• Giussy Barbara, Paola Pifarotti, Federica Facchin, Ivan Cortinovis, Dhohua Dridi, Camilla Ronchetti, Luca Calzolari, and Paolo Vercellini.
• Department of Obstetrics and Gynecology, "G. Fornaroli" Hospital, via Al Donatore di sangue 50, Magenta, Milan, Italy. Electronic address: giussy.barbara@gmail.com.
• J Sex Med. 2016 Mar 1; 13 (3): 393-401.

IntroductionSeveral studies have explored the association between modes of delivery and postpartum female sexual functioning, although with inconsistent findings.AimTo investigate the impact of mode of delivery on female postpartum sexual functioning by comparing spontaneous vaginal delivery, operative vaginal delivery, and cesarean section.MethodsOne hundred thirty-two primiparous women who had a spontaneous vaginal delivery, 45 who had an operative vaginal delivery, and 92 who underwent a cesarean section were included in the study (N = 269). Postpartum sexual functioning was evaluated 6 months after childbirth using the Female Sexual Function Index. Time to resumption of sexual intercourse, postpartum depression, and current breastfeeding also were assessed 6 months after delivery.Main Outcome MeasuresFemale Sexual Function Index total and domain scores and time to resumption of sexual intercourse at 6 months after childbirth.ResultsWomen who underwent an operative vaginal delivery had poorer scores on arousal, lubrication, orgasm, and global sexual functioning compared with the cesarean section group and lower orgasm scores compared with the spontaneous vaginal delivery group (P < .05). The mode of delivery did not significantly affect time to resumption of sexual intercourse. Women who were currently breastfeeding had lower lubrication, more pain at intercourse, and longer time to resumption of sexual activity.ConclusionOperative vaginal delivery might be associated with poorer sexual functioning, but no conclusions can be drawn from this study regarding the impact of pelvic floor trauma (perineal laceration or episiotomy) on sexual functioning because of the high rate of episiotomies. Overall, obstetric algorithms currently in use should be refined to decrease further the risk of operative vaginal delivery.Copyright © 2016. Published by Elsevier Inc.

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