Sexuality after Childbirth: A General Population Study in a Municipality in South of Benin in 2023

Introduction: Despite the importance of daily sexual health, issues related to postpartum sexual health are rarely addressed during pregnancy follow-up and even in the postnatal period by healthcare providers. Pregnancy and childbirth cause significant hormonal, morphological, psychological, and behavioral changes in women. The objective of this study was to describe the postpartum sexuality of women in the municipality of Abomey-Calavi. Method: This was a descriptive cross-sectional study with data collection taking place over one month. The study population consisted of women who had given birth and were residing in the municipality at the time of the study. Women with a permanent partner who were between 6 weeks and 6 months postpartum were included. A three-stage (3) cluster sampling design was conducted. Data were collected using a digital questionnaire. Results: This study included 1,500 women who had given birth. The mean age was 27.3 ± 5.3 years. Of these, 92.3% had successfully monitored their pregnancy, but only 17.7% had received information from healthcare providers about postpartum sexuality. During the study, 59.1% of them had resumed sexual intercourse. The mean time to resume sexual intercourse was 11.4 ± 5.9 weeks. In our sample, 8.8% had adopted a method, and for 75% of them, having contraception was a condition for resuming sexual intercourse. Resumption of sexual intercourse was initiated by the partner in 57.1% of them. Partner satisfaction and maintaining harmony within the couple were the main reasons for resuming intercourse for 68.9% and 51.2% of women, respectively. A sexual function disorder was found in 73.5% of women who gave birth by caesarean section and in 77.6% of women who gave birth vaginally using the Index of Female Sexual Function score. Conclusion: Women in the municipality of Abomey-Calavi received very little information from healthcare providers about postpartum sexual health. There is an urgent need to raise awareness among healthcare professionals about the importance of information sessions on sexual health, mental health, and contraception during women’s follow-up.

• Sexuality
• Postpartum
• Women
• Benin

1. Introduction

Despite the importance of daily sexual health, issues related to sexual health after childbirth are rarely addressed by healthcare providers during pregnancy monitoring and even in the postnatal period. According to the World Health Organization (WHO), sexual health is an issue that arises throughout a person’s life, not only for people of reproductive age, but also for young people and the elderly [1] . Its daily importance has led to its inclusion in the United Nations (UN) Sustainable Development Goals 3 and 5 for 2030. However, pregnancy and childbirth lead to significant hormonal, morphological, psychological, and behavioral changes in women. The objective of this study was to describe the sexuality of women in the municipality of Abomey-Calavi after childbirth. Specifically, we determined the average time to resume sexual intercourse after childbirth, identifying the initiator, motives, and new sexual practices after childbirth.

2. Methodology

Our study was conducted in a population-based setting in the municipality of Abomey-Calavi. We conducted a descriptive cross-sectional study with prospective data collection from July 10 to August 7, 2023. Women were included within a period of 6 weeks to 6 months after childbirth, who had a permanent partner and who had given their free and informed consent to participate in the study. Women with major psychiatric disorders were excluded. We performed a three-stage probability cluster sampling. The sample size, calculated using the Schwartz formula plus 10%, was 1,464 women. The size of each cluster was 59 (1,464/25) women. Sexual health after childbirth has been assessed by the Index of Female Sexual Function (IFSF) score. This is a self-assessment with 19 questions that explore six areas of sexuality: desire, arousal, lubrication, orgasm, satisfaction, and pain. Each area is scored from 0 to 5 or from 1 to 5. The score for each area is obtained by multiplying it by a coefficient assigned to each item. A score of 0 indicates that the person interviewed reports no sexual activity. The total score of the questionnaire therefore varies between a minimum of 2 and a maximum of 36. The proposed cut-off for retaining the existence of sexual dysfunction is 26.55.

The collected data were exported to an Excel file, cleaned, and then compiled. Categorical variables were presented as percentages, and quantitative variables were expressed summarized by the mean (standard deviation) or median (interquartile range) depending on their distribution. To make the questionnaire, particularly the FSFI score, understandable to the respondents and to ensure the reliability of the information collected, we selected as interviewers , students in their fifth year of general medical studies and with a perfect command of their native language. This option has the dual advantage of using an interviewer who already understands medical language and is able to translate medical terms for the respondents. The interviewers also received theoretical and practical guidance on the subject and data collection before the start of the activities to ensure they mastered their mission. When a translation of the questionnaire into the local language was necessary, it was done directly during the interview by the interviewer.

