Introduction and hypothesis: Data on the effect of pregnancy and mode of delivery on postpartum sexual function are very heterogenic and inconclusive. The aim of this review is to examine the current literature for reliable data on the role of pregnancy and the route of delivery on sexual health and different dysfunctions.

Methods: A Medline search was performed for the terms "sexuality," "sexual function," "sexual dysfunction," and "pregnancy," "childbirth," "mode of delivery," "delivery," "cesarean section," "puerperium," and "postpartum." Randomized, prospective, and retrospective studies in published in the English language from 1960 to November 2012 were evaluated.

Results: Sexual function decreases throughout pregnancy, getting worse as the pregnancy progresses. Decreasing desire and orgasm, increasing pain and other sexual dysfunction problems in the first 3 months gradually improved within 6 months after delivery. This process is affected by many factors such as socio-cultural, age, parity, breastfeeding, depression, tiredness, sexual inactivity during the first trimester, postpartum body image, worries about getting pregnant again, and concomitant urinary tract infections are reported as independent risk factors for sexual dysfunction.

Conclusions: In this review there is no clear evidence of a relationship between the mode of delivery and changes in sexual function. Quality of sexual life should be part of history taking because of the possible sequelae of pregnancy and delivery. More adequately powered studies are necessary to answer the many open questions.