A Biopsychosocial Approach to Persistent Postpartum Pain and Postpartum Sexual Function

Abstract

Recently, there has been a push for a maternal-focused model of postpartum care; however, this model of care tends to focus on postpartum depression. Two issues that are related to postpartum depression but may go unaddressed by health-care professionals are persistent postpartum pain (PPP) and postpartum sexual function. Traditionally, these issues have been investigated using a biomedical approach. With a biomedical approach, PPP is attributed to tissue damage during childbirth, and sexual problems emerge due to an overemphasis placed on the (heteronormative) functionality of the genitals. However, the biomedical model provides insufficient explanations for PPP and postpartum sexual function. Therefore, the primary goal of the current studies was to apply a multidimensional framework to the study of PPP and postpartum sexual function using comprehensive conceptualizations of “pain” and “sexual function”. A secondary goal was to elucidate the relationships among postpartum depression, PPP, and sexual function by investigating the role of potential mediating variables. Women within one year postpartum completed an online survey. In Study 1, pain characteristics of PPP (pain persisting for two months or more) were described. Women with PPP were compared to women whose pain resolved within two months postpartum on birth-related physical and psychosocial factors. The results of Study 1 indicated that PPP is pervasive in nature and more common after a Caesarean section. Somatization (functional impairment) was the only biopsychosocial factor to significantly predict PPP, and it mediated the relationship between depressive symptoms and PPP. Study 2 examined the role of birth-related physical, psychological, and relationship variables on several facets of postpartum sexual function. In this study, fatigue and relationship satisfaction predicted sexual function as well as independently mediated the relationship between depressive symptoms and postpartum sexual function. The results of the current studies indicate that PPP and postpartum sexual function are best addressed using a multidimensional approach, which goes well beyond the biomedical model that is so commonly used in the current literature. Furthermore, the results of these studies have significant implications for health-care providers with respect to what information should be integrated into pre- and postpartum health-care.