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Edqvist M, Ajne G, Teleman P, Tegerstedt G, Rubertsson C. Postpartum perineal pain and its association with sub-classified second-degree tears and perineal trauma-A follow-up of a randomized controlled trial. Acta Obstet Gynecol Scand 2024. [PMID: 39150169 DOI: 10.1111/aogs.14938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Postnatal perineal pain is prevalent following childbirth and can impact women both physically and emotionally. The aim of the study was to study the effect of collegial midwifery assistance on perineal pain and pain medication 1 month after birth and to investigate the associations between the type of tear and perineal pain, satisfaction with healing, and resumption of intercourse. MATERIAL AND METHODS A follow-up questionnaire was sent 1 month postpartum to women with a first spontaneous vaginal birth participating in a randomized controlled trial (Oneplus trial). Data were collected from December 2019 to May 2020. Differences in perineal pain between women attended by one or two midwives were analyzed according to intention-to-treat using bivariate analyses. Associations between the type of tear and perineal pain, satisfaction with healing, and resumption of sexual intercourse were investigated using univariable and multivariable logistic regression. The category no tear/first-degree tear was compared separately to each of the other tear categories. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT03770962. RESULTS Out of 2233 women, 1762 responded within 30-60 days postpartum. Of women in the no tear/first-degree tear category, 27.7% reported perineal pain during the past week, in contrast to women with OASI, where 64.2% reported perineal pain. Women with OASI experienced the highest odds of perineal pain (aOR 4.51, 95% CI 2.72-7.47) compared to those with no tear/first-degree tear, followed by women with major second-degree tears (aOR 1.87, 95% CI 1.45-2.41), women with an episiotomy (aOR 1.78, 95% CI 1.11-2.87), and those with minor second-degree tears (aOR 1.43, 95% CI 1.06-1.94). Women with episiotomy reported the highest odds ratios for dissatisfaction with tear healing (aOR 3.48, 95% CI 1.92-6.31). No significant differences in perineal pain and pain medication were observed between women allocated to collegial midwifery assistance and those allocated to standard care. CONCLUSIONS Women with OASI reported the highest odds of perineal pain 30-60 days after birth compared to women with no tear or first-degree tear, followed by women with major second-degree tears. Women subjected to an episiotomy reported highest odds ratios of dissatisfaction with tear healing.
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Affiliation(s)
- Malin Edqvist
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Ajne
- Department of Women's Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Pia Teleman
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Skane University Hospital, Region Skane, Sweden
| | - Gunilla Tegerstedt
- Department of Women's Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Christine Rubertsson
- Department of Obstetrics and Gynecology, Skane University Hospital, Region Skane, Sweden
- Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
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Cardaillac C, Planche L, Dorion A, Ploteau S, Thubert T, Lefizelier E, Winer N, Ducarme G. Ropivacaine perineal infiltration for postpartum pain management in episiotomy repair: a double-blind, randomised, placebo-controlled trial. BJOG 2024; 131:899-907. [PMID: 35876236 DOI: 10.1111/1471-0528.17266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/07/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether perineal infiltration of ropivacaine after episiotomy would decrease the incidence of postpartum pain compared with placebo. DESIGN Two-centre, double-blind, randomised, controlled trial. SETTING Two French maternity units, October 2017 to April 2020. POPULATION 272 women undergoing epidural analgesia with vaginal singleton delivery and mediolateral episiotomy at term (≥37 weeks) were randomly allocated perineal infiltration of ropivacaine (n = 135) or placebo (n = 137) in a 1:1 ratio before episiotomy repair. METHODS Patients were followed at short term (12, 24, 48 h), mid-term (day 7) and long-term (3 and 6 months). MAIN OUTCOME MEASURES The primary outcome was the rate of perineal pain, defined by a Numerical Pain Rating Scale (NPRS) exceeding 3/10, in the mid-term (day 7) postpartum period. Secondary outcomes were perineal pain (NPRS) and analgesic intake, quality of life (SF-36), postpartum depression (EPDS), pain neuropathic component (DN4) and sexual health (FSFI). RESULTS Perineal pain occurred to an equal extent in the ropivacaine and placebo groups at day 7 (34.2% versus 30.4%, odds ratio 1.1, 95% confidence interval 0.7-1.8, p = 0.63). Similar results were recorded in the short and long term. High rates of dyspareunia and postpartum depression were documented in both groups. No differences were highlighted between the groups in terms of analgesic intake, adverse events, pain neuropathic component and postpartum quality of life. CONCLUSIONS This study did not demonstrate any benefit of ropivacaine infiltration over placebo.
