International Journal of Impotence Research (2005) 17, 154–157 & 2005 Nature Publishing Group All rights reserved 0955-9930/05 $30.00 www.nature.com/ijir A prospective analysis of sexual functions during pregnancy G Aslan1*, D Aslan2, A Kızılyar2,C¸I˙spahi2 and A Esen1 1Department of Urology, Dokuz Eylul University School of Medicine, Inciralti, Izmir, Turkey; and 2Department of Obstetrics and Gynecology, SSK Aegean Maternity and Women’s Health Teaching Hospital, Izmir, Turkey The aim of the study was to evaluate the sexual functions during pregnancy using the Female Sexual Function Index (FSFI) questionnaire. Pregnancies were recorded in a prospective cohort study comprising 40 healthy pregnant women. Pregnant women who had a stable relationship with their partner were enrolled in the study when were first diagnosed to be pregnant. During their antenatal visits, subjects were asked to complete the FSFI questionnaire and other information about their sexual life in each trimester. Each FSFI domain score was calculated and mean scores in each domain were compared according to the trimesters of pregnancy. Data of 37 subjects for the first, 36 for the second and 34 for the third trimesters of pregnancy were eligible for the analysis. The mean age was 25.574.5 y; mean parity was 0.470.7 and mean gravity was 1.670.9. The frequency of intercourse attempts during the last 4 weeks was 8.673 before pregnancy, and 6.972.5, 5.472.6 and 2.571.4 in the first, second and third trimesters of pregnancy, respectively. In all domains of FSFI, significant decline in domain scores was determined during pregnancy. The comparison of satisfaction and pain domain scores between first and second trimesters showed significant differences. All of the domain scores significantly decreased in the third trimester of pregnancy. Our results showed that sexual functions are significantly decreased during pregnancy and worsen as the pregnancy progresses. Childbearing couples should be given information about the sexual problems and fluctuations in the patterns of sexuality during pregnancy. International Journal of Impotence Research (2005) 17, 154–157. doi:10.1038/sj.ijir.3901288 Published online 11 November 2004 Keywords: pregnancy; women; sexuality; female sexual disorder; FSFI Introduction loss of interest, physical awkwardness, painful coitus and perceived lack of attractiveness.5,9–12 The association between pregnancy and sexual Female sexual dysfunction is an age-related and dysfunction has been shown in the literature; 1 common problem, affecting 20–50% of women. A however, most of these studies are of cross-sectional combination of biological and psychological risk or retrospective rather than prospective study de- factors has been suggested in the etiology of sexual sign.9 Results from different studies may not be 2 dysfunction. Problems with sexual function have directly comparable, because different methods and also been reported to occur commonly in pregnant definitions were used to evaluate sexual functions 3–9 women. An overall decline in sexual activities in pregnancy. It is also difficult to quantify the 3–10 with increasing gestation has been shown. severity of symptoms. More quantitative measure- Several factors have been suggested to contribute ments are needed on this issue. to a decline in sexual activity during pregnancy, Studies that assess the key dimensions of sexual including physical discomfort, fear of injury to baby, function during pregnancy using multidimensional instruments are lacking. In this perspective, we used the Female Sexual Function Index (FSFI) question- naire13 to evaluate sexual function in this long- itudinal cohort study in a group of healthy pregnant *Correspondence: G Aslan, Department of Urology, Dokuz women undergoing routine antenatal visits. Eylul University School of Medicine, 35340 Inciralti, Izmir, Turkey. E-mail: [email protected] or [email protected] Preliminary results of this study were presented as poster Materials and methods presentation at the 5th ESSIR Congress 2002, Hamburg, Germany. Received 21 June 2004; revised 11 October 2004; accepted The institutional review board approval was taken 12 October 2004 before the initiation of this study and all subjects Sexual functions during pregnancy G Aslan et al 155 provided written consent. Pregnancies were re- the third trimesters of pregnancy were eligible for corded in a prospective cohort study comprising the analysis. 