(1) Background: Sexual function can be affected up to and beyond 18 months postpartum, with some studies suggesting that spontaneous vaginal birth results in less sexual dysfunction. This review examined the impact of mode of birth on sexual function in the medium- (≥6 months and <12 months postpartum) and longer-term (≥12 months postpartum). (2) Methods: Literature published after January 2000 were identified in PubMed, Embase and CINAHL. Studies that compared at least two modes of birth and used valid sexual function measures were included. Systematic reviews, unpublished articles, protocols and articles not written in English were excluded. Quality was assessed using the Newcastle Ottawa Scale. (3) Results: In the medium-term, assisted vaginal birth and vaginal birth with episiotomy were associated with worse sexual function, compared to caesarean section. In the longer-term, assisted vaginal birth was associated with worse sexual function, compared with spontaneous vaginal birth and caesarean section; and planned caesarean section was associated with worse sexual function in several domains, compared to spontaneous vaginal birth. (4) Conclusions: Sexual function, in the medium- and longer-term, can be affected by mode of birth. Women should be encouraged to seek support should their sexual function be affected after birth.

Department of General Practice and Elderly Care Medicine University Medical Center Groningen University of Groningen P O Box 196 9700 AD Groningen The Netherlands

Department of Genetics University Medical Center Groningen University of Groningen 9700 AD Groningen The Netherlands

Department of Psychology Faculty of Arts Charles University 128 08 Prague Czech Republic

Midwifery Academy Amsterdam Groningen InHolland 9713 GL Groningen The Netherlands

Midwifery Science Amsterdam UMC Location Vrije Universiteit Amsterdam De Boelelaan 1117 1081 HZ Amsterdam The Netherlands

School of Nursing and Midwifery Western Sydney University Blacktown NSW 2148 Australia

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