產後婦女授乳方式、身體心像及性功能關係性之探討

Abstract

【研究背景】 性健康是構成良好生活品質的要素，然而婦女在產後由於經歷生理、心理及社會關係的變化，常導致性功能障礙。除了生殖道損傷外，母乳哺育以及身體心像亦可能是影響產後性功能的因素之一，但相關研究結果並不一致，且此議題在國內鮮少被醫療專業照護人員所探討。 【研究目的】 本研究旨在探討婦女於產後三個月時，母乳哺育、身體心像、人口學特徵、身心狀態及產科史和性功能之間的關係性，以及性功能的預測因子。 【研究方法】 本研究為橫斷式研究，於臺灣北部某醫學中心收案，在產後三個月時寄發結構式問卷進行資料蒐集，共618位婦女於納入研究。研究工具包含臺灣版之「女性性功能量表」(Female sexual function index, FSFI)、「產後身體心像量表」與「基本資料與產科史資料問卷」。所得資料以IBM SPSS 19.0版套裝統計軟體進行資料分析，統計方法包含：描述性統計以及皮爾森相關積差 (Pearson correlation coefficient)、卡方檢定 (Chi-squared test)、獨立樣本t檢定 (Independent-samples test) 單因子變異數分析 (One way ANOVA)、克-瓦單因子等級變異數分析(Kruskal-Wallis one way analysis of variance H test)、曼-惠特尼U檢定 (Mann-Whitney U test)及羅吉斯迴歸分析 (Multivariate Logistic regression) 等推論性統計。 【研究結果】 69.26%的婦女在產後三個月有性功能障礙的問題，其預測因子包含：年齡、授乳方式及身體心像得分。年齡增加會提高性功能障礙的風險 (OR=1.054，95% CI=1.007－1.102)；採純母乳哺育的產婦發生性功能障礙的風險高於餵食配方奶的產婦 (OR=1.872，95% CI=1.112－3.152)；較高的身體心像得分可保護免於性功能障礙 (OR=0.945，95% CI=0.917－0.975)。 對體型感受不滿意者，其性功能總分明顯低於對體型感受滿意者 (p<0.05)；個人年收入介於11-50萬者之性功能總分高於個人年收入介於51-70萬 (p<0.05) 以及個人年收入超過70萬者 (p<0.01)；採純母乳哺育產婦在性慾、陰道潤滑、性喚起、性高潮及性交疼痛這些面向以及性功能總得分皆顯著低於混合哺餵 (p<0.01) 及完全餵食配方奶 (p<0.01) 之產婦，但在性滿意度則無顯著差異。 【結論】 將近70%的女性在產後三個月有性功能障礙，純母乳哺育及身體心像是影響此時期性功能衰退的因素。在臨床照護上可協助產婦及其伴侶瞭解母乳哺育及身體心像不滿可能造成的性功能變化，並教導調適的方法，以期能夠改善產後性功能障礙情形，促進其性健康。

【Introduction】 Sexual health is an essential part of life quality. Nevertheless, women usually experienced sexual dysfunction due to physical, psychological and social relationship changes after child birth. Genital tract damage, breastfeeding and body image may affect sexual function in the postpartum period. However, some related studies remain inconclusive. And the issue of postpartum sexual dysfunction rarely discussed by health care professionals in Taiwan. 【Aim】 The aims of this study were to explore female sexual function in the three months postpartum period and the relationships with demographic characteristic, physical and psychological status, obstetrical history, body image, and feeding type. 【Methods】 In this cross-sectional study, 618 mothers were recruited from a medical center in northern Taiwan. Self-report questionnaires were provided to study in the three months postpartum. The following three instruments were applied to collect data: “Female Sexual Function Index (FSFI)”, “Postpartum Body Image Scale”, and “Physical and psychological status, Demographic, and obstetrical information”. SPSS 19.0 statistical software was used to analyze the data. The statistical methods include descriptive statistics, Pearson correlation coefficient, Pearson's chi-squared test, independent samples t-test, one way ANOVA, Kruskal-Wallis one-way analysis of variance H test, Mann-Whitney U test and Logistic regression. 【Results】 The results showed 69.26% of those women experienced sexual dysfunction in the three months postpartum period. Older age (OR=1.054，95% CI=1.007－1.102), and exclusive breastfeeding in comparison to completely formula feeding (OR=1.872，95% CI=1.112-3.152) were two risk factors of sexual dysfunction. While higher body image score (OR=0.945，95% CI=0.917－0.975) was the protective factor of sexual dysfunction. The results also demonstrated significant differences in the FSFI total score in terms of body shape evaluations, personal annual incomes, and feeding types. Women who were dissatisfied with their body shape has lower FSFI total score than those who were satisfied (p<0.05). Women whose personal annual incomes belong to “510,000-700,000 (NTD)” group (p=0.16) and “over 700,000” group (p<0.01) made lower FSFI total score than those whose incomes classified into “110,000-500,000 (NTD)” group. Women who employed exclusive breastfeeding in the three month postpartum period have lower desire, lubrication, arousal, orgasm, dyspareunia and total FSFI score than who employed mixed feeding (p<0.01) and completely formula feeding (p<0.01). But we found no significant difference in sexual satisfaction score with different feeding types. 【Conclusion】 This study revealed about 70% women encountered sexual dysfunction during three months postpartum period. Exclusive breastfeeding and body image dissatisfaction imposed negative effect on the sexual function during this period. We suggest health professionals assisting those mothers and their sexual partner to understand the natual sexual function declined due to breastfeeding and body image change. And provide appropriate information to help them cope with sexual dysfunction in the postpartum period. With these supports, they may also promote their sexual health.