By Carolina Solá, physiotherapist specializing in pelvic floor health

Sexuality is subjective and diverse. It is determined by different physical, psychological, emotional, and social factors. Sexual health is precisely understood as the state of physical, emotional, mental, and social well-being, not only by the absence of disease or dysfunction related to sexuality. Therefore, sexual health requires a positive and respectful approach.

Sexuality changes according to the person’s stages of life. During postpartum and breastfeeding, we must also consider that hormonal and psychological factors may influence this vital period. The experience of pregnancy, childbirth, and the first weeks postpartum can also influence sexuality.

Likewise, after childbirth and during lactation, a hypoestrogenic state presents, which means a decrease in ovarian estrogens. In addition, prolactin, the hormone responsible for maintaining milk supply, also plays a fundamental role in this change. Among these changes are symptoms such as:

Vaginal dryness

Vaginal dryness is defined as a lack of lubrication that causes a burning, stinging, and itching sensation. This lack of natural lubrication is caused by a drop in estrogen, partly due to the absence of menstrual periods in the immediate postpartum time. During lactation, while there is an inhibition of the ovarian cycle and, therefore, the state of hypoestrogenism is maintained, it can also appear due to this cause. This vaginal dryness ends up generating, in many cases, the appearance of dyspareunia (lasting or recurring pain during or after sexual intercourse).

Vaginal dryness is not only due to hormonal factors but also due to the emotional state of the mother, who enters into a state of constant alertness. This excess of orthosympathetic activity ends up increasing vaginal dryness, which negatively affects female sexuality.

The response to sexual stimulation may also be slower, which increases the time it takes for the vagina to become aroused.

Low libido

Sexual desire or libido depends on several factors:

• Hormonal factors: sexual desire is activated by a high level of estrogen, so women have more desire one or two days before and after ovulation and on day 24 of the cycle. Therefore, beyond breastfeeding, if there is no menstrual cycle, it is more difficult to trigger this sexual desire.
• Stimuli: the need for stimulation in women it is more commonly necessary, whether visual or tactile, to trigger sexual desire.
• Surrounding factors: stress, work, lack of sleep, the relationship with the partner and family, and tiredness can cause excessive activation of the sympathetic nervous system, which hinders the appearance of sexual arousal.
• Continued close physical contact with the baby contributes to fulfilling the need for more intimate contact.

Low libido is not a problem in itself. If it is experienced as a problem at some point, it is important to look for the source of this lack of libido, which can be multifactorial: emotional and physical.

Difficulties in reaching orgasm or anorgasmia

To reach orgasm, different phases must have been passed through.

First of all, there has to be a sexual desire to be able to trigger sexual arousal from activation of the genital parasympathetic nervous system, which generates an increase in vascularization and favors lubrication.

This sexual arousal depends on dopamine levels, according to motivation and breathing, to increase sexual pleasure, which ends in an orgasm. After maintaining the activation of the parasympathetic nervous system and a progressive increase of sympathetic signs (secretion of dopamine, noradrenaline, and oxytocin) until reaching the maximum of this parasympathetic activation, a response of the sympathetic nervous system is produced, which leads to orgasm. A lack of tone in the pelvic floor muscles hinders the arousal process in which there is an activation of the sympathetic nervous system in order to reach orgasm.

It is important to differentiate between orgasm and orgasto. Orgasm is the emotional sensation of pleasure due to the activation of the sympathetic nervous system (SNS), a sensation of intense pleasure linked to the secretion of dopamine, oxytocin, and noradrenaline. The other, orgasto, is the physical reaction or physiological manifestation that occurs after prolonged sexual stimulation with an explosion of the sympathetic nervous system (SNS) that generates paroxysmal contraction of the striated perineal musculature.

So whenever a woman has an orgasm, an orgasto has also occurred, but not every time an orgasto occurs, there is also an orgasm.

The constant state of alertness causes the SNS to be fully activated so that the SNPS cannot be activated correctly to trigger an orgasm. In addition, it should be noted that for these to be activated and deactivated, the cerebral cortex must not activate, because if the cerebral cortex is activated, it usually makes it even more difficult to reach orgasm.

Pelvic floor weakness

In many cases, the drop in ovarian estrogens ends up generating a weakness in the tissues that ends up generating alterations such as urinary, fecal, and gas incontinence or possible presence of prolapse and sexual dysfunctions.

Hence, it is very important to assess the pelvic floor of women during pregnancy and postpartum, in order to establish an effective treatment to maintain these tissues in an optimal state and prevent the occurrence of long-term complications.

It should be noted that not everything can be blamed on breastfeeding or the postpartum period, as there are other factors such as:

• Disconnection with the woman’s own body, which means a lack of recognition of her own body.
• The presence of pain can be caused by possible scars resulting from childbirth, which are often left untreated.
• Psychological factors after experiencing certain traumatic situations during pregnancy, childbirth, or postpartum by healthcare professionals, family, and the social surroundings (obstetric violence, self-exigency, fears, insecurities, and so on).
• Continuous, direct physical contact with the baby contributes to the necessary human contact being satiated.

Carolina Solá is a practicing pelvic floor physiotherapist at the LactApp Barcelona Clinic.