1) The study prospectively evaluated women's sexual function and behavior over 24 weeks postpartum based on their delivery method (vaginal without episiotomy, vaginal with episiotomy, instrumental delivery, elective c-section, emergency c-section).
2) Women who delivered vaginally without episiotomy resumed sexual activity sooner (average 4.5 weeks) than those with an episiotomy (average 7.9 weeks).
3) Overall sexual function scores (based on the FSFI questionnaire) improved between 6 weeks and 24 weeks postpartum for all groups but did not significantly differ based on delivery method.
Precautions after ivf pregnancy , lifecare centre ,IVF icsiLifecare Centre
PREGNANCY Outcome following
IVF-ICSI
HURDLES IN EARLY PREGNANCY
lifecare IVF centre
lifecare centre ,Multiple Pregnancy
Pregnancy
&
Co-morbidity
obestetric & neonatal outcome following IVF-ICSI
About humans
Health and wellness
An aspect of Gynecology
Broad for Medical Students
Perfect for teachers
Lucid for the non-medically inclined or the general public
Knowledge based
Result oriented
Contents include:
- Introduction/Definition
- Epidemiology of Infertility
- Anatomy & Physiology
- Factors affecting infertility
- Requirements for infertility
- Causes/Etiology of Infertility
- Evaluation
- Investigations of Infertility
- Treatment of Infertility
- Unexplained infertility
- Assisted Reproductive Technology (ART)
- Psychological support
- Case History
- Summary
Was compiled on 29th June 2014
And was presented on 23rd July, 2014 in the State House Medical Centre, Aso Rock, Abuja - FCT, Nigeria.
THIS IS THE PRESENTATION OF OUR ORATION AT AMU ON 2ND OCT(GOLDEN JUBILEE OF JNMC ,ALIGARH AND AT SMS JAIPUR ON THE 3RD NOV(FAROOQ ABDULLA ORATION AWARD).......
Asymptomatic Uterine Perforation in a Term Pregnancy: A Case Report.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Female fertility begins to decline many years prior to the onset of menopause despite continued regular ovulatory cycles. Although there is no strict definition of advanced reproductive age in women, infertility becomes more pronounced after the age of 35.
Precautions after ivf pregnancy , lifecare centre ,IVF icsiLifecare Centre
PREGNANCY Outcome following
IVF-ICSI
HURDLES IN EARLY PREGNANCY
lifecare IVF centre
lifecare centre ,Multiple Pregnancy
Pregnancy
&
Co-morbidity
obestetric & neonatal outcome following IVF-ICSI
About humans
Health and wellness
An aspect of Gynecology
Broad for Medical Students
Perfect for teachers
Lucid for the non-medically inclined or the general public
Knowledge based
Result oriented
Contents include:
- Introduction/Definition
- Epidemiology of Infertility
- Anatomy & Physiology
- Factors affecting infertility
- Requirements for infertility
- Causes/Etiology of Infertility
- Evaluation
- Investigations of Infertility
- Treatment of Infertility
- Unexplained infertility
- Assisted Reproductive Technology (ART)
- Psychological support
- Case History
- Summary
Was compiled on 29th June 2014
And was presented on 23rd July, 2014 in the State House Medical Centre, Aso Rock, Abuja - FCT, Nigeria.
THIS IS THE PRESENTATION OF OUR ORATION AT AMU ON 2ND OCT(GOLDEN JUBILEE OF JNMC ,ALIGARH AND AT SMS JAIPUR ON THE 3RD NOV(FAROOQ ABDULLA ORATION AWARD).......
Asymptomatic Uterine Perforation in a Term Pregnancy: A Case Report.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Female fertility begins to decline many years prior to the onset of menopause despite continued regular ovulatory cycles. Although there is no strict definition of advanced reproductive age in women, infertility becomes more pronounced after the age of 35.
The Detection of a Salivary Ferning Pattern Using the Knowhen Ovulation Monit...KNOWHEN
The ability to detect the period of potential monthly fertility is of great importance to a large segment of the female population in their reproductive years, both in terms of contraception as well as conception. In the current study, the KNOWHEN® ovulation monitoring system was used by a group of women who tested their saliva on a daily
basis for the presence of a ferning pattern, a known biologic marker of impending ovulation. Transvaginal ultrasound examination, which is the “gold standard” for the detection of ovulation, was employed to visually determine if the cycle was ovulatory, either by demonstrating the presence of a dominant ovarian follicle or a corpus luteum found at the site of follicular rupture. If neither were observed, the cycle was determined to be anovulatory. The presence or absence of a ferning pattern in saliva was correlated with the actual documentation of ovulation with transvaginal ultrasound examination. Twenty two (22) women were studied for a total of 41 menstrual cycles. Salivary ferning was observed in 29 of 30 ovulatory cycles. False positive results in which ferning was present in an anovulatory cycle, occurred twice in 10 anovulatory menstrual cycles. Our findings indicate a strong correlation between the presence of salivary ferning and ovulation, as detected by the Knowhen ovulation microscope (Log Odds ratio 7.64, P<0.01, CI 4.26 to 11.02), thus validating its use. Age and weight did not appear to affect ferning, alone or together (P: NS).
http://knowhen.com/
Characterization and the Kinetics of drying at the drying oven and with micro...Open Access Research Paper
The objective of this work is to contribute to valorization de Nephelium lappaceum by the characterization of kinetics of drying of seeds of Nephelium lappaceum. The seeds were dehydrated until a constant mass respectively in a drying oven and a microwawe oven. The temperatures and the powers of drying are respectively: 50, 60 and 70°C and 140, 280 and 420 W. The results show that the curves of drying of seeds of Nephelium lappaceum do not present a phase of constant kinetics. The coefficients of diffusion vary between 2.09.10-8 to 2.98. 10-8m-2/s in the interval of 50°C at 70°C and between 4.83×10-07 at 9.04×10-07 m-8/s for the powers going of 140 W with 420 W the relation between Arrhenius and a value of energy of activation of 16.49 kJ. mol-1 expressed the effect of the temperature on effective diffusivity.
