This is a summary of our recently published paper: Vannier, S.A., & Rosen, N. O. (2017). Sexual Distress and Sexual Problems during Pregnancy: Associations with Sexual and Relationship Satisfaction. Journal of Sexual Medicine. doi: 10.1016/j.jsxm.2016.12.239
By Sarah Vannier
This study was part of our research program aimed at identifying ways to improve women’s and couples’ sexual and relationship well-being during pregnancy and the transition to parenthood (Read more here, here, and here). We know that sexual problems are very common during pregnancy. For example, 31% to 58% of pregnant women say that they feel less sexual desire, have more trouble feeling turned on, lubricating, or having an orgasm, and are feeling more genital or pelvic pain [1-4]. Similarly, a study in 2007 surveyed 589 pregnant women and found that a whopping 63% said they were dissatisfied with their sex life . As sexual and relationship satisfaction are closely related, pregnant women who experience sexual problems may be at a higher risk for relationship problems during pregnancy and during the early stages of parenthood.
The main goal of this study was to look at women’s experiences of sexual distress during pregnancy. Sexual distress is defined as negative emotions about your sex life. These negative emotions include guilt, frustration, stress, worry, anger, and embarrassment.
In studies with non-pregnant women, women with more sexual distress tend to be less satisfied with their sexual relationship [6, 7]. Further, women with low sexual desire and high sexual distress were more likely to describe themselves as unhappy with their relationship as compared to women with low desire but no sexual distress . Based on this, we expected that pregnant women who reported sexual distress would be at a higher risk for sexual and relationship dissatisfaction. We also expected that this would be particularly true for women who also reported sexual problems.
What did we do?
We recruited pregnant women online from August 2015 to March 2016 through Facebook, classified ads, word of mouth, and Reddit as part of a larger study on sexuality in pregnancy. To participate women had to be over the age of 18, in a romantic relationship, living in the United States or Canada, and fluent in English. Women completed online questionnaires measuring their sexual functioning, sexual distress, sexual satisfaction, and relationship satisfaction. They also answered questions about the demographics (e.g., age, education, income) and characteristics of pregnancy (e.g., how many weeks pregnant they were).
What did we find?
We looked at the data from 261 women. Women ranged in age from 19 to 41 years old (average = 28) and were between 4 and 40 weeks pregnant (average = 23). The average relationship length was just under seven years.
- Overall, 42% of women reported sexual distress.
- Among sexually active women (230 women):
- 36% reported sexual problems.
- 26% reported sexual distress and sexual problems.
- 14% reported sexual distress but not sexual problems.
- Women who reported sexual distress, sexual problems, or both, also reported lower sexual and relationship satisfaction compared to pregnant women with lower sexual distress and fewer sexual problems.
What does it mean?
The main take-home message from this study is that sexual distress is common during pregnancy and associated with lower sexual and relationship satisfaction. There are several possible reasons why many pregnant women experiencing sexual distress. In addition to an increase in sexual problems, many pregnant women say that they experience changes in their body image. In non-pregnant women, negative changes in body image have been linked with feelings of sexual distress. Some pregnant women may also find it difficult to reconciling the changing sexual and maternal parts of their self-identity. For example, thinking of themselves as both a mother and a sexual person. This might translate to feelings of guilt, frustration, worry, and embarrassment about sexuality, and might be linked with lower reduced sexual and relationship satisfaction, even in the absence of sexual problems.
We also found that sexual problems or distress alone may be enough to have a negative impact on women’s broader sexual and relationship well-being. It is possible that pregnant women who experience problems or distress are more likely to avoid sexual intimacy, and in non-pregnant samples this type of avoidance is linked with poorer sexual and relationship satisfaction [8,9].
Overall, this study suggests that there is a need for education and interventions aimed at minimizing sexual distress alone or with sexual problems among pregnant women. We encourage health care providers to ask pregnant women about feelings of sexual distress regardless of their level of sexual functioning. Pregnant women may benefit from conversations in which their health care providers normalize the discussion of sexuality in the context of their broader well-being. Further, sex therapy that incorporates cognitive-behavioral techniques can reduce sexual distress among women with sexual dysfunction  and may also be valuable for women experiencing sexual distress or problems during pregnancy.
What is next?
As with all research it is important to consider the limitations of this study. Our measure of sexual problems could only be scored for women who had engaged in sexual activity in the past four weeks. This means that women who were not sexually active were left out of our main analyses. Our sample was mostly heterosexual, married, and in female-male relationships, which limits our ability to generalize to pregnant women more broadly. The data were cross-sectional, which means we only collected data at one time-point. This means that we cannot make conclusions about the directionality of associations between variables. For example, does sexual distress lead to lower sexual satisfaction, or are women with lower sexual satisfaction increase the risk of feeling sexual distress? Finally, we surveyed only pregnant women, but obviously sexual and romantic relationships are interpersonal and each partner affects the other person’s experience. The way a partner responds to sexual changes and distress during pregnancy may contribute to women’s experiences, and vice versa.
Our future plans include longitudinal research so we can look at the associations between distress and sexual and relationship satisfaction over time, and the links between sexual distress, sexual problems, and sexual and relationship satisfaction from pregnancy to the postpartum. We are also currently recruiting for a study of couples going through the transition to parenthood which will let us look at how one partner’s experience of sexual problems and sexual distress affects the other partner’s sexual and relationship well-being. Find out more about this study here.
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