Analysis the mediating effect of pelvic floor muscle strength recovery on sexual function and depression in postpartum women

doi:10.5498/wjp.121035

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Oct 19, 2026; 16(10): 121035
Published online Oct 19, 2026. doi: 10.5498/wjp.121035

Analysis the mediating effect of pelvic floor muscle strength recovery on sexual function and depression in postpartum women

Teng-Fei Zhao, Yang-Yang Li, Hui-Xue Liu, Lin Liu, Rui-Zhi He, Chong-Xin Tong

Teng-Fei Zhao, Yang-Yang Li, Hui-Xue Liu, Lin Liu, Rui-Zhi He, Chong-Xin Tong, Department of Obstetrics and Gynecology, Hebei Province Children’s Hospital, Shijiazhuang 050000, Hebei Province, China

Co-first authors: Teng-Fei Zhao and Yang-Yang Li.

Author contributions: Zhao TF and Li YY contributed equally to this study as co-first authors, including research design, data collection, statistical analysis, and manuscript writing; Tong CX was responsible for project guidance, quality control, and final revision of the manuscript; Liu HX, Liu L, and He RZ participated in data collection and literature review. All authors approved the final version of the manuscript.

AI contribution statement: The authors declare that no AI or AI-assisted technologies (including but not limited to ChatGPT, Grammarly, DeepL, or automated data analysis software) were utilized during the study design, data analysis, manuscript writing, language editing, or illustration generation of this manuscript. The entire content was prepared solely by the human authors.

Supported by Medical Science Research Project of Hebei Province, No. 20220751.

Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Hebei Province Children’s Hospital (approval No. 202136).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

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 additional data are available.

Corresponding author: Chong-Xin Tong, Chief Physician, Department of Obstetrics and Gynecology, Hebei Province Children’s Hospital, No. 133 Jianhua South Street, Shijiazhuang 050000, Hebei Province, China. youxiang1631202409@163.com

Received: April 22, 2026
Revised: May 21, 2026
Accepted: June 22, 2026
Published online: October 19, 2026
Processing time: 171 Days and 0.1 Hours

Abstract

BACKGROUND

Postpartum pelvic floor muscle weakness easily triggers sexual dysfunction and depressive mood. The internal interaction mechanism among the three still lacks sufficient empirical verification.

AIM

To investigate the mediating effects of pelvic floor muscle strength recovery on sexual function and depressive symptoms in postpartum women.

METHODS

Postpartum women who underwent standardized rehabilitation at a single center from January 2022 to December 2024 were selected using convenience sampling. Sexual function, depression, and pelvic floor muscle strength recovery were assessed using the Female Sexual Function Index (FSFI), Edinburgh Postnatal Depression Scale (EPDS), and modified Oxford grading scale combined with pelvic floor electrophysiological examination. Pearson’s correlation analysis was used to explore the correlations among variables, and Hayes’ PROCESS Model 4 was used to test the mediating effect of pelvic floor muscle strength recovery.

RESULTS

Among the 130 postpartum women their overall sexual function was moderate with mild depressive symptoms. Regarding pelvic floor muscle strength recovery, 90 (69.23%), 28 (21.54%), and 12 (9.23%) cases were classified as good, moderate, and poor, respectively. There were significant differences in the total FSFI, subscale, total EPDS scores. The incidence of depressive symptoms among postpartum women with different grades of pelvic floor muscle strength recovery (P < 0.05). Correlation analysis showed that total FSFI score was negatively correlated with total EPDS score and positively correlated with pelvic floor muscle strength recovery. Total EPDS score was negatively correlated with pelvic floor muscle strength recovery (P < 0.05). Mediation analysis revealed that pelvic floor muscle strength recovery played a partial mediating role between sexual function and depressive symptoms, with a mediating effect value of -0.153, accounting for 33.60% of total effect (95% confidence interval: -0.252 to -0.053).

CONCLUSION

Sexual function, pelvic floor muscle strength recovery, and depressive symptoms are closely correlated in postpartum women. Pelvic floor muscle strength recovery exerts a partial mediating effect on the process by which sexual function influences depressive symptoms. The assessment and rehabilitation intervention of postpartum pelvic floor function combined with psychological screening is important for promoting the coordinated physical and mental recovery of postpartum women.

Keywords: Postpartum women; Sexual function; Depressive symptoms; Pelvic floor muscle strength; Mediating effect

Core Tip: This study included 130 postpartum women to explore the mediating effect of pelvic floor muscle strength recovery (PFMSR) on sexual function (assessed by Female Sexual Function Index) and depressive symptoms (assessed by Edinburgh Postnatal Depression Scale). The results showed that the PFMSR played a partial mediating role, accounting for 33.60% of the total effect, suggesting the need for clinical attention to the PFMSR and psychological screening for postpartum women’s physical and mental recovery.