Does a C-section or vaginal delivery affect women's sex lives more?
Researchers were pleasantly surprised by how little giving birth vaginally affected women’s sex life. “This study can dispel myths,” sexologist Bente Træen says.
Researchers have investigated whether the method of delivery affects sexual well-being after birth.
They wanted to find out whether giving birth vaginally affected women's sex lives long afterwards – and whether having a caesarean section has any advantages or disadvantages.
The women were asked how satisfied they were with their sex life and how often they have sex. They were also asked to state whether they had pain during or after intercourse.
Many believe a vaginal birth will weaken their sex life
Many women fear that a vaginal birth will affect their sex life afterwards. Some request a caesarean section because of this, the researchers write.
“But our data does not support this, which came as a positive surprise,” Viktor H. Ahlqvist tells forskning.se (link in Swedish).
Ahlqvist is taking his PhD on the topic at the Department of Global Public Health at the Karolinska Institute in Sweden.
On the contrary, there was no difference between the women based on whether they had given birth vaginally or had had a caesarean section.
Both groups had sex equally often and were equally sexually satisfied.
Those who had a caesarean section often had more pain
It turned out that women who had had a caesarean section more often stated that they experienced vaginal pain during or after intercourse up to eleven years after delivery.
Caesarean sections therefore appear to increase the risk of experiencing pain during intercourse.
The researchers point out that this is the exact opposite of what some people believe.
Ahlqvist emphasises that, despite reported pain, the women had intercourse just as often and valued their sex life just as much as those who had given birth vaginally.
The researchers are not sure what causes these differences. Maybe the women who had a caesarean section feel pain when they have sex because of scar tissue in the abdomen. The researchers hope that future studies can reveal more about this.
Important for dispelling myths
Studies like this are important to dispel myths about vaginal births, according to sexologist Bente Træen at the University of Oslo.
Some women are greatly affected by horror stories about tearing and being stitched up, and such stories unfortunately have a great impact, she points out.
“Many pregnant women fear they will be destroyed down there and think a caesarean section is better. But the opposite is actually true,” Træen tells sciencenorway.no.
Træen has a background as a dentist and points out that mucous membranes in the vagina, like wounds in the mouth, heal very quickly.
“A caesarean section is a major operation, where you cut through not only skin, but also muscle and fat to get the baby out,” she points out.
If you think logically, the risk is thus greater that not everything will grow as well, according to Træen.
Fear of pain
Many women may also be afraid to give birth because of the pain, and for them a caesarean section may appear to be the only way to get the baby out.
“But the pain relief is constantly improving. With the anesthesia options we have today, such as epidurals, natural childbirth is far preferable,” Træen believes.
The sexologist believes this study should be the first step in putting more focus on sexual health after birth.
“It is also good news that the researchers found only small differences in the frequency and satisfaction of sex, regardless of the delivery method at group level,” she says.
Sex picks up a few years later
Almost half of the women stated that they enjoyed sex to a large extent three years after giving birth. The proportion increased slightly after five years, but decreased after 18 years.
40 per cent stated that they enjoyed sex quite a bit. Around 10 per cent stated that they did not particularly enjoy sex.
Around 20 per cent stated that they experienced some vaginal pain during intercourse. Far fewer had pain elsewhere.
Slightly more anxiety and depression
A slight preponderance of women who had a caesarean section stated that they had experienced anxiety or depression 18 weeks after giving birth.
Just over 17 per cent of women who had a caesarean section stated that they had experienced anxiety. Just over 15 per cent of those who had given birth vaginally stated the same.
In terms of depression, just over 13 per cent reported becoming depressed after a caesarean section, compared to just over 12 per cent among those who had given birth vaginally.
Followed women up to 18 years after birth
Previous studies of sexual satisfaction after childbirth have also indicated that the method of delivery has little effect on women's sex lives.
But these studies have only followed the women for two years after giving birth.
Few or no studies have followed the mothers for longer than that.
In this new study, the researchers therefore wanted to find possible long-term effects of childbirth on women's sex lives, up to 18 years after childbirth.
Cesarean sections are on the rise
International research shows that the proportion of caesareans has increased in recent decades. But there are big differences between countries.
Globally, the proportion of caesareans has increased from 7 per cent in 1990 to 19 per cent in 2014.
In the UK, one in four babies are now born by caesarean section, an increase from 11 per cent thirty years ago.
The results are based on the ALSPAC study at the University of Bristol, which followed 14,500 women who were pregnant between 1991 and 1992.
The women were on average 28 years old (vaginally) and 29.5 years old (caesarean section).
The researchers compared sexual satisfaction and delivery method after just under three, five, 12 and 18 years after birth.
- The researchers asked how often they had sex and to what extent they enjoyed intercourse.
- The scale was: ‘Yes, very much’, ‘yes, somewhat’, ‘no, not a lot’, ‘no, not at all’ and ‘no sex at the moment’.
- Sexual frequency was either: ‘not at all’, ‘less than once a month’, ‘1-3 times a month’, ‘about once a week’, ‘2-4 times a week’ and ‘5 or more times a week’. Most people answered options 3-5.
- They were also asked whether they experienced pain during or after intercourse often or occasionally. Perceived pain eleven years after birth was also asked about.
The register information has been supplemented with questionnaire responses from the women about their perceived sexual health.
(Source: Mode of delivery and maternal sexual well-being: A longitudinal study, Obstetrics & Gynaecology)
Translated by Alette Bjordal Gjellesvik.
Martin et al. Mode of delivery and maternal sexual wellbeing: A longitudinal study, Obstetrics & Gynaecology, 2022. DOI: 10.1111/1471-0528.17262