Breastfeeding Sexual Lives of First-Time Mothers: A Qualitative Explorative Study

Abstract

Background:

Problems with sexuality are experienced in the first 6 months at the most, and often in the first 12 months after birth. Although there are studies reporting negative effects of breastfeeding on sexuality, the evidence is limited.

Objective:

This study was conducted with the aim of exploring the breastfeeding sexual lives of first-time mothers.

Materials and Methods:

The research was carried out in Turkey between October 2020 and December 2021. The study was conducted with 41 women who met the inclusion criteria. Participants were selected by the “snowball” sampling procedure among nonprobability sampling methods. A qualitative approach was used to gather data through semistructured interviews. Content analysis was used for data analysis as described by Graneheim and Lundman. Data analysis was performed using NVivo software (Version 11).

Results:

According to the results of the content analysis, three themes were created: factors affecting sexuality in the breastfeeding process, sexual interaction with the spouse during the breastfeeding process, and understood expectations. The theme, titled factors affecting sexuality in the breastfeeding process, consists of five categories: physical, psychological, sociocultural, infant-related, and health professionals-related factors. The theme of “understood expectations” consists of desires for improving sexual satisfaction and satisfaction during lactation, and sexual communication categories. The contact of sexual interaction with spouse during breastfeeding consists of positive interaction and negative interaction categories.

Conclusions:

It has been concluded that the sexual intercourse of women is adversely affected during the breastfeeding period and that women have expectations to increase their sexual satisfaction. Sexual problems during the breastfeeding process cause problems in the spousal relationship.

Introduction

Factors such as difficulties experienced during childbirth (perineum damage, episiotomy, operative birth, etc.), hormonal changes experienced after birth, changes in family order, reorganization of relations between spouses, fatigue, and breastfeeding affect postpartum sexual life.^1,2 Therefore, a decrease in sexual activity, sexual desire, and satisfaction can be observed in the postpartum period.³

Studies have reported that sexual problems occur mostly in the first 6 months after birth,¹ and most often in the first 12 months.⁴ It has been reported that breastfeeding is among the influencing factors.³ The results of the research conducted with Turkish women similarly emphasize that there is an increase in postpartum sexual problems and that breastfeeding affects them.^5,6

Although there are studies reporting that breastfeeding negatively affects sexuality, the evidence is limited.⁷ Avery et al report that breastfeeding positively affects sexuality.⁸ However, there are research results reporting that the sexual desire and satisfaction of breastfeeding women decrease.^9–11

It has been reported that due to hormonal (increased prolactin, and low estrogen and progesterone) changes related to breastfeeding,¹² dyspareunia complaints increase; libido, vaginal lubrication, sexual desire, and satisfaction decrease.^13,14 Sexual life during breastfeeding is affected not only by physiological changes but also by cultural characteristics.⁹

The cultural characteristics and religious beliefs of women living in Turkey affect their sexuality. It is considered shameful and sinful for Turkish women to talk about their sexual experiences or desires. Sexual issues exist in a limited area of freedom for women under the influence of gender roles.¹⁵ Due to their beliefs and cultural characteristics, Turkish women are not welcome by the society to talk about their sexual desires and desires in any period of their lives. Although there are examples of quantitative studies examining the effect of postpartum breastfeeding on sexuality,^5,6,14 there is no study using qualitative research designs that directly address the breastfeeding period sexual life.

This study was carried out to evaluate the views of women during breastfeeding on the changes in their sexual lives. Considering the studies conducted in our country, the limited number of descriptive studies on the subject reveals the originality of the study.

Objectives

This study was conducted with the aim of exploring the breastfeeding sexual lives of first-time mothers.

Research questions

Within the scope of the study, answers to the following questions are sought.

How has breastfeeding affected women's sex lives?

What are the changes in sexual life during breastfeeding?

What are the expectations for the improvement of sexual life during breastfeeding?

Materials and Methods

This qualitative study was carried out following the Consolidated Criteria for Reporting Qualitative Research (COREQ) that covers the reporting of studies using interviews and was developed to promote explicit and comprehensive reporting of interviews.

Design

The study was carried out using the qualitative research method.

