J Midwifery Womens Health. 2016 Mar;61(2):158-65.

Sexual behavior, satisfaction, and contraceptive use among postpartum women

Sok C, Sanders JN, Saltzman HM and Turok DK

Abstract

Introduction: This study aimed to 1) describe the behaviors and timing of the first sexual activity postpartum, 2) compare characteristics of women who return to vaginal intercourse by 6 weeks postpartum to those who initiate intercourse after 6 weeks, 3) evaluate contraceptive use of postpartum women, and 4) describe the physical and emotional satisfaction with the first sexual activity postpartum.

Methods: This prospective study recruited participants during prenatal visits or postpartum prior to hospital discharge. Women completed an initial survey regarding pregnancy intendedness, contraceptive history, breastfeeding plans, sexual activity, satisfaction, and initiation. Postpartum surveys were conducted every 2 weeks starting 6 weeks after birth until 12 weeks or return to vaginal sexual intercourse.

Results: A total of 370 participants were recruited; 304 (82%) were followed to first intercourse. By life table analysis at 6 weeks (42 days) postpartum, 132 (43%) of women had resumed sexual intercourse, but only 65 (49%) of those women reported using contraception. There were no significant demographic or obstetric differences by timing of resumption of intercourse. However, when controlling for these characteristics, women who reported using contraception at 6 weeks postpartum were 1.8 times (95% confidence interval [CI], 1.2-3.2; P = 0.015) more likely to have had vaginal intercourse by 6 weeks postpartum compared to women who were not using contraception then. By 12 weeks postpartum, 341 (92%) of women had resumed vaginal intercourse. Psychological and physical satisfaction during sex was lower both during pregnancy and after giving birth, relative to satisfaction before pregnancy (P <0.001).

Discussion: By 6 weeks postpartum, 4 in 10 women had resumed vaginal intercourse, with only half using contraception. Counseling regarding postpartum contraception should meet normative behavior. Thus, contraceptive plans need to be established during prenatal care, and the postpartum visit should occur earlier than the current standard time of 6 weeks.

Comment: Although most postpartum visits take place 6 weeks after delivery, it is clear that many couples already have sexual intercourse before that time. So it is crucial to discuss postpartum contraception during prenatal visits, so that reliable contraception can be given immediately after delivery. (HMV)