Breastfeeding and Sexual Activity and Sexual Quality in Postpartum Women

Abstract

Background:

Breastfeeding is the ideal source of nutrition for infants. Breastfeeding can affect sexual activity and sexual quality of women in the postpartum period.

Objective:

The present study was carried out to determine the effect of breastfeeding on sexual activity and sexual quality in postpartum women.

Materials and Methods:

The sample of the study consisted of 161 breastfeeding and 176 nonbreastfeeding women who were cared for in the Family Health Centers utilizing the Descriptive Information Form and Sexual Quality of Life-Female (SQOL-F) questionnaire.

Results:

Half of the breastfeeding and nonbreastfeeding women included in the study had cesarean delivery and the women in both groups reported changes in their sexual life (having less sexual intercourse, and suffering from dyspareunia) during the postpartum period. In the present study, 68.3% of the breastfeeding women and 47.7% of the nonbreastfeeding women experienced dyspareunia, and the difference between them was statistically significant (p < 0.05). There was also a statistical difference between the breastfeeding women and nonbreastfeeding women in terms of the types of changes experienced in sexual life (p < 0.05). The rate of the women who enjoyed sexual satisfaction more was higher in the nonbreastfeeding women (15.9%) than in the breastfeeding women (1.2%). The SQOL-F scale total mean score was 60.07 ± 9.88 in the breastfeeding women and 62.81 ± 9.66 in the nonbreastfeeding women, but the difference between the groups was not statistically significant (p > 0.05).

Conclusions:

In the present study, the sexual life quality mean scores between the breastfeeding and nonbreastfeeding women were moderate and similar to each other. The fact was that the reported sexual life quality was similar in the breastfeeding and nonbreastfeeding women despite the association of a lower sexual desire and frequency of intercourse in the breastfeeding group, suggesting that breastfeeding may serve as a sexual alternative for nursing mothers.

Introduction

The World Health Organization, the American Academy of Pediatrics, and the United Nations Children's Fund all recommend that breastfeeding should be started immediately after birth, that infants should be exclusively breastfed in the first 6 months of life, and that breastfeeding should be continued together with appropriate supplementary foods up to 2 years of age.^1,2

With the end of labor and the onset of lactation, important anatomical, physiological, and hormonal changes occur in the female body³ and these changes during the lactation period may cause changes in the sexual functions of women.⁴ Maintaining a healthy sexual life during the lactation period is important in terms of women's quality of life.^5–7 In this context, studies investigating the effects of breastfeeding on female sexuality in the postpartum period have recently been reported.^8,9 While the results of some of these studies indicated that breastfeeding has a negative effect on sexuality, the results of other studies indicated that breastfeeding led to an increase in women's sexual desire.^10,11

In the literature review, it was noticed that although there were studies investigating the effect of breastfeeding on sexual life, there were no studies distinguishing the quantitative effect of breastfeeding and the mother's perception of the quality of her sexual activity. Thus, to that end, the present study was carried out to study the effect of breastfeeding on sexual activity and sexual quality of life of nursing mothers.

Materials and Methods

Type of study

This study was conducted as a cross-sectional and comparative study between September 2017 and September 2018.

Population and sample

The population of the study was composed of women registered in 6 family health centers (FHCs), which were selected from 11 FHCs in the city center of Yozgat using the random sampling method. The study sample consisted of primiparous women having 3-month-old infants who presented to FHCs for vaccination The selection of breastfeeding and nonbreastfeeding women was performed using the simple random sampling method. The study sample was composed of 337 primiparous women who accepted to participate in the study. Of them, 161 were breastfeeding and 176 were nonbreastfeeding.

The inclusion criteria of the study

Breastfeeding and nonbreastfeeding women who were primiparous, had no speech disorders and hearing loss, were sexually active, had no psychiatric diagnosis, had no disease that could affect their sexual functions, did not take any medication that could affect their sexual functions, and volunteered to participate in the study were included in the study.