Setting

A WhatsApp group titled “Mothers with 0–6-month babies,” which functions as peer support groups, was established by a psychologist and a midwife for mothers to share about their babies or themselves. There are 128 participants registered in the group. Women post messages about their babies or the subjects they are curious about. The purpose of the study was shared within the group, and the study was carried out with volunteer participants and 41 women guided by them.

Sample

Participants were selected by the “snowball” sampling procedure among nonprobability sampling methods. The study was conducted with 41 women who met the inclusion criteria. Inclusion criteria for the study were as follows: being older than 18 years, speaking Turkish, living in Turkey, having given birth for the first time, having a vaginal birth, being between the second and sixth month after birth, no diagnosed disease, no health problem for the baby, feeding her baby only with breast milk, not giving any other food or drink to her baby other than breast milk, not having any physical or mental problem in her sexual life during pregnancy and before, not having any routine intervention during delivery, being sexually active, married or having a partner, and volunteering to participate in the study.

In addition, she is a member of the WhatsApp group titled “Mothers with 0–6-month babies,” which was established by women to get information and share on postpartum, baby care, solutions to breastfeeding problems, seeking social support, and so on. Women who did not meet these criteria were not included in the study. Women who met the inclusion criteria were interviewed by the first author, optionally through platforms such as WhatsApp, Zoom, or Google meet.

After the data sets obtained during the interview were repeated, it was decided that the study reached saturation and the interviews were terminated. Research saturation is used as a term that provides a clue that the research can be terminated if the same answers are received from the interviewees in the research conducted. The aim of this study is not to generalize the universe, but to obtain information about the subject by studying average situations. A total of 41 women were interviewed.

Data collection

The research was carried out between October 2020 and December 2021. The study was conducted with 41 women who met the inclusion criteria. Informed consent was obtained from the study participants. They were informed that they could leave at any stage of the research, whenever they wanted. To ensure anonymity during data analysis, women's P (Participant) code and given number were recorded.

Interviews were collected by experienced researchers through online interviews with volunteer women in the online group. Interviews were held through platforms such as WhatsApp, Zoom, or Google meet by choosing the most suitable time and date for the interview, with women who met the research criteria and the researcher and the participant. During each interview, it was carried out in an environment where the woman felt comfortable and safe, at the most convenient time for her. The interviews were recorded.

Data were collected using a personal information form and a semistructured interview form. The personal information form and the semistructured interview form were prepared by examining the study examples in the literature and taking the opinions of experts. The personal information form consists of questions aimed at obtaining information about the sociodemographic and obstetric characteristics of women. The semistructured interview form was composed of questions prepared to examine the effects of breastfeeding process on sexuality of women who became mothers for the first time.

The semistructured interview form consists of five questions (Table 1). After answering the questions in the personal information form, the interviews started with a general question: Can you talk about the changes in your body after giving birth? Then continued with main questions: “What do you think has changed sexually?” The questions that the interviewed women wondered and wanted to ask at the end of the interview were also answered. The study was concluded with 41 participants. Researchers emphasize that in qualitative research, the sample cannot be calculated, the results cannot be generalized to the population, one or two situations (e.g., individuals, groups) may be sufficient according to the situation and the data, and it can be terminated when it reaches saturation.¹⁶ The interviews lasted between 22 and 45 minutes.

Table 1.

Interview Guide

Interview guide
How did you feel during your first postpartum sexual intercourse?
How do you think breastfeeding affects your sexuality?
What do you think affects your sexuality during breastfeeding?
Do you think breastfeeding has changed your partner's attitudes toward you sexually?
What do you think will increase your sexual desire and satisfaction during breastfeeding?

Data analysis

Sociodemographic variables were expressed as numbers and percentages as descriptive statistics. We used the Graneheim and Lundman's method¹⁷ to analyze the data. At first, the text of the interviews by two coders (A.K.U. and H.K.) was read several times to obtain a general understanding and sense of the whole content. Then the text of each interview was divided into meaningful units as words, phrases, sentences, and paragraphs. Thereafter, the meaning units were condensed and labeled with code. Then the meaning of codes was compared in terms of similarities and differences, and the related codes with similar meaning were put in the initial categories.

