The relationship between types of childbirth, body image, and sexual function in postpartum women

Document Type : Original Article


1 Department of Nursing and Midwifery, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran

2 Soran Technical College, Erbil Polytechnic University, Kurdistan Region-Iraq

3 CPD Department, General Directorate of Health, Ministry of Health, Kurdistan Region-Iraq

4 College of Nursing, University of Duhok, Kurdistan Region-Iraq


Background: Body image (BI) and sexual functioning can be affected by the rapid and significant physical changes that occur during pregnancy and postpartum.
Objectives: This study investigated the relationship between mode of delivery, BI, and sexual function in postpartum women.
Methods: This cross-sectional study was conducted between September and November 2021. A total of 203 postpartum women from five health centers in Sanandaj, Iran, were conveniently selected to enroll in this study. Data were collected using an instrument with four sections: demographic data, the Female Sexual Function Index (FSFI), and the Cash and Pruzinsky Multidimensional Body-Self Relations Questionnaire (MBSRQ). Descriptive statistics and binary logistic regression were used to analyze the data.
Results: In total, 112 and 91 women had a history of normal vaginal delivery (NVD) or cesarean section (CS), respectively. Compared with the NVD group, women in the CS group had a lower MBSRQ mean (251.95±27.99 vs. 236.75±35.22) and a slightly lower FSFI mean (68.43±9.62 vs. 70.63±11.67). Age of marriage, education (none-academic), occupation (employed), method of contraception (tubectomy), husband's occupation (unemployment), number of children (3-4), FSFI score and MBSRQ score were shown as effective factors on type delivery (P≤0.05).
Conclusion: This study showed that women who had a CS were less satisfied with their BI than those who had a NVD. However, the two groups did not differ significantly in terms of their sexual function.


