- Open Access
- Open Peer Review
This article has Open Peer Review reports available.
Demographic and obstetric factors affecting women’s sexual functioning during pregnancy
© Abouzari-Gazafroodi et al. 2015
Received: 17 October 2014
Accepted: 7 August 2015
Published: 19 August 2015
Sexual desire and frequency of sexual relationships during pregnancy remains challenging. This study aimed to assess factors that affect women’s sexual functioning during pregnancy.
This was a cross sectional study carried out at prenatal care clinics of public health services in Iran. An author-designed structured questionnaire including items on socio-demographic characteristics, obstetric history, the current pregnancy, and women’s sexual functioning during pregnancy was used to collect data. The generalized linear model was performed in order to find out factors that affect women’s sexual functioning during pregnancy.
In all, 518 pregnant women participated in the study. The mean age of participants was 26.4 years (SD = 4.7). Overall 309 women (59.7 %) scored less than mean on sexual functioning. The results obtained from generalized linear model demonstrated that that lower education, unwanted pregnancy, earlier stage of pregnancy, older age, and longer duration of marriage were the most important factors contributing to disturbed sexual functioning among couples.
The findings suggest that sexual function during pregnancy might be disturbed due to several factors. Indeed issues on sexual relationship should be included as part of prenatal care and reproductive health programs for every woman.
Pregnancy is considered as one of the most critical periods in a woman’s life. During this period the couples’ sexual relationship and sexual function might be affected for several reasons [1–4]. Also it was reported that 68 % of young mothers did not receive any information about sexual relationships during pregnancy . On the other hand it was determined that sexual intercourse at term is a stimulus for the induction of delivery that leads to decrease requirement for labor induction .
Pregnancy has been verified that plays role in the decreased sexual function [2, 7, 8]. Furthermore, it has been found that disrupted sexual functioning during pregnancy was related to Women’s tiredness, nausea and lack of sexual interest , high number of children [9–11], cultural beliefs, myths, and taboos about sexual behavior during pregnancy . It is argued that the sexual perceptions is an important part of sexual function during pregnancy and sexuality might be influenced by desire from the partner, feelings of attractiveness, and fear of sexual intercourse [13, 14]. However different predictors of sexual functioning during pregnancy were reported. A study reported that the third trimester was the independent variable for both decreased sexual activity frequency and sexual function scores in pregnancy . In addition a recent publication found that satisfaction with body image and body image self-consciousness were related to sexual satisfaction during pregnancy. Even, the study suggested that other aspects of partnership, such as communication, appeared to be much more important predictors of sexual satisfaction than body image variables. The best predictor of sexual frequency was fear that intercourse might harm the fetus . Similarly a study reported that unsatisfying partner relationship was a significant factor affecting the quality of sexual life during pregnancy .
In general the sexual problems that are commonly reported by pregnant women include reduction in sexual desire, enjoyment, coital frequency and overall decline in sexual activities . In addition the result of studies indicated that sexual dysfunction increases as pregnancy progresses [18, 19].
An Iranian descriptive study reported that women felt guilt, feared of pre-term labor and experienced post-coital stomachache, backache and vaginal irritation while they had sexual activity during pregnancy . Sexual satisfaction and its related factors also were studied in another study. The findings indicated that there was a significant relationship between sexual satisfaction during pregnancy and several factors including women's age, their husbands' age, length of marriage, occupation, having pregnancy complication and concerns about fetus . The aim of this study was to assess the most important factors affecting women’s sexual function during pregnancy in order to develop essential information for improving women’s sexual health.
Design and participants
This was a cross-sectional study carried out in Guilan, a province in north, Iran, from September 2010 to March 2011. A sample of women attending all five prenatal care clinics of public health services in Guilan were entered into the study. In all 543 pregnant women were approached. Criteria for inclusion were: being pregnant in any trimester of pregnancy, and being in the age group 18 to 35 years old. The gestational age was determined from the last menstrual cycle or was verified with ultrasound scan measurements. Women were excluded from the study if had complications including threatened abortion, hypertension in pregnancy, placenta previa, premature labor and medications that might have a negative effect on sexual function. Data were collected in a comfortable setting using a structured questionnaire at the prenatal care clinics.