Finally, with the advancement of data analysis, the initial categories or subcategories were developed, and categories formed, from which an overarching theme emerged. As a result, the data-driven categories evolved progressively and inductively from the text data (Table 3). Data analysis was performed using NVivo software (Version 11).

The reliability of data was obtained based on the strategies determined by Colorafi and Evans.¹⁸ These strategies are credibility, transferability, reliability, and confirmability. To ensure the internal validity and credibility of the research, participants were encouraged to freely express their views at the beginning of the interview. The interviews were conducted in an environment where the participants were comfortable. During the interviews, the participants were given sufficient time to express themselves. To ensure credibility, information about the sexuality of breastfeeding women was presented with explanatory notes.

In addition, to ensure the credibility of the research, expert opinion was sought to verify whether the themes given under the seven conceptual categories created in the research represent the aforementioned conceptual category. For this purpose, 43 subcategory lists and the names and properties of 9 categories were given to a faculty member in two lists. Using both of these lists, the expert was asked to match the subcategories in the first list with the category in the second list.

The credibility of the study was calculated using the formula of Miles and Huberman [reliability (consensus/(consensus + disagreement)) × 100]. The expert consulted for credibility placed only one subcategory in a different category.¹⁹ In this case, the reliability of the formula expressed was found to be (42/(42 + 1)) × 100 = 97%. In qualitative research, consensus among researchers is expected to be at least 80%.²⁰ Purposive sampling was used to ensure validity in the study. The data are presented in direct quotations and reported comprehensively, while preserving their originality.

Ethics

This research was conducted in strict accordance with the ethical principles of the Declaration of Helsinki (1964), including the informed consent requested from the participants. Verbal informed consent was obtained from each woman participating in the study. Before the study was carried out, an ethics approval certificate of conformity was obtained by the ethics committee of a university located in the Central Anatolian region of Turkey (Decision No: 14/03 Date: October 21, 2020).

Results

Sample demographics

The mean age of the participants was between 28.26 ± 4.06 and 21–39 years. Fifteen women are university graduates, 22 women's spouses are university graduates, and 21 women are not working in any income-generating job. All the participants are married and 32 of them have a nuclear family structure (Table 2).

Table 2.

Overview of Participants

Characteristics
Age of the women, years, mean ± SD (min–max)	28.26 ± 4.06 (21–39)
	N	%
Education of the women
Primary school	3	7.3
Secondary school	7	17.1
High school	9	22.0
University	15	36.6
Graduate	7	17.1
Education of the women
Primary school	1	2.4
Secondary school	4	9.8
High school	10	24.4
University	22	53.7
Graduate	4	9.8
Working status
Yes	20	48.8
No	21	51.2
Spouse working status
Yes	36	87.8
No	5	12.2
Marital status
Married	41	100.0
Family type
Core family	32	78.0
Extended family	9	22.0
Living place
Rural	6	14.
City	405	96.4
Total	420	100.0

SD, standard deviation.

Themes

According to the results of the content analysis, three themes were created to determine how the sexual life of women during breastfeeding was affected. Factors affecting sexuality in the breastfeeding process consist of the themes of sexual interaction and expectations during breastfeeding (Table 3).

Table 3.

Data Analysis Structure

Subcategory	Category	Theme
Change in body appearanceDecreased vaginal lubricationFullness of breastsPain and tenderness in the breastsPhysical tirednessExperiencing constant painBack pain	Physical factors	Factors affecting sexuality during breastfeeding
Sanctification of breastfeeding,Feeling guilty while breastfeedingDo not think that it will negatively affect the breastfeeding processNot feeling as attractive as beforeFear of being pregnantRecalling the fear at birthStressFeeling of failureDecreased sex drive	Psychological factors
Concerns about privacyBelief of cannot breastfeed without wuduThinking that the taste of the milk will change after Sexual intercourseSexual mythsAttitudes of other caregivers (grandparents)	Sociocultural factors
Lack of timeBaby needs during coitusBaby's wishes	Factors related to the baby
Fear of stigmaShameFeeling uncomfortable	Factors related to health professionals
Making the new version of the breasts more attractiveThinking his wife is more beautifulEnthusiasm for short-term unification	Positive interaction	Sexual interaction with spouse during breastfeeding
The idea that the breasts belong to the babyMilk coming from the breastsBeing a motherNot as attractive as beforeAdapting to new roles	Negative interaction
Sharing family rolesCounseling provided by health care professionalsContinuity of social life	Desires for improving sexual satisfaction and satisfaction during lactation	Understood expectations
Improving communicationAsking about her partner's sexual expectationsFeeling sexy	Sexual communication	Understood expectations

