ObjectiveIdentify factors associated with persistent sexual dysfunction and pain 12-months postpartum in an underserved population. MethodsExtending Maternal Care After Pregnancy (eMCAP) is a program addressing health needs/disparities of patients at risk for worse perinatal outcomes. Participants completed the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and Urinary Distress Index (UDI-6) 12-months postpartum. The PISQ-12 was dichotomized with scores < 32.5 indicating sexual dysfunction. Urinary incontinence (UI) was defined as at-least-somewhat bothersome (vs. none or not-at-all bothersome) urgency urinary incontinence (UUI) or stress urinary incontinence (SUI). Screening for anxiety and depression was completed using Generalized Anxiety Disorder-7 (GAD-7) and Edinburgh Postnatal Depression Scale (EPDS). Bivariate and multivariable logistic regression analyses were performed for sexual dysfunction vs. normal-function, and pain vs. no-pain, using demographic, peri/postpartum, and social-determinant-of-health variables as correlating factors. Results328 sexually active patients provided data. On bivariate analysis, sexual dysfunction (n = 31,9.5 %) vs. normal function (n = 297,90.5 %) groups showed no differences in age, BMI, parity, mode of delivery, episiotomy/laceration types, or breastfeeding. Sexual dysfunction was significantly associatedwith both UUI and SUI: 12(39 %) vs. 46(15 %) had UUI, p = 0.001, and 20(65 %) vs. 97(33 %) had SUI, P < 0.001; the dysfunction group also had higher GAD-7 and EPDS scores and greater overall stress levels. On multivariable analysis, SUI and stress remained significantly associated: OR(95 % CI) 2.45(1.02–6.03) and 1.81(1.32–2.49), respectively. Comparing pain (n = 45,13.7 %) vs. no-pain (n = 283,86.2 %), dyspareunia patients endorsed greater stress levels. ConclusionThe interplay between sexual health, incontinence, and mental health deserves further study, and all three should be routinely addressed in postpartum care.