Factors influencing low sexual desire and sexual distress in pregnancy: A cross-sectional study
Background: Sexual desire and sexual distress are determined by emotional, psychosocial, hormonal, and anatomical factors during pregnancy.
Objective: To identify the factors contributing to female low sexual desire and sexual distress during pregnancy separately and concurrently.
Materials and Methods: Overall, 295 pregnant women were enrolled in this cross-sectional study. Sexual desire and distress were assessed by the sexual interest and desire inventory-female (score ≤ 33.0 indicates low sexual desire) and the female sexual distress scale-revised (score ≥ 11 indicates sexual distress).
Results: 56.3% and 17.3% of pregnant women met the clinical cut-off for low sexual desire and sexual distress, respectively. After adjusting for the effect of the confounding variables by logistic regression multivariate analysis, satisfaction with body image before and during pregnancy, frequency of sexual intercourse, and satisfaction with foreplay were found to be significantly associated with low sexual desire. Factors related to sexual distress were similar to those noted for common sexual desire, except for satisfaction with foreplay. Other factors related to sexual distress included increased age, fear of abortion, and pregnancy trimester. Factors linked to concurrent low sexual desire and sexual distress were similar to those found for sexual distress, except for pregnancy trimester.
Conclusion: Low sexual desire and sexual distress are relatively common sexual experiences during pregnancy. Several factors could predict low sexual desire but were not associated with sexual distress, and conversely. Comprehensive attention to all of these factors is essential while screening for sexual health during pregnancy.
Key words: Pregnancy, Sexual desire, Sexual distress, Sexual dysfunctions, Influencing factors.
 Fuchs A, Czech I, Sikora J, Fuchs P, Lorek M, Skrzypulec-Plinta V, et al. Sexual functioning in pregnant women. Int J Environ Res Public Health 2019; 16: 4216–4225.
 Senobari M, Azmoude E, Mousavi M. The relationship between body mass index, body image, and sexual function: A survey on Iranian pregnant women. Int J Reprod Biomed 2019; 17: 503–512.
 Kafy A, Alamoudi R, Alkafy S, Qary R. Female sexual function during pregnancy: A comparative cross sectional study in Saudi Arabia. Glob J Res Anal 2019; 8: 85–89.
 Bouzouita I, Ellouze F, El Kefi H, Chaari I, Cheikh CB, Krir M, et al. Sexuality of the Tunisian pregnant women: Facts between myth and reality. Sexologies 2018; 27: e103–e109.
 de Jong DC, Reis HT, Peters BJ, DeHaan C, Birnbaum GE. The role of implicit sexual desire in romantic relationships. Personal Individual Diff 2019; 149: 46–56.
 Fernández-Carrasco FJ, Rodríguez-Díaz L, González-Mey U, Vázquez-Lara JM, Gómez-Salgado J, Parrón-Carreño T. Changes in sexual desire in women and their partners during pregnancy. J Clin Med 2020; 9: 526–540.
 Derogatis L, Clayton A, Lewis−D’Agostino D, Wunderlich G, Fu Y. Validation of the female sexual distress scale−revised for assessing distress in women with hypoactive sexual desire disorder. J Sex Med 2008; 5: 357–364.
 Gava G, Visconti M, Salvi F, Bartolomei I, Seracchioli R, Meriggiola MC. Prevalence and psychopathological determinants of sexual dysfunction and related distress in women with and without multiple sclerosis. J Sex Med 2019; 16: 833–842.
 Hendrickx L, Gijs L, Enzlin P. Sexual difficulties and associated sexual distress in Flanders (Belgium): A representative population-based survey study. J Sex Med 2016; 13: 650–668.
 Christensen BS, Grønbæk M, Osler M, Pedersen BV, Graugaard C, Frisch M. Sexual dysfunctions and difficulties in Denmark: Prevalence and associated sociodemographic factors. Arch Sex Behav 2011; 40: 121–132.
 Hendrickx L, Gijs L, Janssen E, Enzlin P. Predictors of sexual distress in women with desire and arousal difficulties: Distinguishing between personal, partner, and interpersonal distress. J Sex Med 2016; 13: 1662–1675.
