Factors associated with early resumption of sexual intercourse among postnatal women in Uganda

Many women had resumed sexual intercourse by 6 weeks postpartum. The finding is similar to that of others [9, 10, 22] who reported that the earliest time for resumption of sexual intercourse was 3 weeks while the latest time was at 13 weeks postpartum. Similarly, a study conducted in Uganda among women with HIV reported that 58 % of women had resumed sexual intercourse within 6 weeks after childbirth [8]. Our study is in agreement with Perry [6], who reported that sexual intercourse can be resumed safely by the second to fourth week after birth, when bleeding has stopped and the episiotomy or laceration site has healed.

Our study shows that occupation of the mother was significantly associated with timing of resumption of sexual intercourse. This finding is similar to that of Radziah et al. [9] from Malaysia who found that mothers who earned more money had early resumption of sexual intercourse during their postpartum period compared to those who earned less money. Therefore, it can be inferred from other studies and ours that higher income is associated with early sexual resumption of sexual intercourse (before six weeks postpartum).

The finding that parity was significantly associated with timing of resumption of sexual intercourse after child birth is in agreement with others [23] who found that women with few children resume sexual intercourse earlier than women who had many children. Regarding education level of spouse, our finding of a significant association with early resumption of sexual intercourse is similar to that of Osinde et al. [8], where women with male partners with a higher educational level resumed sexual intercourse earlier than six weeks postpartum.

Likewise, as in the study by Rowland et al. [23], the age of the baby was significantly associated with early resumption of sexual intercourse after child birth is similar to that of Rowland et al. [23]. The finding that use of family planning was associated with early resumption of sexual intercourse after child birth is similar to that of other studies [8, 9, 17, 23–25]. The finding is contrary other studies [8, 26] which reported no differences in resumption of sexual intercourse among the women who were using postpartum contraception compared with those who were not.

Religion and cultural norms influence the timing of resumption of sexual intercourse, as noted in the study. Religion influenced resumption of sexual intercourse in a study from Cote d’Ivore [18] and the Gambia [18], where Islamic traditions prescribe 40 days of postpartum abstinence. A similar custom was reported in the Gambia in a predominantly Muslim population [18]. In Nigeria, 1 % of women resume sexual intercourse due to cultural demand [10]. A study from Uganda [22] reported that different tribal customs influenced the timing of resumption of sexual intercourse within the early days of puerperium. In this study, some women resumed sexual intercourse early because they were fulfilling cultural demands. For instance, in some cultures it was believed that a woman was expected to resume sexual intercourse within the first week after delivery ‘’so as to help in the healing of the wounds” and ‘’to bring good health to the baby” [22]. The cultural practice of new mothers staying with their in laws or at their parents’ homes after childbirth was also one way in which culture prohibited early resumption of sexual intercourse after childbirth [9, 10, 15, 22]. In Tanzania, women were sometimes described as ‘giving in’ to men’s sexual advances in order to protect their marriage, avoid divorce, or family violence, such as battering and rape, as men force them to have sexual intercourse against their will’ [13]. Spousal pressure and fear that their spouse would leave them were cited as reasons for early resumption of sexual intercourse [8].

The mode of delivery might influence timing of resumption of sexual intercourse. Women who had vaginal delivery with stitches were far less likely to resume intercourse early compared to women who had a vaginal delivery without perineal stitches or who had caesarean sections [15, 22, 23]. Women who had a vaginal delivery were 3.6 times more likely to experience sexual problem(s) on resumption of sexual intercourse postpartum compared with those that delivered by caesarean section [10]. A study from India [25] found that the median time to restart intercourse after a normal vaginal delivery with episiotomy was 40 days postpartum compared to 10 days postpartum and after a caesarean section. The most common problems in the normal delivery group were decreased libido (80 %), sexual dissatisfaction (65 %), and vaginal looseness (55 %), while in the caesarean section group, the most common problems were vaginal dryness (85 %), sexual dissatisfaction (60 %), and decreased libido (35 %) [24]. Occurrence of dyspareunia in the postpartum year was more likely in women who had a vaginal delivery [22–25]. In contrast, a study from Iran [7] found no association between the mode of delivery and timing of resumption of sexual intercourse or dyspareunia during 2–6 weeks postpartum. While interest in sexual activity often decreases throughout pregnancy, it eventually returns to normal postpartum with average resumption of intercourse, ranging between 5 and 8 weeks after childbirth [27–29].