Resumption of sexual intercourse post partum and the utilisation of contraceptive methods in China: a cross-sectional study

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Abstract

Objective

This is a cross-sectional study that aimed to examine the resumption of sexual intercourse post partum, the utilisation of contraceptive methods and the influencing factors among Chinese women at a tertiary teaching hospital.

Design

This is a questionnaire survey by written and online interview for participants.

Participants

Based on medical records, we sent online questionnaires about postpartum sexual intercourse and contraception plans to 550 eligible women.

Main outcome measures

Potential factors affecting postpartum sexual intercourse and utilisation of contraception were determined by analysis of epidemiological and clinical factors and sexual experiences during and after pregnancy.

Results

Of 550 eligible participants, 406 women (73.8%) with a postpartum period of 8.5 months (range 6–10) completed the questionnaires; 146 of 406 (36.0%) resumed sexual intercourse within 3 months, and 259 of 279 (92.8%) used contraceptive methods. In univariate and multivariate analyses, sexual intercourse during pregnancy (adjusted OR 4.4, 95% CI 2.8 to 6.9) and resumption of menstruation (adjusted OR 2.5, 95% CI 1.5 to 4.3) were significant influencing factors in resumption of sexual intercourse within 3 months after childbirth. No factor was found to be associated with using contraceptive methods or the general resumption of sexual intercourse post partum. The questionnaire had good reliability and validity.

Conclusions

Having sexual intercourse during pregnancy and resuming menstruation earlier were independent factors for resumption of sexual intercourse within 3 months after delivery. Almost all women who had postpartum sexual intercourse used various contraceptive methods.

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Most cited references 38

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Outcomes of routine episiotomy: a systematic review.

Rachel Weber, J Thorp, Kathleen N. Lohr … (2005)

Episiotomy at the time of vaginal birth is common. Practice patterns vary widely, as do professional opinions about maternal risks and benefits associated with routine use. To systematically review the best evidence available about maternal outcomes of routine vs restrictive use of episiotomy. We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Collaboration resources and performed a hand search for English-language articles from 1950 to 2004. We included randomized controlled trials of routine episiotomy or type of episiotomy that assessed outcomes in the first 3 postpartum months, along with trials and prospective studies that assessed longer-term outcomes. Twenty-six of 986 screened articles provided relevant data. We entered data into abstraction forms and conducted a second review for accuracy. Each article was also scored for research quality. Fair to good evidence from clinical trials suggests that immediate maternal outcomes of routine episiotomy, including severity of perineal laceration, pain, and pain medication use, are not better than those with restrictive use. Evidence is insufficient to provide guidance on choice of midline vs mediolateral episiotomy. Evidence regarding long-term sequelae is fair to poor. Incontinence and pelvic floor outcomes have not been followed up into the age range in which women are most likely to have sequelae. With this caveat, relevant studies are consistent in demonstrating no benefit from episiotomy for prevention of fecal and urinary incontinence or pelvic floor relaxation. Likewise, no evidence suggests that episiotomy reduces impaired sexual function--pain with intercourse was more common among women with episiotomy. Evidence does not support maternal benefits traditionally ascribed to routine episiotomy. In fact, outcomes with episiotomy can be considered worse since some proportion of women who would have had lesser injury instead had a surgical incision.

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Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women.

J Repke, Harry B. Harlow, Lisa Signorello … (2001)

