Longitudinal Trajectories and Psychosocial Predictors of Postpartum Sexual Dysfunction from Early Pregnancy to 12 Months Postpartum

<i>Background and Objectives:</i> Pregnancy and the postpartum period profoundly affect female sexual function, yet longitudinal data integrating obstetric and psychosocial domains are scarce. We aimed to chart sexual-function trajectories from early pregnancy to 12 months postpartum and identify predictors of persistent dysfunction. <i>Materials and Methods:</i> In this single-center prospective cohort, 187 pregnant women were eligible to complete the FSFI at three trimesters and at 6-8 weeks, 3 months, and 6-12 months postpartum, plus postpartum PHQ-9, WHOQOL-BREF, and body-image scales. Associations with FSFI-defined dysfunction (FSFI < 26.55) and continuous FSFI were examined, of which 90 women were included for having documented dysfunction. <i>Results:</i> Mean FSFI declined from 27.4 ± 3.9 (first trimester) to a nadir of 20.1 ± 4.2 at 6-8 weeks postpartum, with partial recovery to 25.5 ± 4.0 at 6-12 months (<i>p</i> < 0.001). Depressive symptoms were higher in women with dysfunction (PHQ-9 8.8 ± 3.3 vs. 6.7 ± 3.5; <i>p</i> < 0.001) and correlated inversely with FSFI (r = -0.39; <i>p</i> < 0.001). A multivariable model explained 19% of FSFI variance, with each 1 SD PHQ-9 increase predicting a 1.2-point FSFI decrease (<i>p</i> = 0.005). Body-image disturbance exerted a partially PHQ-9-mediated effect, and three FSFI trajectory clusters showed postpartum dysfunction rates from 28.6% to 89.7%. A combined psychosocial prediction model achieved an AUC of 0.9 with a sensitivity and specificity of 0.8. <i>Conclusions:</i> Postpartum sexual dysfunction was common and persisted in many women at one year; depressive symptoms, body image, and psychological quality of life were more influential than mode of birth, breastfeeding, or pelvic-floor symptoms.