Depression & Anxiety During Pregnancy And Postpartum

A new study in The Journal of Sexual Medicine examines the way depression and anxiety during the pregnancy and postpartum periods affect a woman?s sexual life.
Researchers from Brazil and the United States found that depressive/anxiety symptoms, or DAS, can be linked to declines in sexual life for up to eighteen months after a baby is born.
While relationship and socioeconomic problems have been studied in relation to decreased sexual activity after woman gives birth, the association between DAS and sexual decline has not been clear.
The study focused on lower-income women who were receiving antenatal care at public primary clinics in S�o Paulo, Brazil. To learn more about sexual activity, research assistants interviewed the women between 20 and 30 weeks of pregnancy and again at some point during the eighteen months after delivery. During the postpartum period, the women completed the Self Report Questionnaire (SRQ-20), a tool that assesses depression and anxiety.
Eight-hundred thirty-one women participated during pregnancy. Of these, 644 women had resumed sexual activity and were available for follow up after delivery. The women?s mean age was 25 years and approximately 78% of them were living with a partner.
During the interview, the women were asked, ?Considering your sexual life before pregnancy, how would you describe your present sexual life: improved, the same, worsened??
Based on results of the SRQ-20, the women were divided into four groups:

? Group 1 had no DAS during pregnancy and the postpartum period.
? Group 2 had DAS during pregnancy only.
? Group 3 had DAS during the postpartum period only.
? Group 4 had DAS during both pregnancy and the postpartum period.

About 21% of the women had seen their sex lives decline. This result was more likely among women in Group 3 (DAS during the postpartum period only) and Group 4 (DAS during both pregnancy and the postpartum period.)
Sexual decline was also associated with the mother?s age and the number of miscarriages she had had. The risk of sexual decline was twice as high for women over 30 when compared to younger women, a result that could be related to stress. Women who had had miscarriages had a 50% increase in the risk of sexual decline, which could be due to the emotional toll of miscarriage.
The researchers acknowledged that DAS and sexual decline could work in two ways. DAS could lead to sexual difficulties after delivery. But problems after delivery, such as episiotomies, could also lead to DAS.
The findings may help practitioners recognize DAS symptoms and their effects on the sex lives of lower-income women.

Pelvic Floor Dysfunction & Women?s Sexual Concerns
Pelvic organ prolapse (POP) and urinary incontinence can have many sexual repercussions for women. Recently, a team of European researchers described these problems in detail in the Journal of Sexual Medicine.
POP occurs when female pelvic organs drop and put pressure on the vaginal walls. Urinary incontinence (UI) refers to the loss of bladder control and leaking of urine. Both conditions can make women anxious about sex.
The authors explained that healthcare providers often do not consider themselves fully trained to treat sexual issues associated with POP and UI. Also, much research has focused on the quantitative aspects of sexual function for these women. The goal of this study was to add ?meaning and context? to the current literature.
Thirty-seven women between the ages of 31 and 64 participated. Each woman was about to have corrective surgery for POP, UI, or both POP and UI. All participants were sexually active except one, who avoided sex because of her condition, but wanted to start again after surgery.
Each woman was interviewed face-to-face, responding to open-ended questions about how POP and/or UI affected them sexually. Questions focused on desire, arousal, orgasm, pain, satisfaction, body image, partners, and intimacy. Because of a recording error, one interview could not be used. Therefore, results were based on interviews with thirty-six women.
Seventeen percent of the women said their sex lives were satisfactory, with no problems from POP or UI. Thirty-nine percent rated their sex lives negatively and 44% indicated that their sex lives were fine overall, but that certain aspects were negative.
Most Commonly Affected Sexual Areas
 
? Body image. Women with POP described their vaginas negatively, using descriptors like ?ugly? and ?not normal.? Those with UI were anxious about using incontinence pads and emitting urine odor. Many women felt embarrassed, depressed, unattractive, or undesirable. They were also concerned about their partner?s experience. For example, some women with POP worried that a partner could feel the prolapse.
? Desire. Many women found themselves less motivated to have sex because they feared pain and felt awkward. Some rushed through sex; others avoided sex altogether.
? Arousal. Distraction, fear of pain, and difficulty relaxing could all contribute to diminished arousal.
? Orgasm. Some women had trouble reaching orgasm because they couldn?t relax or ?let go.? Others found their orgasm less intense. Some didn?t allow themselves to reach orgasm because they feared incontinence.
? Pain. Women with POP were more likely to report discomfort or pain, which were mainly due to sexual position, the prolapse itself, or the fullness of their bladder.
The authors acknowledged that other factors, aside from POP and/or UI, could play a role in the women?s sexual problems. A partner?s sexual issues, relationship conflict, stress, and menopause could all be involved. ?Despite the profound effect of POP and/or UI, the confounding effect of these factors should not be overlooked when assessing female sexual function,? the authors wrote.
They also noted ways that healthcare providers can help women with POP and/or UI by addressing sexual problems. Letting patients know that these conditions are common may help them gain confidence.