Chapter 25 - Sex after Pelvic Floor Injuries

Summary

During pregnancy and the postnatal period there are many changes that can affect sexual function. In general, during pregnancy there is a decrease in sexual desire, frequency of intercourse, and capacity for orgasm and sexual satisfaction, with these changes being more evident in the first and third trimesters and less so in the second. In the postnatal period hormonal changes involve a decrease in sex hormones due to the release of prolactin for breastfeeding. This can have a negative influence on libido and the emotional state in general, but also in the genital region, causing atrophy of the vaginal epithelium, which is thinner and more fragile, with less lubrication capacity. The prevalence of postpartum sexual dysfunction is frequent. Pain is the most frequent symptom, together with low libido. The main contributing factors are perineal trauma, breastfeeding, postnatal depression, fatigue, and sleep deprivation disorders, as well as changes in body image. Individualized assessment of women must be done at 6–8 weeks postpartum, allowing the implementation of specific techniques for pelvic floor recovery, and thus contributing to the prevention of future pelvic floor dysfunction.