Accuracy of cervico vaginal fetal fibronectin test in predicting risk of spon...Open Access Research Paper
Preterm delivery is the leading cause of neonatal mortality. One of the best predictors to assess the risk of preterm labour (PTB) is by measuring fetal fibronectin (fFN) in cervico vaginal secretion after 26 weeks of pregnancy. The aim is to evaluate the diagnostic accuracy of qualitative cervico vaginal fFN in symptomatic women and asymptomatic high risk women during antenatal care. Prospective study which was conducted in Basrah Maternity and Child Hospital. It included 106 pregnant women at gestational age more than 26 weeks who had uterine contraction with or without pervious risk factors for PTB. Cervico vaginal fluid sampling was undertaken from all women included in the study after the age of 26 weeks of gestation and qualitative fFN assessment was done with 50ng/ml is the cut off point for positivity. As regard qualitative fFN assessment for predicting of PTB sensitivity, specificity, PPV, NPV, were 71%, 87%, 40.50%, 94% respectively in symptomatic women. While in asymptomatic women with previous high risk had 26% sensitivity, 84% specificity, 32% PPV, and 87% NPV. Qualitative assessment of fFN in cervico vaginal fluid is good predictive marker in detecting of PTB.
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The relationship between prenatal self care and adverse birth outcomes in you...iosrjce
Birth outcomes refer to the end result of a pregnancy. The purpose of this study was to examine the
relationship between self care practices during pregnancy and adverse birth outcomes in young women aged 16
to 24 years at a provincial maternity hospital in Zimbabwel. A descriptive corelational design was used. Orem’s
Self Care theory was used to guide the study. Eighty pregnant women were selected using systematic random
sampling and, data was collected using interviews from the 1 March - 31 April 2012. Permission to carry out
the study was obtained from the provincial maternity hospital, the Department of Nursing Science and the
Medical and Research Council of Zimbabwe. Findings revealed such adverse birth outcomes as prematurity
(between 28-32 weeks) 10 (12.5%), still births, 3 (3.75%), low apgar 17 (21.2%) and low birth weight 16 (20%).
Adverse birth outcomes in the mothers included high blood pressure 32 (40%), HIV infection 20 (25%) and post
partum hemorrhage 7 (8.8%) Twenty-four (30%) participants had not booked for antenatal care, 1 (1.8%)
booked for antenatal care at less than 12 weeks while only 1 (1.8%) disclosed her pregnancy at above 29 weeks’
gestation. There was a moderate significant positive correlation between self care practices and adverse birth
outcomes, r=.340. This meant that birth outcomes improved as self care practices increased. Significant R2
. was
.115 meaning self care practices explained 11.5% of the variance observed in birth outcomes. Midwives should
advocate delay in sexual debut in young women to reduce adverse birth outcomes.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
1. MATERNAL-FETAL MEDICINE
Sexual function after childbirth by the mode of delivery:
a prospective study
Samuel Lurie • Michal Aizenberg • Vicky Sulema •
Mona Boaz • Michal Kovo • Abraham Golan •
Oscar Sadan
Received: 2 February 2013 / Accepted: 3 April 2013
Ó Springer-Verlag Berlin Heidelberg 2013
Abstract
Purpose The objective of the present study was to eval-
uate sexual behavior longitudinally in the postpartum per-
iod by mode of delivery.
Methods In this prospective study, five groups were
defined: women who delivered vaginally without an epi-
siotomy (n = 16), women who delivered vaginally with an
episiotomy (n = 14), women who delivered by instru-
mental delivery (n = 16), women who delivered by an
emergent cesarean section (n = 19), and women who
delivered by an elective cesarean section (n = 17). Sexual
behavior was assessed by the female sexual function index
(FSFI) questionnaire at 6, 12, and 24 weeks postpartum
and by the timing of resumption of sexual intercourse.
Results The mean ± SD self-reported timing of resump-
tion of sexual activity was 4.5 ± 1.8, 7.9 ± 3.0, 7.3 ± 3.4,
6.1 ± 2.6, and 6.1 ± 2.4 weeks in the vaginal delivery
without an episiotomy group, in the vaginal delivery with
an episiotomy group, in the instrumental delivery group, in
the elective cesarean delivery group, and in the emergent
cesarean delivery group, respectively (p = 0.013). The
FSFI total score in the entire study group (n = 82) was
14.1 ± 10.8, 24.6 ± 7.6, and 27.7 ± 5.1 at 6, 12, and
24 weeks postpartum, respectively (p 0.05). The FSFI
total score did not differ significantly across types of mode
of delivery at 6, 12, or 24 weeks postpartum.