 Vannier SA, Rosen NO. Sexual distress and sexual problems during pregnancy: Associations with sexual and relationship satisfaction. J Sex Med 2017; 14: 387–395.
 Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573–577.
 Malary M, Pourasghar M, Khani S, Moosazadeh M, Hamzehgardeshi Z. Psychometric properties of the sexual interest and desire inventory-female for diagnosis of hypoactive sexual desire disorder: The Persian version. Iran J Psychiatry 2016; 11: 262–268.
 Clayton AH, Goldmeier D, Nappi RE, Wunderlich G, Lewis−D’Agostino DJ, Pyke R. Validation of the sexual interest and desire inventory−female in hypoactive sexual desire disorder. J Sex Med 2010; 7: 3918–3928.
 Nekoo EA, Burri A, Ashrafti F, Fridlund B, Koenig HG, Derogatis LR, et al. Psychometric properties of the Iranian version of the female sexual distress scale−revised in women. J Sex Med 2014; 11: 995– 1004.
 Jamali S, Mosalanejad L. Sexual dysfnction in Iranian pregnant women. Iran J Reprod Med 2013; 11: 479– 486.
 Witting K, Santtila P, Varjonen M, Jern P, Johansson A, Von Der Pahlen B, et al. Female sexual dysfunction, sexual distress, and compatibility with partner. J Sex Med 2008; 5: 2587–2599.
 Lo SST, Kok WM. Prevalence and risk factors for sexual problems and distress in Chinese unmarried young women: An observational study. J Sex Med 2018; 15: 1620–1628.
 van den Brink F, Smeets MAM, Hessen DJ, Woertman L. Positive body image and sexual functioning in Dutch female university students: The role of adult romantic attachment. Arch Sex Behav 2016; 45: 1217–1226.
 Woertman L, Van den Brink F. Body image and female sexual functioning and behavior: A review. J Sex Res 2012; 49: 184–211.
 Quinn-Nilas C, Benson L, Milhausen RR, Buchholz AC, Goncalves M. The relationship between body image and domains of sexual functioning among heterosexual, emerging adult women. Sex Med 2016; 4: e182–e189.
 Afshari P, Houshyar Z, Javadifar N, Pourmotahari F, Jorfi M. The relationship between body image and sexual function in middle-aged women. Electron Physician 2016; 8: 3302–3308.
 Hamzehgardeshi Z, Malary M, Moosazadeh M, Khani S, Pourasghar M. Body image and hypoactive sexual desire disorder relationship in a representative sample of Iranian women. J Family Reprod Health 2020; 14: 88–94.
 Widen EM, Gallagher D. Body composition changes in pregnancy: Measurement, predictors and outcomes. Eur J Clin Nutr 2014; 68: 643–652.
 Fuller-Tyszkiewicz M, Skouteris H, Watson BE, Hill B. Body dissatisfaction during pregnancy: A systematic review of cross-sectional and prospective correlates. J Health Psychol 2013; 18: 1411–1421.
 Yildiz H. The relation between prepregnancy sexuality and sexual function during pregnancy and the postpartum period: A prospective study. J Sex Marital Ther 2015; 41: 49–59.
 Aribi L, Houidi AB, Masmoudi R, Chaabane K, Guermazi M, Amami O. [Sexualité féminine au cours de la grossesse et en post-partum: A propos de 80 femmes tunisiennes]. Tunis Med 2012; 90: 873–877. (in French)
 Kong L, Li T, Li L. The impact of sexual intercourse during pregnancy on obstetric and neonatal outcomes: A cohort study in China. J Obstet Gynaecol 2019; 39: 455–460.
 Hamzehgardeshi Z, Malary M, Moosazadeh M, Khani S, Pourasghar M, Alianmoghaddam N. Socio-demographic determinants of low sexual desire and hypoactive sexual desire disorder: A population-based study in Iran. BMC Women’s Health 2020; 20: 233–242.
 Miranda CC, Perez AV, Bossardi BR, Brust LC, Grossi FS, Valério EG, et al. Sexual function in pregnant women in the public health system. Open J Obstet Gynecol 2019; 9: 764–774.