The survey form was tested on ten women between six weeks and six months postpartum in a neighborhood outside of those selected for the survey.

The study was conducted with the informed consent of the participants and the guarantee of keeping individual information confidential.

3. Results

In total, we interviewed 1,500 women, 887 of whom had resumed sexual intercourse within six months of giving birth.

Age of women

Figure 1 below shows the distribution of the women surveyed by age group.

Figure 1

Figure 1. Distribution of women by age group (in years) in the municipality of Abomey-Calavi in 2023.

The subjects surveyed were on average 27.3 ± 5.3 years old, with a range of 15 to 48 years. Women between 25 and 29 years old were the most represented.

Age of spouses

The spouses of the women surveyed were on average 32.4 ± 6.5 years old, with a range of 17 to 60 years.

Marital status, marital regime, and postpartum residence

Women who had a civil marriage were the only ones considered married in this study. 83.5% of the women interviewed were cohabiting and 89.6% were in a monogamous household. Among them, 62.6% shared the same bed as their partner.

Delivery

Caesarean sections accounted for 15.3% of deliveries in our sample. The average delivery time was 39 weeks + 1 day ± 2 weeks + 1 day. Across the entire sample, 9.3% of women experienced complications, the most common of which were vulvoperineal tears (58.3%) and hemorrhage (31.7%).

Time to resume sexual intercourse

The time to resume sexual intercourse is shown in Figure 2 .

Figure 2

Figure 2. Time to resumption of sexual intercourse for women in the municipality of Abomey-Calavi in 2023.

Among the 1,500 women included in our study, 887 had resumed sexual intercourse with their partner, representing 59.1%.

The average time to resumption of sexual intercourse was 11.4 ± 5.9 weeks. The majority of women resumed sexual intercourse between twelve and eighteen weeks.

Conditions for Resuming Sexual Intercourse: Initiator of Resumption, Reasons for Resuming Sexual Intercourse, Contraception

Table 1 presents the various information relating to the conditions under which sexual intercourse was resumed.

Table 1

Table 1. Data on the conditions for resuming sexual intercourse for women in the municipality of Abomey-Calavi in 2023.

Features	Effective (n)	Percentage (%)
Contraception after delivery
No	1368	91.2
Yes	132	8.8
Contraception before sexual intercourse resumption
No	33	25
Yes	99	75
Initiator of resumption
Both partners	351	39.6
Spouse	507	57.1
Wife	29	3.3
Reasons for resuming sexual intercourse
To satisfy the spouse	611	68.9
To maintain harmony withing the couple	454	51.2
Personal Pleasure	301	33.9
To avoid spouse’s infidelity	266	30

In our sample, 138 women, or 8.8%, adopted a contraceptive method after giving birth. For 75% of them, having contraception was a condition for resuming sexual intercourse.

Among the women who had resumed sexual activity at the time of the interview (887), this resumption was at the partner’s initiative representing 57.1% of cases.

Partner satisfaction and maintaining harmony within the couple were the main reasons for resuming intercourse in 68.9% and 51.2% of women, respectively.

Sexual Practices After Childbirth

Table 2 presents old and new sexual practices after childbirth.

Table 2

Table 2. Data on postpartum sexual practices of women in the municipality of Abomey-Calavi in 2023.

Features	Effective (n)	Percentage (%)
Post-partum sexual practices
Vaginal intercourse	879	99.7
Oral Sex	210	23.8
Non-penetrative Touching	116	13.2
Female Masturbation	39	4.4
Anal Intercourse	3	0.3
New post-partum sexual practices
No	1482	98.8
yes	18	1.2
Non-penetrative Touching	7	33.3
Masturbation	5	27.8
Coitus interruptus	2	11.1
Oral Sexe	2	11.1
Use of sexual toys	2	11.1
Monthly frequence of sexual intercourses after delivery
4 à 8	448	50.6
Less than 4	330	37.3
Superior to 8	107	12.1

After resuming, sexual practices were primarily vaginal intercourse, found in 99.7% of women, and oral sex in 23.8%.

Across the entire sample, 1.2% of women reported new sexual practices. These included primarily touching without penetration in 33.3% and masturbation in 27.8%.

The Index of Female Sexual Function score

The mean IFSF score of the women surveyed was 17.3±10.5 in women who gave birth by caesarean section while it was 16.2±10.6 in those who gave birth vaginally. Considering the threshold value of 26.5, a sexual function disorder was found in 73.5% of women who gave birth by caesarean section and in 77.6% of women who gave birth vaginally.

