Genitourinary Symptoms in Breastfeeding Postpartum Women

Objectives: Studies report high levels of sexual dysfunction in postpartum women; however, little is known regarding the effect of breastfeeding versus formula feeding on sexual function. Furthermore, there are minimal data on postpartum women’s desire for treatment of sexual dysfunction. We aimed to evaluate sexual function and genitourinary symptoms in postpartum women based on infant feeding status as well as assess desire for treatment.

Methods: We performed a cross-sectional observational study of English-speaking adult women 5-6 months postpartum following singleton delivery at one large academic medical center. Patients with episiotomy, operative delivery or 3rd/4th degree lacerations were excluded. Female Sexual Function Index (FSFI) and Day-to-day Impact on Vaginal Aging (DIVA) questionnaires and interest in treatment were collected. Participants were grouped based on self-reported breastfeeding status into two cohorts: 1) primarily breastfeeding and 2) primarily formula feeding. Standardized differences (SD) between breastfeeding and formula feeding women were reported wherein SD of 0.2, 0.5 and 0.8 denote small, medium, and large effect sizes, respectively. SD less than 0.2 is not meaningfully different.

Results: 125 women were recruited with 61(49%) breastfeeding and 64 (51%) formula feeding. Median age was 33 (IQR 8) in breastfeeding and 30 (IQR 10) in formula feeding cohorts with overall 54% identifying as African American (Table 1). Compared to formula feeding women, breastfeeding women were less likely to be African American (47% vs 79%; SD 0.8) or have Medicaid insurance (28% vs 66%; SD 0.9). No other large differences in demographics were noted between the two cohorts. Both cohorts reported similarly high rates of resumption of sexual activity in the postpartum period (breastfeeding 75%, formula feeding 78%; SD 0.06). Breastfeeding women had significantly lower total FSFI score (20.8 vs 24.5, p=0.009) as well as significantly lower scores in domains of desire, arousal, orgasm, and satisfaction (Figure 1). Both cohorts had low bother of vaginal symptoms on DIVA questionnaire and low interest in treatment of symptoms (Breastfeeding 26%, Formula feeding 16%) with breastfeeding group reporting higher interest in use of vaginal lubricants (69% vs 30%, SD 0.8).

Conclusions: Despite overall low FSFI scores indicating worse sexual function, both breastfeeding and formula feeding women reported low bother from vaginal symptoms and a low interest in treatment of symptoms.

Table 1: Demographic and Clinical Data
Values listed are Median (IQR), Number (percentage). Standardized differences are reported wherein SD of 0.2, 0.5 and 0.8 denote small, medium, and large effect sizes, respectively. SD less than 0.2 is not meaningfully different.

Figure 1: Female Sexual Function Index
Female Sexual Function Index (FSFI) total and sub-domain scores were compared between breastfeeding and bottle-feeding women at 5-6 months postpartum. * denotes p< 0.05.