Nearly one in three women still experience painful sexual intercourse a year after their baby is born and more than half have at least one sex-related health problem, according to research.
482 women who had attended maternity units in Birmingham, UK, took part in a self-administered questionnaire at least a year after their most recent birth.
"87 per cent complained of at least one health problem" says Midwife Amanda Williams, who is currently on secondment to the city's Perinatal Institute.
"Asian women, who made up 15 per cent of the survey, were more likely to complain of health problems than white women, as were women who were older and had larger babies and longer labours."
Key findings include:
The three most common problems reported were sex-related health issues (55 per cent) followed by stress urinary incontinence (54 per cent) and urge urinary incontinence (37 per cent).
Painful intercourse was reported by 19 per cent of women who had had caesareans, 34 per cent who had had a normal birth and 36 per cent of women who had an instrument-assisted birth, such as forceps.
Sex-related health problems were highest among instrument-assisted births (77 per cent) and lowest among caesarean births (51 per cent), with 64 per cent of women having normal births reporting at least one problem related to sex.
Women who had an instrument-assisted delivery also took two weeks longer than woman who had had caesareans and normal births to resume sexual intercourse (ten weeks versus eight) with figures ranging from one week to 52.
Forceps deliveries were also associated with higher levels of stress, urge, and continual incontinence.
Having an epidural did not lead to an overall increase in health problems and this study does not support previous research that identified increased stress incontinence and frequent urinating as risk factors.
Asian women reported greater health problems than white women. Perineal pain was more than two times higher (62 per cent versus 28 per cent) and they experienced much higher levels of continual urinary incontinence (35 per cent versus 20 per cent).
However, Afro-Caribbean women displayed similar levels of ill health to white women.
The women surveyed were aged 16 or over and from all ethnic groups. They had had their babies at least 12 months before the survey began and all had a live baby with no congenital abnormalities at the time of the survey.
"Our research has raised a number of issues" says Amanda Williams. "For example, it has highlighted concerns about the long-term health effects resulting from forceps deliveries and the variations in ill health between white and Asian women. Both these areas could benefit from further research.
"It's also important to point out that while women who had had caesareans reported fewer problems with the health issues covered by this study, this delivery method is associated with other problems that have a negative effect on women's quality of life, like adhesions and wound infections.
"We believe that our study points to the need for health professionals to provide ongoing support for women who have given birth, focusing on issues such as perineal problems and sensitive health problems.
"This, coupled with greater public awareness of these issues, will hopefully make it easier for women to get help for both short-term and long-term health problems."