Skip to main content
SpringerLink
Log in

Sexuality in the puerperium: A review

  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Pregnancy and the puerperium herald dramatic and complex physiological, psychological, interpersonal, and sexual changes in a woman and in the marital process. Pregnancy tends to have an increasingly negative effect on sexual desire, expression, and satisfaction as term approaches. Clinical variables discussed include anatomic and physiological changes, puerperal sexual response patterns, marital adjustment, body image, dyspareunia related to episiotomy, lactation, and traditional taboos and cautions regarding coitus for the new mother. Most research respondents reported gradual return to prepregnancy levels of sexual desire, enjoyment, and coital frequency, with a minority in most cited studies indicating sexual interest and coitus levels below prepregnancy levels up to 1 year after delivery. The most frequently listed reasons for poor postpartum sexual adjustment include episiotomy discomfort, fatigue, vaginal bleeding or discharge, dyspareunia, insufficient lubrication, fears of awakening the infant or not hearing him/her, fear of injury, and decreased sense of attractiveness. Postpartum counseling should be offered prior to hospital discharge.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abarbanel, A. R. (1978). Diagnosis and treatment of coital discomfort. In LoPiccolo, J., and LoPiccolo, L. (eds.),Handbook of Sex Therapy Plenum Press, New York, pp. 241–259.

    Google Scholar 

  • Adams, C. R. (1966). An informal preliminary report on some factors relative to sexual responsiveness of certain college wives. In DeMartino, M. F. (ed.),Sexual Behavior and Personality Characteristics. Grove, New York.

    Google Scholar 

  • Alouf, F. E., and Barglow, P. (1983). Sexual counseling for the pregnant and the postpartum patient. In Sciarra, J. J. (ed.),Gynecology and Obstetrics, Vol. 2, Harper & Row, Philadelphia, pp. 1–13.

    Google Scholar 

  • American College of Obstetricians and Gynecologists. (1983).Breast-Feeding Your Baby. Patient Infomation Booklet. ACOG, Washington, D.C.

    Google Scholar 

  • American College of Obstetricians and Gynecologists. (1984).Childbirth: A Guide to Labor, Delivery, and Postpartum Care. Patient education booklet. ACOG, Washington, DC.

    Google Scholar 

  • American Medical Association. (1972).Human Sexuality. Committee on Human Sexuality, AMA Press, Washington, DC.

    Google Scholar 

  • Ammons, P., and Stinnett, N. (1980). The vital marriage: A closer look.Fam. Rel. 29: 37–42.

    Google Scholar 

  • Anderson, I. (1984). Transition to parenthood research.J. Psychosom. Obstet. Gynecol. 3(1): 3–16.

    Google Scholar 

  • Applebaum, R. M. (1975). The obstetrician's approach to the breasts and breastfeeding.J. Reprod. Med. 14: 98–116.

    PubMed  Google Scholar 

  • Banta, D., and Thacker, S. B. (1982). The risks and benefits of episiotomy: A review.Birth 9: 25–30.

    PubMed  Google Scholar 

  • Barker, G. H. (1981). The unkindest cut of all.World Med. 16: 40.

    Google Scholar 

  • Baxter, S. (1974). Labour and orgasm in primiparae.J. Psychosom. Res. 18: 209.

    PubMed  Google Scholar 

  • Beynon, C. L. (1982). Episiotomy (letter to the editor).Brit. Med. J. 284: 594.

    Google Scholar 

  • Bibring, G. L., Dwyer, T. F., Huntington, D. S., and Valenstein, A. F. (1961). A study of the psychological processes in pregnancy and of the earliest mother-child relationship.Psychoanal. Study Child 16: 9–72.

    Google Scholar 

  • Brennan, S. C. (1976). Postpartum vaginal dryness.Med. Aspects Human Sex. 10: 70–71.

    Google Scholar 

  • Butler, J. C., Reisner, D. P., and Wagner, N. N. (1979). Sexuality during pregnancy and postpartum. In Green, R. (ed.),Human Sexuality. Williams & Wilkins, Baltimore, pp. 177–190.

    Google Scholar 

  • Calhoun, L. G., Selby, J. W., and King, H. E. (1981). The influence of pregnancy on sexuality: A review of current evidence.J. Sex Res. 17: 139–151.

    Google Scholar 

  • Campbell, B., and Peterson, W. E. (1953). Milk “let-down” and the orgasm in the human female.Human Biol. 25: 165–168.

    PubMed  Google Scholar 

  • Chez, R. A., Burchell, R. C., Gray, M. J.,et al. (1975). Sex in pregnancy.Contemp. Obstet. Gynecol. 6: 99.

