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Nearly nine in 10 women experience pain the first time they have sexual intercourse after childbirth. What's more, almost one-quarter still report painful sex 18 months later, the Australian researchers found.
The study also revealed that women who had given birth via cesarean section or vaginally with vacuum extraction were about twice as likely to experience painful intercourse at 18 months postpartum compared to women who had spontaneous vaginal deliveries.
"Two things surprised us, [including] the fact that almost all women experience pain the first time they have sex after childbirth, whether they resume sex in the first six weeks or delay until three or even six months postpartum," said study author Stephanie Brown, a principal research fellow at Murdoch Children's Research Institute.
"Second, there is a common assumption that women who have a cesarean section are less likely to experience sexual difficulties after childbirth," she added. "That turns out not to be true."
The study was published recently in BJOG: An International Journal of Obstetrics and Gynaecology.
Nearly 75 percent of women experience painful sexual intercourse, known as dyspareunia, at some point in their lives, which can stem from many causes, according to the American College of Obstetricians and Gynecologists (ACOG).
Brown and her team also learned that one in six women in the study experienced abuse by an intimate partner within 12 months after giving birth. These women had a greater risk of painful sex compared to women who weren't abused.
The researchers questioned more than 1,200 first-time mothers from six Australian hospitals. The investigators first contacted the women at an average of 15 weeks of pregnancy and then at 3, 6, 12 and 18 months after they had given birth.
Almost 28 percent of women said they had experienced painful sexual intercourse in the year prior to becoming pregnant, the study noted.
About half of the women sampled had a vaginal birth, while nearly 11 percent had a vaginal birth assisted by a vacuum extraction device and another 11 percent gave birth vaginally assisted by forceps, according to the study. Nearly 30 percent of participants delivered through an elective or emergency cesarean section.
Of the women who reported painful sexual intercourse at six months after childbirth, one-third reported that the condition persisted at 18 months postpartum.
Other than intimate partner abuse, other factors associated with painful sex 18 months after childbirth included pre-pregnancy painful sex, the new mothers' fatigue levels, depressive symptoms and younger maternal age, according to the study.
Brown said the safety of the mother and baby during childbirth is the highest aim, but not enough consideration may be paid to how delivery techniques -- whether vaginal or surgical -- influence later complications, such as painful intercourse.
She also said that pain during sex is an "understandable response" to emotional, physical or sexual abuse by a woman's partner and clinicians should be alert to that possibility.
"The clear message from women taking part in our research is that they are unlikely to volunteer information about abuse unless directly asked by health professionals," she said.
"Similarly, women tend not to talk about dyspareunia unless directly asked," she added. "Although the media is saturated with images of sexuality, sex remains somewhat of a taboo topic, especially in the context of motherhood. It's very important for obstetricians to encourage women to talk about sexual difficulties if they are experiencing problems."
Dr. Kathleen Borchardt, an obstetrician and gynecologist at Houston Methodist Hospital in Texas, called the new research "exciting" because a significant number of first-time mothers she treats seem to worry that a vaginal birth will affect their post-delivery enjoyment of sex more than a cesarean section. The study, however, shows this assumption to be wrong, she said.
"About 10 percent of my patients bring up the subject of elective C-sections . . . a large percentage because they're afraid of the ramifications of childbirth on their vagina and sex," Borchardt said.
Women under age 35 seem to be more comfortable talking with clinicians about painful sex, she added, but women over 50 seem to have more trouble bringing up the subject.
"I see a big difference in generations as to who's comfortable speaking about it," Borchardt said. "I bring it up in a very non-judgmental way and ask, 'Are you having painless sex?' "
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