Do women notice the impact of childbirth-related levator trauma on pelvic floor and sexual function? Results of an observational ultrasound study

Thibault-Gagnon, Stéphanie; Yusuf, Salim; Langer, Susanne; Wong, Vivien; Shek, Ka Lai; Martin, Andrew; Dietz, Hans Peter

doi:10.1007/s00192-014-2331-z

Cited by 49 publications

(64 citation statements)

References 29 publications

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“…Search on PubMed found no other studies that are directly comparable with ours. Most published studies have looked into sexual dysfunction and vaginal symptoms in relation to delivery mode and levator ani muscle avulsion and not in relation to PFM function [4–6]. Our results indicate that vaginal laxity is associated with delivery mode and that more women without the symptom had had caesarean section compared with women with the symptom.…”

Section: Discussionmentioning

confidence: 57%

Coital Incontinence and Vaginal Symptoms and the Relationship to Pelvic Floor Muscle Function in Primiparous Women at 12 Months Postpartum: A Cross-Sectional Study

Tennfjord

Hilde

Stær-Jensen

et al. 2015

The Journal of Sexual Medicine

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Introduction Symptoms related to sexual dysfunction postpartum are scarcely addressed in the literature, and the relationship to pelvic floor muscle (PFM) function is largely unknown. Aims The aim of this study was to investigate primiparous women 12 months postpartum and study: (i) prevalence and bother of coital incontinence, vaginal symptoms, and sexual matters; and (ii) whether coital incontinence and vaginal symptoms were associated with vaginal resting pressure (VRP), PFM strength, and endurance. Methods International Consultation on Incontinence Modular Questionnaire (ICIQ) sexual matters module and ICIQ-Vaginal Symptoms Questionnaire were used for questions on coital incontinence, vaginal symptoms, and sexual matters, respectively. PFM function was assessed by manometer (Camtech AS, Sandvika, Norway). Main Outcome Measures Coital incontinence, vaginal symptoms, and PFM function were the main outcome measures. Results One hundred seventy-seven primiparous women, mean age 28.7 (standard deviation [SD] 4.3) participated. Of the 94% of women having sexual intercourse, coital incontinence was found for 1.2% whereas 34.5% reported at least one vaginal symptom interfering with the sexual life of primiparous women. Of the symptoms investigated, “vagina feels dry,” “vagina feels sore,” and “vagina feels loose or lax” were most prevalent, but the overall impact on the woman's sexual life was minimally bothersome, mean 1.4 out of 10 (SD 2.5). Women reporting “vagina feels loose or lax” had lower VRP, PFM strength, and endurance when compared with women without the symptom. Conclusions Twelve-month postpartum coital incontinence was rare, whereas the prevalence of vaginal symptoms interfering with sexual life was more common. The large majority of primiparous women in our study had sexual intercourse at 12 months postpartum and the reported overall bother on sexual life was low. Women reporting “vagina feels loose or lax” had lower VRP, PFM strength, and endurance when compared with women without the symptom.

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Section: Discussionmentioning

confidence: 57%

Coital Incontinence and Vaginal Symptoms and the Relationship to Pelvic Floor Muscle Function in Primiparous Women at 12 Months Postpartum: A Cross-Sectional Study

Tennfjord

Hilde

Stær-Jensen

et al. 2015

The Journal of Sexual Medicine

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“…A bilateral tear indicates that the muscle had detached on both sides of its attachment at the pubic bone, with resultant loss of a main support structure for the pelvic organs. Bilateral levator ani muscle tear has been described by others as causing increased genital hiatus size, or pelvic muscle “laxity” 6. Levator ani tears have also been associated with pelvic organ prolapse that typically does not present until later in life.…”

Section: Discussionmentioning

confidence: 99%

“…Qualitatively, some women express concerns about post-birth body changes to their genitals – specifically about their vaginas being too “loose”,5 a perception attributed to childbirth-related tears of the levator ani or “Kegel” muscle 6. Women’s perceptions of negative changes to the vaginal area may be fueled by social media and websites depicting negative changes associated with childbirth that promote genital cosmetic surgery procedures such as vaginoplasty and labiaplasty as a solution 7.…”

Section: Introductionmentioning

confidence: 99%

Body after baby: a pilot survey of genital body image and sexual esteem following vaginal birth