The questionnaire consisted of two parts. The first part included questions about socio-demographic characteristics, obstetric history and medical details of the current pregnancy. The second section was a structured questionnaire including items on couples’ sexual functioning during pregnancy. An author-designed structured questionnaire derived from the literature [14, 22, 23]. It contained 17 questions measuring two concepts: Sexual satisfaction and Sexual worries. Sexual satisfaction included items on sexual desire (4 items), sexual excitement (3 items), and sexual enjoyment (3 items). Sexual worries included items on dyspareunia (3 item), and fetal injury concern (4 items). Each item was rated on a 5-point Likert scale ranging from 0 to 4, giving a total score ranging from 0 to 68. The higher scores indicated a better sexual function. The internal consistency of the questionnaire was assessed using the Cronbach's α coefficient and it was 0.84 indicating a satisfactory result . For content validity, an expert committee consisting of two sexologists, five obstetricians and three midwives reviewed the questionnaire in order to assess if questions measured what they were intended to measure. Finally to ensure face validity, the questionnaire was given to 10 pregnant women and it was found that the items were clear enough to be understood without difficulty and that the questions were simple enough to be rated.
Descriptive statistics was used to explore the data. Then, the generalized linear model analysis (GLM) was performed in order to indicate factors predicting sexual dysfunction during pregnancy. We used generalized linear model for two reasons: first, the distribution of the dependent or response variable can be non-normal, and second, the dependent variable values are predicted from a linear combination of predictor variables, which are ‘connected’ to the dependent variable . For this study women’s sexual functioning score was considered as outcome variable and women’s characteristics were considered as independent factors. The level of significance was set at 5 %. The B coefficient and 95 % confidence intervals was reported as indication of any association between dependent and independent variables. The SPSS version 16 was used to analyze the data.
Ethics committee of Guilan University of Medical Sciences approved the study. We obtained written informed consent from participants after comprehensive explanation of procedure involved.
The study sample
The characteristics of the study sample (n = 518)
Duration of marriage
History of abortion
Trimester of pregnancy
Sexual functioning during pregnancy
Sexual function scores for the study sample
Possible score rangea
Fetal injury concern
Women scoring less than mean (n, %)
Factors affecting couples’ sexual functioning during pregnancy
The results obtained from generalized linear model analysis indicating risk factors for sexual dysfunction (n = 518)
95 % CI
−0.20 to −0.15
−0.39 to 0.25
−1.41 to −0.90
−3.32 to −2.77
−0.53 to 0.008
1.04 to 1.50
History of abortion
−0.52 to 0.20
Trimester of pregnancy
−0.72 to −0.28
−1.10 to −0.68
Duration of marriage
0.03 to 0.10
We found that unwanted pregnancy could affect sexual function during pregnancy. Perhaps unwanted pregnancy can affect womens’ physical and mental health and thus affects sexual functioning during pregnancy [26, 27]. In addition, it has been suggested that unwanted pregnancy can cause stress. As such emotional and stress-related problems provide high risk of occurring sexual dysfunction . However, it has been suggested that the lack of adequate information about sex in pregnancy and concerns about the possible adverse obstetric outcomes are the most relevant factors responsible for the avoidance of sexual activity during pregnancy . In addition as suggested psychological variables such as relationship satisfaction also play important role in decreased sexual function during pregnancy .
The results showed that level of education was a significant contributing factor to the sexual function. It is well established that individuals with high education level are healthier and have less sexual problems . Perhaps one might argue that this could be explained by the fact that since level of education considered as one of the personality-related predisposing factors for help-seeking behaviors  therefore it seems that the well-educated women were more likely to seek help for sexual dysfunction during pregnancy.
In the present study we showed that the trimester of pregnancy was contributing factor to the sexual function. In fact the current study pointed out that overall sexual activity was higher in the third trimester compared to the first trimester. This might be attributed to the advise couples received for doing sex at that time in order to improve fetal well-being, and facilitate labor or delivery [4, 32, 33].
The present study confirmed that longer duration of marriage was related to sexual dysfunction. as noted by Eryilmaz and Zincir . This might be due to the fact that duration of marriage perhaps is an indication of sexual relationship between couples even at pre-pregnancy period (before conception). A recent study found that women who had pre-pregnancy sexual dysfunction continued to experience it during pregnancy, and the majority of them had a significant level of sexual dysfunction in the postpartum period . However as suggested a discussion of expected changes in sexuality should be routinely checked by health care team in order to improve couples' perception of possible sexual modifications induced by pregnancy .