Conclusion The significance by delivery mode difference
in the postpartum resumption of sexual activity was not
accompanied by difference in sexual function scores.
Specifically, elective cesarean delivery was not associated
with a protective effect on sexual function after childbirth.
Keywords Sexual function Á Cesarean section Á
Instrumental delivery Á Vaginal delivery Á Episiotomy
Introduction
Over the ages, the objective of cesarean delivery has dra-
matically evolved from a universally postmortem proce-
dure toward saving the lives of both the mother and the
child [1]. At the beginning of twenty-first century, we
continue to act on behalf the health and the safety of both
the mother and the child; but we also act in accordance
with the mother’s desire and preference and child’s rights.
This motion raised the concept of prophylactic cesarean
delivery or as it sometimes referred as cesarean on patient’s
demand [2, 3]. One of the apparent concerns that influence
women who choose cesarean delivery is fear that vaginal
delivery impinges on sexual function after childbirth [4, 5].
Certain aspects of female sexual function after child-
birth have been studied by many investigators since 1960;
still, the vast majority of available studies do not ade-
quately separate the data between the different modes of
deliveries [6]. During the first 3 months postpartum, many
S. Lurie (&) Á V. Sulema Á M. Kovo Á A. Golan Á O. Sadan
Department of Obstetrics and Gynecology,
Edith Wolfson Medical Center, Holon, Israel
e-mail: drslurie@hotmail.com
S. Lurie Á M. Aizenberg Á M. Boaz Á M. Kovo Á
A. Golan Á O. Sadan
Sackler School of Medicine, Tel Aviv University,
Tel Aviv, Israel
M. Boaz
Epidemiology and Statistics Unit, Edith Wolfson Medical
Center, Holon, Israel
123
Arch Gynecol Obstet
DOI 10.1007/s00404-013-2846-4
2. women experience some problems related to sexual
function, such as dyspareunia, decreased libido, difficulty
achieving orgasm, or vaginal dryness [7]. Typically, these
problems resolve by the end of first postpartum year.
There are three mechanisms which may contribute to
sexual dysfunction after childbirth: dyspareunia, birth
canal injury (‘‘pudendal neuropathy’’), and overall general
health of the mother [4, 7]. Thus, various obstetrical
events such as cesarean, instrumental or spontaneous
delivery or episiotomy could theoretically affect maternal
sexual function in a dissimilar way. However, it is unclear
whether or how these different obstetrical events influence
short- or long-term prognosis for maternal sexual function
[7]. Several investigators have addressed some aspects of
the influence of some obstetrical events on sexual func-
tion after childbirth. Rate of resumption of sexual activity
has been reported to be independent of mode of delivery
(vaginal or cesarean) at 6 weeks [8] or at 3 months [9], or
2 years [10] postpartum. At 6 weeks postpartum, women
who had delivered vaginally without an episiotomy were
reported to resume sexual activity sooner than those with
an episiotomy [8]. At 6 months postpartum, women who
sustained anal sphincter lacerations were reported less
likely to return to sexual activity [11]. The prevalence of
dyspareunia was reported to be higher in women after
vaginal than after cesarean delivery at 3 months post-
partum [12, 13] and in women after instrumental delivery
than after cesarean delivery in the second stage of labor
[14]. This protective effect of cesarean delivery usually
disappears by 6 months postpartum [12, 13, 15]. Sexual
function was reported to be similar among women who
delivered vaginally or by cesarean at 6 weeks [8] or at
3 months [12] or at 6 months [11] postpartum. Addi-
tionally, there was no reported impact of planned mode of
delivery (vaginal vs. cesarean) on satisfaction with sexual
relations at 2 years postpartum [10]. Likewise, mode of
delivery history (vaginal vs. cesarean) did not appear to
have a significant effect on sexual function at 6 years
postpartum [16].
The objective of the present study was to evaluate
sexual behavior in the postpartum period by mode of
delivery. To that end, subjects were divided into five
groups of mode of delivery: vaginal delivery without
episiotomy, vaginal delivery with episiotomy, instrumen-
tal delivery, emergent cesarean, and elective cesarean.
Sexual behavior was assessed by the female sexual
function index (FSFI) questionnaire and by self-reported
timing of resumption of sexual intercourse. In contrary to
previous studies, sexual function was assessed prospec-
tively and longitudinally over a period of 6–24 post
partum weeks in a non-self-administered manner (by
interview) and included a more comprehensive model for
mode of delivery.
Materials and methods
Study design
The protocol for this prospective study was approved by
the Edith Wolfson Medical Center Institutional Review
Board at June 18, 2009 (protocol number WOMC-0019-
09). Participants were recruited from the Maternity Ward
of Edith Wolfson Medical Center between January 2010
and February 2011. In 2010, we had 4,362 deliveries, of
those 1,611 were primiparas (36.9 %). Of the 1,611
primiparas, 395 parturient women had a cesarean section
(24.6 %) while 1,216 delivered vaginally either spontane-
ously or with instrumental assistance (75.4 %). The
instrumental delivery rate was 4.5 % and episiotomy rate
was 20.0 %. The women were approached on the day of
discharge from the hospital after childbirth. Five groups
were defined: women who delivered vaginally without an
episiotomy, women who delivered vaginally with an epi-
siotomy, women who delivered by instrumental delivery,
women who delivered by an emergent cesarean section,
and women who delivered by an elective cesarean section.
