Zhao CY, Peng XC, Liu ZH, Yin J, Zhao L. Psychological distress and pelvic floor dysfunction in postpartum women: Associations with anxiety, perceived stress, and sexual health. World J Psychiatry 2026; 16(10): 119636 [DOI: 10.5498/wjp.119636]
Corresponding Author of This Article
Cong-Ying Zhao, MD, Department of Ultrasound Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang 050005, Hebei Province, China. congyingzcy@163.com
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Psychiatry
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Zhao CY, Peng XC, Liu ZH, Yin J, Zhao L. Psychological distress and pelvic floor dysfunction in postpartum women: Associations with anxiety, perceived stress, and sexual health. World J Psychiatry 2026; 16(10): 119636 [DOI: 10.5498/wjp.119636]
World J Psychiatry. Oct 19, 2026; 16(10): 119636 Published online Oct 19, 2026. doi: 10.5498/wjp.119636
Psychological distress and pelvic floor dysfunction in postpartum women: Associations with anxiety, perceived stress, and sexual health
Cong-Ying Zhao, Xian-Chai Peng, Zhen-Hong Liu, Jing Yin, Li Zhao
Cong-Ying Zhao, Jing Yin, Li Zhao, Department of Ultrasound Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang 050005, Hebei Province, China
Xian-Chai Peng, Department of Obstetrics, The Second Hospital of Hebei Medical University, Shijiazhuang 050005, Hebei Province, China
Zhen-Hong Liu, Department of Psychiatry, The Second Hospital of Hebei Medical University, Shijiazhuang 050005, Hebei Province, China
Co-corresponding authors: Cong-Ying Zhao and Li Zhao.
Author contributions: Zhao CY and Zhao L conceived and designed the study, they contributed equally as co-corresponding authors of this study; Zhao CY, Peng XC, and Yin J were responsible for participant recruitment, data collection, and clinical assessment; Liu ZH provided psychiatric expertise, contributed to the psychological assessment framework, and participated in the interpretation of mental health–related data; Peng XC and Yin J performed the statistical analysis; Zhao CY drafted the initial manuscript; Zhao L critically revised the manuscript for important intellectual content; all authors reviewed and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.
Supported by 2023 Hebei Province Medical Research Project Plan, No. 20230070.
Institutional review board statement: The study protocol was approved by the Ethics Committee of the Second Hospital of Hebei Medical University.
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: No available data.
Corresponding author: Cong-Ying Zhao, MD, Department of Ultrasound Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang 050005, Hebei Province, China. congyingzcy@163.com
Received: March 27, 2026 Revised: April 27, 2026 Accepted: May 22, 2026 Published online: October 19, 2026 Processing time: 196 Days and 23.6 Hours
Abstract
BACKGROUND
In postpartum women, pelvic floor dysfunction (PFD) may be closely related to anxiety, perceived stress, and sexual health, providing insights for enhancing their psychological well-being.
AIM
To explore associations between PFD and anxiety, perceived stress, and sexual health in postpartum women and factors influencing psychological distress.
METHODS
This cross-sectional study included 140 consecutive postpartum women attending postpartum follow-up or pelvic floor outpatient services. PFD, anxiety, perceived stress, and sexual function were assessed using the Pelvic Floor Distress Inventory-20 (PFDI-20), Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A), 10-item Perceived Stress Scale (PSS-10), and Female Sexual Function Index (FSFI), respectively, and compared between the PFD and non-PFD groups. Spearman correlation analysis assessed between-scale correlations. Multivariable logistic regression identified independent factors associated with anxiety, high perceived stress, and sexual dysfunction.
RESULTS
Among the 140 postpartum women, 98 (70.0%) were in the PFD group, and 42 (30.0%) were in the non-PFD group. In the PFD group, the HADS-A and PSS-10 scores were significantly higher (7.6 ± 3.8 vs 5.2 ± 3.1 and 19.8 ± 6.1 vs 15.7 ± 5.4, respectively; both P < 0.001), and the total FSFI score was significantly lower (23.7 ± 5.4 vs 27.8 ± 4.6, P < 0.001). The PFDI-20 total score was positively correlated with HADS-A (r = 0.46) and PSS-10 (r = 0.52) and negatively correlated with the FSFI total score (r = -0.49; all P < 0.001). Multivariable analysis indicated that each 10-point increase in the PFDI-20 score was associated with increased risks of anxiety, high perceived stress, and sexual dysfunction. Poor sleep quality and lower social support were also independently associated with adverse psychological and sexual outcomes.
CONCLUSION
PFD in postpartum women increases with the severity of anxiety, perceived stress, and sexual dysfunction. Management should include psychological screening, sexual health assessments, and attention to sleep and social support.
Core Tip: Postpartum pelvic floor dysfunction mainly presents with a mixture of physiological changes and severe psychological problems; anxious reactions arising from mothers’ overly intense self-assessment have also appeared. The burden of pelvic floor symptoms is positively correlated with the degree of psychological problems; therefore, patients presenting with more severe pelvic floor symptoms will have higher levels of anxiety or depression. Poor quality of sleep and a lack thereof also contribute to this problem; thus, they are essential moderators. The above data show that integrating regular psychological screening content in the postpartum period of pelvic-facility-follow-up programme for women will not only help them recover health comprehensively but also improve their overall quality of life.
