Obstetric perineal tears, sexual function and dyspareunia among primiparous women 12 months postpartum: a prospective cohort study

Abstract

ObjectiveSexuality is an important aspect of human identity and contributes significantly to the quality of life in women as well as in men. Impairment in sexual health after vaginal delivery is a major concern for many women. We aimed to examine the association between degree of perineal tear and sexual function 12 months postpartum.DesignA prospective cohort studySettingFour Danish hospitals between July 2015 and January 2019ParticipantsA total of 554 primiparous women: 191 with no/labia/first-degree tears, 189 with second-degree tears and 174 with third-degree/fourth-degree tears. Baseline data were obtained 2 weeks postpartum by a questionnaire and a clinical examination. Sexual function was evaluated 12 months postpartum by an electronic questionnaire (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12)) and a clinical examination.Primary outcome measuresTotal PISQ-12 score and dyspareuniaResultsEpisiotomy was performed in 54 cases and 95 women had an operative vaginal delivery. The proportion of women with dyspareunia was 25%, 38% and 53% of women with no/labia/first-degree, second-degree or third-degree/fourth-degree tears, respectively.Compared with women with no/labia/first-degree tears, women with second-degree or third-degree/fourth-degree tears had a higher risk of dyspareunia (adjusted relative risk (aRR) 2.05; 95% CI 1.51 to 2.78 and aRR 2.09; 95% CI 1.55 to 2.81, respectively). Women with third-degree/fourth-degree tears had a higher mean PISQ-12 score (12.2) than women with no/labia/first-degree tears (10.4).ConclusionsImpairment of sexual health is common among primiparous women after vaginal delivery. At 12 months postpartum, more than half of the women with a third-degree/fourth-degree tear experienced dyspareunia. Women delivering with no/labia/first-degree tears reported the best outcomes overall. Thus, it is important to minimise the extent of perineal trauma and to counsel about sexuality during and after pregnancy.

Effect of Epidural Analgesia on Pelvic Floor Dysfunction at 6 Months Postpartum in Primiparous Women: A Prospective Cohort Study

“…The type of delivery, episiotomy, perineal lacerations, lactation, and depression have been regarded as risk factors for dyspareunia. 34 , 35 Several studies have investigated the effect of perineal tears and episiotomy on dyspareunia and concluded that the incidence of dyspareunia develops with progressive perineal tears and episiotomy. 35 , 36 Moreover, perineal lacerations and episiotomy were found to be associated with a longer second stage of labor duration.…”

Postpartum sexual function; the importance of the levator ani muscle

“…Finally, the PISQ-12 questionnaire may not be the best questionnaire to identify sexual dysfunction in our cohort of postpartum women. The PISQ-12 is validated to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse, but has previously also been used to evaluate sexual function after vaginal delivery [26,27]. The EpiLeva study was conducted to assess the association of mediolateral episiotomy with levator injury and urogynecological complaints.…”

Disfunção sexual em mulheres no período pós-parto: revisão da literatura

“…O tempo médio de 52,83 (± 20,4) dias após o parto vaginal e 52,94 (± 19,88) dias após a cesárea, onde a disfunção sexual estava presente em 78,2 % (n = 61) das participantes, Research, Society and Development, v. 9, n. 9, e344996785, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i9.6785 sendo a dispareunia uma das principais queixas, principalmente em primíparas, em que é comum nas que tiveram parto vaginal, apresentarem algum tipo de trauma perineal, como a episiotomia e lacerações de terceiro e quarto grau. (Pereira et al, 2018;Oliveira et al, 2018;Gommesen et al, 2019).…”