With a sample size of n = 15 subjects in each group, the
present study was designed to have 80 % power to detect a
true, across-group difference of 1 ± 0.5 summary score
points, using any of the six domain summary scores
(desire, arousal, lubrication, orgasm, satisfaction, or pain)
as an endpoint. This calculation assumes an overall alpha
of 0.001 to control for multiple comparisons. At recruit-
ment, we added 5 participants for loss of follow up, thus,
initially, 20 participants were enrolled in each group. The
recruitment was done by a quota sampling method. After
the groups were pre-defined, every eligible subject was
approached and, if consented, was enrolled in accordance
with mode of delivery until each group was filled (n = 20).
Each participant signed a consent form prior to enrollment
in the study. All of the participants were interviewed by
telephone at 6, 12, and 24 weeks postpartum by one of the
authors (M.A.) using the FSFI questionnaire.
Participants
Healthy, postpartum women between the ages of 18 and 45
were eligible to participate. Specific inclusion criteria for
each group were as follows. Women in the vaginal delivery
group without episiotomy were allowed to have first degree
perineal tears. As first-degree tear, we defined those
superficially involving the vaginal mucosa, fourchette, or
the skin of perineum. Women in the vaginal delivery group
with an episiotomy had a mediolateral episiotomy. Women
in the instrumental delivery group were delivered either by
a vacuum extraction or by forceps. Instrumental delivery
was performed for non-reassuring fetal heart pattern during
Arch Gynecol Obstet
123
3. second stage of labor or for prolonged the second stage
after the prerequisites for instrumental delivery were met.
The prerequisites for instrumental delivery in our institu-
tion are: cephalic presentation, engaged fetal head (station
?2 or more), ruptured membranes, and no evidence for
cephalo-pelvic disproportion. In our institution, the diag-
nosis of prolonged second stage and non-reassuring fetal
heart pattern are made in accordance with the guidelines of
the American College of Obstetricians and Gynecologists
(ACOG). Women in the emergent cesarean section were
parturients who entered a spontaneous labor and were
operated thereafter. The indications for emergent cesareans
were: 8 (42.1 %) for non-reassuring fetal heart rate pattern
and 11 (57.9 %) for non-progressive labor. Women in the
elective cesarean deliver group had a planned cesarean
section. The indications for elective cesareans were: 10
(58.8 %) for malpresentation, 3 (17.7 %) for suspected
macrosomia, 3 (17.7 %) for patient’s demand, and 1
(5.8 %) for previous cesarean section. Refusal to partici-
pate was the only exclusion criterion. The demographic
characteristics of the study participants are summarized in
Table 1.
FSFI questionnaire
The FSFI, an assessment tool developed by a group of
experts in female sexual dysfunction was used for the study
[17]. This 19-item survey assesses six domains of sexual
function: desire, arousal, lubrication, orgasm, satisfaction,
and pain. A scoring algorithm was generated to assess each
domain as outlined in the original paper [17]. Briefly,
individual domain scores are obtained by adding the scores
of the individual items that comprise the domain and
multiplying the sum by the domain factor. The full scale
score is obtained by adding the six domain scores.
Statistical analysis
Analysis of data was carried out using SPSS 11.0 statistical
analysis software (SPSS Inc., Chicago, IL, USA). For
continuous variables, such as age, scores, and birth
weights, descriptive statistics were calculated and reported
as mean ± SD. Distributions of continuous variables were
assessed for normality using the Kolmogorov–Smirnov test
(cut off at p = 0.01). Scores had distributions deviating
from normal so were compared across delivery type using
the Kruskal–Wallis test. Categorical variables such as
delivery type were described using frequency distributions
and are presented as frequency (%). Repeated measures
general linear modeling was used to assess across-group
differences in summary scores over time. Delivery type
was included as a fixed factor in these models. All tests are
two-sided and considered significant at p 0.05.
Results
Eighteen participants out of the 100 initially recruited and
enrolled in the study did not agree to continue and coop-
erate after the discharge from the hospital. Eighty-two
questionnaires were, therefore, analyzed: 16 in the vaginal
delivery without an episiotomy group, 14 in the vaginal
delivery with an episiotomy group, 16 in the instrumental
delivery group, 17 in the elective cesarean delivery group,
and 19 in the emergent cesarean delivery group. Additional
three women (one in emergent cesarean group and two in
Table 1 Participants’ characteristics
Delivery type Vaginal delivery
without episiotomy
Vaginal delivery
with episiotomy
Instrumental
delivery
Elective
cesarean
delivery
Emergent
cesarean delivery
p value
Number 16 14 16 17 19
Age (years) 27.7 ± 4.8 28.4 ± 3.9 27.3 ± 5.7 31.2 ± 5.6 29.4 ± 5.4 NS
Marital status p = 0.006
Single 7 (43.7 %) 0 (0.0 %) 2 (14.2 %) 4 (23.5 %) 1 (5.2 %)
Married 8 (56.3 %) 14 (100.0 %) 14 (85.8 %) 13 (76.5 %) 18 (94.8 %)
Gravidity 1.6 ± 0.6 1.1 ± 0.4 1.2 ± 0.4 1.2 ± 0.4 1.3 ± 0.6 NS
Parity 1.0 ± 0.0 1.0 ± 0.0 1.0 ± 0.0 1.1 ± 0.3 1.1 ± 0.2 NS
Gestational week at
delivery (weeks)
39. 1 ± 2.2 39.5 ± 1.1 39.6 ± 1.4 38.8 ± 1.7 38.6 ? 2.6 NS
Birth weight (g) 3,008.8 ± 505.6 3,201.0 ± 477.3 3,270.1 ± 478.7 3,280.4 ± 663.2 3,199.4 ± 643.9 NS
Apgar score of B7 at
5 min
0 (0.0 %) 0 (0.0 %) 0 (0.0 %) 0 (0.0 %) 1 (5.2 %) NS
Data are expressed as mean ? SD or as frequency (%)
NS not significant
Arch Gynecol Obstet
123
4. instrumental delivery group) did not agree to continue and
cooperate after the first interview. Thus, these three women
were included in the 6 weeks analysis but not in the 12 and
24 weeks analysis.
