產後婦女性功能與疲倦之探討

Abstract

背景： 女性歷經懷孕與生產之後，身體、心理皆產生重大改變，發展母親角色的同時，也必須重新適應與伴侶間的性關係。在產後期間，產婦普遍的疲倦症狀，不只影響其精神狀態、體力、情緒，和子女的養育，更可能使性生活、親密關係改變，並且產婦有性方面的問題會危及其生活品質，甚至婚姻關係。然而，性功能與疲倦的議題是產後照護中較少被關注的，國內也欠缺相關研究。 研究目的： 描述產後二個月婦女性功能與疲倦的分布狀況，檢視人口學、產科因素、身心因素以及情境因素，分別與性功能、疲倦之相關性，以及檢視產後婦女性功能低落的危險因子。 研究方法： 本研究為相關性研究，以方便取樣收集產後二個月的婦女並郵寄問卷，共263位產婦納入研究。問卷內容含：基本資料、女性性功能量表 (female sexual function index, FSFI)、疲倦症狀量表 (fatigue symptom inventory, FSI)、流行病學研究中心憂鬱量表 (the center for epidemiologic studies depression scale, CES-D)。資料分析使用統計軟體SPSS，以描述性統計詳述個案基本資料、疲倦以及性功能的分布狀況，並用Mann-Whitney U檢定、Kruskal-Wallis H檢定、Spearman’s correlation、logistic regression進行推論性統計分析。 研究結果： 在產後二個月，性功能低落的婦女佔 83.30%、疲倦發生率為 87.50%。疲倦程度越高，整體性功能及性慾、性喚起、陰道濕潤度、性高潮、性滿意度越差，性交疼痛程度也較高 (p < 0.05)。此外，疲倦程度高且有憂鬱傾向 (OR: 1.02, 95% CI: 1.00-1.03)、純母乳哺餵 (OR: 2.87, 95% CI: 1.06-7.78)、混合哺餵 (OR: 3.51, 95% CI: 1.31-9.36)、伴侶關係滿意度差 (OR: 2.14, 95% CI: 1.20-3.81)是為性功能低落的危險因子。產後疲倦則與身心舒適度、憂鬱、有無固定疲倦型態，以及伴侶關係滿意度、與伴侶家務分工/照顧子女分工滿意度相關。 結論： 本研究確認產後二至三個月間（五到八週）性功能與疲倦具有關聯性，產婦同時有高度疲倦及憂鬱傾向者，較容易導致性功能低落。因此，建議加強臨床護理師、專業人士具備產後性生活方面、情緒的評估與諮詢能力；另外，鼓勵產婦的伴侶、親屬參與母嬰照顧，形成持續的支持模式，有助於減輕產後的疲倦，以提升產後婦女的性健康。

Introduction: Women undergo significant physical and psychological changes after experiencing pregnancy and giving birth. As they develop their role as a mother, they must also readapt to their sexual relationship with their partner. After giving birth, women generally suffer from fatigue that affects their mental state, stamina, emotions, and parenting and may even change their sex life and intimate relationships. Furthermore, women who face sexual problems in postpartum period are more likely to have negative influence on their quality of life, even the marital satisfaction. However, few studies on postpartum care focused on sexual functions and fatigue, and there is little domestic research on the two issues as well. Aim: This study examined the sexual functions and fatigue of women two months after giving birth and their correlation with various demographic, obstetric, physical, psychological, and situational factors to identify the risk factors of sexual problems in women after giving birth. Methods: In this correlation study, convenience sampling was adopted to find women two months after giving birth, and a questionnaire survey was administered via mail, which resulted in 263 respondents. The questionnaire included basic information, the Female Sexual Function Index (FSFI), the Fatigue Symptom Inventory (FSI), and the Center for Epidemiologic Studies Depression Scale (CES-D). Using SPSS to analyze the data, we derived descriptive statistics for basic information, fatigue, and sexual function and employed the Mann-Whitney U test, the Kruskal-Wallis H test, Spearman’s correlation, and logistic regression to perform inferential statistical analysis. Results: Among the respondents, 83.30% and 87.50% displayed sexual dysfunction and fatigue two months after giving birth. When the score of fatigue higher, overall sexual function and the scores of desire, arousal, vaginal lubrication, orgasm, satisfaction are relatively lower, and could be much pain during intercourse (all p < 0.05). Furthermore, women that displayed high levels of fatigue and depressive tendencies (OR: 1.02, 95% CI: 1.00-1.03), employed exclusive breastfeeding (OR: 2.87, 95% CI: 1.06-7.78) or mixed feeding (OR: 3.51, 95% CI: 1.31-9.36), expressed dissatisfaction with their partner relationships (OR: 2.14, 95% CI: 1.20-3.81) were more likely to have sexual dysfunction. Besides, physical and mental comfort, depression, daily pattern of fatigue, and the satisfaction of partner relationships, division of housework/infant care were found to be correlated to fatigue. Conclusion: This study confirmed the correlation between sexual function and fatigue in women between two and three months (5~8 weeks) after giving birth. Women with both high levels of fatigue and depressive tendencies are even more likely to have sexual problems. We therefore suggest that clinical nurses and experts enhance their assessment and advisory capabilities regarding postpartum sex life. In addition, encouraging the partners and family members of the mothers to participate in maternal and child care can provide a continuous caring that will reduce the postpartum fatigue and improve the sexual health of women after they give birth.