Women sexual dysfunction in the postpartum period: concept analysis

Freitas, Gilson Nogueira; Gomes, Ryanne Carolynne Marques; Pascoal, Lívia Maia; Perrelli, Jaqueline Galdino Albuquerque; Mangueira, Suzana de Oliveira; Linhares, Francisca Márcia Pereira

doi:10.1590/1983-1447.2024.20230199.en

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Sumário

Original Article • Rev. Gaúcha Enferm. 45 • 2024 • https://doi.org/10.1590/1983-1447.2024.20230199.en linkcopy

Women sexual dysfunction in the postpartum period: concept analysis

Disfunción sexual en mujeres puerperas: análisis de concepto

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To analyze the concept of sexual dysfunction in postpartum women and identify their essential attributes, antecedents, and effects.

Method: Concept analysis based on a framework by Walker and Avant, elaborated in eight stages, which were: concept selection; identification of the use of the concept; determination of essential attributes; construction of the model case; additional case; identification of antecedents and effects; and definition of empirical references. Furthermore, an integrative review was carried out simultaneously, with a view to supporting the analysis of the concept.

Results: The sample consisted of 55 studies included in the integrative review. 3 essential attributes, 38 antecedents and 6 effects were identified. The most prevalent antecedents were: perineal laceration, depression, and breastfeeding. Dyspareunia, decreased sexual desire, and altered sexual satisfaction were the main effects.

Conclusion: The concept indicates that the diagnosis involves multifactorial conditions that affect the sexual response cycle, limiting the woman's ability to perform satisfactory sexual relations in the postpartum period.

Keywords:
Physiological sexual dysfunctions; Puerperium; Nursing care; Concept formation; Risk factors

P (Population)	Women in the postpartum period	List of descriptors and synonyms
I (Interest)	Attributes, antecedents, and effects	Postpartum Period Puerperium Risk factors Signs and simptomys
Co (context)	Sexual dysfunction	Sexual Dysfunction, Physiological Sexuality Sexual function
SEARCH IN DATABASES
1.Postpartum Period [MeSHTerms] OR Puerperium [Title/Abstract] 2. Risk Factors [MeSHTerms] OR signs and simptomys [Title/Abstract] 3. Sexual Dysfunction, Physiological [MeSHTerms] OR Sexuality [MeSHTerms] OR Sexual function [Title/Abstract] CROSSED SEARCH #1 AND #2 AND #3 (Postpartum Period [MeSHTerms])) OR (Puerperium [Title/Abstract])) AND (Risk Factors[MeSHTerms])) OR (Signs and simptomys [Title/Abstract])) AND (Sexual Dysfunction, Physiological [MeSHTerms])) OR (Sexuality[Title/Abstract])) OR (Sexual function [Title/Abstract]))

Attributes	I
Disturbance in the sexual response cycle	8
Multifactorial origin	3
Can have a negative effect on quality of life	1
Definition proposed by the conceptual analysis
Multifactorial condition that affects the ability of an individual to enjoy satisfying sexual activities, including issues related with desire, arousal, orgasm, and other issues that have a negative effect on sexual performance.

Antecedents	I
Reduced vaginal lubrication	24
Breastfeeding	20
Depression	21
Episiotomy	13
Fatigue	12
Perineal laceration	10
Cesarean section	9
Use of instruments for delivery (forceps and vacuum extraction)	8
Relationship dissatisfaction	6
Urinary incontinence	4
Anxiety	4
Body self-image alterations	4
Perineal Pain	3
Stress	3
Overweight/obesity	3
Hypoestrogenism	3
Hemorrhage	2
Sleep deprivation	2
Insufficient privacy	2
Pelvic organ prolapse	2
Hypertensive syndrome	2
Lack of communication with partner	2
Advanced age of the mother	2
Socioeconomic vulnerability	2
Alcoholism	1
Amenorrhea	1
Fear of getting pregnant	1
Smoking	1
Post-traumatic stress disorder	1
Sexual violence	1
Fecal incontinence	1
Placenta accreta	1
Vulvovaginal atrophy	1
Diabetes mellitus	1
Hyperprolactinaemia	1
Pelvic muscle hypotension	1
Hypothyroidism	1
Interruption of pregnancy	1
Effects
Dyspareunia	33
Decreased sexual desire	21
Altered sexual satisfaction	21
Unwanted changes in sexual intercourse/function	19
Sexual abstinence	6
Altered sexual activity	4

Model case
Postpartum woman, M.A.S., 42, single, brown, housewife, incomplete high school and no stable income. Family history of hypertension and diabetes mellitus type 2. Smoker, alcoholic, sedentary, and overweight. During pregnancy, she developed hypertension and was monitored in high-risk prenatal care. At 39 weeks of pregnancy, she was diagnosed with preeclampsia. Induced labor was recommended. There were complications in the immediate postpartum period due to placenta accreta and associated hemorrhage. 90 days after delivery, she returns to the health service to plan for contraception. During the nursing consultation, she states that she is anxious and depressive, with trouble maintaining sleep due to the demands of care for the newborn. She presents urinary incontinence and trouble resuming her sexual relationship, continuing her abstinence due to the fact she feels pain during intercourse. She mentions little vaginal lubrication and is afraid of another early pregnancy.
Additional case
A.M.S., 24, married, brown, teacher, with an income of 2 minimum wages. No family history of comorbidities. During pregnancy showed no alterations. At 40 weeks and 2 days, vaginal deliver took place with no complications and an IUD was inserted in the immediate postpartum period. 40 after delivery she came back to the health service for postpartum follow up. When asked about her sexual health, she mentioned having resumed her sexual activities, not feeling any difficulties resuming them, and continuing to use the IUD as her contraceptive method.

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[TFN1] Source: Research Data, 2023.