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Affiliation(s)
- Claire Cardaillac
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Nantes University Hospital, Nantes, France
- Federative Pelvic Pain Centre, Nantes University Hospital, Nantes, France
| | - Lucie Planche
- Clinical Research Centre, Centre Hospitalier Departemental (Departmental Hospital Centre), La Roche sur Yon, France
| | - Agnès Dorion
- Clinical Research Centre, Centre Hospitalier Departemental (Departmental Hospital Centre), La Roche sur Yon, France
| | - Stéphane Ploteau
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Nantes University Hospital, Nantes, France
- Federative Pelvic Pain Centre, Nantes University Hospital, Nantes, France
| | - Thibault Thubert
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Nantes University Hospital, Nantes, France
| | - Emelyne Lefizelier
- Department of Obstetrics and Gynaecology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Norbert Winer
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Nantes University Hospital, Nantes, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynaecology, Centre Hospitalier Departemental, La Roche sur Yon, France
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Blair A, Tan A, Homer CSE, Vogel JP. How do postnatal care guidelines in Australia compare to international standards? A scoping review and comparative analysis. BMC Pregnancy Childbirth 2024; 24:121. [PMID: 38336632 PMCID: PMC10854083 DOI: 10.1186/s12884-024-06295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND There is no single national guideline in Australia on the provision of postnatal care, which means there is potential for significant variation in the standard and quality of care. This review aimed to systematically identify, synthesise, and assess the quality of postnatal care guidelines produced for use in Australia. A second aim was to compare postnatal care recommendations in Australian guidelines to the National Institute for Health and Care Excellence's (NICE) and the World Health Organization's (WHO) postnatal care recommendations, to identify gaps and areas of disagreement. We focussed on recommendations regarding postnatal assessment of the woman or newborn, infant feeding, discharge planning, or community-based care. METHODS A scoping review was undertaken informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews. A database search and a manual search of state and national government health departments, professional associations and research institute websites was performed to identify relevant guidelines and recommendations. Guideline quality was assessed using the AGREE II tool. Guideline recommendations from Australia were mapped to 67 NICE/WHO recommendations. Recommendations that partially agreed, were modified, or in disagreement underwent further analysis. RESULTS A total of 31 Australian postnatal guidelines were identified and overall, these were of moderate- to high-quality. Of the 67 NICE/WHO recommendations, most agreed with the recommendations contained in Australian guidelines. There were five NICE/WHO recommendations with which corresponding Australian recommendations disagreed. There were 12 NICE/WHO recommendations that were commonly modified within Australia's guidelines. There were three NICE/WHO recommendations that did not appear in any Australian guideline. CONCLUSIONS Recommendations from postnatal guidelines in Australia have a high level of agreement with corresponding NICE/WHO recommendations. The few disagreements and modifications found in guideline recommendations - both across Australia's guidelines and between Australia's and the NICE/WHO guidelines - are worrying and warrant further examination, as they may result in different standards of care across Australia. Identified gaps in guidance should be prioritised for inclusion in new or updated guidelines where appropriate.
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Affiliation(s)
- Amanda Blair
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Annie Tan
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
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Vogel JP, Jung J, Lavin T, Simpson G, Kluwgant D, Abalos E, Diaz V, Downe S, Filippi V, Gallos I, Galadanci H, Katageri G, Homer CSE, Hofmeyr GJ, Liabsuetrakul T, Morhason-Bello IO, Osoti A, Souza JP, Thakar R, Thangaratinam S, Oladapo OT. Neglected medium-term and long-term consequences of labour and childbirth: a systematic analysis of the burden, recommended practices, and a way forward. Lancet Glob Health 2024; 12:e317-e330. [PMID: 38070535 PMCID: PMC10805007 DOI: 10.1016/s2214-109x(23)00454-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 01/22/2024]
Abstract
Over the past three decades, substantial progress has been made in reducing maternal mortality worldwide. However, the historical focus on mortality reduction has been accompanied by comparative neglect of labour and birth complications that can emerge or persist months or years postnatally. This paper addresses these overlooked conditions, arguing that their absence from the global health agenda and national action plans has led to the misconception that they are uncommon or unimportant. The historical limitation of postnatal care services to the 6 weeks after birth is also a contributing factor. We reviewed epidemiological data on medium-term and long-term complications arising from labour and childbirth beyond 6 weeks, along with high-quality clinical guidelines for their prevention, identification, and treatment. We explore the complex interplay of human evolution, maternal physiology, and inherent predispositions that contribute to these complications. We offer actionable recommendations to change the current trajectories of these neglected conditions and help achieve the targets of Sustainable Development Goal 3. This paper is the third in a Series of four papers about maternal health in the perinatal period and beyond.