    Google Scholar 

  • Cohen, A. W. (1985). Human sexuality during normal pregnancy. In Farber, M. (ed.),Human Sexuality: Psychosexual Effects of Disease. Macmillan, New York, pp. 55–76.

    Google Scholar 

  • Colman, A., and Colman, L. (1971). Pregnancy. InThe Psychological Experience. Bantam Books, New York.

    Google Scholar 

  • Dameron, G. W. (1983). Helping couples cope with sexual changes pregnancy brings.Contemp. Obstet. Gynecol. 21: 23.

    Google Scholar 

  • DeGarmo, E., and Davidson, K. (1976). Psychosocial effects of pregnancy on the mother, father, marriage and family. In McNall, L. K., and Galuner, D. T. (eds.),Current Practice in Obstetric and Gynecologic Nursing. C.V. Mosby, St. Louis.

    Google Scholar 

  • Deutsch, H. (1945).The Psychology of Women, Vol. 1. Grune & Stratton, New York.

    Google Scholar 

  • Dushoff, I. M. (1974). In commentary on I.S., Kolin, J. S., Baker, and E. S. Bartlett (authors), “Psychosexual aspects of mammary augmentation.”Med. Aspects Human Sex. 8: 88–100.

    Google Scholar 

  • Droegemueller, W. (1980). Cold sitz baths for relief of postpartum perineal pain.Clin. Obstet. Gynecol. 23: 1039–1043.

    PubMed  Google Scholar 

  • Easterling, W. E. (1977). The puerperium. In Danforth, D. N. (ed.),Obstetrics and Gynecology. Harper & Row, Hagerstown, Maryland.

    Google Scholar 

  • Elliot, J. P., and Flaherty, J. F. (1983). The use of breast stimulation to ripen the cervix in term pregnancies.Am. J. Obstet. Gynecol. 145: 553.

    PubMed  Google Scholar 

  • Ellis, H. (1935).Psychology of Sex. Emerson Books, New York, pp. 48–50.

    Google Scholar 

  • Falicov, C. J. (1973). Sexual adjustment during first pregnancy and post-partum.Am. J. Obstet. Gynecol. 117: 991.

    PubMed  Google Scholar 

  • Flowers, J. S., and Flowers, C. E. (1985). Psychosexual and psychosomatic gynecology. In Nichols, D. H., and Evrardl, J. R. (eds.),Ambulatory Gynecology. Harper & Row, Philadelphia.

    Google Scholar 

  • Ford, C. S., and Beach, F. A. (1951).Patterns of Sexual Behavior. Harper & Row, New York.

    Google Scholar 

  • Fordney, D. S. (1978). Dyspareunia and vaginismus.Clin. Obstet. Gynecol. 21: 205–221.

    PubMed  Google Scholar 

  • Fox, C. A., and Knaggs, G. S. (1969). Milk-ejection activity (oxytocin) in association with coitus.J. Endocrinol. 45: 145.

    PubMed  Google Scholar 

  • Fuchs, A. R. (1983). Endocrinology of lactation, In Fuchs, F., and Klopper, A. (eds.),Endocrinology of Pregnancy. Harper & Row, Philadelphia.

    Google Scholar 

  • Gardner, R. A. (1974). Breast-petting.Med. Aspects Human Sex. 8: 178–183.

    Google Scholar 

  • Goodlin, R. C. (1983). On protection of the maternal perineum during birth.Obstet. Gynecol. 62: 393.

    PubMed  Google Scholar 

  • Grudzinskas, J. G., and Atkinson, L. (1984). Sexual function during the puerperium.Arch. Sex. Behav. 13: 85–91.

    PubMed  Google Scholar 

  • Hames, C. T. (1980). Sexual needs and interests of postpartum couples.J. Obstet. Gynecol. Nurs. 9: 313.

    Google Scholar 

  • Heiman, M. (1963). Sexual response in women: A correlation of phsyiologic and psychoanalytic concepts.J. Am. Psychoanal. Assoc. 11: 360.

    PubMed  Google Scholar 

  • Hollender, M. H., and McGehee, J. B. (1974). The wish to be held during pregnancy.J. Psychosom. Res. 18: 193.

    PubMed  Google Scholar 

  • Holtzman, I. D. (1976). Sexual practices during pregnancy.J. Nurse-Midwifery 21: 28.

    Google Scholar 

  • Inglis, T. (1980). Postpartum sexuality.J. Obstet. Gynecol. Nurs. 9: 298.

    Google Scholar 

  • Jacobson, L., Kaij, L. and Nilsson, A. (1967). The course and outcome of the of the postpartum period from a gynaecological and general somatic standpoint.Acta Obstet. Gynecol. Scand. 46: 183–203.