Zielinski¹,

Low²,

Smith³

et al. 2017

IJWH

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ObjectiveThe aim of this study was to determine acceptability of the Vaginal Changes Sexual and Body Esteem (VSBE) scale for women post childbirth and explore the association between childbirth events and sexual/body esteem.DesignThis is a cross-sectional study within the Evaluating Maternal Recovery from Labor and Delivery study.SettingThis study was conducted in a community setting.PopulationThe study was conducted in women post first vaginal birth with birth events that posed risk factors for levator ani muscle tears.MethodsSurvey, magnetic resonance images of levator ani, and physical examination were the data collected 8 months postpartum. Birth variables were collected by hospital chart review. Descriptive analysis of VSBE response rates and distribution of responses was conducted. An exploratory analysis of the potential association of demographic, birth, clinical, and magnetic resonance image characteristics with VSBE scores was conducted.Main outcome measuresThe outcome measure used in this study is VSBE scale.ResultsThe majority of participants (97%) completed the scale, with responses to most questions skewed toward positive sexual/body esteem, with the exception of sexual enjoyment, where 38% indicated some interference due to genital changes. The scale showed high internal consistency (alpha =0.93). In the exploratory analysis of potential characteristics associated with VSBE, women with episiotomies had lower sexual/body esteem compared to those who did not (median VSBE scores 35 vs 42.5, P=0.01). Anal sphincter tear was not associated with sexual/body esteem (P=0.78). Additional study is indicated to further explore observed trends toward the association of severe levator ani tear, maternal age at childbirth, and forceps with VSBE scores.ConclusionThe VSBE is suitable for use to assess sexual/body esteem in women post childbirth. Most women in this sample did not indicate negative genital body image/sexual esteem. However, some indicated that the changes post birth negatively affected their sexual/body esteem, particularly those who had episiotomies.

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“…10,[19][20][21][22][23] This form of obstetric trauma has important long-term implications such as sexual and pelvic floor dysfunction. 24 The strong association between levator muscle avulsion and female POP is increasingly recognised. [25][26][27] However, due to the long time gap between delivery and onset of POP, there is little detailed urogynaecological data comparing the long-term effects of forceps to other modes of delivery.…”

Section: Introductionmentioning

confidence: 99%

Delivery mode and pelvic organ prolapse: a retrospective observational study

Trutnovsky

Atan

Martin

et al. 2015

BJOG

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Objective To analyse the associations between delivery mode and symptoms and signs of pelvic organ prolapse (POP) in a cohort of symptomatic women.Design Retrospective observational study.Population A total of 1258 consecutive women attending a tertiary urogynaecological unit for the investigation of lower urinary tract or pelvic floor disorders between January 2012 and December 2014.Methods Obstetric history and clinical examination data were obtained from the unit database. Prolapse quantification on imaging was performed using stored four-dimensional translabial ultrasound volume data sets. Women were grouped into four groups according to the most traumatic delivery reported. The presence of symptoms and signs of POP were compared between delivery groups while controlling for potential confounders.Main outcome measures Prolapse symptoms, visual analogue score for prolapse bother, International Continence Society Prolapse Quantification System findings and ultrasound findings of anterior, central and posterior compartment descent.Results Nulliparae showed the lowest prevalence of most measures of POP, followed by women exclusively delivered by caesarean section. Highest prevalences were consistently found in women delivered at least once by forceps, although the differences between this group and women delivered by normal vaginal delivery and/or vacuum extraction were significant in three out of eight measures only. Compared with women in the caesarean section group, the adjusted odds ratios for reporting symptoms of prolapse were 2.4 (95% CI 1.30-4.59) and 3.2 (95% CI 1.65-6.12) in the normal vaginal delivery/vacuum extraction group and forceps group, respectively.Conclusions There is a clear link between vaginal delivery and symptoms and signs of pelvic organ prolapse in urogynaecological patients.Keywords Caesarean section, delivery, forceps, pelvic organ prolapse.Tweetable abstract Compared with caesarean section a history of vaginal delivery more than doubles the risk for POP.

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Do women notice the impact of childbirth-related levator trauma on pelvic floor and sexual function? Results of an observational ultrasound study

Cited by 49 publications

References 29 publications

Coital Incontinence and Vaginal Symptoms and the Relationship to Pelvic Floor Muscle Function in Primiparous Women at 12 Months Postpartum: A Cross-Sectional Study

Coital Incontinence and Vaginal Symptoms and the Relationship to Pelvic Floor Muscle Function in Primiparous Women at 12 Months Postpartum: A Cross-Sectional Study

Body after baby: a pilot survey of genital body image and sexual esteem following vaginal birth

Delivery mode and pelvic organ prolapse: a retrospective observational study

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