Within 3 months of delivery, 78 women (95.1 %)
reported resuming sexual intercourse. The mean ± SD
timing of resumption of sexual activity was 4.5 ± 1.8,
7.9 ± 3.0, 7.3 ± 3.4, 6.1 ± 2.6, and 6.1 ± 2.4 weeks in
the vaginal delivery without an episiotomy group, in the
vaginal delivery with an episiotomy group, in the instru-
mental delivery group, in the elective cesarean delivery
group, and in the emergent cesarean delivery group,
respectively (p = 0.013). Multiple comparison post hoc
testing revealed that women in the vaginal delivery without
an episiotomy group resumed sexual intercourse signifi-
cantly earlier than women in the in the vaginal delivery
with an episiotomy group (p = 0.013).
Table 2 summarizes FSFI at 6 weeks postpartum. None
of the domain scores (desire, arousal, lubrication, orgasm,
satisfaction, or pain) differed across types of mode of
delivery. Table 3 summarizes FSFI at 12 weeks post-
partum. None of the domain scores (desire, arousal, lubri-
cation, orgasm, satisfaction, or pain) differed across types
of mode of delivery. Table 4 summarizes FSFI at 24 weeks
postpartum. None of the domain scores (desire, arousal,
lubrication, orgasm, satisfaction, or pain) differed across
the various types of mode of delivery.
The FSFI total score changed over time but not across
delivery modes. The FSFI total score in the entire study
group (n = 82) was 14.1 ± 10.8, 24.6 ± 7.6, and
27.7 ± 5.1 at 6, 12, and 24 weeks postpartum, respectively
(p 0.05). The FSFI total score did not differ significantly
across types of mode of delivery at 6, 12, or 24 weeks
postpartum. Each of the domain score (desire, arousal,
Table 2 Female sexual
function index (FSFI) at
6 weeks postpartum
None of the domain scores
differed significantly (ANOVA)
across groups of rout of delivery
FSFI domain Rout of delivery Number Mean ± SD 95 % CI
Desire Vaginal no episiotomy 16 3.41 ± 1.04 2.86, 3.97
Vaginal ? episiotomy 14 2.96 ± 0.93 2.42, 3.49
Instrumental 16 3.15 ± 1.39 2.41, 3.89
Elective cesarean 17 3.35 ± 1.10 2.79, 3.92
Emergent cesarean 19 3.19 ± 1.33 2.55, 3.83
Arousal Vaginal no episiotomy 16 3.00 ± 2.22 1.82, 4.18
Vaginal ? episiotomy 14 1.24 ± 2.14 0.01, 2.48
Instrumental 16 1.86 ± 2.28 0.64, 3.07
Elective cesarean 17 2.06 ± 2.19 0.94, 3.19
Emergent cesarean 19 1.18 ± 1.86 0.29, 2.08
Lubrication Vaginal no episiotomy 16 3.26 ± 2.37 2.00, 4.52
Vaginal ? episiotomy 14 1.24 ± 2.24 -0.05, 2.54
Instrumental 16 1.86 ± 2.37 0.60, 3.12
Elective cesarean 17 2.35 ± 2.39 1.12, 3.58
Emergent cesarean 19 1.39 ± 2.14 0.36, 2.42
Orgasm Vaginal no episiotomy 16 2.68 ± 2.30 1.45, 3.90
Vaginal ? episiotomy 14 1.43 ± 2.42 0.03, 0.83
Instrumental 16 1.88 ± 2.40 0.60, 3.15
Elective cesarean 17 2.02 ± 2.22 0.88, 3.17
Emergent cesarean 19 1.26 ± 2.02 0.29, 2.24
Satisfaction Vaginal no episiotomy 16 4.03 ± 1.60 3.17, 4.88
Vaginal ? episiotomy 14 2.89 ± 1.45 2.05, 3.72
Instrumental 16 3.33 ± 1.82 2.35, 4.30
Elective cesarean 17 3.44 ± 1.63 2.60, 4.27
Emergent cesarean 19 2.80 ± 1.62 2.02, 3.58
Pain Vaginal no episiotomy 16 2.95 ± 2.45 1.65, 4.25
Vaginal ? episiotomy 14 0.94 ± 1.86 -0.13, 2.02
Instrumental 16 1.48 ± 2.08 0.36, 2.59
Elective cesarean 17 2.52 ± 2.56 1.20, 3.83
Emergent cesarean 19 1.39 ± 2.16 0.35, 2.43
Arch Gynecol Obstet
123
5. lubrication, orgasm, or satisfaction) increased significantly
increased and pain during sex significantly decreased
(inverse scale) from 6 to 24 weeks postpartum (general
linear model, p 0.001). However, between the mode of
delivery group, differences were not detected.
