Abstract Overview:
Postpartum sexual functioning is influenced by a complex interplay of biological, psychological, and social factors. Despite its importance, this topic re-mains under- researched within the Greek population. Understanding its evolution can help improve postpartum care and address women's concerns about sexual health after childbirth.

Aims and Objectives:
To explore the progression of sexual functioning during the first postpartum year and identify key influencing factors through a prospective comparative study and secondary data analyses.

Methods:
A prospective study was conducted with 34 women of Greek or Cypriot origin, who completed validated questionnaires at two time points: the first and second postpartum trimesters. Secondary statistical analyses with stepwise multinomial logistic regression analysis were performed to further enrich the findings.

Results:
A significant improvement in sexual functioning was observed in the second postpartum trimester. Influencing factors varied: during the first trimester, income, family and social support, and sleep duration were significant, whereas in the second trimester, parental leave and time since birth played a major role. Additional analyses revealed that longer second- stage labor duration was associated with gas incontinence (OR=1.01, p<0.001). The poorer a mother’s sexual life after childbirth, the worse her psychological state (β=0.14,p=0.018), while prolonged labor was similarly linked to diminished psychological well-being (β=0.03, p=0.044). Women living outside Athens were more likely to engage in sexual intercourse during pregnancy compared to those residing in the capital (OR=0.63, p=0.049), and greater gestational age increased the likelihood of intercourse during pregnancy (OR=1.10,p=0.028). Additionally, age was inversely correlated with pre-pregnancy sexual frequency (β=–0.60, p<0.001), and older, employed mothers were more likely to exclusively breastfeed (p<0.05).

Conclusion:
Postpartum sexual functioning is dynamic and influenced by diverse factors. Integrating sexual health education into prenatal care is essential. Further research is needed to elucidate long-term trends and regional differences, ultimately informing interventions that support women's overall well-being.