Sexual function in breastfeeding women: a systematic review

Sexual function during breastfeeding is a clinically significant but under-researched aspect of postpartum health. Hormonal, physical, psychological, and social changes may influence women’s sexual function, affecting marital satisfaction and quality of life. This systematic review aimed to synthesize evidence on sexual function in breastfeeding women and the factors contributing to its variations. A comprehensive search was conducted in Persian (SID, MAGIRAN) and international databases (Medline, Scopus, Web of Science, Science Direct, Cochrane Library, Google Scholar) for studies published between 2010 and 9 August 2025. Quantitative and qualitative studies reporting on sexual function, psychological, emotional, and physical effects, and quality of life in breastfeeding women were included. Methodological quality was assessed using the NICE checklist, which was selected due to its comprehensiveness and applicability to both quantitative and qualitative studies, while other common tools such as JBI and Cochrane Risk of Bias exist. Following screening, 22 studies were included. Narrative synthesis was used to address heterogeneity in study designs, outcomes, and populations. Findings indicate that breastfeeding is associated with changes in sexual function, including decreased libido, vaginal dryness, dyspareunia, and reduced sexual satisfaction, with prevalence estimates ranging from 60% to 80% across studies. Hormonal factors, particularly increased prolactin and decreased estrogen, contributed significantly during the early postpartum months. Psychological factors such as stress, postpartum depression, and body image concerns also affected sexual function. Social and relational factors, including partner support and cultural expectations, moderated these effects. Notably, some women reported positive experiences, such as increased emotional intimacy and improved relationship satisfaction, particularly when adequate social and psychological support was available. Sexual function during breastfeeding results from a complex interplay of hormonal, psychological, social, and relational factors. Although many women face challenges, supportive environments and educational or counseling interventions can mitigate negative effects and enhance marital satisfaction. These findings highlight the need to integrate sexual health counseling into postpartum care programs, emphasizing both physiological and psychosocial dimensions to optimize women’s overall postpartum well-being. (PROSPERO: CRD42025637151)