Discussion
In this study, 95.1 % of women had resumed sexual
intercourse within 3 months of delivery, consisted with
previously reported rate 80–93 % [17–21]. In addition, the
study revealed that women who delivered vaginally with-
out an episiotomy resumed sexual intercourse significantly
earlier than women who had any additional pelvic surgical
intervention such as episiotomy, instrumental delivery,
elective or emergent cesarean section (4.5 ? 1.8 vs.
7.9 ? 3.0, 7.3 ? 3.4, 6.1 ? 2.6, and 6.1 ? 2.4 weeks,
respectively, p = 0.013). One possible explanation for this
difference could be different overall general health of the
mother after different modes of delivery, which is one of
the three previously described mechanisms [4, 7], which
may contribute to sexual dysfunction after childbirth.
Another possible explanation is altered body image fol-
lowing various modes of delivery. Body image after
childbirth was previously described as one of the important
themes in women’s’ experience with sexuality after
childbirth [22].
The current study differed from previous studies on
postpartum sexual function in that it directly and longitu-
dinally compared sexual function by mode of delivery
using a well validated questionnaire. By that, we were able
to address the other two previously described mechanisms
[4, 7] that may contribute to sexual dysfunction after
childbirth, i.e., dyspareunia and birth canal injury
(‘‘pudendal neuropathy’’). The relative contribution of each
study group to the above-mentioned mechanisms, namely
the vaginal delivery without an episiotomy group, the
Table 3 Female Sexual
Function Index (FSFI) at
12 weeks postpartum
None of the domain scores
differed significantly (ANOVA)
across groups of rout of delivery
FSFI domain Rout of delivery Number Mean ± SD 95 % CI
Desire Vaginal no episiotomy 16 3.75 ± 1.11 3.16, 4.34
Vaginal ? episiotomy 14 3.39 ± 0.84 2.90, 3.87
Instrumental 14 3.64 ± 0.98 3.08, 4.21
Elective cesarean 17 3.67 ± 0.90 3.21, 4.13
Emergent cesarean 18 3.67 ± 1.22 3.06, 4.27
Arousal Vaginal no episiotomy 16 4.01 ± 1.23 3.36, 4.67
Vaginal ? episiotomy 14 3.99 ± 1.49 3.13, 4.85
Instrumental 14 3.77 ± 1.95 2.65, 4.90
Elective cesarean 17 3.78 ± 1.58 2.96, 4.59
Emergent cesarean 18 4.07 ± 1.11 3.52, 4.62
Lubrication Vaginal no episiotomy 16 4.71 ± 1.55 3.88, 5.53
Vaginal ? episiotomy 14 4.18 ± 1.78 3.15, 5.21
Instrumental 14 3.75 ± 2.12 2.53, 4.97
Elective cesarean 17 4.15 ± 1.79 3.22, 5.07
Emergent cesarean 18 5.02 ± 0.99 4.52, 5.51
Orgasm Vaginal no episiotomy 16 4.05 ± 1.84 3.07, 5.03
Vaginal ? episiotomy 14 3.69 ± 1.65 2.73, 4.64
Instrumental 14 3.11 ± 2.19 1.85, 4.38
Elective cesarean 17 3.76 ± 1.66 2.91, 4.62
Emergent cesarean 18 3.89 ± 1.72 3.03, 4.74
Satisfaction Vaginal no episiotomy 16 4.65 ± 1.24 3.99, 5.31
Vaginal ? episiotomy 14 4.80 ± 1.15 4.13, 5.47
Instrumental 14 4.17 ± 1.57 3.27, 5.08
Elective cesarean 17 4.71 ± 1.07 4.15, 5.26
Emergent cesarean 18 4.44 ± 1.51 3.69, 5.19
Pain Vaginal no episiotomy 16 4.90 ± 1.71 3.99, 5.81
Vaginal ? episiotomy 14 3.69 ± 1.94 2.56, 4.81
Instrumental 14 3.46 ± 2.25 2.16, 4.76
Elective cesarean 17 4.33 ± 1.96 3.32, 5.33
Emergent cesarean 18 5.07 ± 1.30 4.42, 5.71
Arch Gynecol Obstet
123
6. vaginal delivery with an episiotomy group, the instru-
mental delivery group, the elective cesarean delivery
group, and the emergent cesarean delivery, is obviously
dissimilar and emphasizes different angles of influence.
Women after vaginal delivery experience vaginal pain and
it obviously worsens after vaginal delivery with episiotomy
and, moreover, after an instrumental delivery. In contrast,
women after cesarean delivery experience abdominal pain
and it may be different in women after emergent cesarean
delivery. As expected, along with previously described
data [7], sexual function improved as time elapsed from
delivery (FSFI total score was 14.1 ? 10.8, 24.6 ? 7.6,
and 27.7 ? 5.1 at 6, 12, and 24 weeks postpartum,
respectively, p 0.05). However, sexual function as
measured by the FSFI total score did not differ significantly
by mode of delivery at 6, 12, or 24 weeks postpartum. A
similar picture emerged when analyzing the specific
domain scores (desire, arousal, lubrication, orgasm,
satisfaction, or pain) that did not differed across types of
mode of delivery at 6, 12, or 24 weeks postpartum
(Tables 2, 3, 4). This is an important new finding.
