Decline in Female Sexual Function From Late Pregnancy to Early Postpartum: A Prospective Longitudinal Study in Nicaragua

Background: Sexual function is a key component of maternal well-being and is frequently affected during pregnancy and the postpartum period due to hormonal, physical, and psychosocial changes. Despite its clinical relevance, postpartum sexual dysfunction remains underrecognized in routine care. Objective: To evaluate changes in female sexual function between the third trimester of pregnancy and the early postpartum period and to identify factors associated with postpartum sexual dysfunction. Methods: A prospective longitudinal observational study was conducted on 184 women attending the Department of Gynecology and Obstetrics of a tertiary care center in Nicaragua. Participants were assessed during the third trimester of pregnancy and again at 4-8 weeks postpartum (mean: six weeks) using the Female Sexual Function Index (FSFI). Descriptive statistics were calculated, paired comparisons were performed using Student's t-test, and normality of differences was assessed with the Shapiro-Wilk test. A multivariable Poisson regression model with robust variance was constructed to identify factors independently associated with postpartum sexual dysfunction, estimating adjusted prevalence ratios (aPR). Results: The mean age was 29.6 ± 5.2 years. Mode of delivery was predominantly vaginal (n = 110; 59.8%), with cesarean section accounting for 40.2% (n = 74) of cases. During pregnancy, sexual function was largely preserved (mean FSFI total score: 27.81 ± 2.96, above the clinical threshold of 26.55). In contrast, a marked decline was observed postpartum (mean FSFI total score: 16.64 ± 4.76; p < 0.0001). When the validated cutoff of FSFI < 26.55 was applied, 100% of postpartum participants met criteria for sexual dysfunction. Domain-level analysis showed statistically significant reductions in all six FSFI domains, with the greatest decreases in lubrication (−2.06 points), arousal (−1.71), and desire (−1.69). The prevalence of postpartum sexual dysfunction based on the analytic binary variable was 62.0% (114/184). In the multivariable analysis, university education (aPR = 1.84) and multiparity (aPR = 1.20) were associated with sexual dysfunction. The presence of anxiety or sadness showed the strongest association, increasing the prevalence fivefold (aPR = 5.06). Participation in institutional support groups was associated with a 37% reduction in dysfunction prevalence (aPR = 0.63). Mode of delivery was not significantly associated with postpartum sexual dysfunction (aPR = 1.055; p = 0.479). Conclusions: Female sexual function declines significantly in the early postpartum period, affecting all domains of sexual response. These findings highlight the urgent need for integrated, biopsychosocial approaches to postpartum care, particularly in resource-limited settings where this dimension of maternal health remains systematically overlooked.