A scoping review on women’s sexual health in the postpartum period: opportunities for research and practice within low-and middle-income countries

(2022) 19:112 Wood et al. Reproductive Health https://doi.org/10.1186/s12978-022-01399-6 Open Access REVIEW A scoping review on women’s sexual health in the postpartum period: opportunities for research and practice within low‑and middle‑income countries Shannon N. Wood1* , Alexandria Pigott1, Haley L. Thomas1, Chloe Wood2 and Linnea A. Zimmerman1 Abstract Background: Women’s sexual health is generally defined and explored solely in relation to reproductive capacity, and often omits elements of sexual function and/or dysfunction. Concerted focus is given to women’s health during pregnancy; however, women’s sexual health is largely neglected after childbirth. This scoping review explored how the sexual health of postpartum women has been defined, measured, and researched in low- and middle-income countries (LMICs). Methods: Articles eligible for review were those that investigated women’s sexual health during the first 12 months postpartum and were conducted among women aged 15–49 in LMICs. Eligibility was further restricted to studies that were published within the last 20 years (2001–2021). The initial PubMed search identified 812 articles, but upon further eligibility review, 97 remained. At this time, the decision was made to focus this review only on articles addressing sexual function and/or dysfunction, which yielded 46 articles. Key article characteristics were described and analyzed by outcome. Results: Of the final included articles, five studies focused on positive sexual health, 13 on negative sexual health, and the remaining 28 on both positive and negative sexual health or without specified directionality. The most common outcome examined was resumption of sex after childbirth. Most studies occurred within sub-Saharan Africa (n = 27), with geographic spread throughout the Middle East (n = 10), Asia (n = 5), North Africa (n = 3), and crossgeography (n = 1); notably, all five studies on positive sexual health were conducted in Iran. Negative sexual health outcomes included vaginismus, dyspareunia, episiotomy, perineal tears, prolapse, infection, obstetric fistula, female genital cutting, postnatal pain, uterine prolapse, coercion to resume sex, sexual violence, and loss of sexual desire/ arousal. Most studies were quantitative, though eight qualitative studies elucidated the difficulties women endured in receiving information specific to sexual health and hesitance in seeking help for sexual morbidities in the postpartum period. Conclusions: Overall, the evidence base surrounding women’s sexual health in the postpartum period within LMICs remains limited, with most studies focusing solely on the timing of resumption of sex. Integration of sexual health *Correspondence: 1 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Wood et al. Reproductive Health (2022) 19:112 Page 2 of 34 counseling into postnatal care and nonjudgmental service provision can help women navigate these bodily changes and ultimately improve their sexual health. Plain language summary Women’s sexual health is often studied in relation to reproductive health and childbearing. While reproductive health during pregnancy and immediately after is well documented, it remains unclear how women’s sexual health is addressed, particularly within low- and middle-income countries. The aim of this review is to understand how researchers have measured, defined, and examined postpartum sexual health. In October 2021, we searched PubMed database with the following criteria: published in the last 20 years; conducted in a low- or middle-income context; examined sexual function and/or dysfunction among women aged 15–49 within 1 year after childbirth. From this inclusion criteria, we identified 46 relevant articles. Most studies were conducted in sub-Saharan Africa. Only five studies focused exclusively on positive sexual health, and the majority of studies examined the resumption of sex after childbirth. Multiple qualitative studies described women’s reluctance to seek help for postpartum sexual health issues and highlighted the difficulties they faced in receiving information specific to sexual health. Overall, the evidence base surrounding women’s sexual health after childbirth within low- and middle-income contexts is limited. Future research should examine sexual health beyond resumption of sex after childbirth and explore barriers to help-seeking for women experiencing sexual health issues. Further exploration of positive sexual health is needed across contexts. Keywords: Sexual health, Postpartum, Sexual function, Sexual dysfunction Introduction Women’s health is often framed in relation to reproductive capacity, with less attention on the wide spectrum of health outcomes that are both unique to women or disproportionately impact women [1, 2]. The sexual and reproductive health (SRH) field has been largely criticized for underemphasis on the “S” in SRH, where these critiques highlight underinvestment in and lack of policies surrounding women’s sexual health [3, 4]. Sexual health, or “the positive and respectful approach to sexual relationships, including pleasurable and safe sexual experiences, free from coercion, discrimination, or violence” [5], is a cornerstone of Sustainable Development Goal-5 [6], however, indicators notably center around infringements on sexual rights, including sexual violence, child marriage, and female genital cutting (FGC), rather than addressing positive outcomes, such as voluntary resumption of sex or sexual pleasure. Pregnancy and childbirth are profound physical and psychological transition periods for women, and vast literature has documented the impact of pregnancy on women’s sexual health, including the necessity of sexual health counseling during (...truncated)