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Affiliation(s)
- Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia.
| | - Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Tina Lavin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Grace Simpson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Dvora Kluwgant
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Virginia Diaz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Soo Downe
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ioannis Gallos
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
| | - Geetanjali Katageri
- S Nijalingappa Medical College and HSK Hospital & Research Centre, Bagalkot, India
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; University of the Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Tippawan Liabsuetrakul
- Department of Epidemiology and Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Imran O Morhason-Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences and Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Alfred Osoti
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Olufemi T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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de Aquino ACQ, Sarmento ACA, Simões ACZ, de Oliveira R, Monteiro MN, Gonçalves AK. Nonpharmacological treatment of postpartum sexual dysfunction: a systematic review and meta-analysis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230808. [PMID: 37971132 PMCID: PMC10645184 DOI: 10.1590/1806-9282.20230808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 11/19/2023]
Affiliation(s)
| | | | - Ana Carolina Zimmermann Simões
- Universidade Federal do Rio Grande do Norte, Sciences Applied to Women’s Health Postgraduate Program – Natal (RN), Brazil
| | | | - Michelly Nóbrega Monteiro
- Universidade Federal do Rio Grande do Norte, Department of Obstetrics and Gynecology – Natal (RN), Brazil
| | - Ana Katherine Gonçalves
- Universidade Federal do Rio Grande do Norte, Health Sciences Postgraduate Program – Natal (RN), Brazil
- Universidade Federal do Rio Grande do Norte, Sciences Applied to Women’s Health Postgraduate Program – Natal (RN), Brazil
- Universidade Federal do Rio Grande do Norte, Department of Obstetrics and Gynecology – Natal (RN), Brazil
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Huber M, Larsson C, Lehmann J, Strigård K, Lindam A, Tunón K. Sonographic postpartum anal sphincter defects and the association with pelvic floor pain and dyspareunia. Acta Obstet Gynecol Scand 2023; 102:1290-1297. [PMID: 37350333 PMCID: PMC10540925 DOI: 10.1111/aogs.14606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/09/2023] [Accepted: 05/15/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Pelvic floor pain and dyspareunia are both important entities of postpartum pelvic pain, often concomitant and associated with perineal tears during vaginal delivery. The association between postpartum sonographic anal sphincter defects, pelvic floor pain, and dyspareunia has not been fully established. We aimed to determine the prevalence of postpartum anal sphincter defects using three-dimensional endoanal ultrasonography (3D-EAUS) and evaluate their association with symptoms of pelvic floor pain and dyspareunia. MATERIAL AND METHODS This prospective cohort study followed 239 primiparas from birth to 12 months post delivery. Anal sphincters were assessed with 3D-EAUS 3 months postpartum, and self-reported pelvic floor function data were obtained using a web-based questionnaire distributed 1 year after delivery. Descriptive statistics were compared between the patients with and without sonographic defects, and the association between sonographic sphincter defects and outcomes were analyzed using logistic regression. RESULTS At 3 months postpartum, 48/239 (20%) patients had anal sphincter defects on 3D-EAUS, of which 43 (18%) were not clinically diagnosed with obstetric anal sphincter injury at the time of delivery. Patients with sonographic defects had higher fetal weight than those without defects, and a perineum <2 cm before the suture was a risk factor for defects (odds ratio [OR], 6.9). Patients with sonographic defects had a higher frequency of dyspareunia (OR, 2.4), and pelvic floor pain (OR, 2.3) than those without defects. CONCLUSIONS Our results suggest an association between postpartum sonographic anal sphincter defects, pelvic floor pain, and dyspareunia. A perineal height <2 cm, measured by bidigital palpation immediately postdelivery, was a risk factor for sonographic anal sphincter defect. We suggest offering pelvic floor sonography around 3 months postpartum to high- risk women to optimize diagnosis and treatment of perineal tears and include perineum <2 cm prior to primary repair as a proposed indication for postpartum follow-up sonography.
