The relationship between sexual function and quality of life of pregnant women in different trimesters of pregnancy

Document Type : Original Article


1 Associate Professor, Department of Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Assistant Professor, Department of Midwifery, Hazrat Fatemeh School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.

3 Assistant Professor, Department of Midwifery, Zeynab School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.

4 M.Sc.of Counseling in Midwifery, Health Center of Malayer City, Hamedan University of Medical Sciences, Hamedan, Iran.


Introduction: Although pregnancy is a pleasant period for most women, it is often a stressful period with physiological and psychological changes. Physical health and mental health are two general dimensions of quality of life. It seems that the quality of life has an effect on the sexual function of pregnant women. Therefore, this study was conducted with aim to compare the relationship between sexual function and the quality of life of pregnant women in different trimesters of pregnancy.
Methods: This cross-sectional study was conducted in 2019 on 360 pregnant women (120 pregnant women in each trimester) referring to the pregnancy care clinic of Rasht public Hospitals. The tools were questionnaires of demographic characteristics, FSFI sexual function, and quality of life SF-36. Data analysis was done using SPSS statistical software (version 23) and t-test, Chi-square, ANOVA and Pearson's correlation coefficient. P<0.05 was considered statistically significant.
Results: The mean score of the total sexual function of the studied subjects was 18.64 ± 10.05. Sexual dysfunction was seen in 86.4% of the samples. The scores of sexual functions in the first to third trimester of pregnancy were 23.92 ± 7.79, 18.84 ± 8.84, and 13.17 ± 10.37, respectively. It showed a statistically significant difference between the total score and the scores of the dimensions of sexual function with trimesters of pregnancy (p<0.001). The quality of life of the groups with and without sexual dysfunction had statistically significant differences in the two main dimensions of physical health and mental health (p<0.001). The mean scores of physical health and mental health were 54.82 ± 18.73 and 60.18 ± 17.59, respectively. Also, satisfaction (r=0.162, p=0.002) and pain (r=0.108, p=0.041) had a positive correlation with physical health. The total score of sexual function (r=0.158 and p=0.003) had a positive correlation with mental health. Lubrication (r=0.126, p=0.017), orgasm (r=0.146, p=0.006), satisfaction (r=0.247, p=0.0001), pain (r=0.165, p=0.002) and the total score of sexual function (r=0.158, p=0.003) were positively correlated with mental health.
Conclusion: The rate of sexual dysfunction increases with increasing gestational age. Also, quality of life with the highest mean score of mental health was related to the first trimester and the highest mean score of physical health was in the third trimester of pregnancy. Sexual function had a positive correlation with the mental health dimension of quality of life.