    PubMed  Google Scholar 

  • Jelliffe, D. B., and Jelliffe, E. F. P. (1977). ‘’Breast is Best”: Modern meanings.New Engl. J. Med. 297: 912–915.

    PubMed  Google Scholar 

  • Jennings, B., and Edmundson, M. (1980). The postpartum period: After confinement: The fourth trimester.Clin. Obstet. Gynecol. 23: 1093–1103.

    PubMed  Google Scholar 

  • Jessner, L. (1974). Pregnancy as a stress in marriage. In Nash, E. M., and Louden, L. M. R. (eds.),Marital and Sexual Counseling in Medical Practice. Harper & Row, Hagerstown, Maryland, pp. 292–304.

    Google Scholar 

  • Kayner, C. E., and Zagar, J. A. (1983). Breast-feeding and sexual response.J. Fam. Practice 17: 69–73.

    Google Scholar 

  • Kegel, A. H. (1952). Sexual functions of the pubococcygeus muscle.West. J. Surg. 60: 532.

    Google Scholar 

  • Kenny, J. A. (1973). Sexuality of pregnant and breast feeding women.Arch. Sex. Behav. 2: 215.

    PubMed  Google Scholar 

  • Kinsey, A., Pomeroy, W., Martin, C., and Gebhard, P. (1953).Sexual Behavior in the Human Female. W. B. Saunders, Philadelphia.

    Google Scholar 

  • Kitzinger, S. (1973). Intercourse during pregnancy.Brit. J. Sex. Med. 1: 22.

    Google Scholar 

  • Kitzinger, S. (1977). Sex during pregnancy and in the puerperium. InEducation and Counselling for Childbirth. Bailliere Tindall, London,

    Google Scholar 

  • Kluckhohn, C. (1947). Some aspects of Navaho infancy and early childhood.Psychoanalyt. Soc. Sci. 1: 31.

    Google Scholar 

  • Kochenour, N. K. (1980). Lactation suppression.Clin. Obstet. Gynecol. 23: 1045–1059.

    PubMed  Google Scholar 

  • Kolin, I. S., Baker, J. L., and Bartlett, E. S. (1974). Psychosexual aspects of mammary augmentation.Med. Aspects Human Sex. 8: 88–99.

    Google Scholar 

  • Kumar, R., Brant, H. A., and Robson, K. M. (1981). Childbearing and maternal sexuality: A prospective survey of 119 primiparae.J. Psychosom. Res. 25: 373–383.

    PubMed  Google Scholar 

  • Ladas, A. K. (1970). How to help mothers breast feed: Deductions from a survey.Clin. Pediatr. 9: 702.

    Google Scholar 

  • Lanahan, C. M. C. (1976). Eroticism and orgasm in pregnancy. In McNall, L. K., and Galuner, D. T. (eds.),Current Practice in Ob & Gyn Nursing. C.V. Mosby, St. Louis, pp. 63–70.

    Google Scholar 

  • Lawrence, R. A. (1980).Breast-feeding: A guide for the medical profession. C.V. Mosby Company, St. Louis.

    Google Scholar 

  • Leander, K., and Grassley, J. (1980). Making love after birth.Birth Fam. J. 7: 181–185.

    Google Scholar 

  • Lenke, R. R., and Nemes, J. M. (1984). Use of nipple stimulation to obtain contraction stress test.Obstet. Gynecol. 63: 345–348.

    PubMed  Google Scholar 

  • L'esperance, C. M. (1980). Pain or pleasure: The dilemma of early breastfeeding.Birth Fam. J. 7: 21–26.

    Google Scholar 

  • Ling, F. W. (1985). Sex in pregnancy. In Sciarra, J. J. (Ed.),Gynecology & Obstetrics. Vol. 2. Harper & Row, Philadelphia, pp. 1–2.

    Google Scholar 

  • Lumley, J. (1978). Sexual feelings in pregnancy and after childbirth.Aust. N.Z. J. Obstet. Gynecol. 18: 114.

    Google Scholar 

  • Mabray, C. R. (1979). Postpartum examination: A reevaluation.South. Med. J. 72: 1433–1455.

    PubMed  Google Scholar 

  • Maddock, J. W. (1974). Breast-petting.Med. Aspects Human Sex. 8: 183.

    Google Scholar 

  • Masters, W. H., and Johnson, V. E. (1966).Human Sexual Response. Little, Brown, Boston.

    Google Scholar 

  • Masters, W. H., and Johnson, V. E. (1970).Human Sexual Inadequacy. Little, Brown. Boston.