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Affiliation(s)
- Malin Huber
- Department of Clinical Sciences, Obstetrics and GynecologyUmeå UniversityUmeåSweden
| | - Charlotta Larsson
- Department of Surgical and Perioperative SciencesUmeå UniversityUmeåSweden
| | - Jan‐P Lehmann
- Department of SurgeryÖstersund HospitalÖstersundSweden
| | - Karin Strigård
- Department of Surgical and Perioperative SciencesUmeå UniversityUmeåSweden
| | - Anna Lindam
- Unit of Research, Education and Development, Department of Public Health and Clinical Medicine, Östersund HospitalUmeå UniversityUmeåSweden
| | - Katarina Tunón
- Department of Clinical Sciences, Obstetrics and GynecologyUmeå UniversityUmeåSweden
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Alarcon-Rodriguez R, Fernández-Sola C, García-Alvarez R, Fadul-Calderón R, Ruiz-Ortiz A, Requena-Mullor M, Garcia-Gonzalez J. Experiences of Dyspareunia in Dominican Women with a History of Sexual Abuse: A Phenomenological Study. J Midwifery Womens Health 2023; 68:637-644. [PMID: 37288822 DOI: 10.1111/jmwh.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/29/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Dyspareunia refers to painful sexual intercourse that negatively affects a person's psychological well-being and quality of life and can also have an impact on their partner, family, and social circle. The objective of this study was to understand the experiences of women with dyspareunia and a history of sexual abuse in the Dominican Republic. METHODS This was a qualitative study based on Merleau-Ponty's hermeneutic phenomenology. Fifteen women with a diagnosis of dyspareunia and a history of sexual abuse participated. The study was carried out in Santo Domingo, Dominican Republic. RESULTS In-depth interviews were conducted for data collection. Through inductive analysis using ATLAS.ti, 3 main themes were developed that represent women's experiences of dyspareunia and sexual abuse: (1) a history of sexual abuse as a background to dyspareunia, (2) living in fear in a society that revictimizes the survivor, and (3) the sexual consequences of dyspareunia. DISCUSSION In some Dominican women, dyspareunia stems from their history of sexual abuse, which was unknown to their families and partners. The participants experienced dyspareunia in silence and found it difficult to seek help from health care professionals. In addition, their sexual health was marked by fear and physical pain. There are individual, cultural, and social factors that influence the occurrence of dyspareunia; a better understanding of these factors is vital for planning innovative preventive strategies that reduce the progression of sexual dysfunction and its impact on the quality of life of people with dyspareunia.
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Affiliation(s)
- Raquel Alarcon-Rodriguez
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
| | - Rafael García-Alvarez
- Faculty of Health Sciences, Human Sexuality Institute, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic
| | - Rosario Fadul-Calderón
- Faculty of Health Sciences, Human Sexuality Institute, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic
| | - Antonio Ruiz-Ortiz
- Faculty of Health Sciences, Human Sexuality Institute, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic
| | - Mar Requena-Mullor
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
| | - Jessica Garcia-Gonzalez
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
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Smetanina D, Awar SA, Khair H, Alkaabi M, Das KM, Ljubisavljevic M, Statsenko Y, Zaręba KT. Risk of sexual dysfunctions in breastfeeding females: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e074630. [PMID: 37527888 PMCID: PMC10394553 DOI: 10.1136/bmjopen-2023-074630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Epidemiological studies do not provide accurate statistics on the percentage of breastfeeding women experiencing sexual dysfunctions and restraining from sexual activity. The data vary between 40% and 83% in the first group and 20-50% in the second one. Despite excessive studies on contributors to intimacy changes, breast feeding received little attention from researchers. The relationship between lactation and postpartum sexual dysfunctions remains unclear. This systematic review and meta-analysis will synthesise available data and establish the link between breast feeding and sexuality problems. METHODS AND ANALYSIS A comprehensive literature search will be performed in biomedical databases PubMed/Medline, Scopus, Web of Science, EMBASE and CINAHL. We will extract peer-reviewed original studies written in English, Arabic or Polish from 2000 to June 2023. We will also search for reports from international health organisations and local health authorities. The preliminary search was performed on 04 April 2023. The studies must provide data on dysfunction prevalence/incidence and the strength of the relationship between breast feeding and sexuality in generally healthy women. The Covidence software will be used to perform literature screening, data extraction and quality assessment of individual studies. We will use a random-effects model meta-analysis to calculate pooled weighted frequency measures and effect size. Between-study heterogeneity will be assessed with the I2 test. ETHICS AND DISSEMINATION This meta-analysis does not require ethical approval because it synthesises data from previously published original studies. The final work will be published in a peer-reviewed journal and presented at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42023411053.
