Finally a multiple regression analysis was

Finally, a multiple regression analysis was performed to determine the variables that predicted sexual health. Maternal age and cesarean section were significant predictors of the SHQ28 domains of desire (P = 0.005 and P = 0.015, respectively), arousal (lubrication) (P = 0.003 and P = 0.032, respectively), and arousal (cognitive) (P = 0.007 and P = 0.036, respectively). Maternal age was a significant predictor of the enjoyment domain (P = 0.001). Associations of the SHQ28 UNC2025 domain with maternal age was P = 0.071. Associations of the SHQ28 pain domain with maternal age and cesarean section were P = 0.057 and P = 0.071, respectively.

Discussion
The present study is the first to analyze the association between maternal sexual function and maternal status, delivery mode, episiotomy, and laceration. There were significant differences in the SFQ28 partner domain between the vaginal and operative delivery groups. There were also nonsignificant differences in the orgasm and pain domains. The association between delivery mode and postpartum sexual activity is controversial. In a 12‐month study of 912 pregnant women and their husbands, instrumental deliveries were associated with the highest and planned cesarean section with the lowest rate of long‐term maternal and paternal sexual dysfunction [5]. Our results were similar to Safarinejad et al.\’s study [5], because of the similar timing of the examination. One study demonstrated that both cesarean section and perineal scars were associated with sexual malfunction [4]. However, another study demonstrated that elective cesarean delivery was not associated with a protective effect on postpartum sexual function [8]. Gungor et al. demonstrated that sexual dissatisfaction should not be assumed simply a product of the delivery mode. Individual, sociodemographic, lifestyle, and marital characteristics should also be taken into account [9]. Mode of delivery history appeared to have minimal effect on sexual function at 6 years post‐index delivery [7]. Fehniger et al. reported the sexual function of women aged 40 years and older with at least one past child event. The sexual activities of women were not associated with a history of cesarean delivery compared with vaginal delivery alone. Women with a history of operative‐assisted delivery were more likely to report low desire [10]. Operative‐associated delivery affected sexual function for a long time. Low partnership in the operative‐assisted delivery in our study might affect the long‐term sexual function. Because the interval between the delivery time and the study time differs in the studies, the association between delivery mode and postpartum sexual activity is controversial. Accordingly, further investigation is necessary to determine the relationship between maternal sexual health and the delivery mode.
In the present study, episiotomy had negative effects on sexual function in Japan. All SFQ28 domains were superior in mothers without laceration and episiotomy. However, we could not demonstrate the cause and the effect of episiotomy on sexual function because of our cross‐sectional single‐time point data. This was one of the limitations of the present study. Several studies have demonstrated a relation between the condition of the perineum after delivery and sexual function. Large lacerations (anal sphincter laceration) damaged the maternal sexual activity [14,15]. In 55 postpartum women compared with women with intact perineum, those who had both episiotomy and second‐degree perineal tears had lower levels of libido, orgasm, and sexual satisfaction and more pain during intercourse at 3 months after delivery [6]. Another study demonstrated retina there was no significant difference in sexual function 12–18 months after childbirth between women who delivered vaginally without episiotomy, heavy perineal laceration, or secondary operative interventions and women who underwent elective cesarean section [11]. A meta‐analysis revealed that evidence does not support maternal benefits traditionally ascribed to routine episiotomies. Routine episiotomies also have negative effects on maternal sexual function and activity. For instance, pain with intercourse was more common among women who underwent an episiotomy [16]. Our results also supported the negative effects of episiotomies on female sexual function. Including the present study, we recommend that routine episiotomy be avoided at delivery to improve maternal sexual function after delivery.