40 healthy pregnant women. Pregnant women who All of the participants were Caucasian. The mean had a stable relationship with their partner were age was 25.574.5 y; mean parity was 0.470.7 and included in this study. Patients were enrolled in mean gravity was 1.670.9. A total of 28 women the study when were first diagnosed to be pregnant. were null parity. At this initial admission and during each antenatal The frequency of intercourse attempts during visit, the patients were asked to complete the the last 4 weeks was 8.673 before pregnancy, and FSFI questionnaire and other information 6.972.5, 5.472.6 and 2.571.4 in first, second about their sexual life in each trimester. Routine and third trimesters of pregnancy, respectively. antenatal follow-up was performed throughout the The frequency of intercourse attempts was signifi- pregnancy. cantly decreased with the increasing gestational age Women with fetal–maternal complications or any (Figure 1). comorbid conditions occurring during the preg- Domain scores of FSFI before pregnancy and nancy such that they should refrain from sexual according to the trimesters of pregnancy are shown activities were excluded from the study. Gestational in Table 1. Lower scores were observed as the age was determined from the last menstrual cycle gestational age increased. In all domains of FSFI, and was verified with ultrasound scan measure- significant decreases in domain scores were deter- ments. mined during pregnancy. All subjects were asked to complete FSFI ques- When the domain scores were compared accord- tionnaire forms during the visits in the outpatient ing to each trimester of pregnancy, significant rooms, alone. FSFI is a validated and reliable differences were determined in all domains of FSFI measure for female sexual function.13 It has 19 except for desire, arousal, lubrication and orgasm, questions, which assess the six domains of sexual which were not significantly different between the function including desire, arousal, lubrication, first and second trimesters of pregnancy. orgasm, satisfaction and pain.13 Score ranges for items 3–14 and 1–19 are 0–5 and for items 1, 2, 15 and 16 are 1–5.13 The composite score is determined by the sum of the domains multiplied by the domain factor. The full-scale score range is from 2 to 36 with higher scores associated with a lesser degree of sexual dysfunction. Subjects were also asked to report their frequency of intercourse by responding to the following question: how often did you experience sexual intercourse attempt during the last month? Individual responses were tabulated onto a com- puter database. Each FSFI domain score was calculated and mean scores in each domain were compared according to the trimesters of pregnancy. Data were represented as mean7standard deviation. For comparison of mean scores in pregnant women, the Friedman test was used. The comparison of scores between the first, second and third trimesters Figure 1 Frequency of intercourse before and during pregnancy. of pregnancy was performed using Wilcoxon’s signed-rank test. Differences were considered statis- tically significant at Po0.05. Table 1 Domain scores before and during the trimesters of pregnancy (mean7s.d.) FSFI Before Trimester Trimester Trimester P* Results domain pregnancy 1 2 3 n ¼ 40 n ¼ 37 n ¼ 36 n ¼ 34 The initial study sample consisted of 40 convenient Desire 4.670.9 4.070.9 3.870.6 370.8 samples of gravid women recruited for this prospec- Arousal 4.971 4.471.1 4.170.9 371.2 tive study. Three women in the first trimester, one Lubrication 5.670.6 5.170.9 4.870.9 3.671.4 Orgasm 5.470.8 4.871.2 4.671 3.571.4 woman in the second trimester and two women in Satisfaction 5.770.5 5.370.8 570.9 4.171 the third trimester were excluded from the study Pain 5.271 4.871.1 4.171.3 3.271.6 due to maternal–fetal comorbid conditions occur- Total 31.474 28.475 26.374.4 20.676.2 ring through the pregnancy. Thus, data of 37 subjects for the first, 36 for the second and 34 for *Po0.000 for all domains in the Friedman test. International Journal of Impotence Research Sexual functions during pregnancy G Aslan et al 156 Discussion as shown in our study.3–5 Dysparenia is reported to be experienced by 22–50% of the pregnant women.9 In the present study, pain was determined It is widely accepted that pregnancy has some to rise as the gestation increased. Our results influences on the sexual behavior of women. A are in agreement with these reports showing decline in sexual activity is reported during preg- general decline in sexual functions during preg- nancy.6,9,10,14 The physiologic and psychological nancy. However, it should be stressed that changes that occur during pregnancy may affect since different definitions and methods are used sexual function and satisfaction as well. Sexuality in most of these studies, our results may not be and sexual activity among pregnant women have directly comparable. Normative data on the sexual been extensively studied in the literature. However, functions of pregnant women are scarce. Prospective prospective studies assessing the sexual function studies evaluating pregnant women with quantita- during pregnancy are limited. In our study, we have tive and valid instruments to establish normative designed a prospective cohort study to evaluate data on sexual function in this population are sexual function during pregnancy and we have needed.