Developing a Conceptual Model and Measure of Postpartum Sexual Well-Being

Abstract

Postpartum sexual well-being is a complex, multidimensional concept yet most research and clinical care continue to emphasize biomedical and behavioral outcomes. This dissertation aimed to (1) develop an integrated, person-centered model of postpartum sexual well-being and (2) develop and evaluate a measure of internal, cognitive-affective factors that influence whether postpartum individuals can engage in sexual experiences aligned with their values and priorities.The study was conducted in three phases. Phase I used qualitative interviews (N=12) to refine a multidimensional conceptual model of postpartum sexual well-being. The final model identified important factors across four domains: cognitive-affective, interpersonal, cultural, and structural/system-level. Within the cognitive-affective domain, five key factors emerged: sexual self-image, self-determination, resilience, comfort, and acceptance. This work laid the foundation for Phase II, which focused on developing a new self-report measure targeting the cognitive-affective domain. Item development and cognitive interviews (N=13) were used to iteratively refine content based on participant and expert feedback. In Phase III, the 34-item Postpartum Sexual Well-Being Inventory: Cognitive-Affective Domain (PSWI-CA) was administered to a diverse sample of postpartum individuals (N=46). Exploratory factor analyses supported unidimensionality for most subscales, with items trimmed based on psychometric performance. Trimmed subscales demonstrated acceptable internal consistency and significant associations with related constructs, including sexual satisfaction, distress, psychological functioning, and alignment between sexual experiences and personal values. Findings support the PSWI-CA as a promising tool for capturing postpartum individuals’ internal experiences of sexual well-being, with future work needed to conduct continued modification and testing of the PSWI-CA items, and extend measurement across all domains of the model.