Sexual Health Education During Pregnancy

Overview

This experimental, randomized controlled, single-blind study includes intervention and control groups. Pregnant women between 16 and 20 weeks of gestation who meet the inclusion criteria and agree to participate will be included in the study. Pregnant women will be randomly assigned to groups. Pre-test data will be collected from both groups. The intervention group will receive sexual counseling training in two sessions, face-to-face and in groups, until week 22. Second test data will be collected after week 37 (before delivery), and final test data will be collected three months after delivery. This study is expected to have a significant impact on women's lives, as this topic is considered taboo in our country, leading to a lack of open discussion and the prevalence of misconceptions and false beliefs (sexual myths).

While it varies from woman to woman, there is generally a decrease in the frequency of sexual intercourse in the first trimester due to decreased libido, and avoidance of sexual intercourse is quite common in the first three months due to the belief that it is associated with a risk of miscarriage. The belief that partners may harm the fetus during sexual intercourse is another important factor that negatively affects men's sexual desire and arousal and reduces the quality of sexual intercourse. Conversely, the results of some studies suggest that sexual intercourse is most comfortable in the first trimester. In their study with pregnant women, Khalesi et al. (2018) reported that pregnant women's interest in sexuality decreased in the first trimester, increased in the second trimester, and decreased again in the third trimester. In the same study, it was found that the frequency of sexual activity reached lower levels in the early stages of pregnancy and in the third trimester, and it was reported that 90% of pregnant women did not have sexual intercourse in the last four weeks of pregnancy. During pregnancy, a decrease in sexual intercourse and a lack of interest in sexuality are the most common occurrences. Studies have shown that the decrease in the frequency of sexual intercourse and sexual desire during pregnancy varies between 40% and 100%. Pregnant women whose sexual life quality is negatively affected also experience negative impacts on their marital harmony. Maintaining a healthy and happy sexual life is crucial for the continuation of a marriage. Deterioration in sexual life and marital harmony during pregnancy continues to cause problems between couples in the postpartum period. With childbirth, estrogen decreases, while oxytocin and prolactin hormones increase. The effect of increased prolactin on the decrease in androgen hormones leads to decreased sexual desire and arousal. In the postpartum period, decreased estrogen causes problems such as decreased vaginal lubrication, dryness, and decreased vaginal congestion, leading to dyspareunia and decreased/avoidant sexual desire; decreased sexual desire is the most common problem in the postpartum period. In our culture, during the period called postpartum, women try to adapt to their new lives, and avoiding sexual intercourse is common due to the risk of postpartum bleeding and infection related to episiotomy. Additionally, mothers face many challenges during the postpartum period, trying to adjust to their new lives. Fatigue, insomnia, and difficulties with breastfeeding increase susceptibility to symptoms such as depression, anxiety, and stress. These mental health issues can lead to communication problems, withdrawal, and estrangement from their spouses. These problems negatively impact the marital harmony of the couple. Mental health issues can also lead to decreased sexual activity, and antidepressant medications used during treatment can cause orgasm problems. Sexual myths are also one of the reasons why sexual life is negatively affected during pregnancy . Misinformation believed to be true causes pregnant women to distance themselves from sexuality. Breastfeeding also has an impact on sexual life during the postpartum period. Problems such as milk leakage from the breasts during intercourse, the mother feeling unattractive, breast tenderness due to enlargement, and cracked nipples also negatively affect sexual intercourse . One study reported that breastfeeding women experienced more dyspareunia than non-breastfeeding women, and that non-breastfeeding women had greater sexual satisfaction . Various studies on the time required for sexual life to return to normal in the postpartum period are available in the literature. One study found that breastfeeding women experienced more sexual dysfunction in the first 4 months after childbirth . Sexual counseling education plays a crucial role in resolving issues related to sexual life that arise during pregnancy and the postpartum period. In our country, routine sexual counseling education during pregnancy and the postpartum period is insufficient. Since sexuality is often overlooked in our country, it is essential to provide couples with sexual counseling education starting from pregnancy and to continue monitoring them in the postpartum period, including an assessment of their sexual life quality. Several models have been developed for providing sexual counseling education.