To evaluate the sexual function in 1.5 to 3 months post-partum period in Indian female and to compare the female sexual dysfunction in relation to the mode of delivery.

Type of study: Cross sectional observation study
Sample size: A total of 100 women who delivered in our centre were included
Inclusion criteria:
Age 18 to 40 yrs
Postpartum day 45 to 90 (1.5 to 3 months)
Exclusion criteria:
Patients having sexual dysfunction pre-pregnancy
Patients having pelvic organ prolapse
Patients not giving consent

Materials and methods:
A  total of 100 women aged 18 to 45 years undergoing vaginal delivery or caesarean section in our centre were interviewed and detailed history was obtained regarding sexual function in between postpartum days 45 and 90 using FSFI (Female Sexual Function Index) questionnaire after obtaining written consent.
The data was analysed to find out the prevalence of female sexual dysfunction postpartum, timing of resumption of sexual activity and comparison of sexual dysfunction between patients undergoing normal delivery and caesarean section.
Episiotomy and perineal tears as a factor and the incidence of sexual problems with or without episiotomy were analysed.

Of the 100 women who were interviewed, 52 underwent caesarean section while 48 had vaginal delivery. Of the women undergoing vaginal delivery, 35 (72.9%) had episiotomy or 2nd and 3rd degree perineal tear. 
Total 57 women had resumed sexual intercourse in 45 to 90 days (1.5 to 3 months)postpartum. After caesarean, 31 women (59.61%) while after vaginal delivery, 26 (54.16%) women were sexually active in the study period. In women who had episiotomy or 2nd and 3rd degree perineal tear, 17 (48.5%) resumed sexual activity. Postpartum mean duration of resumption of sexual activity was 58.7+/- 18.6 days overall. After caesarean section it was 57.5 +/- 19.6 days while after vaginal delivery it was 60.3 +/- 17 days. In women with episiotomy or 2nd/3rd degree perineal tears, it was 62.8 days. 
Among 43 women, who had not resumed sexual activity, 19 (44.1%) stated the reason as excessive fatigue and lack of sleep, 16 (37.2%) were staying away from husband, 4 (9.3%) had fear of unintended pregnancy, 2 (4.6%) had sick babies, 1 (2.3%) had pain in abdomen and 1 (2.3%) had wound gape at caesarean site.
FSFI questionnaire was filled by all. The mean FSFI score overall was 13.89. After caesarean section, it was  15.75 and after vaginal delivery, it was 12.64. Of the vaginal delivery group, the women who had episiotomy or 2nd/3rd perineal tears had further lower FSFI scores of 10.90. Considering an overall cut off of 26.55 to differentiate between women with and without sexual dysfunction, it was found that after caesarean only 13 women (25%) and following vaginal delivery, only 2 (4.1%) women had score more than 26.55. None of the women who had episiotomy or 2nd/3rd degree perineal tear had score more than 26.55. 
Considering desire as a separate domain and taking 5 as the cutoff, all the women had scores less than 5 indicating all (100%) had hypoactive sexual desire disorder (HSDD).

The difference between the number of women resuming sexual activity after 45 to 90 days postpartum in caesarean group (59.61%) vs undergoing vaginal delivery group (54.16%) was not statistically significant (p=0.28). Comparing caesarean group (59.61%) with women with episiotomy or 2nd/3rd degree perineal tear (48.5%), this difference is not statistically significant (p=0.15).
Most common reason for not resuming sexual activity was excessive fatigue and lack of sleep in 44.1% women.
Considering cut off for FSFI score as 26.55, sexual dysfunction was present in 39 women (75%) after caesarean section and in 46 women (95.83%) after vaginal delivery and 100% in women with episiotomy or 2nd/3rd degree perineal tears. This difference between cesarean and vaginal delivery group was statistically significant (p=0.001).
All the women (100%) had hypoactive sexual desire disorder.

Sexual dysfunction is highly prevalent in the postpartum period and is affected by mode of delivery, occurring more commonly in women undergoing vaginal delivery, especially with episiotomy.

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