Factors affecting sexuality during breastfeeding

The theme, titled factors affecting sexuality in the breastfeeding process, consists of five categories: physical, psychological, sociocultural, infant-related, and health professionals-related factors.

Physical factors

The majority of women state that physical changes in their postpartum body affect their sexuality. It was determined that the majority of them had negative experiences with the first postpartum sexual intercourse. Among the women, there are those who report that the first sexual intercourse is with pain and pain, and that they experience a feeling of reluctance.

“I remember the first day we got married. When I was together that night for the first time, I thought how painful it was, why do people enjoy it. When I had sexual intercourse for the first time after giving birth, I said that pain was nothing. It was very terrible.” (P8)

“All the women who gave birth around me said they were in pain during postpartum intercourse. But I didn't think I'd be in this much pain.” (P3).

Most women reported that changes in their body image negatively affected their sexuality. There are 12 women who reported that they think the fullness of the breasts, the increase in breast size, and the milk flow that occurs during intercourse due to milk production in lactation period is not sexually attractive during intercourse. Among women, there are those who report that they are more desired by their husbands due to the appearance of the increase in breast size, and that the milk flow does not cause discomfort.

“Previously, my bra size was 80B, now I use a 95C fit. I am happy when I think that they are producing a lot of milk for my baby because they have grown so much. But when I think about having something sexual with my wife, I feel so fat. The biggest reason is that my breasts have grown so much” (P21).

“I used to think that men like big breasts. I wish my breasts were too big. I felt old and sagging when I saw that when they grew up, they came like a weight and lay in my direction. I did not want to open it so that my wife would not touch it during sexual intercourse” (P13).

“My husband could not continue our relationship because of the milk coming from her breasts during sexual intercourse. He became uncomfortable when my milk gushed out” (P33).

“The fullness of my breasts after giving birth made me think that I looked very attractive during intercourse” (P40).

Psychological factors

It has been determined that the period of breastfeeding affects sexuality psychologically because women remember the traumas they experienced during childbirth, feel guilty toward their baby during breastfeeding, and think that the breastfeeding process will be adversely affected and of the stress they experience due to their responsibilities toward the baby, and the feeling of failure and sexual reluctance. It was determined that the majority of women were not willing to have sexual intercourse the next time because of the guilt and bad feelings they experienced when they had to breastfeed their baby after sexual intercourse, and they thought that they felt anger toward their spouses.

“I could not rest during my pregnancy or at birth. The baby was born. I get very tired with housework, cooking, taking care of the baby. Breastfeeding is already difficult. Sometimes my baby sucks, sometimes he cries. My back hurts all the time. My nerves are getting worse. On top of that, when my wife comes with the desire for sexual intercourse, I get more angry. I have neither the will nor the time” (P1).

“I try to breastfeed my baby prior to intercourse. If he does not wake up for a long time, I think that I will clean up (to make ablution) and give him clean milk, at least until he wakes up” (P2).

“I don't want to have sexual intercourse at all. I'm just pretending I don't want our relationship to deteriorate. Afterwards, I spend my time feeling embarrassed in front of my baby for what would have happened if I held my baby in my arms while breastfeeding” (P9).

Sociocultural factors

It has been concluded that during the breastfeeding process, women direct their sexual lives with the desire to behave as required by the culture and religious beliefs (Muslims) in which they live. Among the women participating in our study, it was determined that cultural factors, such as the fact that the family elders who came to help after giving birth were at home, believing that they could not breastfeed without ablution, and thinking that the taste of their milk would change after sexual intercourse, that it was not acceptable to oppose their spouse's desire for sexual intercourse, and that the sexual needs of men should be met, affected sexual life during breastfeeding.