Data collection forms

Personal information form

The form prepared by the researchers was composed of 18 items of sociodemographic characteristics (such as age, educational status, and working status) and obstetric characteristics (such as delivery type, postpartum menstruation, and use of family planning).

Sexual Quality of Life-Female questionnaire

Turkish validity and reliability study of the scale developed by Symonds et al. (2005) was conducted by Tuğut (2009). The 6-point Likert-type scale composed of 18 items. The lowest and highest possible scores to be obtained from the scale were 18 and 108, respectively. The higher the score is the better the sexual quality of life is. The Cronbach's alpha reliability coefficient, which indicates the internal consistency of the scale, was 0.83 in Tuğut's study¹² and 0.85 in the present study.

Data collection

After the routine follow-up examination of their children was over, the questionnaires were filled in by the researcher who interviewed the breastfeeding and nonbreastfeeding women, using the face-to- face interview technique in a room in the FHC to avoid noise and interruptions. The administration of the questionnaire and the scale took 20 minutes on average for each woman.

Data analysis

The data were analyzed using the IBM statistic 21 program. While numbers, percentages, and arithmetic mean were used to show descriptive characteristics, the chi-square test was used to test relationships between categorical variables, the Shapiro–Wilk normality test was used to check whether numerical values were normally distributed, and the t-test was used for comparison.

Ethical principles of the study

Before the study was started, permission was obtained from the Public Health Institution of Yozgat and Bozok University Faculty of Medicine Ethics Committee (2017.08.24_10). In addition, after the women who participated in the study were informed about the purpose of the study, were told that the data obtained from them would be kept confidential within the framework of the “Confidentiality and Privacy Protection” principle, and that participation was voluntary within the framework of the “Respect for Autonomy” principle, their informed consent was obtained.

Results

Of the breastfeeding participants, 52.2% were in the 25–34-year age group, 39.8% were university graduates 58.4% were unemployed, 56.5% lived in a district or village, and 77% had a nuclear family. Of the nonbreastfeeding women, 53.4% were in the 18–24-year age group, (53.4%), 33.5% were university graduates, 61.4% were unemployed, 51.7% lived in a district or village, and 76% had a nuclear family. There was no statistically significant difference between the sociodemographic characteristics of women in the breastfeeding and nonbreastfeeding groups and the groups had similar characteristics (having a homogeneous distribution) in terms of variables such as age, gender, socioeconomic status, working status, marriage age, and family type (p > 0.05) (Table 1).

Table 1.

Comparison of Sociodemographic Characteristics of Women

Characteristics	Breastfeeding group (n = 161)	Nonbreastfeeding group (n = 176)	Test/p
Characteristics	n (%)	n (%)	Test/p
Age
18–24 years	70 (43.5)	94 (53.4)	χ² = 4.306
25–34 years	84 (52.2)	72 (40.9)	p > 0.05
35 years and older	7 (4.3)	10 (5.7)
Educational status
Literate	6 (3.7)	8 (4.5)	χ² = 8.412
Primary school	10 (6.2)	23 (13.1)	p > 0.05
Secondary school	35 (21.7)	37 (21.0)
High school	46 (28.6)	59 (33.5)
University	64 (39.8)	49 (27.8)
Working status
Employed	67 (41.6)	68 (38.6)	χ² = 0.311
Unemployed	94 (58.4)	108 (61.4)	p > 0.05
Marriage age
Younger than 18	26 (16.1)	46 (26.1)	χ² = 4.992
Older than 18	135 (83.9)	130 (73.9)	p > 0.05
Residence place
District/village	91 (56.5)	91 (51.7)	χ² = 0.786
City center	70 (43.5)	85 (48.3)	p > 0.05
Family type
Nuclear family	124 (77.0)	135 (76.7)	χ² = 0.005
Extended family	37 (23.0)	41 (23.3)	p > 0.05
Marriage year
1–5 years	145 (16.1)	167 (26.1)	χ² = 2.849
6–10 years	16 (83.9)	9 (73.9)	p > 0.05
Spouse's profession
Unemployed	26 (14.8)	24 (14.9)	χ² = 9.027
Self-employed	18 (10.2)	23 (14.3)	p > 0.05
Worker	79 (44.9)	48 (29.8)
Civil servant	53 (30.1)	66 (41.0)

