From the Delivery Room to the Bedroom

By Matthew Hutson

Childbirth can wreak havoc on a couple's intimate relations. Everything that happens during this euphoric yet agonizing event in the delivery room can have lasting effects in the bedroom. To the degree that a woman has any control over the situation, should anticipation of postpartum sexual functioning play a role in her selecting a mode of delivery?

Cesarean sections now make up 30 percent of deliveries in the US, and that number is increasing. Lisa Pastore, an epidemiologist in the University of Virginia's obstetrics and genecology department who recently published a study of postpartum sexuality concerns among first-time parents, says most people who ask for C-sections ask because of scheduling issues or for more control over the situation. But a lot of people don't want to discuss matters of sexuality with their health-care providers. Further, they might not even stop to think that various styles of delivery might have different sexual side effects. In two surveys of obstetricians, a third of doctors say they would choose cesarean sections for themselves. One of their biggest concerns: sex after delivery. Do they know something we don't?

The C-Section

A number of studies in recent years have looked at C-sections and sexual health. One Canadian study published in 2005 showed that three months after childbirth, first-time mothers who had a vaginal birth noted greater sexual dissatisfaction than those who'd had a C-section—70 percent compared with 55 percent. A 2006 study found similar results in women two full years after birth. Another study published in 2005 found long-term differences in the strength of new mothers' pelvic floors—the pelvic muscles and connective tissue supporting the bladder, intestines, and reproductive organs that contract involuntarily during orgasm and can intensify orgasm when contracted voluntarily. More than two years after giving birth, women who'd delivered vaginally had significantly lower pelvic floor muscle strength than those who'd delivered by cesarean section.

A Note on Kegels

There are no studies showing that increasing pelvic floor strength directly improves sex because "sexual function is such a complex thing," says Linda Brubaker, a urogynecologist at Loyola University. But we know that pelvic floor exercises such as Kegels decrease incontinence, and we know that women with less incontinence, particularly coital incontinence (leaking of urine during intercourse), have better sex lives. "Feeling comfortable with yourself is key to feeling comfortable within a sexual relationship," Brubaker says, "and fear of incontinence can be a devastating thing for a woman." Further, Brubaker recently finished a study showing that women completing a pelvic fitness course reported improved sexual function, including better orgasm. She says we can't be sure the mediating factor isn't improved social support ("the girls night out effect") instead of stronger muscles or better muscle control, but benefits persisted a year after the end of classes.