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• Infections of the genital area: Candida, Trichomonas vaginalis, genital herpes, or warts
• psychosocial factors may include tiredness, anxiety and fear, low self- esteem, poor body image, sexual guilt, and interpersonal problems between the woman and her partner.
Sexuality and labour
Some of the procedures and examinations performed during labour involve the exposure of the genital area and penetrative vaginal examination by either the hand or a speculum. Many women find this very disturbing and difficult to cope with, not only because of the associated physical discom-fort but also because of psychological feelings of vulnerability and power-lessness. this is especially relevant to women who have been sexually abused. there is an increased need for awareness of these factors by mid-wives and doctors, who often perform these examinations in a ritualistic manner and often without a sound rationale.
Obstetric procedures, including artificial rupture of the membranes (ARM), episiotomies, instrumental deliveries, and Caesarean sections, can also have a profound effect on a woman’s sexuality. Many women find these procedures traumatic and they can have long- term consequences for sexual relationships.
the experience of seeing their significant other in childbirth can affect the partner’s sexuality. It can be a very powerful and overwhelming experience, which will bond the couple together, but it may also be a traumatic experi-ence. the partner may feel responsible for the pain and procedures their significant other may be undergoing, or their reaction could be linked with feelings of inadequacy and powerlessness. In extreme cases this experience has been known to cause impotency for male partners.
Midwives and obstetricians need to be aware of the implications of obstetric procedures and the traumatic effects they can have on the lives of couples who have been in their care.
Sexuality postnatally
Sexuality following childbirth is a much neglected area that is inadequately addressed by many midwives and health professionals. Sexual behaviour and sexual health of women following childbirth have been shown to be influenced by profound psychological, interpersonal, social, and physical fac-tors.31 Many women are anxious about their bodies following the birth of a child and this is linked to perineal pain, soreness, and a decreased sense of attractiveness. Sexual activity and enjoyment following childbirth is usually diminished for up to 1 year.
Resuming sexual relations
there is no set time when to resume sexual intercourse. It is more import-ant that it is the right time for both of the partners. It is advisable to wait 3 weeks before having penetrative sex. It is important to avoid deliber-ately blowing air into the vagina during oral sex during pregnancy and in the weeks following birth, as this may cause an air embolism. Contraception needs consideration before resuming sexual intercourse, as the woman will ovulate prior to menstruating. Some women will experience dyspareunia
for a while following childbirth, but if this does not resolve, they should be referred for medical advice.
Common causes of postnatal dyspareunia include:
• Decreased vaginal lubrication, associated with either breastfeeding or diminished sexual arousal
• Inflammation and infection
• Contracture and scarring of the perineum
• Sensitive hymenal or skin tags through malalignment of perineal repair.
Breastfeeding and sexuality
Women who breastfeed may find that they and their partners have a dimin-ished sexual desire, whilst others may find it enhanced. the physiological and psychological experiences associated with breastfeeding may reduce sexual libido for the woman and also reduce vaginal lubrication. tenderness of the breasts and leakage of milk may inhibit women from sexual activity whilst some partners may find it off- putting.
It is normal for some women to feel sexual arousal whilst breastfeeding;
this is a response to the oxytocin increase during breastfeeding.32 Mothers will need reassurance as it may engender feelings of guilt and anxiety in the woman.
Many women will not menstruate whilst exclusively breastfeeding.
Menstruation returns when the number of night- feeds declines or when the baby begins to have solid foods and breastfeeding is less frequent. Ovulation will occur before menstruation returns and the mother needs to ensure adequate contraception if another pregnancy is to be avoided.
Maternity care for lesbian mothers
When considering sexuality in relation to childbirth, it is important to acknowledge that some mothers are choosing to have babies outside of a heterosexual relationship and some will have a female partner. Many lesbian women have negative health- care experiences and therefore it is important that midwives provide support and information in a non- judgemental, sen-sitive, woman- centred approach that takes into consideration the individual mother’s needs. Specific considerations are:
• Lesbians want to be treated, and be treated to the same standard, as everyone else whilst having their individual differences recognized and appreciated33
• Disclosure of sexual orientation should be confidential and not recorded in the notes
• Other health professionals should not be informed without the woman’s expressed consent
• provision of information should be appropriate to their needs
• the lesbian partners should be acknowledged as a couple and co- parents
• Creation of an atmosphere that acknowledges sexual diversity.
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References
31 De Judicibus MA, McCabe Mp (2002). psychological factors and the sexuality of pregnant and postpartum women. J Sex Res 39: 94– 103.
32 Convery KM, Spatz DL (2009). Sexuality and breastfeeding: what do you know? MCN Am J Matern Child Nurs 34: 218– 23.
33 Dibley LB (2009). Experiences of lesbian parents in the UK: interactions with midwives. Evidence- based midwifery. Available at: M www.rcm.org.uk/ learning- and- career/ learning- and- research/
ebm- articles/ experiences- of- lesbian- parents- in- the- uk- 0.