“The house is very crowded. My mother-in-law came to live with us to help with the babysitting and housework. She often enters our room without asking permission to enter. At that moment, I wonder how they would react if I was either naked or having sexual intercourse with my husband. This had a huge impact on my relationship with my spouse. I was not very keen on having sexual intercourse anyway, and when my mother-in-law was added, it became a dead end for me.” (P22).

“There is always someone in the house. Those who come to see the baby, my mother, my father, my husband's family etc… Breastfeeding turns into torture when everyone is at home. Even when I go to breastfeed in my room, someone comes up to us. I struggle to keep my breasts from showing. At night, whenever the baby cries, my father-in-law, my mother or my father, whoever is sleeping at home that day, burst into my room. My husband started sleeping in another room. There was no skin-to-skin contact between us, sexual intercourse became a dream.” (P27).

“I had breastfeeding problems at first. The baby did not suck. It couldn't hold the breast. That's when my mother and siblings started coming to help. Then they began to stay at night. It's been four months. We continue in the same order. My husband is very uncomfortable with this situation. We always experience anxiety when he wants to have sexual intercourse. We worry about what if someone sees or hears. In the end, sexual intercourse either does not happen or the baby wakes up and is interrupted. I need to breastfeed. We have become a vicious circle.” (P31).

“I don't want to breastfeed my baby without ablution after sexual intercourse. If I do not do this, I do not think that the milk I will give my baby will be halal. If I get up at night and do ablution, I don't want it because the people in the house (mother-in-law and sister-in-law) will understand what I am doing.” (P20).

“They said that if I do not make wudu after sexual intercourse, my milk will taste bad. We did not have sexual intercourse for 90 days after birth. My husband was also patient because the baby is small, it is more important for me to breastfeed. Even if we try to coincide the sexual intercourse with the baby's sleep afterwards, it is very difficult.” (P39).

“I accept even if I don't want it because everyone around me tells me that I shouldn't neglect my husband after the birth, that if I don't accept his desire for sexual intercourse, he will become alienated from me, that divorces and cheating are due to this.” (P17).

Factors related to the baby

It has been concluded that not only factors related to the mother or the environment are effective in the breastfeeding process but also factors related to baby care are effective on sexuality. Among the participants, there are women who report that they have difficulty in allocating time for their spouse due to the time allocated for baby care, and that the thought of their baby crying or needing during sexual intercourse affects sexual satisfaction.

“While we are preparing for sexual intercourse, my mind is constantly spinning around asking if my baby wakes up or wants to breastfeed, how will I do it, what will happen if I stop and breastfeed. Then I neither understand nor enjoy my togetherness. At one time, I wanted to be with my husband too. As soon as we hug each other, my baby wakes up as if he is feeling it, and if I don't breastfeed, it won't stop. Now we have trauma too. We worry if he sees us.” (P15).

“My back hurts a lot while breastfeeding. It has been 3 months since birth. I know I have very little time when I lie in bed. During that time, I try to fight back pain and rest. I don't want sexual intercourse and I get angry when my husband comes to his mind.” (P23).

Factors related to health professionals

It was concluded that the women in our study had difficulty in meeting their information needs regarding sexual intercourse during the breastfeeding process, and that they were hesitant to ask questions because of the fear of being stigmatized or labeled by health professionals.

“I'm going to the midwife at the family health center to have my baby vaccinated. I wanted to ask if my milk would taste bad if I had sexual intercourse. But I didn't ask. I was afraid of her calling me ignorant.” (P32).

“After giving birth, we went to the doctor for a check-up. The doctor said that you can have sexual intercourse after you recover. I don't want to give milk without wudu, when I asked if it would be okay if I express my milk and give it, I didn't want to say anything again when the doctor said don't talk nonsense” (P21).

Sexual interaction with spouse during breastfeeding

Sexual interaction with spouse during breastfeeding theme consisted of positive interaction and negative interaction categories.

