Postpartum Sexual Function in Women with Intrapartum Pelvic Floor Muscle Trauma

Introduction and Hypothesis Sexual dysfunction in postpartum women is common, yet the impact of intrapartum pelvic floor trauma (PFT) on domain-specific sexual recovery remains unclear, and pelvic floor physical therapy (PFPT) referral patterns in this population are poorly characterized. This study compared postpartum sexual function trajectories from 2 to 6 months in women with and without intrapartum PFT and examined PFPT referral and utilization. Methods Participants were recruited from Midwest hospitals in the USA at discharge, postpartum visits, and well-baby checkups. Eligibility required age ≥18, vaginal delivery, English fluency, internet access, and follow-up availability. Women with ≥ grade 2 perineal tears were classified as having PFT. Baseline and follow-up surveys included the Carol Scale and FSFI-9, with Wilcoxon signed-rank and Mann–Whitney U tests used for analyses. Results Eighty-six women (45 PFT, 41 no-PFT) completed both timepoints. Overall sexual function, lubrication readiness, and vulvar caressing discomfort improved (all p ≤ .020), whereas libido worsened ( p = 0.009). Penetration-related pain did not change. Groups did not differ at baseline; at follow-up, women with PFT reported poorer overall function, lubrication, penetration pain, and post-activity pain ( p = 0.020 to 0.041). Recovery trajectories were parallel, with the only difference in change magnitude being greater improvement in intercourse pain in the PFT group ( p = 0.039). Among participants reporting PFPT access, only 33.9% were both referred and seen; 86.9% of those who received PFPT reported symptom improvement. Conclusions Women with PFT carried a higher residual symptom burden at 6 months, despite recovery trajectories parallel to those without PFT. Penetration-related pain was the most persistent symptom. Low PFPT referral rates represent a critical and actionable care gap. Postpartum sexual health assessments should include domain-specific screening for penetration-related discomfort and libido, with proactive follow-up for women with PFT and early referral to PFPT.