Original articles
Sexuality during pregnancy and after childbirth: A metacontent analysis of 59 studies

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Abstract

The aim of this study is to gain a systematic overview of all existing studies on parental sexuality during pregnancy and the postpartum period (months 1–6). Investigations of psychological and medical data banks and cross-references revealed 59 relevant studies published in English or German between 1950 and 1996. These primary studies were metacontent analyzed, according to the following categories: methodology (samples, designs); type of descriptive data researched (sexual activity, interest, enjoyment, orgasm, problems); and type of correlational data researched (sexual variables and pregnancy outcome, maternal physical and psychological health, sociodemographic data, biographical data, partnership data). On average, female sexual interest and coital activity declines slightly in the first trimester of pregnancy, shows variable patterns in the second trimester, and decreases sharply in the third trimester. Most couples do not practice intercourse for about 2 months around the delivery. Afterwards, sexual interest and activity tends to be reduced for several months as compared with the prepregnancy level, and sexual problems occur relatively often. But most remarkable is the interindividual variability concerning sexual responsiveness, orgasm, activity, and enjoyment. Descriptive research is focused on coital activity of (expectant) mothers. Data about fathers, noncoital activities, and sexual feelings are scarce. Data analysis is focused on three questions: (1) Does sexual activity in pregnancy harm the fetus? (if there are no risk factors: no); (2) Are physical and mental symptoms or data about the delivery and sexual variables correlated? (in some cases: yes); (3) Are sociodemographic data and sexual variables correlated? (mostly not). Research deficits (e.g., conceptual reductionism “sexuality=intercourse,” neglect of the male partners, validity, reliability, neglect of the nonsexual partnership and of biographical influences) are critically discussed. Medical, counseling, and psychotherapeutic implications are derived.

Introduction

The sexual relationship of expectant and young parents is of great medical and psychological significance. On the one hand, sexual activity might be a medical risk factor, as intercourse or maternal orgasm in pregnancy might harm the fetus. On the other hand, sexual activity can be a psychological resource factor that can enhance couples' and individuals' quality of life. As has been shown in several studies, the marital happiness of couples decreases markedly after the birth of the (first) child. The sexual relationship seems to be the most vulnerable area in the relationship of expectant and young parents and is, therefore, the focus of our research project on “Parenthood, Partnership, and Sexuality.”

As a basis for our longitudinal study we wanted to gain a comprehensive and systematic overview of all existing studies on parental sexuality during pregnancy and the postpartum period (months 1–6). Because the review articles 1, 2, 3, 4, 5, 6, 7 neither include all relevant primary articles nor analyze the primary studies and their results in a systematic way, we conducted a systematic search of medical and psychological databases and metacontent analyzed all relevant primary studies. We wanted to know which research methodologies have been employed, which descriptive sexual variables have been researched, and what is known about (expectant) parents' sexual activity, interest, enjoyment, orgasm, or problems, and to what degree correlations between sexual and other variables have been explored.

The primary studies that we have analyzed can be divided roughly into three classes, which represent three different phases of research: Phase I is: How much sex can be allowed during pregnancy? (1950s to 1980s). The first studies on this subject were conducted by gynecologists and were based on the assumption that sexual activity in pregnant women might harm the fetus. They focused on coital activity (and sometimes also on orgasmic experiences), included only female participants, and researched relationships between sexuality and pregnancy outcome. Although the first studies worked with small, biased samples, in the 1980s some final conclusions could be drawn from large, representative samples, which opened the way to a more tolerant attitude toward sexual activities in expectant mothers. In phase II—the second half of the 1980s—the focus is on: Who has intercourse during pregnancy and postpartum? Psychologists and other social scientists started to become interested in partnership and family development. In some of their studies both partners were included. For the most part correlations between coital activity and sociodemographic data were researched. At the end of the 1980s, and during the 1990s, several psychological longitudinal studies about partnership and parenthood, which researched both partners, were conducted. Phase III, therefore, focuses on: How does the marital and sexual couple relationship develop when partners become parents? Some of these studies are methodologically advanced, but the topic of “sexuality” is often only superficially explored.

Section snippets

Method

We were interested in all empirical results concerning sexual activity, interest, enjoyment, attitudes, initiative, and the problems of (expectant) parents during pregnancy and the postpartum period, published up to the year 1996 (research question). The studies were found through multiple search strategies, namely, by investigations of computerized medical and psychological databases, congresses, and cross-references. We conducted a systematic search of empirical primary results in the

Methodology of primary studies researched

The sample sizes vary between 1 and 39,217 subjects (see Table I). Only 5 (8%) of the 59 studies are representative of a given maternal population and only 19 studies (32%) included the male partners. The majority of the female participants are 25–30 years old; the males, on average, are 1–4 years older. About half of the studies are confined to married women/couples; the remaining studies also include nonmarital relationships and, less frequently, single mothers. Fifteen studies (25%) refer to

Discussion

The purpose of this study was to give a systematic and comprehensive overview of all 59 studies on parental sexuality during pregnancy and the postpartum period published in English or German between 1950 and 1996. In going beyond the existing reviews 1, 2, 3, 4, 5, 6, 7, our aim was to integrate two different branches of research—the medical–obstetrical one and the psychological one. The gap between these two branches, which has not been closed up to now, might be related to the fact that

Acknowledgements

This study was supported by a grant from the German Science Foundation (Deutsche Forschungsgemeinschaft [DFG] Sy 30/1-1 and Sy 30/1-2) as part of the research project “Parenthood, Partnership, and Sexuality” at the Universities of Gießen (Clinic of Psychosomatic Medicine and Psychotherapy) and Hamburg (Psychological Institute III). This is a revised version of a paper presented at the 13 Tagung Entwicklungspsychologie (13th Congress for Developmental Psychology) at the University of Vienna,

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