BACKGROUND Postnatal sexual health remains underresearched. The main aims of this study were to investigate the prevalence of postnatal sexual health issues, and the extent to which primary care practitioners routinely inquire about sexual health issues. METHOD 1,507 first time mothers were recruited in early pregnancy and followed up at 3, 6, and 12 months postpartum. Sexual health issues were assessed at every follow-up using a checklist. RESULTS Eighty-nine percent of women reported sexual health issues in the first 3 months postpartum. The most common sexual health issues at 3 months postpartum were: loss of interest in sex, pain during sex, vaginal tightness, and lack of lubrication. Fifty-one percent continued to report loss of interest in sex at 12 months postpartum, and around 30 percent reported persisting pain. Although most women had contact with primary care practitioners during the first 3 months postpartum, only 24 percent recalled being asked about sexual health issues by general practitioners and 14 percent by maternal and child health nurses. Women who had a cesarean delivery had equivalent or higher odds of reporting persisting sexual health issues, but had lower odds of being asked directly about sexual problems (OR 0.58 [95% CI 0.4-0.9]). CONCLUSIONS Sexual health issues are extremely common after childbirth. There was no evidence that women who had a cesarean delivery experienced fewer sexual health problems. Despite frequent contact with health professionals, women rarely discussed sexual health issues unless health professionals asked them directly. Given the high prevalence of postpartum sexual health issues routine inquiry is warranted.