Breastfeeding and Postpartum Maternal Sexual Functioning: A Review

Article excerpt

ABSTRACT: In this paper we review the existing literature on the relationship between breastfeeding and postpartum maternal sexuality. Latency to resumption of sexual activity and frequency of sexual activity, sexual desire, dyspareunia, fatigue, mood and depression are used as discrete categories for discussion. The research literature indicates that women who breastfeed, as compared to those who bottle-feed, are more likely to experience decreases in sexual functioning, especially desire. Research increasingly suggests that various factors modulate the influence of breastfeeding on sexual functioning, including psychosocial and hormonal variables. Of particular interest is the potential association between hyperprolactinemia in breastfeeding women and sexual functioning, as mediated by its effects on both androgen and estrogen secretion. The limitations and deficits of past research, practical implications of these findings, and future directions for research are discussed.

Key words: Breastfeeding Sexual functioning Sexual desire Prolactin Androgens

INTRODUCTION

Research on sexual functioning has proliferated over the past few decades, stimulated by an increasing awareness of the high incidence of sexual difficulties in both men and women. Sexual functioning is now recognized as a multidimensional phenomenon, influenced by many biopsychosocial factors. Pregnancy and the postpartum period (typically defined as the first six months after birth; von Sydow, 1999) are, along with puberty and menopause, among the most salient times in a woman's sexual life span. Given their psychological, physical, and hormonal associations, these phases are of considerable interest to the study of female sexuality. Past taboos surrounding the sexual functioning of expectant and postpartum mothers discouraged research in this area. For example, Reamy and White (1987) point out that traditional obstetrics textbooks prohibited sexual intercourse from 6 weeks before to 6 weeks after delivery. With more accurate scientific information about the negligible risk posed by pre- and perinatal sexual activity, these taboos have been relaxed considerably over the last half-century. This article provides an overview of past and current literature on how breastfeeding, and the hormonal changes associated with it, influence maternal sexual functioning during the postpartum period. Other reviews have described normative sexual practices during pregnancy and the postpartum period (e.g., von Sydow, 1999) but, to our knowledge, no review has incorporated the current understanding of hormonal factors.

In general, sexual functioning typically declines during pregnancy, and remains low during the postpartum period for many women. It is often a year post birth before pre-pregnancy levels of sexual interest and activity are regained (Alder & Bancroft, 1988). During the postpartum period, maternal sexuality may be affected by any number of variables, including hormonal changes, breastfeeding, psychosocial variables such as energy level, body image, well-being, sexual attitude, adjustment to changes in social roles, relationship quality, and mood changes that may be experienced by either the new mother or her sexual partner (De Judicibus & McCabe, 2002).

Sexual difficulties experienced postpartum by the new mother and/or her partner can cause much distress, due in part to the influence of sexual functioning on quality of life, physical and mental well-being, and relationship functioning. This last issue has far-reaching implications as lack of communication and understanding about one's sexual relationship can escalate to greater relationship problems. A decline in postpartum sexual functioning may be particularly troublesome if sexual expression has previously been highly valued and integral to the woman's self-concept and relationship with her partner. In other cases, changes in sexual desire and expression may be egosyntonic, whereby any decline in sexual functioning by the woman does not interfere with her well-being or cause distress. …