Table 2 notes the comparison of the characteristics about obstetric and sexual lives of the breastfeeding and nonbreastfeeding women. While 68.3% of the breastfeeding women experienced dyspareunia, the rate was 47.7% among the nonbreastfeeding women and the difference between them was statistically significant (p < 0.05). In the present study, there was a statistically significant difference between the breastfeeding and nonbreastfeeding women in terms of the types of changes in sexual life (p < 0.05). The rate of the women who enjoyed sexual satisfaction more was higher in the nonbreastfeeding women (15.9%) than in the breastfeeding women (1.2%). On the contrary, there was no difference between the groups in terms of the variables such as the type of delivery, experiencing menstruation in the postpartum period, and using an effective family planning method (p > 0.05).

Table 2.

Comparison of Obstetric and Sexual Life Characteristics of Women

Characteristics	Breastfeeding group (n = 161)	Nonbreastfeeding group (n = 176)	Test/p
Characteristics	n (%)	n (%)	Test/p
Mode of delivery
Cesarean	81 (50.3)	89 (50.6)	χ² = 0.02
Vaginal delivery	80 (49.7)	87 (49.4)	p > 0.05
Status of experiencing dyspareunia
Experiencing	110 (68.3)	83 (47.7)	χ² = 16.199
Not experiencing	51 (31.7)	94 (53.4)	p < 0.05
Postpartum menstruation status
Regular	72 (44.7)	91 (51.7)	χ² = 1.641
Irregular	89 (55.3)	85 (48.3)	p > 0.05
Status of using an effective FP method
Using	70 (43.5)	81 (46.0)	χ² = 4.532
Not using	91 (56.5)	95 (54.0)	p > 0.05
Type of change experienced in sexual life
No change	86 (53.4)	95 (54.0)	χ² = 25.538
Decreased sexual desire	73 (45.3)	53 (30.1)	p < 0.05
Increased sexual satisfaction	2 (1.3)	28 (15.9)
Status of getting information about sexual life
Receiving	78 (48.4)	88 (50.0)	χ² = 0.081
Not receiving	83 (51.6)	88 (50.0)	p > 0.05

FP, family planning.

Table 3 shows the comparison of the scores the breastfeeding and nonbreastfeeding participants obtained from the sexual quality-of-life questionnaire. The mean scores obtained from the Sexual Quality of Life-Female (SQOL-F) questionnaire by the breastfeeding and nonbreastfeeding participants were 60.9 ± 9.88 and 62.81 ± 9.66, respectively, and the score was considered to be of a moderate sexual quality.

Table 3.

Comparison of Women's Scores from the Sexual Quality of Life Questionnaire

Sexual quality of life	Breastfeeding group (n = 161)	Nonbreastfeeding group (n = 176)	Test/p
Questionnaire (SQOL-F)	\documentclass{aastex}\usepackage{amsbsy}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{bm}\usepackage{mathrsfs}\usepackage{pifont}\usepackage{stmaryrd}\usepackage{textcomp}\usepackage{portland, xspace}\usepackage{amsmath, amsxtra}\usepackage{upgreek}\pagestyle{empty}\DeclareMathSizes{10}{9}{7}{6}\begin{document} $$\bar x \; \pm \;ss$$ \end{document}	\documentclass{aastex}\usepackage{amsbsy}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{bm}\usepackage{mathrsfs}\usepackage{pifont}\usepackage{stmaryrd}\usepackage{textcomp}\usepackage{portland, xspace}\usepackage{amsmath, amsxtra}\usepackage{upgreek}\pagestyle{empty}\DeclareMathSizes{10}{9}{7}{6}\begin{document} $$\bar x \; \pm \;ss$$ \end{document}	2.565
Questionnaire (SQOL-F)	60.07 ± 9.88	62.81 ± 9.66	p > 0.05

SQOL-F, Sexual Quality of Life-Female.