4. Discussion

1. Sociodemographic Characteristics

Age

This study was conducted on 1,500 women. The mean age of the sample was 27.3 ± 5.3 years. This age range is thought to correspond to that of peak fertility in the human species. Data from the literature are comparable. Indeed, Yamontche et al. [2] found a mean age of 27.8 ± 5.9 years in Cotonou in 2022; Adanikin et al. in 2014 [3] reported a mean age of 29.11 ± 5.42 years in Nigeria. This similarity in mean ages could also be explained by African culture, which advocates early marriage.

Spouse

The mean age was 32.4 ± 6.5 years. This higher age of spouses than their wives is found throughout the literature. Indeed, a 2021 study in the USA on six million couples who had a child between 2018 and 2020 found that in 80.2% of cases, spouses were older than their wives [4] . This could be explained by the emotional and financial stability that an older spouse could provide, as well as socio-demographic constraints.

Resumption of Sexual Intercourse Postpartum

In our study, 887 women, or 59.1%, had resumed sexual intercourse between six weeks and six months after giving birth. Our results are comparable to those reported by some authors worldwide. For example, in a cohort study conducted in sub-Saharan Africa from 2014 to 2020, Asmamaw et al. found a proportion of 67.9% [5] . In the USA in 2013, Yee et al. found that 60.7% of women had resumed sexual activity before six months [6] . Other authors, however, have found higher rates of resumption than ours. Indeed, in Morocco in 2022, Lehiany et al. found a resumption in 100% of women three months postpartum [7] . The same was true for Kahramanoglu et al. in Turkey in 2017, who found a resumption of sexual intercourse in 98.8% of women [8] . These variations could be explained by cultural, ethnic, religious, and healthcare personnel differences.

Among women who gave birth by cesarean section, 65.2% had resumed sexual intercourse during our study, compared to 58% of those who gave birth vaginally. This difference could be explained by the injuries sustained to the genital tract during a vaginal delivery. Indeed, a vaginal delivery can cause injuries of varying severity (erosions, tears, thrombi), especially in cases of instrumental delivery. All these factors could explain the difference in the proportions of women who resumed sexual intercourse between the two delivery methods.

The mean time to resumption of sexual intercourse in this study was 11.4 ± 5.9 weeks. This timeframe is similar to that found in Cotonou by Yamontche et al in 2022 [2] , which was 10.7 ± 0.45 weeks, and that found in Brazil in 2015 by Matijasevich et al., which was 10.4 ± 5.2 weeks [9] . Different resumption times have been found by other authors. Alum et al in Uganda [10] in 2015 and Ebisa et al in Ethiopia in 2019 found mean times of 6 and 8 weeks, respectively [11] . This can be explained by the fact that several factors influence the time to resume sexual intercourse. In addition to the method of delivery, other factors such as religious and ethnic beliefs, the couple’s sexual habits and libido play an important role. The period of abstinence after childbirth varies according to beliefs. Regarding beliefs, the abstinence period can range from 40 days to three months.

Conditions for Resuming Sexual Intercourse: Initiator of Resumption, Reasons for Resuming Sexual Intercourse, Contraception, and New Sexual Practices

In our sample, 138 women, or 8.8%, adopted a contraceptive method after giving birth. For 75% of them, having contraception was a condition for resuming sexual intercourse.

Among women who had resumed sexual activity at the time of the interview (887), the resumption was initiated by the partner representing 57.1% of cases. Partner satisfaction and maintaining harmony within the couple were the main reasons for resuming sexual intercourse for 68.9% and 51.2% of women, respectively.

After resuming sexual intercourse, the most common sexual practices were vaginal intercourse (99.7% of women) and oral sex (23.8% of women).

Across the entire sample, 1.2% of women reported having new sexual practices. These included primarily touching without penetration (33.3%) and masturbation (27.8%).

Sexual Health

In our study, the mean FSFI score of the women surveyed was 17.3 ± 10.5 in women who gave birth by caesarean section, while it was 16.2 ± 10.6 in those who gave birth vaginally.