    Google Scholar 

  • McNeilly, A. S., Glasier, A., Jonassen, J., and Howie, P. W. (1982). Evidence for direct inhibition of ovarian function by prolactin.J. Reprod. Fert. 65: 559–569.

    Google Scholar 

  • The Medical Letter on Drugs and Therapeutics (1980). Bromocriptine to prevent lactation. 22: 11(Issue 558).

  • Monheit, A. G., Cousins, L., and Resnik, R. (1980). The puerperium: Anatomic and physiologic readjustments.Clin. Obstet. Gynecol. 23: 973–984.

    PubMed  Google Scholar 

  • Nadelson, C. (1973). “Normal” and “special” aspects of pregnancy.Obstet. Gynecol. 41: 611.

    PubMed  Google Scholar 

  • Newton, N. (1971a). Trebly sensuous woman.Psychol. Today 7: 68–71.

    Google Scholar 

  • Newton, N. (1971b). Psychologic differences between breast and bottle feeding.Am. J. Clin. Nutr. 24: 993–1004.

    PubMed  Google Scholar 

  • Newton, N. (1973). Interrelationships between sexual responsiveness, birth, and breast feeding. In Zubin, J., and Money, J. (eds.),Contemporary Sexual Behavior. Johns Hopkins Univ. Press, Baltimore, pp. 77–98.

    Google Scholar 

  • Newton, N., and Newton, M. (1967). Psychologic aspects of lactation.New Engl. J. Med. 277: 1179–1188.

    PubMed  Google Scholar 

  • Newton, N., and Newton, M. (1972). Lactation—Its psychologic components. In Howells, J. (ed.),Modern Perspectives in Psycho-Obstetrics. Brunner/Mazel, New York, pp. 385–409.

    Google Scholar 

  • Oski, F. A. (1968). Breast feeding and its effect on the shape of the breast.Am. pediatr. Soc. Abstr., p. 58.

  • Perkins, R. P. (1979). Sexual behaviors and responses in relation to complications of pregnancy.Am. J. Obstet. Gynecol. 134: 498.

    PubMed  Google Scholar 

  • Perkins, R. P. (1982). Sexuality in pregnancy: What determines behavior?Obstet. Gynecol. 59: 189.

    PubMed  Google Scholar 

  • Perkins, R. P. (1984). Sexuality during pregnancy.Clin. Obstet. Gynecol. 27: 706–716.

    PubMed  Google Scholar 

  • Petrakis, N. L. (1978). Recurrent extreme breast involution following pregnancy and susceptibility to breast cancer: A hypothesis. In G. W. Hooper Foundation (ed.),Medical Hypotheses, Vol. 4, Univ. of Calif., San Francisco, pp. 268–272.

    Google Scholar 

  • Pion, R. J., and Reich, D. O. (1977, March). Sex during pregnancy.Female Patient pp. 85–88.

  • Pizer, H., and Garfink, C. (1979).The post partum book: How to cope with and enjoy the first year of parenting. Grove Press, New York.

    Google Scholar 

  • Pritchard, J. A., MacDonald, P. C., and Gant, N. F. (1985).Williams Obstetrics. Appleton-Century-Crofts, Norwalk.

    Google Scholar 

  • Reading, A. E. (1982). How women view post-episiotomy pain.Brit. Med. J. 284: 283.

    Google Scholar 

  • Reamy, K. (1982). The treatment of vaginismus by the gynecologist: An eclectic approach.Obstet. Gynecol. 59: 58.

    PubMed  Google Scholar 

  • Reamy, K. (1984). Sexual counseling for the non-therapist.Clin. Obstet. Gynecol. 27: 781.

    PubMed  Google Scholar 

  • Reamy, K., White, S. E., Daniell, W. C. and LeVine, E. S. (1982). Sexuality and pregnancy: A prospective study.J. Reprod. Med. 27: 321.

    PubMed  Google Scholar 

  • Richardson, A. C., Lyon, J. B., Graham, E. E.,et al. (1976). Decreasing postpartum sexual abstinence time.Am. J. Obstet. Gynecol. 126: 416.

    PubMed  Google Scholar 

  • Riordan, J. M., and Rapp, E. T. (1980). The sensuousness of breastfeeding.J. Obstet. Gynecol. Nurs. 2: 109.

    Google Scholar 

  • Robinson, J. E., and Short, R. V. (1977). Changes in breast sensitivity at puberty, during the menstrual cycle, and at parturition.Brit. Med. J. 1: 1188–1191.

    PubMed  Google Scholar 

  • Robson, K. M., and Kumar, R. (1981). Maternal sexuality.Brit. J. Obstet. Gynaecol. 88: 882.

