**Author details**

**Prenatal Care**

106 Sexology in Midwifery

**Intrapartum**

**Postpartum**

screening questionnaire.

• Consider alternative positions.

validated pain scale [114].

of anal sphincter lacerations. • Limit the use of episiotomy.

• Determine whether dysfunction was present before pregnancy.

• Repair perineal lacerations with synthetic absorbable suture.

• Assess for presence of urinary and anal incontinence symptoms.

• Assess for postpartum mood changes, adequate rest, and time for intimacy.

• Assess perineal repair if dyspareunia is present.

• Evaluate presence of depression during pregnancy.

• Discuss changes in anatomy, physiology, and sexual function that commonly occur during pregnancy. • Discuss the likely safety of continuing sexual activity throughout pregnancy for most women.

• Careful postpartum examination to increase the detection and repair of anal sphincter lacerations.

• Discuss perineal pain, dyspareunia, and initiation of postpartum sexual activity before hospital discharge.

• Encourage vaginal lubricants, particularly in breastfeeding women with a physiologic hypoestrogenic state.

**Table 4.** Clinical approach for prevention, evaluation and treatment of postpartum sexual concerns Leeman et al. [79]

Leeman and his colleagues [79] have offered the possibility of perineal massage as an option to minimize perineal trauma and postpartum pain. There are also many other things we can advise women to practice in order to minimize the risk of birth injury or to prepare her body optimally. One of them is pelvic floor exercise, formerly known as Kegel exercise. Research shows that exercising the pelvic floor muscles during pregnancy makes it less likely that urinary incontinence will occur after birth [104]. Continuing these exercises after pregnancy can help to prevent long-term problems, such as prolapse. Both prolapse and urinary incon‐ tinence have a great impact on altered sexual life [21]. What seems to be missing from Leeman et al.'s [79] intrapartum list is also the way that the second stage is delivered, the use of unnecessary actions to speed the birth process and not letting the nature taking its course, which are all influences on birth outcomes that have an impact on pain and subsequently on sexual life postpartum. A study confirms that midwifery-led care is associated with low rates of episiotomy and operative delivery and very low rates of postpartum pain measured by a

Optimal sexual health for women consists of a variety of physical and psychological factors, and open dialogue to encourage women to discuss these sensitive issues should be part of routine maternity care. Endocrine and psychosomatic factors as well as anatomical changes

• Assess sexual function and address concerns, including considering the use of a brief sexual function

• Judicious use of operative vaginal delivery and selection of vacuum rather than forceps will decrease the incidence

• Discuss option of perineal massage to minimize perineal trauma and postpartum pain.

Teja Škodič Zakšek\*

Address all correspondence to: teja.zaksek@zf.uni-lj.si

Ljubljana University, Health Faculty, Midwifery Department, Slovenia

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