  1. Calou CG, Pinheiro AK, Castro RC, Oliveira MF, Aquino PD, Antezana FJ. Health related quality of life of pregnant women and associated factors: An integrative review. Health 2014; 6(18):2375-87.
  2. Reisman Y, Porst H, Lowenstein L, Tripodi F, Kirana PS. The ESSM manual of sexual medicine. Amsterdam: Medix; 2015.
  3. Jahanfar SH, Molaeenezhad M. Textbook of sexual disorders. Tehran: Salemi & bizhe publication 2002; 253.
  4. Yeniel AO, Petri E. Pregnancy, childbirth, and sexual function: perceptions and facts. International urogynecology journal 2014; 25:5-14.
  5. Hosseini Teshnizi S, Roozbeh N, Dabiri F, Ozgoli G, Alizadeh S. Translation and psychometrics of the Persian version of the Pregnancy Sexual Response Inventory (PSRI). Iran J Obstet Gynecol Infertil 2022; 25(8):42-57.
  6. Jawed-Wessel S, Herbenick D, Schick V, Fortenberry JD, Cattelona GA, Reece M. Development and validation of the maternal and partner sex during pregnancy scales. Journal of sex & marital therapy 2016; 42(8):681-701.
  7. Fuchs A, Czech I, Sikora J, Fuchs P, Lorek M, Skrzypulec-Plinta V, et al. Sexual functioning in pregnant women. International Journal of Environmental Research and Public Health 2019; 16(21):4216.
  8. Bostani Khalesi Z, Ghanbari Khanghah A. Perception and experience of married women of reproductive age about the importance of sexual health education: A content analysis study. Iran J Obstet Gynecol Infertil 2015; 18(172):7-17.
  9. Khalesi ZB, Bokaie M, Attari SM. Effect of pregnancy on sexual function of couples. African health sciences 2018; 18(2):227-34.
  10. Ahmed MR, Madny EH, Sayed Ahmed WA. Prevalence of female sexual dysfunction during pregnancy among E gyptian women. Journal of Obstetrics and Gynaecology Research 2014; 40(4):1023-9.
  11. Aydin M, Cayonu N, Kadihasanoglu M, Irkilata L, Atilla MK, Kendirci M. Comparison of sexual functions in pregnant and non-pregnant women. Urology journal 2015; 12(5):2339-44.
  12. Küçükdurmaz F, Efe E, Malkoç Ö, Kolus E, Amasyalı AS, Resim S. Prevalence and correlates of female sexual dysfunction among Turkish pregnant women. Turkish journal of urology 2016; 42(3):178-83.
  13. Alizadeh S, Riazi H, Alavi-Majd H, Ozgoli G. Prevalence of female sexual dysfunction during pregnancy in Eastern Mediterranean Regional Office Countries (EMRO): a systematic review and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine 2022; 35(25):6654-62.
  14. Janghorban R, Latifnejad Roudsari R, Taghipour A, Abbasi M. A review of the concept and structure of sexual and reproductive rights in international human rights documents. Iran J Obstet Gynecol Infertil 2014; 17(100):16-26.
  15. World Health Organization. Developing sexual health programmes: A framework for action. World Health Organization; 2010.
  16. World Health Organization. Sexual health and its linkages to reproductive health: an operational approach; 2017.
  17. Gökyildiz Ş, Beji NK. The effects of pregnancy on sexual life. Journal of Sex & Marital Therapy 2005; 31(3):201-15.
  18. Afrakoti NB, Shahhosseini Z. Bio-psycho-social factors affecting women's sexual function during pregnancy: A narrative review. Global Journal of Health Science 2016; 8(10):9.
  19. Ahmadi SE, Mozafari R, Azari A, Nateghi MR. Maternal Quality of Life before and after Delivery. Iranian Red Crescent Medical Journal 2013; 15(7):622.
  20. Lagadec N, Steinecker M, Kapassi A, Magnier AM, Chastang J, Robert S, et al. Factors influencing the quality of life of pregnant women: a systematic review. BMC pregnancy and childbirth 2018; 18:1-14.
  21. Makvandi S, Kermani AE. Quality of life of pregnant women referred to health centers in Izeh (2010). Journal of Kermanshah University of Medical Sciences 2012; 16(1).
  22. Casarin ST, Barboza MC, de Siqueira HC. Quality Of Life In Pregnancy: Literature Systematic Review. Journal of Nursing UFPE/Revista de Enfermagem UFPE 2010; 4.
  23. Altazan AD, Redman LM, Burton JH, Beyl RA, Cain LE, Sutton EF, et al. Mood and quality of life changes in pregnancy and postpartum and the effect of a behavioral intervention targeting excess gestational weight gain in women with overweight and obesity: a parallel-arm randomized controlled pilot trial. BMC pregnancy and childbirth 2019; 19(1):1-2.
  24. Saridi M, Toska A, Latsou D, Chondropoulou MA, Matsioula A, Sarafis P. Assessment of quality of life and psycho-emotional burden in pregnant women in Greece. European Journal of Midwifery 2022; 6.