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Affiliation(s)
- Darya Smetanina
- Department of Radiology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Medical Imaging Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
| | - Shamsa Al Awar
- Department of Obstetrics & Gynecology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, UAE
| | - Howaida Khair
- Department of Obstetrics & Gynecology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, UAE
| | - Meera Alkaabi
- Department of Obstetrics & Gynecology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, UAE
| | - Karuna M Das
- Department of Radiology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
| | - Milos Ljubisavljevic
- Department of Physiology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Neuroscience Platform, ASPIRE Precision Medicine Institute in Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
| | - Yauhen Statsenko
- Department of Radiology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Medical Imaging Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
| | - Kornelia Teresa Zaręba
- Department of Obstetrics & Gynecology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, UAE
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Frequency and associated symptoms of isthmoceles in women 6 months after caesarean section: a prospective cohort study. Arch Gynecol Obstet 2023; 307:841-848. [PMID: 36350429 PMCID: PMC9644016 DOI: 10.1007/s00404-022-06822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to determine the frequency of detection of isthmoceles by ultrasound 6 months after caesarean section (CS) and which symptoms associated with isthmocele formation occur after CS. Subsequently, it was determined how often the ultrasound finding "isthmocele" coincided with the presence of complaints. METHODS A prospective multicentre cohort study was conducted with 546 patients from four obstetric centres in Berlin, who gave birth by primary or secondary CS from October 2019 to June 2020. 461 participants were questioned on symptoms 3 months after CS; 329 participants were included in the final follow-up 6 months after CS. The presence of isthmoceles was determined by transvaginal sonography (TVS) 6 months after CS, while symptoms were identified by questionnaire. RESULTS Of the 329 women, 146 (44.4%) displayed an isthmocele in the TVS. There was no statistically significant difference in the manifestation of symptoms between the two groups of women with and without isthmocele; however, when expressed on a scale from 1 to 10 the intensity of both scar pain and lower abdominal pain was significantly higher in the set of women that had shown to have developed an isthmocele (p = 0.014 and p = 0.031, respectively). CONCLUSION The prevalence of isthmoceles 6 months after CS was 44.4%. Additionally, scar pain and lower abdominal pain were more pronounced when an isthmocele was also observed in the TVS. TRIAL REGISTRATION Trial registration number DRKS00024977. Date of registration 17.06.2021, retrospectively registered.
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Ghasemi V, Beheshti Nasab M, Saei Ghare Naz M, Shahsavari S, Banaei M. Estimating the prevalence of dyspareunia according to mode of delivery: a systematic review and meta-analysis. J OBSTET GYNAECOL 2022; 42:2867-2878. [PMID: 35980976 DOI: 10.1080/01443615.2022.2110461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The present study aimed to examine the prevalence of dyspareunia in the post-partum period in relation to the mode of delivery. In this systematic review and meta-analysis, published articles until February 2020 were searched through the related key term based on mesh term in national and international databases. In the initial search, 1391 articles were found that after removing duplicate, unrelated or non-English and non-Persian articles, finally 20 studies with a sample size of 11354 of women who had given birth were introduced in this study. The prevalence of dyspareunia following vaginal delivery, C-section, and instrumental delivery with 95%CI was 42%(31-56%), 26%(19-34%), and 37%(28-46%) respectively. In addition, the prevalence of dyspareunia in primiparous was higher than multiparous (34%vs.24%), in breastfeeding women was higher than non-breastfeeding women (48%vs.33%), in women who non-used hormonal contraceptive methods were higher than who used hormonal contraceptive methods (43%vs.35%) and its prevalence was similar in women with and without episiotomy. The results indicated that vaginal delivery, breastfeeding, used hormonal contraceptive and primiparity have an impact on dyspareunia. Thus, considering the high prevalence of dyspareunia, and its impact on the quality of life of couples in the postpartum period, attention to, planning, and designing effective interventions in this regard are essential.IMPACT STATEMENTWhat is already known on this subject? Dyspareunia is one of the common experiences of women in the post-partum period. One of the most important factors affecting dyspareunia in the post-partum period is the mode of delivery.What do the results of this study add? The present study adds to examine the prevalence of dyspareunia in the postpartum period in terms of the mode of delivery. So far, no study has been found which comprehensively and systematically estimating the prevalence of dyspareunia in relation to the type of delivery mode in women who have given birth recently. In addition to the type of delivery the prevalence of dyspareunia was estimated based on parity, breastfeeding, episiotomy and consumption of hormonal contraceptive status.What are the implications of these findings for clinical practice and/or further research? This finding will be a small step to familiarise physicians and midwives as well as people with the relationship between delivery mode and dyspareunia. In addition, in the absence of medical indications and the possibility of choosing the mode of delivery selectively, help them decide and choose the appropriate method of termination of labour and ultimately improve the mental and physical health of the birthing person, family and community.