This study had some limitations. We obtained our sample of women pregnancy from public health services in the Eastern district of Guilan, Iran thereby excluding women who had not used any healthcare facilities. In addition to recall bias that is a central issue in this type of research, the study was cross-sectional and one should not draw causality from the results. Furthermore the study sample was not representative of Iranian pregnant population in term of maternal age, education, parity, and employment. Thus the results could not be generalized and should be interpreted with caution.
Sexual function in pregnant women might be influenced by several factors including lower education, unwanted pregnancy, earlier stage of pregnancy, older age, and longer duration of marriage. It seems that issues on sexual function during pregnancy should be included as part of prenatal care and reproductive health programs for every woman.
The authors gratefully acknowledge the Institutional Review Board of the Guilan University of Medical Sciences, which approved and supported this project. They also wish to thank the women who participated in the study.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Bartellas E, Crane JM, Daley M, Bennett KA, Hutchens D. Sexuality and sexual activity in pregnancy. Br J Obstet Gynaecol. 2000;107:964–8.View ArticleGoogle Scholar
- Trutnovsky G, Haas J, Lang U, Petru E. Womens perception of sexuality during pregnancy and after birth. Aust NZ J Obstet Gynaecol. 2006;46:282–7.View ArticleGoogle Scholar
- Orji EO, Ogunlola IO, Fasubaa OB. Sexuality among pregnant women in South West Nigeria. J Obstet gynaecol. 2002;22:166–8.View ArticlePubMedGoogle Scholar
- Pauls RN, Occhino JA, Dryfhout VL. Effects of pregnancy on female sexual function and body image: a prospective study. J Sex Med. 2008;5:1915–22.View ArticlePubMedGoogle Scholar
- Malarewicz A, Szymkiewicz J, Rogala J. Sexuality of pregnant women. Ginekol Pol. 2006;77:733–9 [Article in Polish].PubMedGoogle Scholar
- Tan PC, Andi A, Azmi N, Noraihan MN. Effect of coitus at term on length of gestation, induction of labor, and mode of delivery. Obstet Gynecol. 2006;108:134–40.View ArticlePubMedGoogle Scholar
- Fok WY, Chan LKY, Yuen PM. Sexual behavior and activity in Chinese pregnant women. Acta Obstet Gynecol Scand. 2005;84:934–8.View ArticlePubMedGoogle Scholar
- Ozgoli G, Zaki F, Amir Ali Akbari S, Alavi Majd H. A Survey upon the sexual function and behaviour of pregnant women referring to state health centers of Ahvaz City-2007. J Pajoohandeh. 2008;13:397–403.Google Scholar
- Kadri N, Alami KHM, Tahiri SM. Sexual dysfunction in women: Population based epidemiological study. Arch Women’s Ment Health. 2002;5:59–63.View ArticleGoogle Scholar
- Botros SM, Abramov Y, Millar J-JR, Sand PK, Gandhi S, Nickolov A, et al. Effect of parity on sexual function. An identical twin study. Obstet and Gynecol. 2006;107:765–70.Google Scholar
- Gruszecki L, Forchuk C, Fisher WA. Factors associated with common sexual concern in women: New findings from the Canadian contraception study. Can J Hum Sex. 2005;14:1–13.Google Scholar
- Aslan G, Aslan D, Kızılyar A, Spahi CI, Esen A. A prospective analysis of sexual functions during pregnancy. Int J Impot Res. 2005;17:154–7.View ArticlePubMedGoogle Scholar
- Pauleta JR, Pereira NM, Graça LM. Sexuality During Pregnancy. J Sex Med. 2010;7:136–42.View ArticlePubMedGoogle Scholar
- Torkestani F, Hadavand SH, Khodashenase Z, Besharat S, Davati A, Karimi Z, et al. Frequency and Perception of Sexual Activity during Pregnancy in Iranian Couples. Int J Fertil Steril. 2012;6:107–10.Google Scholar
