The role of maternal age, education, birth experience and self-esteem in shaping anxiety before first postpartum intercourse.

Introduction: The postpartum period involves significant physical and psychological changes that can impact a woman's sexual health. Anxiety experienced prior to resuming sexual intercourse after childbirth is a common yet understudied issue that may affect relationship satisfaction and overall wellbeing. While multiple biopsychosocial factors likely contribute to this anxiety, their interactions and particularly the role of self-esteem remain insufficiently understood. The aim of this study is to identify factors associated with anxiety before first postpartum sexual intercourse and to examine the relationship between self-esteem and sexual activity resumption among Polish women. Methods: We conducted an observational, cross-sectional study among 350 Polish women up to 12 months postpartum. Data were collected via an anonymous online questionnaire, which included socio-demographic characteristics, delivery details, sexual health aspects and self-esteem assessed using the Rosenberg Self-Esteem Scale (RSES). Logistic regression analysis was applied to identify significant predictors of postpartum sexual anxiety. Results: Higher maternal age (OR = 0.93) and more frequent previous sexual activity (OR = 0.78) were associated with reduced odds of anxiety. Conversely, higher education level (OR = 1.55), more time elapsed since delivery (OR = 1.14) and perceived delivery difficulty (OR = 1.31) significantly increased the risk of anxiety. Women with higher self-esteem reported more frequent sexual activity and lower anxiety levels. The final model showed moderate predictive accuracy (AUC = 0.65-0.70) and explained 7%-12% of variance. Discussion: Multiple factors, including maternal age, education, delivery experience and self-esteem level, are associated with anxiety prior to first postpartum intercourse. The findings highlight the importance of comprehensive perinatal care aimed at both physical recovery and psychological wellbeing. Healthcare providers should incorporate assessment of sexual health concerns and self-esteem issues into routine postpartum care to better support women during this transition.