Our study is with disagreement with previously pub-
lished studies that remarked that patients undergoing vag-
inal delivery record a significant higher rate of dyspareunia
at 3 months after childbirth in comparison with women
undergoing a planned cesarean section [12, 23–25]. How-
ever, similar to our findings at 12 and 24 weeks, after the
1 year postpartum, no significant differences were
observed between vaginal and cesarean delivery in previ-
ous studies [12, 15, 25].
A limitation of this study is that a pre-conceptional sexual
sent a return to baseline pre-conceptional level. However, it
is reasonable to speculate that, even if this existed, the rate of
pre-conceptional sexual dysfunction was similarly present
across the five study groups. Additionally, this potential bias
is minute, as it was previously shown that sexual practices
Table 4 Female Sexual
Function Index (FSFI) at
24 weeks postpartum
None of the domain scores
differed significantly (ANOVA)
across groups of rout of delivery
FSFI domain Rout of delivery Number Mean ± SD 95 % CI
Desire Vaginal no episiotomy 16 4.16 ± 0.71 3.78, 4.54
Vaginal ? episiotomy 14 3.77 ± 0.64 3.40, 4.14
Instrumental 14 3.92 ± 1.04 3.35, 4.49
Elective cesarean 17 3.92 ± 0.71 3.55, 4.28
Emergent cesarean 18 4.07 ± 0.91 3.61, 4.52
Arousal Vaginal no episiotomy 16 4.65 ± 0.86 4.19, 5.11
Vaginal ? episiotomy 14 4.61 ± 0.80 4.14, 5.07
Instrumental 14 4.38 ± 1.46 3.57, 5.19
Elective cesarean 17 4.50 ± 1.21 3.88, 5.12
Emergent cesarean 18 4.33 ± 1.01 3.83, 4.84
Lubrication Vaginal no episiotomy 16 5.04 ± 0.94 4.54, 5.55
Vaginal ? episiotomy 14 4.86 ± 1.26 4.14, 5.59
Instrumental 14 4.66 ± 1.50 3.83, 5.49
Elective cesarean 17 4.62 ± 1.33 3.94, 5.31
Emergent cesarean 18 5.12 ± 0.69 4.78, 5.46
Orgasm Vaginal no episiotomy 16 4.38 ± 1.66 3.49, 5.26
Vaginal ? episiotomy 14 4.60 ± 1.16 3.93, 5.27
Instrumental 14 3.73 ± 1.92 2.67, 4.79
Elective cesarean 17 4.45 ± 1.32 3.77, 5.12
Emergent cesarean 18 4.58 ± 1.17 4.00, 5.16
Satisfaction Vaginal no episiotomy 16 4.98 ± 1.09 4.39, 5.56
Vaginal ? episiotomy 14 4.83 ± 1.16 4.16, 5.50
Instrumental 14 4.83 ± 1.03 4.26, 5.40
Elective cesarean 17 5.06 ± 0.66 4.72, 5.40
Emergent cesarean 18 4.73 ± 1.02 4.23, 5.24
Pain Vaginal no episiotomy 16 5.38 ± 0.95 4.87, 5.88
Vaginal ? episiotomy 14 5.17 ± 1.13 4.52, 5.82
Instrumental 14 4.77 ± 1.60 3.89, 5.66
Elective cesarean 17 5.11 ± 1.45 4.36, 5.85
Emergent cesarean 18 5.36 ± 0.96 4.88, 5.83
Arch Gynecol Obstet
123
7. changed during pregnancy but returned to early pregnancy
levels in the postpartum period [26]. The rate and length of
breastfeeding was not assessed in our study. It appears that
influence of this potential bias on our study results is mini-
mal, as it was previously summarized by Leeman and
Rogers [27], that breastfeeding mainly affects only lubri-
cation and in a dual manner, as in 55 % it decreases lubri-
cation and in 39 % increases. A potential selection bias may
have been caused by the 18 % drop out of the study. A
strength of the present study is its use of a validated sexual
function instrument (FSFI questionnaire) in carefully char-
acterized obstetric patients longitudinally comparing out-
come following different modes of delivery. The FSFI, a
19-item questionnaire, assesses the key dimensions of sex-
ual function in women and is able to discriminate between
clinical and nonclinical populations [17].
In light of our data, it is clear that elective cesarean sec-
tion does not seem to be advantageous compared with
vaginal delivery with regard to sexual function 6–24 weeks
postpartum. Thus, at least from the sexual function point of
view maternal-choice of a cesarean delivery has a limited
influence on maternal health or quality of life. It appears that
a woman considering an elective cesarean simply because of
concerns about postpartum sexual function would gain little
additional benefit, if any, from this more dangerous mode of
delivery. Perhaps, such expressed fear that vaginal delivery
impinges on sexual function after childbirth [4, 5] is actually
a general fear from of childbirth [28] triggering an super-
fluous demand for elective cesarean [3].
In conclusion, our results should be taken into consid-
eration when counseling patients antenatally regarding
elective mode of delivery. It is specifically significant in
view of the contemporary societal trend of many women
choosing cesarean delivery without an obstetrical indica-
tion. Perhaps, the results of our study will help women to
make a more balanced decision regarding the preferred
mode of delivery.
