title: Does Severe Maternal Morbidity Affect Female Sexual Activity and Function? Evidence from a Brazilian Cohort Study.
abstract: OBJECTIVE
  to assess Female Sexual Function Index (FSFI) scores and delay to resume sexual activity associated with a previous severe maternal morbidity.
  
  
  METHODS
  This was a multidimensional retrospective cohort study. Women who gave birth at a Brazilian tertiary maternity between 2008 and 2012 were included, with data extraction from the hospital information system. Those with potentially life-threatening conditions and maternal near miss episodes (severe maternal morbidity) were considered the exposed group. The control group was a random sample of women who had had uncomplicated pregnancy. Female sexual function was evaluated through FSFI questionnaire, and general and reproductive aspects were addressed through specific questions. Statistical analyses were performed using Mann-Whitney and Pearson´s Chi-square for bivariate analyses. Logistic regression was used to identify variables independently associated with lower FSFI scores.
  
  
  RESULTS
  638 women were included (315 at exposed and 323 at not exposed groups). The majority of women were under 30 years-old in the control group and between 30 and 46 years-old in the exposed group (p = 0.003). Women who experienced severe maternal morbidity (SMM) had statistically significant differences regarding cesarean section (82.4% versus 47.1% among deliveries without complications, p<0.001), and some previous pathological conditions. FSFI mean scores were similar among groups ranging from 24.39 to 24.42. It took longer for exposed women to resume sexual activity after index pregnancy (mean 84 days after SMM and 65 days for control group, p = 0.01). Multiple analyses showed no significant association of FSFI below cut-off value with any predictor.
  
  
  CONCLUSIONS
  FSFI scores were not different in both groups. However, they were lower than expected. SMM delayed resumption of sexual activity after delivery, beyond postpartum period. However, the proportion of women in both groups having sex at 3 months after delivery was similar. Altered sexual response may be evaluated as one of possible long-term consequences after SMM episodes. Further studies on the growing population of women surviving severe maternal conditions might be worth for improvement of care for women.
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.|Federal University of Sao Carlos (UFSCar), Sao Carlos, SP, Brazil.
authors.forename: Carla B
authors.initials: CB
authors.lastname: Andreucci
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: José G
authors.initials: JG
authors.lastname: Cecatti
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Pacagnella
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Carla
authors.initials: C
authors.lastname: Silveira
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Parpinelli
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Elton C
authors.initials: EC
authors.lastname: Ferreira
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Carina R
authors.initials: CR
authors.lastname: Angelini
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Juliana P
authors.initials: JP
authors.lastname: Santos
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Dulce M
authors.initials: DM
authors.lastname: Zanardi
authors.affiliation: Federal University of Sao Carlos (UFSCar), Sao Carlos, SP, Brazil.
authors.forename: Jamile C
authors.initials: JC
authors.lastname: Bussadori
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Gustavo N
authors.initials: GN
authors.lastname: Cecchino
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Renato T
authors.initials: RT
authors.lastname: Souza
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Maria H
authors.initials: MH
authors.lastname: Sousa
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Costa
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D002585:Cesarean Section / Q000379:methods*; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D009017:Morbidity; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012098:Reproduction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012725:Sexual Behavior / Q000502:physiology*; D011795:Surveys and Questionnaires