scar and sexual function domains.
Females who had subjective feeling of vaginal laxity during sexual acts experienced lesser orgasm compared to females who didn’t report such a thing.
Moreover, females who reported negative comments from husband on their overall sexual activity after childbirth and those who described subjectively change in their overall sexual performance after childbirth had lesser scores in all the female sexual function index questionnaire indicating lesser sexual functioning and more sexual distress than females who did not.
However different educational levels, lactation status at time of study, presence or absence of foreplay, different sexual positions didn’t have statistical difference upon the female sexual function domains and sexual distress scale.
Our study showed that age was significantly negatively correlated with desire, arousal, orgasm, sexual satisfaction domains and total score of FSFI. This highlights that by aging, the desire, arousal, orgasm, satisfaction and overall sexual functioning decreases, yet it was not correlated with lubrication and sexual pain (dyspareunia) domains.
As regards duration of marriage, it was negatively correlated with desire, arousal, sexual satisfaction domains and total score of FSFI indicating that the longer duration of marriage, the less the desire, arousal, orgasm, satisfaction and overall sexual functioning, yet there was no correlation between it and lubrication, orgasm and dyspareunia
Moreover the body mass index was positively correlated with orgasm, and sexual pain (dyspareunia) domain, showing that females with higher body mass index are more likely to experience orgasm and less dyspareunia yet body mass index was not correlated with desire, arousal, lubrication, sexual satisfaction domains and total score of FSFI
Concerning the number of parities, it was negatively correlated with desire, arousal, lubrication, orgasm, sexual satisfaction domains and total score of FSFI. However, it was not correlated with sexual pain (dyspareunia) domain and that means females with more children, experienced less desire, arousal, lubrication, orgasm, less likely sexual satisfied and decrease in overall sexual functioning.
Furthermore, time to restart intercourse after delivery was negatively correlated with the lubrication domain, yet no significant correlation between all other FSFI questionnaire domains indicating that female who resumed their sexual activity at an earlier time had better lubrication
However, the frequency of intercourse was not correlated to any of the FSFI questionnaire domains.
Notably, we found that sexual distress scale was negatively correlated to all FSFI questionnaire domains, indicating that the less over sexual functioning, the more the female is sexually distressed.
Also, our results declared that females genital mutilation was carried out among females with lower income, lower educational level and is more associated with female sexual dysfunction and more sexual distress.
Thus our results indicated no association between mode of delivery and female sexual dysfunction and female sexual distress, consistent with studies done worldwide, abolishing the idea of doing a C-section to have preserve sexual functions, which could be used to deceive females and adding to the increment of C-section rates in the last two decades and having an economic burden.
Also, female genital mutilation is unfortunately a bad practice, banned by law, yet still done among low socioeconomic status population affects female sexual functions, adding to the aetiology of female sexual dysfunction and causing females sexual distress.