Discussion

Although having a child is a very special experience for both parents, physical, psychological, hormonal, and sociocultural changes experienced by women after birth and the increase in domestic responsibilities potentially affect both the practice of breastfeeding and mothers' sexual activity.¹³ This comparative study was conducted to determine the effect of breastfeeding on sexual activity and sexual quality of life.

Many parameters affect sexual activity after birth. One of these parameters is the delivery method. Since the pelvic muscles are stretched and episiotomy is frequently performed in vaginal deliveries, the sexual life of the woman is affected more than that of women who had a cesarean section.¹⁴ However, there are also study results showing that sexual functions of women who had cesarean section were worse than those of women who had vaginal delivery.¹⁵ In our study, the delivery method was comparable in both groups, and so, this factor could not explain the sexual activity difference.

Another factor that affects the frequency of sexual activity during the postpartum period is dyspareunia. In the present study, dyspareunia was more common in breastfeeding women, which was consistent with the results of other studies.^16,17 In addition, breastfeeding mothers report increased breast tenderness, milk release from breasts during sexual intercourse, not feeling sexually attractive, and concerns for becoming pregnant again.¹⁸

In the present study, more than half of the women in the breastfeeding group (55.3%) had irregular menstruation, but there was no statistical difference between the groups (p > 0.05). Since irregular menstruation in the postpartum period causes the fear of pregnancy in women, it can be considered a parameter that can affect the sexual life negatively. However, no data were found in the studies about the effect of this variable on sexual life.

Another factor could that affect sexual activity is the preferred family planning method.¹⁹ In the present study, there was no significant difference in the family planning method. The rate of using a family planning method with limited effect was 56.5% among the breastfeeding women and 54.0% among the nonbreastfeeding women. Among the family planning methods with little effect were withdrawal, vaginal shower, and calendar method.²⁰

In other studies, it was reported that the decrease in sexual desire and satisfaction level is the most frequently experienced change in the sexual life in the postpartum period.^21,22 In the present study, the difference between the breastfeeding and nonbreastfeeding women in terms of the types of changes experienced in sexual life was statistically significant (p < 0.05). The increase in the sexual satisfaction rate was higher in the nonbreastfeeding women than in the breastfeeding women. One may speculate that the mothers' priorities for their babies' nutrition, especially if they require frequent night feedings, may be the major cause of these results. This suggests that breastfeeding may have a sexual dimension or that breastfeeding mothers have lowered expectations and thus they are more easily satisfied.

In the present study, it was determined that the self-reported quality of sexual life of the breastfeeding and nonbreastfeeding women was moderate and that there was no statistically significant difference between them. The impact of breastfeeding on the sexual life of postpartum women has been previously reported. In studies conducted by Yilmaz et al. in Turkey (2018) and by Hanafy and El-Esawy (2015) in Egypt, no correlation was determined between breastfeeding and sexual life.^23,24 In a study conducted in Iran (2015), Anbaran et al. found that breastfeeding mothers' sexual function scores were higher than those of the nonbreastfeeding mothers.²⁵ These results may be explained by the differences in sociocultural structures and different societies.

Limitations of the study

One of the limitations of the study is that the study may not be generalizable to other populations since it was conducted only in one center. The other limitations of the study are that people do not have sexual intercourse in the first 40 days after the birth as a cultural rule, and that sexuality is a private issue and people do not want to talk about it thus raising the question as to the validity of some of the self-reported data. An additional limitation of the study was that no information was obtained on the sexual satisfaction and/or quality of sexual activity of the husband.

Conclusions

In the present study, the mean scores obtained from the SQOL-F by the breastfeeding and nonbreastfeeding participants were 60.9 ± 9.88 and 62.81 ± 9.66, respectively, and the score was considered to be of a moderate sexual quality. The nonbreastfeeding group had a higher rate (15.9%) of increased sexual satisfaction than did the breastfeeding group (1.2%). One may thus speculate that the act of breastfeeding may substitute for some mothers the satisfaction they would receive from sexual activity per se.

Footnotes

Disclosure Statement

No competing financial interests exist.

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