Summary: New long-term research shows that a mother’s sexual enjoyment in the years after childbirth does not depend on whether she delivered by cesarean section or vaginally.
Source: University of Bristol
Research indicates that sexual enjoyment and frequency in the years following childbirth are not linked to the mode of delivery.
A team from the University of Bristol and Karolinska Institutet analyzed data from the Children of the 90s cohort—a prospective study that followed more than 14,000 people—to examine the long-term relationship between delivery method and maternal sexual wellbeing. The study was published in BJOG: An International Journal of Obstetrics & Gynaecology.
Previous short-term studies have generally found little difference in sexual outcomes between women who had cesarean sections and those who had vaginal deliveries within six months postpartum. This new analysis extends the scope by assessing outcomes up to 18 years after childbirth, focusing specifically on sexual enjoyment, sexual frequency, and sex-related pain.
Using obstetric records to determine mode of delivery and self-reported questionnaires for sexual wellbeing, the researchers compared women who had cesarean sections with those who delivered vaginally. Their analyses adjusted for factors known to influence sexual and reproductive health, such as maternal age at delivery, body mass index before pregnancy, diabetes during pregnancy, socio-economic status, parity, and mental health measures.
The study found no evidence that cesarean section offers lasting benefits for sexual enjoyment or sexual frequency after childbirth. At multiple time points between about three years and 18 years postpartum, sexual enjoyment and how often women reported having sex did not differ meaningfully by delivery type.
However, the researchers observed a difference in reported sex-related pain. Specifically, at around 11 years postpartum, women who had delivered by cesarean section reported higher odds of experiencing vaginal pain during sex compared with those who delivered vaginally. The study could not determine whether this pain began before pregnancy, whether it motivated a cesarean delivery, or whether it developed after delivery, because prenatal measures of sex-related pain were not available for all participants.
Flo Martin, a Wellcome Trust PhD student in Epidemiology and the lead author, noted that cesarean section rates have risen over recent decades and that a common belief has been that cesarean delivery might protect against sexual dysfunction by preventing pelvic trauma or preserving vaginal tone. The study’s results challenge that assumption: while cesarean delivery was not associated with improved sexual enjoyment or higher sexual frequency, it was associated with an increased likelihood of dyspareunia (pain during intercourse) more than a decade after birth.
Martin emphasized the importance of evaluating a wide range of maternal and fetal outcomes when considering cesarean section, so that expectant parents and clinicians have reliable evidence to inform delivery choices. Lynn Molloy, Chief Operating Officer at Children of the 90s, highlighted the value of long-term cohort studies for helping women make informed decisions about delivery and for guiding postnatal care when birth choices are limited by clinical circumstances.
About this childbirth research
Author: Press Office
Source: University of Bristol
Contact: Press Office – University of Bristol
Image: The image is in the public domain
Original Research: Open access. “Mode of delivery and maternal sexual wellbeing: A longitudinal study” by Florence Z. Martin et al., published in BJOG: An International Journal of Obstetrics & Gynaecology.
Abstract
Mode of delivery and maternal sexual wellbeing: A longitudinal study
Objectives
To assess whether mode of delivery is associated with later maternal sexual wellbeing, including enjoyment, frequency of sexual activity, and sex-related pain.
Design
Prospective birth cohort study using longitudinal data from the Avon Longitudinal Study of Parents and Children (ALSPAC).
Setting
Avon area (Bristol), United Kingdom.
Population
Participants enrolled in ALSPAC, part of the Children of the 90s cohort.
Methods
Mode of delivery was taken from obstetric records. Sexual wellbeing was measured by self-report questionnaires at multiple postpartum time points. The analysis used multiple imputation for missing data and ordinal logistic regression for ordered outcomes, adjusting for maternal age at delivery, pre-pregnancy body mass index, diabetes during pregnancy, socio-economic position, parity, and measures of depression and anxiety.
Main outcome measures
Sexual enjoyment and sexual frequency were assessed at four time points between roughly 33 months and 18 years after birth. Two types of sex-related pain—vaginal pain during sex and pain elsewhere after sex—were assessed at 11 years postpartum.
Results
There was no clear association between mode of delivery and sexual enjoyment (for example, adjusted odds ratio [OR] 1.11, 95% confidence interval [95% CI] 0.97–1.27 at 33 months) or sexual frequency (OR 0.99, 95% CI 0.88–1.12 at 33 months). Cesarean section was associated with higher odds of reporting vaginal pain during sex at 11 years postpartum compared with vaginal delivery in adjusted models (OR 1.74, 95% CI 1.46–2.08).
Conclusions
The findings do not support the notion that cesarean section improves long-term sexual enjoyment or frequency. However, the association between mode of delivery and dyspareunia suggests that cesarean section may be linked to increased long-term sex-related pain. Further research is needed to clarify timing and causes of pain, including whether pre-existing pain influences delivery choice.