Sexuality in the puerperium: a review.

Pregnancy and the puerperium herald dramatic and complex physiological, psychological, interpersonal, and sexual changes in a woman and in the marital process. Pregnancy tends to have an increasingly negative effect on sexual desire, expression, and satisfaction as term approaches. Clinical variables discussed include anatomic and physiological changes, puerperal sexual response patterns, marital adjustment, body image, dyspareunia related to episiotomy, lactation, and traditional taboos and cautions regarding coitus for the new mother. Most research respondents reported gradual return to prepregnancy levels of sexual desire, enjoyment, and coital frequency, with a minority in most cited studies indicating sexual interest and coitus levels below prepregnancy levels up to 1 year after delivery. The most frequently listed reasons for poor postpartum sexual adjustment include episiotomy discomfort, fatigue, vaginal bleeding or discharge, dyspareunia, insufficient lubrication, fears of awakening the infant or not hearing him/her, fear of injury, and decreased sense of attractiveness. Postpartum counseling should be offered prior to hospital discharge.

Sexual counseling for the nontherapist.

Sexual health is a part of total health. Sexual problems can cause marital dissolution and emotional impoverishment. The physician is seen as a wise authority figure often and one who can provide sexual guidance and counsel. To be an effective counselor, an obstetrician/gynecologist must acquire sexual knowledge, comfort, and counseling skills. A sexual history is a recommended routine--as part of the new workup, when management of organic problems and treatment (mastectomy, hysterectomy, radical vulvectomy) necessitate inquiry into the patient's sexual practices and sexual value system, and when the patient presents with suspected "functional" or obscure complaints (hyperventilation, palpitations, chronic pelvic pain, recurrent vaginal discharge without obvious pathogens, chronic concerns that everything is all right "down there", cancerphobia). The sexual problem history is readily applicable, especially when a patient presents with an explicit sexual concern. The PLISSIT method is a paradigm that can be utilized effectively with usual referral for intensive therapy (sex therapy) if sexual counseling is ineffectual. The obstetrician/gynecologist can play an important role in facilitating healthful sexual changes in women and couples, enhancing intimacy, and enriching the marital bond.

Sexuality and pregnancy: a review.

Marital success and failure may be related to sexual satisfaction, including orgasmic capability. Pregnancy represents a life crisis to the pregnant woman and her husband. Complex psychosocial and physiological demands may produce insecurities, anxieties, and somatic complaints. The expectant mother may seek to fulfill increasing nurturant needs through increased physical contact such as cuddling or being held. A pregnant woman's interest in sexual activity may be affected by her changing physical appearance and the hormonal milieu of pregnancy. Although there are marked individual variations and methodological biases and differences among empirical studies, pregnancy appears to be usually accompanied by a decrease in sexual desire, coital frequency, and orgasm. Sexual behavior in pregnancy has been traditionally restricted and is currently poorly defined. Sexual proscriptions may precipitate sexual frustration and marital estrangement. Abortion is only rarely caused by coitus. The relationship of coitus and orgasm to prematurity and distress of the fetus and newborn has not been clearly established. Coitus can indirectly result in maternal, fetal, and neonatal morbidity and mortality through the spread of sexually transmitted diseases. Deaths from air embolism in pregnancy associated with cunnilingus and vaginal insufflation have been reported.

Sexuality and pregnancy. A prospective study.

The normative changes in various sexual variables in pregnancy remain controversial. Much of the data available have been derived from retrospective and subjective, prospective investigations. The present prospective study indicated decreases in sexual enjoyment, coital frequency and orgasm as pregnancy progressed. A midtrimester increase in sexual desire preceding a progressive decrease was evident. Overall sexual satisfaction was correlated with feeling happy about being pregnant, feeling more attractive in late pregnancy than before pregnancy and experiencing orgasm. Anticipatory guidance and informed counsel regarding sexual changes in pregnancy should be provided to help pregnant patients and their husbands adapt to the pregnancy and enhance their marital bonds.

The treatment of vaginismus by the gynecologist: an eclectic approach.

Thirteen of 14 patients with vaginismus have been successfully treated using systematic in vivo desensitization and other simple but individualized behavioral techniques. Resolution of symptoms was usually effected within 3 to 4 weekly sessions with important supplementary home assignments. All but 1 patient were seen without partners. Neither mechanical dilators nor hymenotomy was employed. Primary orgasmic dysfunction was associated wih vaginismus in a minority of patients and was treated concomitantly. Vaginismus appears to be more frequent than the literature indicates and can be situational or absolute. Presenting symptoms include an inability to tolerate pelvic examination, severe superficial dyspareunia, and a history of unconsummated coitus. Although gynecologic experience with vaginismus has been generally limited, the gynecologist is seen as a potentially ideal therapist for establishing or confirming the diagnosis at that time of pelvic examination.