(511) Prior Sexual Frequency and Ethnicity Contribute to the Return to Sexual Function in Post-Partum Asian Women: A Prospective Longitudinal Study

Introduction The World Health Organization defines secondary subfertility as the inability to have a second child after having a first child and has been reported to be a significant contributing factor to declining birth-rates world-wide. Delayed return to sexual function post-partum can be a cause of secondary subfertility. While some groups have studied the return to post-partum sexual function after one year, research into shorter time-frames has not been well established. In addition, there remains a paucity in research into Asian ethnicities and the factors which may contribute to secondary subfertility. Objective We aimed to establish the factors affecting the return to female sexual function 3-4 months post-partum in a multi-ethnic Asian cohort. Methods A longitudinal prospective study was conducted in a tertiary-care center. 423 women completed sexual health surveys at delivery(Survey 1) and 3-4 months post-partum(Survey 2). FSFI(female sexual function index), FSDS(female sexual distress scale), GMREL(global measure of relationship satisfaction) and GMSEX(global measure of sexual satisfaction) scales were used to assess sexual health at different time-points (3-months pre-pregnancy, delivery, 3-4 months post-partum). ANOVA and Tukey’s post-hoc test were used to determine statistical significance between groups. Results Women were 31.6years on average, with 58.9% Malays (27.6% Chinese,6.3% Indian,7.2% Other Asian descent), 40.8% primiparous, medium education (50.9%), employed(71.8%) with a desk-bound day-job(50.9%). As expected, sexual frequency decreased as pregnancy progressed. In addition, sexual abstinence during confinement(4-weeks for Asian cultures where post-partum women recover) was practiced by most women(69.1%), of all ethnicities. 45% of women felt comfortable resuming sexual intercourse after 6-weeks post-partum with GMSEX(p=0.005) and GMREL(p=0.015) scores being most associated with return to coitus. Majority of women do not use birth control (79.3%), do not feel they need help regarding sexual health (93.4%) nor need to speak to a doctor regarding sexual health (90.1%) as majority of them are multi-parous(59.2%). Pre-pregnancy sexual frequency(p<0.001) and ethnicity (p<0.001), but not parity(p=0.324) nor occupation(p=0.453), were significant predictors of return to sexual intercourse 3-months post-partum (ROC AUC= 0.684). Birth-mode was not associated with post-partum return to sexual intercourse(p=0.244). The reduction in GMREL and GMSEX scores from 3-months pre-pregnancy to delivery to 3-4 months post-partum showed a general reduction in relationship and sexual satisfaction post-partum(p<0.001). As expected, FSFI scores reduce during pregnancy but improve 3-4 months post-partum (p<0.001). All components of FSFI (“arousal”,“lubrication”,“orgasm”,“satisfaction”, “pain”) except for “desire” improved post-partum likely due to fatigue from caregiving/breastfeeding. FSDS scores remained <11 longitudinally, indicating a lack of sexual dysfunction in this cohort which comprised mostly of women in their 2nd or more births. However, information on mode of conception(natural or assisted) was not recorded, which represents a study limitation. Conclusions This study provides new knowledge on the effect of prior sexual behaviors on the return to coitus post-partum. While most studies have analyzed return to coitus 6-12 months post-partum, this study provides data on a 3-4 months post-partum time-frame and is one of the rare longitudinal studies on sexual health of Southeast Asian women and a glance into potential reasons for secondary subfertility which is less likely in women who have higher birth orders. Disclosure No