Does post-caesarean dyspareunia reflect sexual malfunction, pelvic floor and perineal dysfunction?

Persistent Postpartum Pain - A Somatic and Psychologic Perfect Storm

Persistent postpartum pain is common and has a complex etiology. It has both somatic and psychosocial provoking factors and has both functional and psychological ramifications following childbirth. Pain that limits the functional capacity of a person who has the daunting task to take care of all the demands of managing a growing newborn and infant can have debilitating consequences for several people simultaneously. We will review the incidence of persistent postpartum pain, analyze the risk factors, and discuss obstetric, anesthetic, and psychological tools for prevention and management. Based on the current knowledge, early antenatal screening and management is described as the most likely measure to identify patients at risk for persistent postpartum pain. Such antenatal management should be based on the close collaboration between obstetricians, anesthesiologists, and psychologists to tailor peripartum pain management and psychological support-based individual needs.

The Impact of Mode of Birth, and Episiotomy, on Postpartum Sexual Function in the Medium- and Longer-Term: An Integrative Systematic Review

(1) Background: Sexual function can be affected up to and beyond 18 months postpartum, with some studies suggesting that spontaneous vaginal birth results in less sexual dysfunction. This review examined the impact of mode of birth on sexual function in the medium- (≥6 months and <12 months postpartum) and longer-term (≥12 months postpartum). (2) Methods: Literature published after January 2000 were identified in PubMed, Embase and CINAHL. Studies that compared at least two modes of birth and used valid sexual function measures were included. Systematic reviews, unpublished articles, protocols and articles not written in English were excluded. Quality was assessed using the Newcastle Ottawa Scale. (3) Results: In the medium-term, assisted vaginal birth and vaginal birth with episiotomy were associated with worse sexual function, compared to caesarean section. In the longer-term, assisted vaginal birth was associated with worse sexual function, compared with spontaneous vaginal birth and caesarean section; and planned caesarean section was associated with worse sexual function in several domains, compared to spontaneous vaginal birth. (4) Conclusions: Sexual function, in the medium- and longer-term, can be affected by mode of birth. Women should be encouraged to seek support should their sexual function be affected after birth.

The association of mode of delivery and dyspareunia: a systematic review and meta-analysis

This meta-analysis aimed to examine the association between the mode of delivery and dyspareunia worldwide. Epidemiologic studies evaluating the link between the mode of delivery and dyspareunia (published up to July 2019) were included in this research. These studies were selected by searching several databases such as MEDLINE, ClinicalTraial.gov, PubMed, Web of Science, Scopus and Google Scholar and considering the list of selected articles extracted from references. Then, meta-analyses, subgroup analyses and meta-regressions of the studies were conducted to evaluate the association between the mode of delivery and dyspareunia. In this study, 23 out of 1099 articles were identified and used in the final analysis. Dyspareunia differed according to the mode of delivery although this difference was not statistically significant. In terms of the mode of delivery, a difference was found between instrumental vaginal delivery and caesarean section, but it was not significant. It seems that more studies with a larger sample size should be considered to determine the difference.

Factors Influencing Couples' Sexuality in the Puerperium: A Systematic Review

INTRODUCTION

The puerperium is a period of adaptation in which various transformations take place in the lives of women and men on their way to becoming mothers and fathers. These changes can also have repercussions on their sexual relations. How the couple deals with this transition is crucial to the well-being of the couple and affects how parents relate to the baby.

AIM

This study aimed to explore the factors that influence sexuality in both women and men during postpartum.

METHODS

We conducted a bibliographic review of 236 articles found on the PubMed database and published from 2008 to January 2019.

MAIN OUTCOME MEASURE

The main outcome measure was the impact of various physical, psychological, and sociocultural factors on couples' sexual functioning during postpartum.

RESULTS

The main problems that couples face after childbirth can be classified as (i) psychological changes, such as loss of a sense of self, transitioning to parenthood, taking on the new roles of mother and father, and feelings of abandonment among men; (ii) body changes in women that affect their self-image and perineal trauma; (iii) hormonal changes in women and men that can lead to reduced sexual desire in both and vaginal dryness or dyspareunia in women; (iv) changes in the marital relationship, including changes in each other's roles, taking time for intimacy, and initiating sexual intercourse; (v) sociocultural influences, such as social support, culturally expected roles, and beliefs regarding when to resume sex; and (vi) lifestyle changes, especially with regard to baby care.

