BACKGROUND: The postnatal sexual health of women is crucial in reproductive health, due to lack of sexual knowledge and sexual heath care service as well as conventional idea, the medical staff and postnatal women themselves pay little attention and discussion on the sexual health after childbirth.OBJECTIVE; To investigate the prevalence and types of women's sexual problems after childbirth, identify the factors associated with dyspareunia and investigate the status quo of postnatal sexual health care service. DESIGN: Cross-sectional study and follow-up survey within six months after delivery.SETTING: Department of Reproductive Medicine, Chongqing University of Medical Sciences. PARTICIPANTS: A total of 798 primiparous women delivering a live birth in Department of Obstetrics at the First Affiliated Hospital of Chongqing University of Medical Sciences between November 2000 and July 2001, and 79 husbands who accompanied their wives during the follow-ups were adopted in this study.METHODS: The primiparous women after 6 months of childbirth and husbands conducted routine postnatal follow-ups and were informed of the follow-up content. The interview was used in this cross-sectional study and the questionnaires were finished under the help of health professional. And some advice, consultations and treatments can be given in time. MAIN OUTCOME MEASURES; ①main change of postnatal sexual life;②postnatal sexual problems and related factors. RESULTS: Totally 460 out of 798 primiparous women in accordance with the inclusive and exclusive criterions received follow-up surveys after telephone or letter notification. ①Main change of postnatal sexual life: Of the 460 respondents, 94.74% had resumed sexual activity within six months after delivery. Compared with one year pre-pregnancy, the number of sexual activity decreased obviously within 3-6 months after delivery, and 66.0％ of postnatal women decreased the sexual desire.②Postnatal sexual problems and related factors: Sexual morbidity increased significantly after the childbirth: In the first three months after delivery, 70.6％ of women experienced sexual problem(s), declining to 55.6％ during the 4th-6th months, and reduced to 34.2％ at the 6th month, but not reaching pre-pregnancy levels of 7.17％. The sexual problems of women after delivery included dyspareunia, vaginal dryness, orgasm disorder and vaginal relaxation, etc.4. And dyspareunia was the most common type. Between the 4th and 6th month after delivery, dyspareunia was significantly associated with the effect of traditional sexual ideas, experience of dyspareunia before pregnancy and current breastfeeding (P ＜ 0.05), while the association of dyspareunia with delivery mode was not significant.③Sexual care service and sexual counseling after delivery: Only 20.8％ of women received information about sexual health from health care personnel within 42 days after delivery, and consultation rate of sexual intercourse problems was 8.0％.④Husbands' comprehension of postnatal problems in women: Only 59.2％ of partners whose wives had postnatal sexual problem(s) knew that their wives had ever experienced sexual problem(s) and 8.1％ of partners had sought medical help. CONCLUSION; Sexual health problems are very common in women after childbirth, taking up for 70.6％. And the quality of postnatal sexual health is unrelated with delivery mode, but postnatal health care service are often overlooked, additionally lack of professional counseling and treatment. The current practices of encouraging the husband's supports after the childbirth may well influence the prevention and treatment of postnatal sexual problems in women.%背景:妇女产后的性健康是生殖健康的重要部分,在中国由于性知识,性健康保健服务的缺乏,加之传统观念的影响,医务人员及妇女本人对产后性健康的关注、讨论较少.目的:了解妇女产后各种不同类型性问题的发生率、产后性交疼痛发生的相关因素以及在产后保健服务中对性健康的重视状况.设计:横断面调查,3～6个月随访.单位:重庆医科大学生殖医学系.对象:2000-11/2001-07在重庆医科大学附属第一临床学院产科分娩活胎的初产妇798名,及陪妻子来院随访的丈夫79名.方法:采用横断面调查方法,在门诊对产后6个月的初产妇及部分产妇的丈夫以面谈方式进行性健康问卷调查,并进行妇科检查及必要的心理咨询与治疗.主要观察指标:①产后性生活的主要变化.②产后性问题及其相关因素.结果:符合纳入、排除标准的初产妇共798名,通过电话或信件通知,来院接受随访调查者460名.①产后性生活的主要变化:94.7%初产妇于产后6个月内恢复性生活,与孕前1年相比,产后3～6个月内的性生活次数明显减少,有66.0%的妇女产后性欲下降.②产后性问题及其相关因素:妇女性问题的发生率较产前明显增加.其中,产后3个月内70.6%存在性问题,产后4～6个月下降为55.6%,产后6个月时降至34.2%,但未恢复到妊娠前(7.2%)的水平.产后常见的女性性问题有性交疼痛、阴道干涩、性高潮障碍、阴道松弛等;其中,性交疼痛发生率占第1位.产后4～6个月内,性交疼痛与当前是否正在哺乳、传统性观念及孕前性交疼痛史明显相关,而与分晚方式无显著关系.③性保健服务及妇女产后性咨询情况:产后42 d接受产科随访时,仅20.8%的妇女从卫生保健人员得到有关的性健康知识.在有产后性问题的妇女中,与卫生保健人员讨论过该问题者仅为8.0%.④丈夫对妇女产后性问题的了解情况:有59.2%的丈夫知道妻子有产后性问题,但仅有8.1%的丈夫曾就此问题进行过医学咨询.结论:产后性健康问题发生率为70.6%,产后性生活质量与分娩方式无关,但产后保健服务中性健康未得到应有重视,更缺乏专业人员提供咨询与治疗,产后保健中男方的参与有利于妇女产后性问题的预防和治疗.
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