    Google Scholar 

  • Rossi, A. S. (1973). Maternalism, sexuality, and the new feminism. In Zubin, J., and Money, J. (eds.),Contemporlary Sexual Behavior. Johns Hopkins Univ. Press, Baltimore, pp. 145–173.

    Google Scholar 

  • Ryan, F., and Pernoll, M. W. (1981). Is postpartum atrophy of the breast an iatrogenic disease? (letter to the editor).Plast. Reconstr. Surg. 68: 647–648.

    Google Scholar 

  • Ryding, E. L. (1984). Sexuality during and after pregnancy.Acta Obstet. Gynecol. Scand. 63: 679–682.

    PubMed  Google Scholar 

  • Sarlin, C. (1963). Feminine identity.J. Am. Psychoanal. Assoc. 11: 790.

    PubMed  Google Scholar 

  • Smith, E. D. I. (1978). Pregnancy and marital stress. In McNall, L. K., Galuner, D. T., and Mosby, C. V. (eds.),Current Prac. Nursing 2: 45–51.

    Google Scholar 

  • Solberg, D. A., Butler, J., and Wagner, N. N. (1973). Sexual behavior in pregnancy.New Engl. J. Med. 288: 1098.

    PubMed  Google Scholar 

  • Speroff, L., Glass, R. H., and Kase, N. G. (1978).Clinical Gynecologic Endocrinology and Infertility 2nd ed. Williams & Wilkins, Baltimore.

    Google Scholar 

  • Swanson, J. (1980). The marital sexual relationship during pregnancy.J. Obstet. Gynecol Nurs. 9: 267.

    Google Scholar 

  • Taylor, E. S. (1982). Editor comment.Obstet. Gynecol. Surv. 37: 318.

    Google Scholar 

  • Terman, L. M. (1938).Psychological Factors in Marital Happiness. McGraw-Hill, New York.

    Google Scholar 

  • Thacker, S. B., and Banta, H. D. (1983). Benefits and risks of episiotomy: An interpretative review of the English language literature.Obstet. Gynecol. Surv. 38: 322.

    PubMed  Google Scholar 

  • Tolor, A., and DiGrazia, P. V. (1976). Sexual attitudes and behavior patterns during and following pregnancy.Arch. Sex. Behav. 5: 539.

    PubMed  Google Scholar 

  • Vandenbergh, R. L. (1980). Postpartum depression.Clin. Obstet. Gynecol. 23: 1105–1111.

    PubMed  Google Scholar 

  • Wabrek, A. J., and Wabrek, C. J. (1975). Dyspareunia.J. Sex Marital Ther. 1: 234.

    PubMed  Google Scholar 

  • Waletsky, L. R. (1979). Breastfeeding and weaning: Some psychological considerations.Primary Care 6: 341.

    PubMed  Google Scholar 

  • Weichert, C. (1975). Breast-feeding: First thoughts.Pediatrics 56: 987–990.

    PubMed  Google Scholar 

  • Weichert, C. (1977). Sexual arousal from breast-feeding.Med. Aspects Human Sex. 11: 99.

    Google Scholar 

  • Weisskopf, S. (1980). Maternal sexuality and asexual motherhood.J. Women Cult. Soc. 5: 766.

    Google Scholar 

  • Wenner, N. K., Cohen, M. B., Weigert, E. V.,et al. (1969). Emotional problems in pregnancy.Psychiatry 32: 359.

    Google Scholar 

  • White, S. E., and Reamy, K. (1982). Sexuality and pregnancy: A review.Arch. Sex. Behav. 11: 429–444.

    PubMed  Google Scholar 

  • White, S. E., Reamy, K., and Southward, G. M. (1983). Nurturant needs of pregnancy: Sexual, psychological, and demographic correlates.J. Psychosom. Obstet. Gynaecol. 2: 243.

    Google Scholar 

  • Zalar, M. K. (1976). Sexual counseling for pregnant couples.Matern. Child Nurs. J. 1: 176.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Obstetrics and Gynecology and Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, 26506-6302, Morgantown, West Virginia, USA

    Kenneth J. Reamy M.D., M.P.H.

  2. Department of Psychiatry, Texas Tech University, Regional Academic Health Center, El Paso, Texas, USA

    Susan E. White Ph.D.

Authors
  1. Kenneth J. Reamy M.D., M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan E. White Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reamy, K.J., White, S.E. Sexuality in the puerperium: A review. Arch Sex Behav 16, 165–186 (1987). https://doi.org/10.1007/BF01542069

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01542069

Key words

Search

Navigation