Postpartum depression and sexual dysfunction: a literature review

Postpartum depression (PPD) and sexual dysfunction during the postpartum period frequently co-occur, sharing common neurobiological and hormonal mechanisms. This literature review synthesizes clinical, experimental, and systematic data on the pathomechanisms of PPD and associated sexual dysfunctions, with a particular focus on their clinical implications. A systematic search of PubMed, Embase, and Web of Science (1984–2025) identified 42 studies evaluating neurosteroid levels (especially allopregnanolone), fluctuations in gonadal hormones, hypothalamic–pituitary– adrenal (HPA) axis dysfunction, GABA-A receptor function, neurotrophins (e.g., BDNF), inflammatory markers, and assessments of sexual function and maternal behaviors. The findings indicate that abrupt postpartum declines in allopregnanolone and gonadal hormones, HPA axis dysregulation, and GABA-A receptor dysfunction contribute to low mood, anhedonia, and deficits in sexual functioning, including reduced libido and difficulties with arousal. Alterations in neurotrophins and proinflammatory cytokines exacerbate depressive and sexual symptoms, while psychosocial factors such as stress, maternal burdens, and a family history of depression further modulate the risk of dysfunction. Experimental and neuroimaging studies confirm the impact of these mechanisms on brain regions responsible for reward, motivation, and emotion regulation. The integration of neurobiological, hormonal, and psychosocial factors forms a comprehensive model of PPD and sexual dysfunction as part of a shared continuum. Clinical implications include the need for early assessment of sexual function as a marker of PPD risk and the implementation of therapies addressing both mood and sexual quality of life, such as neurosteroid-based treatments. Future research should employ longitudinal approaches, integrating neurobiological, hormonal, and psychosocial biomarkers, to develop personalized therapeutic strategies for postpartum women.