CONCLUSION

Sexuality during postpartum is influenced by multiple factors: physical, psychological, and sociocultural. Our findings offer a deeper understanding of how the transition to parenthood affects sexual relationships during the postpartum period. Implications regarding caring for and promoting the sexual health of individuals and couples after childbirth are discussed, and some medical recommendations for parents are offered. Serrano Drozdowskyj E, Gimeno Castro E, Trigo López E, et al. Factors Influencing Couples' Sexuality in the Puerperium: A Systematic Review. Sex Med Rev 2020;8:38-47.

Risk Factors for Dyspareunia After First Childbirth

OBJECTIVE

To investigate risk factors for dyspareunia among primiparous women.

METHODS

This was a planned secondary analysis using data from the 1- and 6-month postpartum interviews of a prospective study of women who delivered their first neonate in Pennsylvania, 2009-2011. Participants who had resumed sexual intercourse by the 6-month interview (N=2,748) constituted the analytic sample. Women reporting a big or medium problem with painful intercourse at 6 months were categorized as having dyspareunia. Multivariable logistic regression was used to evaluate the effect of patient characteristics, obstetric and psychosocial factors, and breastfeeding on dyspareunia.

RESULTS

There were 583 women (21.2%) who reported dyspareunia at 6 months postpartum. Nearly one third of those breastfeeding at 6 months reported dyspareunia (31.5%) compared with 12.7% of those not breastfeeding (adjusted odds ratio [OR] 2.89, 95% confidence interval [CI] 2.33-3.59, P<.001); 32.5% of those reporting a big or medium problem with perineal pain at 1 month reported dyspareunia at 6 months compared with 15.9% of those who did not (adjusted OR 2.45, 95% CI 1.93-3.10, P<.001); 28.3% of women who reported fatigue all or most of the time at 1 month reported dyspareunia at 6 months compared with 18.0% of those who reported fatigue less often (adjusted OR 1.60, 95% CI 1.30-1.98, P<.001); and 24.1% of those who scored in the upper third on the stress scale at 1 month reported dyspareunia at 6 months postpartum compared with 15.6% of those who scored in the lowest third (adjusted OR 1.55, 95% CI 1.18-2.02, P=.001).

CONCLUSION

In this prospective cohort study, we identified specific risk factors for dyspareunia in primiparous women that can be discussed at the first postpartum visit, including breastfeeding, perineal pain, fatigue, and stress.

Comparing the Prevalence, Risk Factors, and Repercussions of Postpartum Genito-Pelvic Pain and Dyspareunia

INTRODUCTION

Childbirth is a risk factor for developing genito-pelvic pain and/or dyspareunia during the postpartum period and potentially in the longer term. These two types of pain can occur simultaneously or sequentially and could be affected by different risk factors and have a range of repercussions to women's lives, including their sexual functioning.

AIM

This study reviewed the available evidence to compare and contrast the prevalence, risk factors, and repercussions of postpartum genito-pelvic pain vs dyspareunia.

METHODS

All available data related to postpartum genito-pelvic pain and dyspareunia were reviewed.

MAIN OUTCOME MEASURES

A description of the prevalence, risk factors, and sexual and psychological consequences of postpartum genito-pelvic pain and dyspareunia and the methodologic limitations of previous studies.

RESULTS

The prevalence of postpartum genito-pelvic pain is much lower than that of postpartum dyspareunia. There is evidence of converging and differential risk factors for acute and persistent experiences of these two types of pain. Postpartum genito-pelvic pain and dyspareunia are associated with impaired sexual functioning. Rarely are these pain experiences examined together to make direct comparisons.

CONCLUSION

There has been a critical lack of studies examining postpartum genito-pelvic pain and dyspareunia together and integrating biomedical and psychosocial risk factors. This approach should be spearheaded by a multidisciplinary group of researchers of diverse and relevant expertise, including obstetricians, gynecologists, anesthesiologists, and psychologists.

Sexual life and dysfunction after maternal morbidity: a systematic review

Background

Because there is a lack of knowledge on the long-term consequences of maternal morbidity/near miss episodes on women´s sexual life and function we conducted a systematic review with the purpose of identifying the available evidence on any sexual impairment associated with complications from pregnancy and childbirth.