Lehiany A et al. [7] , in their study conducted in the Agadir region (Morocco) on 50 women who had undergone an episiotomy, found that all participants were able to resume sexual activity 40 days after delivery. However, they presented sexual dysfunction with an FSFI score of 22.96. Scores were obtained for the IFSF domains: desire (3.9 ± 1.27), sexual arousal (3.88 ± 1.21), vaginal lubrication (4.26 ± 1.87), orgasm (3.78 ± 1.09), sexual satisfaction (4.28 ± 1.21) and pain (2.86 ± 1.26). In our study the mean score for women who gave birth vaginally was 16.2 ± 10.6. Furthermore, those with sexual dysfunction represented 77.6%. This difference may be due to the fact that our sample included women with and without episiotomy unlike that of Lehiany where all had benefited from an episiotomy.

5. Conclusion

Women in the municipality of Abomey-Calavi received very little information from healthcare staff about postpartum sexual health. There is an urgent need to raise awareness among healthcare professionals about the importance of information sessions on sexual health, mental health, and contraception during women’s follow-up.

Limitations

1. Despite all the measures taken, a language barrier persisted with some women; translating certain FSFI terms into local languages was a challenge;

2. The reluctance of some women to answer certain questions, believing they needed their spouse’s permission; or deeming the questions too personal.

3. The reluctance of women when it came to male interviewers.

References

1. Bonvin, J.M., Hugentobler, V. and Knöpfel, C. (2022) Dictionnaire de politique sociale Suisse. >https://doi.org/10.33058/seismo.20729

2. Yamontche, S. (2022) Etude des facteurs influençant la reprise de la sexualité après accouchement chez les femmes à Cotonou. Master’s Thesis, UAC.

3. Adanikin, A.I., Awoleke, J.O., Adeyiolu, A., Alao, O. and Adanikin, P.O. (2014) Resumption of Intercourse after Childbirth in Southwest Nigeria. The European Journal of Contraception & Reproductive Health Care, 20, 241-248. >https://doi.org/10.3109/13625187.2014.971742

4. Pelham, B.W. (2021) The Husband-Older Age Gap in Marriage Is Associated with Selective Fitness. Journal of Personality and Social Psychology, 121, 601-632. >https://doi.org/10.1037/pspi0000319

5. Asmamaw, D.B., Belachew, T.B. and Negash, W.D. (2023) Multilevel Analysis of Early Resumption of Sexual Intercourse among Postpartum Women in Sub-Saharan Africa: Evidence from Demographic and Health Survey Data. BMC Public Health, 23, Article No. 733. >https://doi.org/10.1186/s12889-023-15687-8

6. Yee, L.M., Kaimal, A.J., Nakagawa, S., Houston, K. and Kuppermann, M. (2013) Predictors of Postpartum Sexual Activity and Function in a Diverse Population of Women. Journal of Midwifery & Women’s Health, 58, 654-661. >https://doi.org/10.1111/jmwh.12068

7. Lehiany, A., Boutakrida, H., Bibourane, G., Haboul, A. and Chadli, S. (2022) La vie sexuelle chez les femmes ayant subi une épisiotomie: Étude descriptive au centre de santé urbain Jorf (région d’Agadir, Maroc). Revue des Sciences Infirmières et Techniques de Santé, 1, 46-51. >https://www.researchgate.net/publication/368882451

8. Kahramanoglu, I., Baktiroglu, M., Hamzaoglu, K., Kahramanoglu, O., Verit, F.F. and Yucel, O. (2017) The Impact of Mode of Delivery on the Sexual Function of Primiparous Women: A Prospective Study. Archives of Gynecology and Obstetrics, 295, 907-916. >https://doi.org/10.1007/s00404-017-4299-7

9. Matijasevich, A., Diniz, G., De, D., Paulo, U.D.S., Paulo, S. and De, D. (2015) 1 La relation entre le mode d’accouchement et les résultats en matière de santé sexuelle après l’accouchement.

10. Alum, A.C., Kizza, I.B., Osingada, C.P., Katende, G. and Kaye, D.K. (2015) Factors Associated with Early Resumption of Sexual Intercourse among Postnatal Women in Uganda. Reproductive Health, 12, Article No. 107. >https://doi.org/10.1186/s12978-015-0089-5

11. Jambola, E.T., Gelagay, A.A., Belew, A.K. and Abajobir, A.A. (2020) Early Resumption of Sexual Intercourse and Its Associated Factors among Postpartum Women in Western Ethiopia: A Cross-Sectional Study. International Journal of Women’s Health, 12, 381-391. >https://doi.org/10.2147/ijwh.s231859