Negative interaction

It is stated that breastfeeding women's husbands think that their wife's breasts belong to the baby, that the milk flowing from the breasts during intercourse is disturbing, that changes in body image make it not as attractive as it used to, and that they experience a dilemma between their parenting roles and the spouse relationship.

“When I have sexual intercourse, milk flows from my breasts as if it were squirting. I interpreted it as if I was going back and forth between my motherhood and my womanhood. My husband interpreted it as if I didn't want because of him, he said he wanted to stop having sexual intercourse” (P41).

“With breastfeeding, my breasts have grown excessively. My image sometimes resembles a cow. My wife makes jokes about me being a cow. But my low sexual desire ends.” (P37).

Positive interaction

Among women, there were some who reported that the breastfeeding period had a positive effect on their sexual interactions. Some of the women were determined by their husbands that the enlargement of their breasts after giving birth increased their attractiveness, they were stimulated while breastfeeding their baby, and they looked sexier than before pregnancy, and there were those who thought that sexual intercourse in a short time was more exciting.

“My husband watches me with admiration while I breastfeed. Afterwards, he waits for time to have sexual intercourse” (P35).

“I was very thin before pregnancy. I look a little fuller now. My husband said that my breast growth suits me very well” (P7).

Understood expectations

The theme of understood expectations was gathered under the category of desires for improving sexual satisfaction and satisfaction during breastfeeding.

Desires to improve sexual satisfaction during breastfeeding

It was concluded that among the understood expectations that women see as a solution to the problems and difficulties they experience during the breastfeeding process, it is possible to reduce their fatigue, to be active in the domestic role distribution, to learn effective methods by health professionals to find solutions to their problems, and to take part in social activities has been reached.

“It's my job to clean the house, cook the meals, and take care of the baby. My husband doesn't know what I'm doing and how I'm doing until he comes home in the evening. I get angry when he says something like, “The baby is crying.,” “What to eat?” I regret the situation I am in a thousand times” (P3).

“I used to have a life. I am defective at home or my husband without getting comfortable on my own. In order for me to have sex, I must first live. I never once left my baby and my wife and went out except for necessity” (P25) (Table 3).

Sexual communication

It has been determined that the theme of “understood expectations” is within the category of sexual communication, women's views on improving their communication between spouses, being able to talk about their sexual expectations, and feeling sexy.

“I think I am not understood. Having sexual intercourse is not only with my body. I need to be comfortable. I am very tired both physically and mentally. I need support on this. What I want most is waiting for my husband to talk to me and say I understand you. Even that will be good” (P36).

“My body changed a lot after giving birth. I need to know that I still look sexy to my partner” (P12) (Table 3).

Discussion

This study was conducted using a qualitative research design and content analysis to explore the effects of breastfeeding on the sexual lives of Turkish women. It was concluded that the majority of participants experienced discomfort, dryness, strain, and reluctance during the first postpartum sexual intercourse. Previous study results report that these problems may occur due to postpartum vaginal dryness, changing hormones, and breastfeeding.^10,21

It was concluded that the majority of women experienced negativity during sexual intercourse due to changes in body appearance and breasts, sensitivity, pain, and fatigue. According to O'Malley et al, it causes many sexual problems, especially sexual dryness with negative perception of body image after birth and breastfeeding.¹⁰ According to Pissolato et al, physical changes and fatigue affect sexuality together with breastfeeding.²² Seventeen women in the study stated that the milk coming from the breasts was disturbing during sexual intercourse. Akpınar and Yangın state that the majority of women are not bothered by the milk coming from the breasts during sexual intercourse.⁵

While breastfeeding is affected by psychological and sociocultural factors, it also affects sexuality.²² The women in the study reported that their sexuality was adversely affected due to sanctification of breastfeeding, feeling guilty while breastfeeding after sexual intercourse, thinking that it would affect their milk negatively, and believing that they could not breastfeed without wudu. Cantarino et al emphasize that cultural norms of postpartum women put pressure on their sexual lives.²³