Our goal was to evaluate the relationship between obstetric perineal trauma and postpartum sexual functioning. Our study was carried out with a retrospective cohort design in 3 groups of primiparous women after vaginal birth: Group 1 (n = 211) had an intact perineum or first-degree perineal tear; group 2 (n = 336) had second-degree perineal trauma; group 3 (n = 68) had third- or fourth-degree perineal trauma. These sample sizes reflect a 70% response rate. Outcomes were time to resuming sexual intercourse, dyspareunia, sexual satisfaction, sexual sensation, and likelihood of achieving orgasm. At 6 months post partum about one quarter of all primiparous women reported lessened sexual sensation, worsened sexual satisfaction, and less ability to achieve orgasm, as compared with these parameters before they gave birth. At 3 and 6 months post partum 41% and 22%, respectively, reported dyspareunia. Relative to women with an intact perineum, women with second-degree perineal trauma were 80% more likely (95% confidence interval, 1.2--2.8) and those with third- or fourth-degree perineal trauma were 270% more likely (95% confidence interval, 1.7--7.7) to report dyspareunia at 3 months post partum. At 6 months post partum, the use of vacuum extraction or forceps was significantly associated with dyspareunia (odds ratio, 2.5; 95% confidence interval, 1.3--4.8), and women who breast-fed were > or = 4 times as likely to report dyspareunia as those who did not breast-feed (odds ratio, 4.4; 95% confidence interval, 2.7--7.0). Episiotomy conferred the same profile of sexual outcomes as did spontaneous perineal lacerations. Women whose infants were delivered over an intact perineum reported the best outcomes overall, whereas perineal trauma and the use of obstetric instrumentation were factors related to the frequency or severity of postpartum dyspareunia, indicating that it is important to minimize the extent of perineal damage incurred during childbirth.

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Sexual function after childbirth: women's experiences, persistent morbidity and lack of professional recognition.

C. Glazener (1997)

To describe the sexual behaviour of postnatal women, including time of restarting intercourse, problems encountered, use of contraception and related use of available services. Longitudinal survey using postal questionnaires following discharge from hospital, and at eight weeks and twelve to eighteen months postnatally. The questionnaires referred to postnatal care received in a teaching hospital and general practitioner delivery units, and in the community. Randomly selected one in five sample of women who were delivered in the Grampian Region of Scotland over a 12-month period. Times to restarting intercourse and contraception; problems related to intercourse and their relation to perineal pain, tiredness and method of infant feeding; and perceived need for and adequacy of help. The median times to restarting intercourse and contraception were each six weeks. Problems with intercourse were reported by 569/1075 (53%, 95% CI 50-56) of women in the first eight weeks after delivery, and by 215/435 (49%, 95% CI 45-54) in the subsequent year. Women who reported perineal pain, depression or tiredness experienced problems related to intercourse more often than those who did not. Women who breastfed their infants were significantly less interested in intercourse than those who bottlefed, irrespective of tiredness or depression, but this effect did not persist in the long term. The need for help with problems was expressed by 7% to 13% of women, but a quarter of these had not sought it. Postnatal sexual problems are common. Health professionals ought to educate and prepare patients antenatally; be trained to identify problems; and be competent to deal with them openly and sympathetically.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2019

Publication date (Electronic): 12 March 2019

Volume: 9

Issue: 3

Electronic Location Identifier: e026132

Affiliations

[1] departmentObstetrics and Gynecology , Peking Union Medical College Hospital , Beijing, China

Author notes

[Correspondence to ] Dr Lei Li; lileigh@ 123456163.com

Author information

Lei Li http://orcid.org/0000-0001-8723-3461

Article

Publisher ID: bmjopen-2018-026132

DOI: 10.1136/bmjopen-2018-026132

PMC ID: 6429937

PubMed ID: 30862636

SO-VID: a7ffcef3-6b27-4c48-bc48-5695efdf20dd

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 22 August 2018

Date revision received : 03 February 2019

Date accepted : 07 February 2019

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special-feature unlocked

ScienceOpen disciplines: Medicine

Keywords: coitus,contraception,postpartum period

Data availability:

ScienceOpen disciplines: Medicine

Keywords: coitus, contraception, postpartum period

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Resumption of sexual intercourse post partum and the utilisation of contraceptive methods in China: a cross-sectional study

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Abstract

Objective

Design

Participants

Main outcome measures

Results

Conclusions

Related collections

China Tropical Medicine

Most cited references 38

Outcomes of routine episiotomy: a systematic review.

Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women.

Sexual function after childbirth: women's experiences, persistent morbidity and lack of professional recognition.

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Cited by 9

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