Introduction Sexual function through pregnancy and the postpartum period is an important aspect of quality of life. Despite this, prospective studies are limited, and the impact of body image on sexual function has not been explored. Aim To prospectively assess the effects of pregnancy on sexual function, and explore causative factors for sexual function alterations such as body image and pelvic floor symptoms. Materials and Methods Pregnant women completed the questionnaires in the first and third trimester and at 6 months postpartum. These included general information, questions regarding sexual activity and practices, and five validated indices: the Female Sexual Function Index (FSFI), the Body Exposure during Sexual Activities Questionnaire, short forms of Urogenital Distress Inventory and Incontinence Impact Questionnaire, and the Fecal Incontinence Quality of Life Scale. Main Outcome Measures An assessment of the FSFI domains through the 6 months postpartum and relationships between sexual function, body image, and pelvic floor symptoms. Results One hundred seven women were enrolled, 63 completed the final questionnaire. Sexual function declined through pregnancy and was not recovered by postpartum (P = 0.017); sexual frequency was highest prior to becoming pregnant (P < 0.0005). Sexual practices changed during pregnancy but returned to early pregnancy levels in the postpartum period. Although body image during sexual functioning did not significantly change during pregnancy, it worsened in the postpartum period (P = 0.01). In early pregnancy, low sexual function was associated with impaired body image, while in the postpartum period, worse urinary symptoms correlated with poor FSFI. Conclusion Sexual function worsens during pregnancy and is not recovered by the 6 months postpartum; poor scores may be attributable to low body image and urinary complaints.

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Impact of pregnancy on pelvic symptom-related quality of life and body image has not been previously documented. We hypothesize that pregnancy will have a negative impact on pelvic symptoms and body image. Pregnant subjects completed questionnaires in the first (S1) and third trimester (S2) and 6 months postpartum (S3) including: Body Exposure During Sexual Activities Questionnaire, Urogenital Distress Inventory, Incontinence Impact Questionnaire, and Fecal Incontinence Quality of Life Scale. Urinary symptoms worsened through pregnancy with improvement postpartum. However, quality of life impact of fecal incontinence was stable. Although some associations between low body image and maternal weight, urinary distress, and bowel complaints were suggested, no significant relationships were noted. Poorest body image was noted in the postpartum period. Urinary symptoms worsen during pregnancy with recovery postpartum, while body image suffers most following pregnancy.

Little is known regarding patient preferences for method of delivery despite concern about rising cesarean section rates. We hypothesize that the majority of pregnant women desire a vaginal birth. An anonymous survey was distributed to pregnant women assessing demographics, pregnancy history, delivery preference, and concern for outcomes. Five-hundred fifty respondents completed the survey; 43% were nulliparous. The majority preferred vaginal delivery (89.6%). Reasons included reduced recovery pain (72%), scars (68%), and bleeding (48%). Cesarean deliveries were believed to cause more maternal injuries (39%), but affect sexual function less (35%). Nulliparas were more concerned about vaginal support damage (p = .005), sexual function changes (p < or = 0.001), and need for episiotomy (p < or = .001). Despite this, 93% of nulliparas chose vaginal birth. Increased parity was associated with preference for cesarean delivery (r = 0.108, p = 0.013). Despite nulliparas' concerns about complications of vaginal delivery, the majority of pregnant women would choose vaginal birth.

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