Regarding postpartum sexual life, it is reported that Muslim women's sexual reluctance during breastfeeding increases^9,24; women believe that it is not right to take care of their babies and breastfeed without ablution.⁹ In Turkish society, it is considered sacred for women to be a mother and breastfeed their baby. Sexuality is seen as a taboo in the Muslim Turkish society. Women are especially asked not to talk about sexuality. Sexuality is seen as a private matter, and sexual desire and the pursuit of satisfaction are condemned.²⁵ Akpınar and Yangın state that sanctifying the breasts, which helps to stimulate sexually, is among the reasons for the decrease in sexual desire during breastfeeding.⁵

It was concluded that women's sexual lives were also affected due to not feeling as attractive as before, feeling of failure due to stress and role confusion, decreased interest in sexuality, and concerns about privacy. There are research results that there is discomfort due to the change in the breasts, which reduces sexual desire during breastfeeding.^22,26

It has been concluded that the reasons such as the fear of becoming pregnant and remembering the fear experienced during childbirth negatively affect the sexual life of women during the breastfeeding process. It has been reported that oxytocin levels of breastfeeding women who experienced their birth traumatically is negatively affected.^27,28 Dynamics that negatively affect breastfeeding also affect sexuality.

The fatigue experienced by women in our study due to baby care, the inability to spare time, and the need for their baby during sexual intercourse also affect their sexuality. Martínez-Martínez et al reported that the physical and psychological difficulties of breastfeeding women while caring for their babies also affect their sexuality by causing stress.²⁹

Women who reported that their sexuality was positively affected, stated that they felt more attractive. Studies indicate that postpartum sexual desire by their partners increases sexual desire by providing a positive development on mothers' feelings of self-efficacy.^30,31 It was determined that the majority of women in our study did not receive professional support, stating that they would not be understood or stigmatized by health professionals. It is thought that this situation is effective in leaving the problems unresolved. The understood expectations of women in our research regarding their sexuality are effective communication with their spouses, role sharing within the family, providing information and support by health professionals, and the continuity of their personal lives.

Delgado-Pérez et al drew attention to the fact that women spending time on self-care, spouse, and personal pursuits is an important strategy in increasing sexual desire. In addition, the importance of the support of health professionals in resuming sexuality with physical (position, lubricant use, etc.) and psychological (effective communication with the spouse, support, etc.) strategies in improving postpartum sexuality has been reported.

It was concluded that the relationships of women with their husbands were affected positively and negatively. It is stated that women and their spouses are not prepared for changes in the postpartum and breastfeeding process,²⁹ and they do not have an idea about possible changes in sexuality.³⁰ It is reported that it would be beneficial for couples to evaluate together, and talk about their feelings, beliefs, and changes in sexual life.³²

Limitations

The strength of the research is that it clarifies the sexual problems experienced by women in the field of reproductive health and obstetrics during breastfeeding. Another strength of the study is that it provides guidance for other studies to be carried out on sexual problems during breastfeeding using qualitative research methods. Along with the strengths of this research, there are several limitations. Finding participants who meet the sampling criteria and agree to talk about sexuality during breastfeeding is the first limitation of the study. The second limitation is the small number of studies examining sexuality during breastfeeding with qualitative research methods. The strengths of the study are that women participating in the research can talk about their sexuality, volunteer to participate in the study, and clarify the gap in the literature.

For future studies, it is recommended to conduct a focus group discussion on sexuality in breastfeeding period. In postpartum follow-ups, it is recommended to provide counseling about sexual life by using effective communication methods, to clarify the questions that women are curious about, and to make an evaluation about sexual health. Studies are needed to determine the training and counseling needs of women regarding possible changes that women may experience during breastfeeding, and to take initiatives to solve the problems.

Conclusion

In the study, it was determined that the sexual life of women during the breastfeeding process was affected by physical, psychological, and sociocultural factors, baby, and health professionals. It has been determined that the sexual intercourse of women is negatively affected during the breastfeeding period and that women have expectations for improving their sexual satisfaction. Due to the sexual problems experienced during the breastfeeding process, the spousal relationship may deteriorate and cause irreparable problems. Especially in Turkey, since talking about sexuality is considered a shame and sin, the problems cannot be noticed and solved. For this reason, health workers have important duties.

Ethical Approval

Footnotes

Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

Supplementary Material

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