Main Subjects

  1. World Health Organization. Sexual health and its linkages to reproductive health: an operational approach. 2017. Available from: [Last access date: 4 October 2023]
  2. McCool-Myers M, Theurich M, Zuelke A, Knuettel H, Apfelbacher C. Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms. BMC Womens Health 2018;18(1):108. doi:10.1186/s12905-018-0602-4 PMid:29929499 PMCid:PMC6013982
  3. Zielinski R, Kane Low L, Smith AR, Miller JM. Body after baby: a pilot survey of genital body image and sexual esteem following vaginal birth. Int J Womens Health 2017;9:189-198. doi:10.2147/IJWH.S123051PMid:28450789 PMCid:PMC5399976
  4. Alp Yilmaz F, Avci D, Arzu Aba Y, Ozdilek R, Dutucu N. Sexual Dysfunction in Postpartum Turkish Women: It's Relationship with Depression and Some Risk Factors. Afr J Reprod Health 2018; 22(4):54-63. doi: 10.29063/ajrh2018/v22i4.6. PMID: 30632722.
  5. Burychka D, Miragall M, Baños RM. Towards a Comprehensive Understanding of Body Image: Integrating Positive Body Image, Embodiment and Self-Compassion. Psychol Belg 2021;61(1):248-261. doi:10.5334/pb.1057 PMid:34394951 PMCid:PMC8323527
  6. Mbada C, Ehinomen JO, Mbada KA, Akinwande OA, Adeyemi AB, Orji OE, et al. Body Image and Health-Related Quality of Life of Nigerian Nulligravid, Pregnant, and Postpartum Women. Women's Health Bulletin 2020; 7(1):39-47.
  7. Wallis K, Prichard I, Hart L, Yager Z. The Body Confident Mums challenge: a feasibility trial and qualitative evaluation of a body acceptance program delivered to mothers using Facebook. BMC Public Health 2021; 21(1):1052. doi:10.1186/s12889-021-11126-8
    PMid:34078356 PMCid:PMC8173806
  8. Przybyła-Basista H, Kwiecińska E, Ilska M. Body Acceptance by Pregnant Women and Their Attitudes toward Pregnancy and Maternity as Predictors of Prenatal Depression. Int J Environ Res Public Health 2020;17(24). doi:10.3390/ijerph17249436
    PMid:33339240 PMCid:PMC7766827
  9. Gutzeit O, Levy G, Lowenstein L. Postpartum Female Sexual Function: Risk Factors for Postpartum Sexual Dysfunction. Sex Med 2020;8(1):8-13. doi:10.1016/j.esxm.2019.10.005 PMid:31837965 PMCid:PMC7042171
  10. Gumusay M, Erbil N, Demirbag BC. Investigation of sexual function and body image of pregnant women and sexual function of their partners. Sex RelationTher 2021, 36(2-3):296-310. doi:10.1080/14681994.2021.1883580
  11. Youseflu S, Rostami F, Yousefi Afrashteh M, Bayat Z, Rastegari L. The Effect of Body Image Satisfaction on Women's Sexual Function in Postpartum Period. Prev Care Nurs Midwifery J 2019; 8(4):27-31. doi:10.29252/pcnm.8.4.27
  12. Shemshadi H, Shams A, Sahaf R, Shamsipour Dehkordi P, Zareian H, Moslem AR. Psychometric Properties of Persian Version of The Multidimensional Body-self Relations Questionnaire Among Iranian Elderly. Iran J Age 2020; 15(3):298-311. doi:10.32598/sija.
  13. Daescu AC, Navolan DB, Dehelean L, Frandes M, Gaitoane AI, Daescu A, et al. The Paradox of Sexual Dysfunction Observed during Pregnancy. Healthcare (Basel) 2023;11(13):1914. doi:10.3390/healthcare11131914 PMid:37444748 PMCid:PMC10341396
  14. Senobari M, Azmoude E, Mousavi M. The relationship between body mass index, body image, and sexual function: A survey on Iranian pregnant women. Int J Reprod Biomed 2019;17(7):503-512 doi:10.18502/ijrm.v17i7.4862 PMid:31508576 PMCid:PMC6718881
  15. Ghassamia M, Asghari A, Shaeiri MR, Safarinejad MR. Validation of psychometric properties of the Persian version of the Female Sexual Function Index. Urol J 2013;10(2):878-85. PMID: 23801471.
  16. Pasupuleti S, Kumar MS. Comparison of body image dissatisfaction in postpartum mothers after normal and caesarean delivery. Indian J Priv Psychiatry 2020;14(1):12. doi:10.5005/jp-journals-10067-0056
  17. Tavakoli M, Hasanpoor-Azghady SB, Farahani LA. Predictors of mothers' postpartum body dissatisfaction based on demographic and fertility factors. BMC Pregnancy Childbirth. 2021;21(1):8. doi:10.1186/s12884-020-03501-x PMid:33402110 PMCid:PMC7784021
  18. Dryer R, Graefin von der Schulenburg I, Brunton R. Body dissatisfaction and Fat Talk during pregnancy: Predictors of distress. J Affect Disord 2020;267:289-296. doi:10.1016/j.jad.2020.02.031 PMid:32217229
  19. Musabeyezu J, Santos J, Niyigena A, Uwimana A, Hedt-Gauthier B, Boatin AA. Discharge instructions given to women following delivery by cesarean section in Sub-Saharan Africa: A scoping review. PLOS Glob Public Health 2022;2(4):e0000318. doi:10.1371/journal.pgph.0000318 PMid:36962191 PMCid:PMC10021225
  20. Lovering ME, Rodgers RF, George JE, Franko DL. Exploring the Tripartite Influence Model of body dissatisfaction in postpartum women. Body Image 2018;24:44-54. doi:10.1016/j.bodyim.2017.12.001 PMid:29258016
  21. Alesheikh A, Jaafarnejad F, Esmaily H, Asgharipour N. The relationship between mode of delivery and sexual function in nulliparous women. J Midwifery Reprod Heal 2016;4(3):635-643.
  22. Amiri FN, Omidvar S, Bakhtiari A, Hajiahmadi M. Female sexual outcomes in primiparous women after vaginal delivery and cesarean section. Afr Health Sci 2017;17(3): 623-631 doi:10.4314/ahs.v17i3.4 PMid:29085389 PMCid:PMC5656191
  23. Banaei M, Azizi M, Moridi A, Dashti S, Yabandeh AP, Roozbeh N. Sexual dysfunction and related factors in pregnancy and postpartum: a systematic review and meta-analysis protocol. Syst Rev 2019;8(1):161. doi:10.1186/s13643-019-1079-4 PMid:31277721 PMCid:PMC6612152
  24. Eid MA, Sayed A, Abdel-Rehim R, Mostafa T. Impact of the mode of delivery on female sexual function after childbirth. Int J Impot Res 2015;27(3): 118-20. doi:10.1038/ijir.2015.2 PMid:25672800
  25. Ghades S, Kaabia O, Fatnassi MR. Impact de la voie d'accouchement sur la sexualité des primipares. Sexologies 2022;31(4):366-373. doi:10.1016/j.sexol.2022.05.007
  26. Barbara G, Pifarotti P, Facchin F, Cortinovis I, Dridi D, Ronchetti C, et al. Impact of Mode of Delivery on Female Postpartum Sexual Functioning: Spontaneous Vaginal Delivery and Operative Vaginal Delivery vs. Cesarean Section. J Sex Med 2016;13(3): 393-401. doi:10.1016/j.jsxm.2016.01.004 PMid:26857530
  27. Cappell J, Bouchard KN, Chamberlain SM, Byers-Heinlein A, Chivers ML, Pukall CF. Is mode of delivery associated with sexual response? a pilot study of genital and subjective sexual arousal in primiparous women with vaginal or cesarean section births. J Sex Med 2020;17(2):257-272 doi:10.1016/j.jsxm.2019.11.264 PMid:31859234
  28. Shirzad M, Shakibazadeh E, Hajimiri K, Betran AP, Jahanfar S, Bohren MA, et al. Prevalence of and reasons for women's, family members', and health professionals' preferences for cesarean section in Iran: a mixed-methods systematic review. Reprod Health 2021;18(1):3 doi:10.1186/s12978-020-01047-x PMid:33388072 PMCid:PMC7778821
  29. Słabuszewska-Jóźwiak A, Szymański JK, Ciebiera M, Sarecka-Hujar B, Jakiel G. Pediatrics Consequences of Caesarean Section-A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2020;17(21):8031. doi:10.3390/ijerph17218031 PMid:33142727 PMCid:PMC7662709