Conflict of interest None of the authors of the above manuscript
has declared any conflict of interest.
References
1. Lurie S (2005) The changing motives of cesarean section from
ancient times to 21st century. Arch Gynecol Obstet 271:281–285
2. Wagner M (2000) Choosing cesarean section. Lancet 356:677–680
3. Handelzalts JE, Fisher S, Lurie S, Shalev A, Golan A, Sadan O
(2012) Personality, fear of childbirth and cesarean delivery on.
Acta Obstet Gynecol Scand 91:16–21
4. Nama V, Wilcock F (2011) Caesarean section on maternal
request: is justification necessary? The Obstet Gynaecol 13:263–
269
5. Al-Mufti R, McCarthy A, Fisk NM (1996) Obstetricians’ per-
sonal choice and mode of delivery. Lancet 347:544
6. Serati M, Salvatore S, Siesto G et al (2010) Female sexual function
during pregnancy and after childbirth. J Sex Med 7:2782–2790
7. Handa VL (2006) Sexual function and childbirth. Semin Perinatol
30:253–256
8. Woranitat W, Taneepanichskul S (2007) Sexual function during
the postpartum period. J Med Assoc Thai 90:1744–1748
9. Wiklund I, Edman G, Andolf E (2007) Cesarean section on
maternal request: reasons for the request, self-estimated health,
expectations, experience of birth and signs of depression among
first-time mothers. Acta Obstet Gynecol Scand 86:451–456
10. Hannah ME, Whyte H, Hannah WJ et al (2004) Term breech trial
collaborative group. Maternal outcomes at 2 years after planned
cesarean section versus planned vaginal birth for breech presen-
tation at term: the international randomized term breech trial. Am
J Obstet Gynecol 191:917–927
11. Brubaker L, Handa VL, Bradley CS, Connolly A, Moalli P,
Brown MB (2008) Weber a; pelvic floor disorders network.
Sexual function 6 months after first delivery. Obstet Gynecol
111:1040–1044
12. Klein K, Worda C, Leipold H, Gruber C, Husslein P, Wenzl R
(2009) Does the mode of delivery influence sexual function after
childbirth? J Women Health 18:1227–1231
13. Barrett G, Peacock J, Victor CR, Manyonda I (2005) Cesarean
section and postnatal sexual health. Birth 32:306–311
14. Liebling RE, Swingler R, Patel RR, Verity L, Soothill PW,
Murphy DJ (2004) Pelvic floor morbidity up to one year after
difficult instrumental delivery and cesarean section in the second
stage of labor: a cohort study. Am J Obstet Gynecol 191:4–10
15. Buhling KJ, Schmidt S, Robinson JN, Klapp C, Siebert G, Du-
denhausen JW (2006) Rate of dyspareunia after delivery in
primiparae according to mode of delivery. Eur J Obstet Gynecol
Reprod Biol 124:42–46
16. Dean N, Wilson D, Herbison P, Glazener C, Aung T, Macarthur
C (2008) Sexual function, delivery mode history, pelvic floor
muscle exercises and incontinence: a cross-sectional study six
years post-partum. Aust N Z J Obstet Gynaecol 48:302–311
17. Rosen R, Brown C, Heiman J et al (2000) The female sexual
function index (FSFI): a multidimensional self-report instrument
for the assessment of female sexual function. J Sex Marital Ther
26:191–208
18. Abraham S (1990) Recovery after childbirth. Med J Aust 152:387
19. Signorello LB, Harlow BL, Chekos AK et al (2001) Postpartum
sexual functioning and its relationship to perineal trauma: a ret-
rospective cohort study of primiparous women. Am J Obstet
Gynecol 184:881–888
20. Barrett G, Pendry E, Peacock J et al (2000) Women’s sexual
health after childbirth. Br J Obstet Gynaecol 107:186–195
21. Connolly A, Thorp J, Pahel L (2005) Effects of pregnancy and
childbirth on postpartum sexual function: a longitudinal prospec-
tive study. Int Urogynecol J Pelvic Floor Dysfunct 16:263–267
22. Olsson A, Lundqvist M, Faxelid E, Nissen E (2005) Women’s
thoughts about sexual life after childbirth: focus group discussions
with women after childbirth. Scand J Caring Sci 19:381–387
23. Safarinejad MR, Kolahi AA, Hosseini L (2009) The effect of the
mode of delivery on the quality of life, sexual function, and
sexual satisfaction in primiparous women and their husbands.
J Sex Med 6:1645–1667
24. Minkoff H, Chervenak FA (2003) Elective primary cesarean
delivery. N Engl J Med 348:946–950
25. Hicks TL, Goodall SF, Quattrone EM, Lyndon-Rochelle MT
(2004) Postpartum sexual functioning and method of delivery:
Arch Gynecol Obstet
123
8. summary of the evidence. J Midwifery Womens Health 49:
430–436
26. Pauls RN, Occhino JA, Dryfhout VL (2008) Effects of pregnancy
on female sexual function and body image: a prospective study.
J Sex Med 5:1915–1922
27. Leeman LM, Rogers RG (2012) Sex after childbirth. Postpartum
sexual function. Obstet Gynecol 119:647–655
28. Saisto T, Halmesma¨ki E (2003) Fear of childbirth: a neglected
dilemma. Acta Obstet Gynecol Scand 82:201–208
Arch Gynecol Obstet
123