Pregnancy and the puerperium herald dramatic and complex physiological, psychological, interpersonal, and sexual changes in a woman and in the marital process. Pregnancy tends to have an increasingly negative effect on sexual desire, expression, and satisfaction as term approaches. Clinical variables discussed include anatomic and physiological changes, puerperal sexual response patterns, marital adjustment, body image, dyspareunia related to episiotomy, lactation, and traditional taboos and cautions regarding coitus for the new mother. Most research respondents reported gradual return to prepregnancy levels of sexual desire, enjoyment, and coital frequency, with a minority in most cited studies indicating sexual interest and coitus levels below prepregnancy levels up to 1 year after delivery. The most frequently listed reasons for poor postpartum sexual adjustment include episiotomy discomfort, fatigue, vaginal bleeding or discharge, dyspareunia, insufficient lubrication, fears of awakening the infant or not hearing him/her, fear of injury, and decreased sense of attractiveness. Postpartum counseling should be offered prior to hospital discharge.