Methods

Systematic review on aspects of women sexual life after any maternal morbidity and/or maternal near miss, during different time periods after delivery. The search was carried out until May 22^nd, 2015 including studies published from 1995 to 2015. No language or study design restrictions were applied. Maternal morbidity as exposure was split into general or severe/near miss. Female sexual outcomes evaluated were dyspareunia, Female Sexual Function Index (FSFI) scores and time to resume sexual activity after childbirth. Qualitative syntheses for outcomes were provided whenever possible.

Results

A total of 2,573 studies were initially identified, and 14 were included for analysis after standard selection procedures for systematic review. General morbidity was mainly related to major perineal injury (3^rd or 4^th degree laceration, 12 studies). A clear pattern for severity evaluation of maternal morbidity could not be distinguished, unless when a maternal near miss concept was used. Women experiencing maternal morbidity had more frequently dyspareunia and resumed sexual activity later, when compared to women without morbidity. There were no differences in FSFI scores between groups. Meta-analysis could not be performed, since included studies were too heterogeneous regarding study design, evaluation of exposure and/or outcome and time span.

Conclusion

Investigation of long-term repercussions on women’s sexual life aspects after maternal morbidity has been scarcely performed, however indicating worse outcomes for those experiencing morbidity. Further standardized evaluation of these conditions among maternal morbidity survivors may provide relevant information for clinical follow-up and reproductive planning for women.

Association between sexual health and delivery mode

Introduction

Female sexual function changes considerably during pregnancy and the postpartum period. In addition, women's physical and mental health, endocrine secretion, and internal and external genitalia vary during these times. However, there are limited studies on the relationship between delivery and sexual function.

Aim

The present study aimed to demonstrate the association between sexual function and delivery mode.

Methods

Mothers who delivered a single baby at term were recruited for the study, and 435 mothers were analyzed.

Main Outcome Measures

The Female Sexual Function Questionnaire (SFQ28) scores and mothers' backgrounds were assessed at 6 months after delivery.

Results

The delivery mode affected the SFQ28 partner domain. Episiotomy affected the arousal (sensation) domain. Multiple regression analysis revealed that maternal age and cesarean section were significantly associated with several SHQ28 domains.

Conclusion

This study suggests that routine episiotomies at delivery should be avoided to improve postpartum maternal sexual function. Maternal age and cesarean section were found to affect postpartum sexual health.

Effect of mode of delivery on perceived risks of maternal health outcomes among expectant parents: a cohort study in Beijing, China

Background

Misperceptions regarding maternal health outcomes after vaginal delivery (VD) and cesarean delivery (CD) may contribute to the increasing trend towards CD. The effects of mode of delivery on parents’ perceived risks of health outcomes are unclear. This study aimed to compare the perceived risks of maternal health outcomes among pregnant women and their partners before and after delivery, and to evaluate factors related to inaccurate perceptions among women after delivery.

Methods

Consecutive eligible nulliparous women at 36-40 weeks gestation were approached during antenatal registration for electronic fetal monitoring, regardless of whether CD or VD was planned. Eligible women were aged 18-45 years, received antenatal care and planned delivery at the First Hospital of Tsinghua University, Beijing, and had partners who could be approached. Concerns about 12 maternal health outcomes were identified by literature search and validated using the content validity index. Women and their partners were questioned anonymously about the perceived risks of outcomes after CD and VD before delivery, and the perceived risks of the delivery experienced at 2-3 days after delivery. Perceived risks were compared with reported risks, and factors associated with inaccurate perceptions were evaluated.

Results

Among 272 couples approached, 264 women (97%) and 257 partners (94%) completed the questionnaire both before and after delivery. After CD, the perceived risk of seven health outcomes decreased in women and the perceived risk of two health outcomes increased in partners. After VD, the perceived risk of two outcomes decreased and of one outcome increased in women, and the perceived risk of three outcomes increased in partners. Women perceived higher risks of long-term perineal pain, pelvic organ prolapse, urinary/fecal incontinence, sexual dissatisfaction, and negative impact on the couple’s relationship after VD than after CD (all p < 0.05). CD was the most common factor associated with inaccurate perceptions among women after delivery.

Conclusions

The perceived risks of maternal health outcomes decreased after delivery in women and increased after delivery in their partners. Women continued to have inaccurate perceptions of the risks of health outcomes after delivery, indicating that further education is important.