Sexual well-being before and after childbirth: a prospective longitudinal study using the Female Sexual Function Index

BACKGROUND: Childbirth is a complex life event that may signi - cantly affect women’s sexual well-being. Prospective longitudinal data evaluating changes in sexual function before and postpartum using vali- dated instruments remain limited. OBJECTIVE: This study aimed to assess changes in female sexual function before and after childbirth and to identify obstetric factors associ- ated with postpartum sexual well-being. STUDY DESIGN: This prospective longitudinal study was conducted at a tertiary university hospital. Women aged ≥18 years were consecutively enrolled and completed the Female Sexual Function Index (FSFI) at 35 weeks of gestation and 6 months postpartum. Demographic, obstetric, and perinatal variables were collected. Changes in FSFI scores over time were analyzed using multivariable mixed models for repeated measures, including interaction terms to account for sexual activity status. Clinically signi cant sexual dysfunction was de ned as a total FSFI score ≤26. RESULTS: A total of 197 women were included; 144 (73.1%) were sexually active during late pregnancy. Among sexually active women, the mean total FSFI score signi cantly decreased postpartum (26.98 vs 23.53; 12.78%, P<.001). Cesarean section was independently associ- ated with higher postpartum FSFI scores (B=+3.55; 95% CI 1.50−5.60; P=.001), while major perineal trauma showed a negative trend. Among FSFI domains, arousal demonstrated the strongest correlation with total FSFI scores both before and postpartum. Higher predelivery arousal scores were strongly associated with improved postpartum sexual function. Cesarean section also emerged as an independent protective factor against clinically signi cant sexual dysfunction at 6 months postpartum. CONCLUSION: Female sexual well-being declines after childbirth among sexually active women, with mode of delivery and perineal trauma in uencing postpartum outcomes. Arousal represents a key determinant of overall sexual function postpartum. These ndings highlight the multi- factorial nature of postpartum sexual health and the limitations of current assessment tools, particularly in sexually inactive women, underscoring the need for pregnancy-speci c, multidimensional instruments.