- Corbacioglu Esmer A, Akca A, Akbayir O, Goksedef BP, Bakir VL. Female sexual function and associated factors during pregnancy. J Obstet Gynaecol Res. 2013;39:1165–72.View ArticlePubMedGoogle Scholar
- Radoš SN, Vraneš HS, Šunjić M. Limited role of body satisfaction and body image self-consciousness in sexual frequency and satisfaction in pregnant women. J Sex Res. 2014;51:532–41.View ArticlePubMedGoogle Scholar
- Gałązka I, Drosdzol-Cop A, Naworska B, Czajkowska M, Skrzypulec-Plinta V. Changes in the sexual function during pregnancy. J Sex Med. 2015;12:445–54.View ArticlePubMedGoogle Scholar
- Leite AP, Campos AA, Dias AR, Amed AM, De Souza E, Camano L. Prevalence of sexual dysfunction during pregnancy. Rev Assoc Med Bras. 2009;55:563–8.View ArticlePubMedGoogle Scholar
- Erol B, Sanli O, Korkmaz D, Seyhan A, Akman T, Kadioglu A. A cross-sectional study of female sexual function and dysfunction during pregnancy. J Sex Med. 2007;4:1381–7.View ArticlePubMedGoogle Scholar
- Rahimi S, Seyyed Rasooli E. Sexual behavior during pregnancy: A descriptive study. Payesh. 2004;3:291–9.Google Scholar
- Ahmadi Z, Molaie Yarandi E, Malekzadegan A, Hosseini AF. Sexual satisfaction and its related factors in primigravidas. Iran J Nurs. 2011;24:54–62.Google Scholar
- Mohammadi M, Heidari M, Faghihzadeh S. The female sexual function index: validation study of the Iranian version. Payesh. 2009;7:269–78.Google Scholar
- Sheikheslami G. Quality of life and sexual function after child birth: vaginal versus elective cesarean delivery. Tehran, Iran: Dissertation: Tehran University of Medical Sciences; 2005. [In persian]Google Scholar
- Nunnally JC, Bernstein IR. Psychometric Theory. 3rd ed. New York: McGraw-Hill; 1994.Google Scholar
- Lee Y, Nelder JA. Hierarchical Generalized Linear Models. Journal of the Royal Statistical Society Series B. 1996;58:619–78.Google Scholar
- Khajehpour M, Simbar M, Jannesari S, Ramezani-Tehrani F, Majd HA. Health status of women with intended and unintended pregnancies. Public Health. 2013;127:58–64.View ArticlePubMedGoogle Scholar
- Gessessew A. Unwanted pregnancy and its impact on maternal health and utilization of health services in Tigray Region (Adigrat Hospital). Ethiop Med J. 2009;47:1–8.PubMedGoogle Scholar
- Serati M, Salvatore S, Siesto G, Cattoni E, Zanirato M, Khullar V, et al. Female sexual function during pregnancy and after childbirth. J Sex Med. 2010;7:2782–90.Google Scholar
- Laumann EO, Gagnon JH, Michael RT, Michaels S. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago, Ill: University of Chicago Press; 1994.Google Scholar
- Oniye AO. Sex and marriage. In: Yahaya LA, Esere MO, Ogunsanmi JO, Oniye AO, editors. Marriage, sex and family counselling. Ilorin: Unilorin Press; 2008. p. 25–62.Google Scholar
- Schomerus G, Appel K, Meffert PJ, Luppa M, Andersen RM, Grabe HJ, et al. Personality-related factors as predictors of help-seeking for depression: a population-based study applying the behavioral model of health services use. Soc Psychiatry Psychiatr Epidemiol. 2013;48:1809–17.Google Scholar
- Naim M, Bhutto E. Sexuality during pregnancy in Pakistani women. J Pak Med Assoc. 2000;50:38–44.PubMedGoogle Scholar
- Bello FA, Olayemi O, Aimakhu CO, Adekunle AO. Effect of pregnancy and childbirth on sexuality of women in ibadan, Nigeria. ISRN Obstet Gynecol. 2011;2011:856586.View ArticlePubMedGoogle Scholar
- Eryilmaz G, Ege E, Zincir H. Factors affecting sexual life during pregnancy in eastern Turkey. Gynecol Obstet Invest. 2004;57:103–8.View ArticlePubMedGoogle Scholar