Postpartum sexual resumption and dysfunction in primiparous women seen at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Globally there is an effort to provide comprehensive postpartum care by assessing sexual resumption and dysfunction. This has received little attention in Kenya. Most studies on this topic are international, cross-sectional in design, and few utilize validated tools with conflicting results. Objective: To assess sexual resumption and dysfunction in the first postpartum year among Primiparous women seen at Moi Teaching and Referral Hospital, Kenya. Methods: A prospective cohort study at Moi teaching and referral hospital. Systematic sampling involving every seventh Primipara delivery was used to recruit 125 women. They were followed up at the postnatal clinic for one year at five intervals (six, ten, fourteen weeks then at nine and twelve months). Data was collected on socio-demographics, obstetric characteristics, infant feeding options, contraceptive use, antenatal sex education, and time to resumption of sexual intercourse. A self-administered validated Female Sexual Function Index questionnaire was used to assess for sexual dysfunction (Total score ≤ 26). Data was summarized using frequency and percentages for categorical variables and measures of central tendency and dispersion for continuous variables. Bivariate and multivariable logistic regression analyses were carried out to test for association between several factors (socio-demographic and clinical) and sexual dysfunction at one year. Results: The median age was 23 years (Range:19-43), majority 69.6% had University/college education, 67.2% had no occupation and 96.0% lived within Uasin Gishu County. The median gestation was 40 weeks (Range:37-44), majority 79.2% had a vaginal delivery, median birth weight 3200 grams (Range:1500-4300) and 52.5% had intact perineum. Minority 20.0% received antenatal sexual health education. The median duration of sexual intercourse resumption was 72 days (Range:43.0-98.0). The proportion of those who resumed was 0.9%, 17.2%, 52.6%, 58.5% and 59.4% during the five visits while sexual dysfunction based on overall score was 30.0%, 39.0%, 29.5%, 29.0% in second, third, fourth and fifth visits respectively. On the fifth visit, 46.8% had pain disorder, 53.2% desire disorder, 58.1% sexual dissatisfaction, 64.5% orgasmic problems, 79.0% arousal disorder, 90.3% lubrication difficulty, 31.1% used a contraceptive with the most common (24.2%) being Implanon. Several factors (age, education level, occupation, residence, mode of delivery, perineal injury, birth weight, antenatal sex education, and contraceptive use) were tested at bivariate analysis none was statistically significant. After adjusting for age, education, birth weight, and contraceptive use, those with perineal injury had higher odds of experiencing sexual dysfunction (AOR:5.70, 95% CI:1.41-28.5, p-value 0.02). Conclusion: The median duration to resumption of sexual intercourse by women in this study was 72 days with a majority having resumed by one year. Of those who had resumed, a minority had sexual dysfunction with the most common being lubrication difficulty. Perineal injury was significantly associated with this dysfunction. Recommendations: Postpartum care should involve assessing women for sexual resumption and dysfunction throughout the first year. The use of vaginal lubricants should be considered as needed and perineal injury after delivery should be managed appropriately. Further studies should incorporate a qualitative approach.