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背景:妇女产后的性健康是生殖健康的重要部分,在中国由于性知识,性健康保健服务的缺乏,加之传统观念的影响,医务人员及妇女本人对产后性健康的关注、讨论较少。目的:了解妇女产后各种不同类型性问题的发生率、产后性交疼痛发生的相关因素以及在产后保健服务中对性健康的重视状况。设计:横断面调查,3～6个月随访。单位:重庆医科大学生殖医学系。对象:2000-11/2001-07在重庆医科大学附属第一临床学院产科分娩活胎的初产妇798名,及陪妻子来院随访的丈夫79名。方法:采用横断面调查方法,在门诊对产后6个月的初产妇及部分产妇的丈夫以面谈方式进行性健康问卷调查,并进行妇科检查及必要的心理咨询与治疗。主要观察指标:①产后性生活的主要变化。②产后性问题及其相关因素。结果:符合纳入、排除标准的初产妇共798名,通过电话或信件通知,来院接受随访调查者460名。①产后性生活的主要变化:94.7%初产妇于产后6个月内恢复性生活,与孕前1年相比,产后3～6个月内的性生活次数明显减少,有66.0%的妇女产后性欲下降。②产后性问题及其相关因素:妇女性问题的发生率较产前明显增加。其中,产后3个月内70.6%存在性问题,产后4～6个月下降为55.6%,产后6个月时降至34.2%,但未恢复到妊娠前(7.2%)的水平。产后常见的女性性问题有性交疼痛、阴道干涩、性高潮障碍、阴道松弛等;其中,性交疼痛发生率占第1位。产后4～6个月内,性交疼痛与当前是否正在哺乳、传统性观念及孕前性交疼痛史明显相关,而与分娩方式无显著关系。③性保健服务及妇女产后性咨询情况:产后42d接受产科随访时,仅20.8%的妇女从卫生保健人员得到有关的性健康知识。在有产后性问题的妇女中,与卫生保健人员讨论过该问题者仅为8.0%。④丈夫对妇女产后性问题的了解情况:有59.2%的丈夫知道妻子有产后性问题,但仅有8.1%的丈夫曾就此问题进行过医学咨询。结论:产后性健康问题发生率为70.6%,产后性生活质量与分娩方式无关,但产后保健服务中性健康未得到应有重视,更缺乏专业人员提供咨询与治疗,产后保健中男方的参与有利于妇女产后性问题的预防和治疗。
BACKGROUND: The postnatal sexual health of women is an important part of reproductive health. Due to the lack of sexual knowledge and sexual health care services in China and the influence of traditional concepts, the medical staff and women themselves have less concern about postpartum sexual health. OBJECTIVE: To understand the incidence of various types of postpartum women’s postpartum problems, related factors of postpartum intercourse pain, and the status of sexual health in postnatal care services. Design: Cross-sectional survey, 3 to 6 months follow-up. Unit: Department of Reproductive Medicine, Chongqing Medical University. PARTICIPANTS: A total of 798 primipara from obstetric delivery of live births at the First Affiliated Hospital of Chongqing Medical University between 2000-11 and 2001-07, and 79 husbands who accompanied their wives to hospital. Methods: The cross-sectional survey method was used to carry out the questionnaire of sexual health among interviewees of primipara and part-time mothers of 6 months postpartum in outpatient interviews, gynecological examinations and necessary psychological consultation and treatment. MAIN OUTCOME MEASURES: ① major changes in postpartum sexual life. ② postpartum problems and related factors. Results: A total of 798 primiparae who met the inclusion and exclusion criteria were asked by telephone or mail to come to the hospital to receive 460 follow-up investigators. ① The main changes of postpartum sexual life: 94.7% of primipara recovered within 6 months after delivery, and compared with 1 year before pregnancy, the number of sexual life within 3 ~ 6 months postpartum was significantly reduced, 66.0% of women postpartum libido decline. ② Postpartum problems and related factors: The incidence of women’s sexual problems than prenatal significantly increased. Among them, 70.6% of the patients were experiencing problems within 3 months after delivery, 55.6% from 4 to 6 months after delivery and 34.2% within 6 months after delivery, but did not return to the level before pregnancy (7.2%). Common postpartum women sexual intercourse pain, vaginal dryness, orgasmic disorders, vaginal relaxation, etc .; of which, the incidence of intercourse pain accounted for the first one. Postpartum 4 to 6 months, sexual intercourse pain and whether the current breast-feeding, the traditional concept and history of preoperative intercourse pain was significantly correlated, but not with the mode of delivery. (3) Sexual health services and women’s postpartum sexual counseling: Only 42% of women received relevant health knowledge from health-care workers at obstetrics follow-up at 42 days postpartum. Among women who had post-partum problems, only 8.0% of those who discussed the issue with health-care providers. ④Husband’s understanding of women’s postpartum sexual problems: 59.2% of the husbands knew that the wife had postpartum sexual problems, but only 8.1% of the husbands had medical consultation on this issue. Conclusion: The incidence of postpartum sexual health problems was 70.6%. The quality of postpartum sexual life was not related to the mode of delivery. However, the postpartum health care services did not receive the attention of neutral health, lack of professional counseling and treatment, and the participation of men in postpartum care was Benefit from the prevention and treatment of post-natal sexual problems of women.