Female sexual function declines significantly during the postpartum period, and psychosocial factors play a major independent role in postpartum sexual dysfunction.

A prospective longitudinal observational study was conducted including 184 pregnant women. Sample size was calculated based on the anticipated mean difference in FSFI score between time points, assuming a difference of 5 points, standard deviation of 8, α=0.05, power 80%, yielding a minimum of 56 participants. To account for potential attrition and allow for multivariable analysis, 184 women were enrolled. Female sexual function was assessed using the Female Sexual Function Index (FSFI) during the third trimester and at 4–8 weeks postpartum. Postpartum sexual dysfunction was defined as a total FSFI score < 26.55. Paired comparisons were performed using Student’s t-test. A multivariable logistic regression model was constructed to identify independently associated factors, including age (continuous), educational level, parity, and presence of anxiety or sadness. Model construction followed epidemiological criteria, with assessment of collinearity and control for overfitting. Ethical approval was obtained, and all participants provided written informed consent.

The mean age was 29.6 ± 5.2 years. The total FSFI score decreased significantly from 29.8 during pregnancy to 16.8 postpartum (mean difference −13.0; p < 0.001). Significant declines were observed across all domains, including desire, arousal, lubrication, orgasm, and satisfaction, with significant worsening of pain (all p < 0.01). The largest decline was observed in lubrication.

In multivariable analysis, lack of university education (adjusted OR 24.4; 95% CI 6.5–91.3; p < 0.001), multiparity (aOR 8.6; 95% CI 2.3–31.3; p = 0.001), and the presence of anxiety or sadness (aOR 256.3; 95% CI 46.8–1402.8; p < 0.001) were independently associated with postpartum sexual dysfunction. Age was not significantly associated (aOR 0.93; 95% CI 0.85–1.02; p = 0.114).

A marked and clinically relevant decline in female sexual function was observed postpartum, affecting all FSFI domains. Psychosocial factors, particularly emotional distress, showed strong independent associations with postpartum sexual dysfunction. The magnitude of these associations suggests a relevant role of psychosocial determinants; however, estimates should be interpreted with caution given potential model instability and outcome distribution.

Postpartum sexual dysfunction is highly prevalent and multifactorial. These findings highlight the importance of integrating sexual and mental health assessment into routine prenatal and postpartum care.

Continence 19S (2026) 102536
DOI: 10.1016/j.cont.2026.102536