Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births

Abstract

Introduction: Although postpartum sexual concerns are common, limited data exist on postpartum sexual response. Furthermore, the physiological process of vaginal birth may negatively impact genital response compared with unlabored cesarean section (C-section), but this hypothesis has yet to be tested. Aim: To (i) compare genital and subjective sexual response and sexual concordance by mode of delivery with inclusion of a control group, (ii) compare groups on self-reported sexual function over the past month, (iii) examine the relationship between laboratory measurement of sexual response and self-reported sexual function, and (iv) investigate association between obstetrical factors and breastfeeding and between sexual response and self-reported sexual function. Methods: 3 groups of cisgender women were recruited from the community: primiparous women who delivered via vaginal birth within the past 2 years (VB group; n ¼ 16), primiparous women who delivered via unlabored C-section within the past 2 years (CS group, n ¼ 15), and age-matched nulliparous women (NP group, n ¼ 18). Laser Doppler imaging was used to assess genital response while participants watched a neutral and erotic film. Main Outcome Measures: The main outcome measures were change in flux units from neural to erotic video as a measure of genital response, subjective sexual arousal rated continuously throughout films, perceived genital response rated after films, and Female Sexual Function Index (FSFI). Results: Women in the VB group had significantly lower change in flux units than women in the CS (P ¼ .005, d ¼ 1.39) and NP (P < .001, d ¼ 1.80) groups. Groups did not differ on their subjective indices of sexual response or in sexual concordance. Women in both postpartum groups reported lower FSFI scores than women in the NP group. No relationship was determined between FSFI scores and sexual response in the laboratory. Results suggested that genital trauma and breastfeeding may negatively impact FSFI scores, but they were not related to genital response or subjective sexual arousal as measured in the laboratory. Clinical Implications: Results underscore the importance of balancing objective and subjective indices of sexual response and function, especially considering the biopsychosocial nature of postpartum sexuality. Strengths & Limitations: The present study is the first to apply modern sexual psychophysiological methodology to the study of postpartum sexuality. Cross-sectional methodology limits the ability to make causal inferences, and the strict inclusion criteria limits generalizability. Conclusion: Physiological changes as a result of labor and delivery may have a detrimental impact on genital response; however, these physiological differences may not impact women's subjective experience of postpartum sexuality.

The Effect of Type of Delivery on Female Postpartum Sexual Functioning: A Systematic Review

“…With respect to the effect of delivery type on the sexual function, there was no statistically significant difference between cesarean and vaginal delivery in 10 studies [ 12 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. Among the remaining six studies, one found no statistically significant difference between groups apart from the arousal subscale [ 28 ].…”

Fatores que influenciam a via de parto no Brasil

“…In a case-control study to analyze the genital response in the postpartum period, it was observed that women with vaginal delivery had decreased genital flow compared to women undergoing caesarean delivery. However, both groups did not present significant differences regarding subjective sexual experience 47 .…”

Validation of laser Doppler flowmetry for the continuous measurement of women's genital response

“…Laser Doppler flowmetry data were collected at a highly localized area on the labia minora and results from this study may have differed if the laser had been placed on a different area of the vulva, or if the laser placement was inconsistent across experimental stimuli due to participant movement. However, genital responses assessed by laser Doppler flowmetry exhibited high correlations with blood flow assessed using the laser Doppler imager within testing sessions (r(43) = .73, p < .001) and across (r(35) = .62, p < .001), suggesting that data obtained by single-point measurement were consistent with the conventional approach of assessing blood flow in a larger region of interest (Bouchard et al, 2017;Boyer et al, 2012Boyer et al, , 2013Cappell et al, 2020;Waxman & Pukall, 2009). With respect to potential variability in laser placement across the testing session, consistency was attained by emphasizing to participants the importance of remaining still during testing and providing support to the legs and buttocks with pillows to limit movement.…”

“…Additional research showed that the laser Doppler imager is a specific measure of women's genital response, detecting increases in genital blood flow for sexual, but not neutral or emotionally evocative, nonsexual stimuli (e.g., anxiety, humor; Waxman & Pukall, 2009) and is sensitive to varying degrees of genital response elicited by stimuli of different sexual intensities (Bouchard et al, 2019). Laser Doppler imaging also distinguishes the genital response patterns of women with and without a genito-pelvic pain disorder (i.e., provoked vestibulodynia; Boyer et al, 2013), as well as women who have given birth vaginally compared to those who have not given birth (Cappell et al, 2020). Furthermore, genital blood flow assessed via laser Doppler imaging has been shown to exhibit a moderate, positive correlation with an objective measure of genital lubrication (Bouchard et al, 2019), which is a theoretically-related aspect of sexual response (Levin, 2003).…”

“…For studies examining group differences between clinical and control samples, presenting a single, 15‐min sexual stimulus with five repeated scans may provide a more reliable assessment of genital response than shortening the stimulus and using fewer than five scans (e.g., Boyer et al, 2013; Cappell et al, 2020), though this comparison has not been empirically tested. The use of a 15‐min sexual stimulus was adopted from a study employing a thermographic camera to assess genital temperature during sexual response (Kukkonen et al, 2007) and continues to be used in thermography studies of clinical populations (e.g., Cherner & Reissing, 2013; Sarin et al, 2016).…”