Maternal and Child Care

Maternal and Child Care

Sara is a 34-year-old, happily married G1P2 who is 18 months postpartum after an uncomplicated vaginal delivery of two 6-lb twins—a boy
and a girl. She notes that “I should be delighted that my family is complete, but I’ve lost all my desire for sex. We seldom ‘get together’—
usually once every month or two, and when we do, I’m not aroused and have a hard time with orgasm. I’m just going through the motions.
Sex just isn’t the same since I gave birth.” Sara notes that she is also having pain with sex, primarily with penetration. Sara breastfed until
two months ago, has no history of anxiety or depression, or any significant medical history. She began taking oral contraceptives only four
months ago for contraception.
1. What additional history should be gathered during the visit?
2. What are the physical issues associated with postpartum dyspareunia?
3. Describe the physical exam and emphasize the importance of Sara’s situation?
4. What resources are available for Sara and her partner?
5. What would your treatment plan for Sara be?

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