  25. Morin M, Claris O, Dussart C, Frelat A, de Place A, Molinier L, et al. Health‐related quality of life during pregnancy: a repeated measures study of changes from the first trimester to birth. Acta obstetricia et gynecologica Scandinavica 2019; 98(10):1282-91.
  26. Wang P, Liou SR, Cheng CY. Prediction of maternal quality of life on preterm birth and low birthweight: a longitudinal study. BMC pregnancy and childbirth 2013; 13:1-1.
  27. Babazadeh R, Mirzaii K, Masomi Z. Changes in sexual desire and activity during pregnancy among women in Shahroud, Iran. International Journal of Gynecology & Obstetrics 2013; 120(1):82-4.
  28. Mazúchová L, Kelčíková S, Dubovická Z. Measuring women's quality of life during pregnancy. Kontakt 2018; 20(1):e31-6.
  29. Bayrami R, Sattarzadeh N, Koochaksariie FR, Pezeshki MZ. Sexual dysfunction in couples and its related factors during pregnancy. Journal of Reproduction & Infertility 2008; 9(3):271-83.
  30. Rosen C, Brown J, Heiman S, Leiblum C, Meston R, Shabsigh D, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. Journal of sex & marital therapy 2000; 26(2):191-208.
  31. Mohammadi KH, Heydari M, Faghihzadeh S. The Female Sexual Function Index (FSFI): validation of the Iranian version. Payesh 2008; 7(3):269-78.
  32. Fakhri A, Pakpour Haji Agha A, Morshedi H, Mohammadjafari R, Ghalambor Dezzfuli F. Psychometric properties of Iranian version of female sexual function index. Scientific Medical Journal 2011; 10(4 (73)):345-54.
  33. Fakhri A, Pakpour AH, Burri A, Morshedi H, Zeidi IM. The Female Sexual Function Index: translation and validation of an Iranian version. The journal of sexual medicine 2012; 9(2):514-23.
  34. Ware Jr JE, Gandek B. Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. Journal of clinical epidemiology 1998; 51(11):903-12.
  35. Derogatis LR, Revicki DA, Rosen RC, Jordan R, Lucas J, Spana C. Psychometric validation of the female sexual distress scale-desire/arousal/orgasm. Journal of Patient-Reported Outcomes 2021; 5:1-11.
  36. Bushmakin AG, Cappelleri JC. A practical approach to quantitative validation of patient-reported outcomes: a simulation-based guide using SAS. John Wiley & Sons; 2022.
  37. Cassis C, Mukhopadhyay S, Morris E, Giarenis I. What happens to female sexual function during pregnancy?. European Journal of Obstetrics & Gynecology and Reproductive Biology 2021; 258:265-8.
  38. Davari-Tanha F, A’LAM ZR, Shirazi M, Askari F, Ghajarzadeh M. Comparison of sexual function in pregnant women with different gestational age. Maedica 2020; 15(3):335.
  39. Yıldız H. The relation between prepregnancy sexuality and sexual function during pregnancy and the postpartum period: a prospective study. Journal of sex & marital therapy 2015; 41(1):49-59.
  40. Johnson CE. Sexual health during pregnancy and the postpartum (CME). The journal of sexual medicine 2011; 8(5):1267-84.
  41. Lippincott Williams & Wilkins. Straight A's in Maternal-Neonatal Nursing. 1nd Lippincott Williams & Wilkins; 2007.
  42. Jawed-Wessel S, Sevick E. The impact of pregnancy and childbirth on sexual behaviors: a systematic review. The Journal of Sex Research 2017; 54(4-5):411-23.
  43. Pobee RA, Setorglo J, Kwashie Klevor M, Murray-Kolb LE. High levels of depressive symptoms and low quality of life are reported during pregnancy in Cape Coast, Ghana; a longitudinal study. BMC public health 2022; 22(1):1-10.
  44. Boutib A, Chergaoui S, Azizi A, Hilali A, Marfak IY, Marfak A. Health-related quality of life during three trimesters of pregnancy in Morocco: cross-sectional pilot study. Eclinicalmedicine 2023; 57.
  45. Nik-Azin A, Nainian MR, Zamani M, Bavojdan MR, Bavojdan MR, Motlagh MJ. Evaluation of sexual function, quality of life, and mental and physical health in pregnant women. Journal of family & reproductive health 2013; 7(4):171-6.
  46. Gokyildiz Surucu S, Avcibay Vurgec B, Kaya Senol D, Gozuyesil E, Bilgic D, Onat Koroglu C, et al. Evaluation of women's sexual quality of life, depression, and sexual functions in the pregnancy and postpartum periods: A multi‐centered study. Journal of Obstetrics and Gynaecology Research 2022; 48(6):1379-89.
  47. Zahedi M, Deris F. The quality of life in pregnant women in Farokhshahr city, 2012. Journal of clinical nursing and midwifery 2014; 3(3):63-9.
  48. Wallwiener S, Müller M, Doster A, Kuon RJ, Plewniok K, Feller S, et al. Sexual activity and sexual dysfunction of women in the perinatal period: a longitudinal study. Archives of gynecology and obstetrics 2017; 295:873-83.
  49. Murtagh J. Female sexual function, dysfunction, and pregnancy: implications for practice. Journal of midwifery & women's health 2010; 55(5):438-46.