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Affiliation(s)
- Vida Ghasemi
- Department of Public Health, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Maryam Beheshti Nasab
- Department of Midwifery, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeideh Shahsavari
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mojdeh Banaei
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Hidalgo-Lopezosa P, Pérez-Marín S, Jiménez-Ruz A, López-Carrasco JDLC, Cubero-Luna AM, García-Fernández R, Rodríguez-Borrego MA, Liébana-Presa C, López-Soto PJ. Factors Associated with Postpartum Sexual Dysfunction in Spanish Women: A Cross-Sectional Study. J Pers Med 2022; 12:jpm12060926. [PMID: 35743712 PMCID: PMC9225642 DOI: 10.3390/jpm12060926] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/28/2022] [Accepted: 05/29/2022] [Indexed: 12/01/2022] Open
Abstract
(1) Background: Female sexual dysfunction (FSD) has a high prevalence globally, and perinatal factors favor FSD, especially in the postpartum period. The aim was to determine the prevalence and factors influencing FSD in the postpartum period; (2) Methods: An observational study carried out in three primary care centers in southern Spain, with women in the postpartum period who had a single low-risk birth. One hundred and seventeen women answered the Female Sexual Function questionnaire during the 4th month postpartum, between January 2020 and December 2021. Sociodemographic, obstetric, neonatal variables and level of self-esteem were analyzed. A multiple logistic regression model was carried out; (3) Results: 78.4% had high level of self-esteem. FSD prevalence was 89.7%. Factors related to FSD were having an instrumental vaginal delivery, women with university studies, and prenatal preparation. Maternal age ≥ 35, multiparity, pathological processes in the child, a medium–low level of self-esteem and newborn weight were associated with disorders in some of domains of sexual function; (4) Conclusions: FSD is highly prevalent in the postpartum period and is associated with preventable factors. A preventive approach by health professionals to these factors is essential. Health services should implement postpartum follow-up programs, which may coincide in time and place with newborn follow-up programs.
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Affiliation(s)
- Pedro Hidalgo-Lopezosa
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; (S.P.-M.); (A.J.-R.); (J.d.l.C.L.-C.); (A.M.C.-L.); (M.A.R.-B.); (P.J.L.-S.)
- Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, 14004 Córdoba, Spain
- Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain
- Correspondence: ; Tel.: +34-957-218-107
| | - Sandra Pérez-Marín
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; (S.P.-M.); (A.J.-R.); (J.d.l.C.L.-C.); (A.M.C.-L.); (M.A.R.-B.); (P.J.L.-S.)
- Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, 14004 Córdoba, Spain
| | - Andrea Jiménez-Ruz
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; (S.P.-M.); (A.J.-R.); (J.d.l.C.L.-C.); (A.M.C.-L.); (M.A.R.-B.); (P.J.L.-S.)
- Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, 14004 Córdoba, Spain
- Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain
| | - Juan de la Cruz López-Carrasco
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; (S.P.-M.); (A.J.-R.); (J.d.l.C.L.-C.); (A.M.C.-L.); (M.A.R.-B.); (P.J.L.-S.)
- Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, 14004 Córdoba, Spain
- Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain
| | - Ana María Cubero-Luna
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; (S.P.-M.); (A.J.-R.); (J.d.l.C.L.-C.); (A.M.C.-L.); (M.A.R.-B.); (P.J.L.-S.)
- Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, 14004 Córdoba, Spain
- Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain
| | - Rubén García-Fernández
- SALBIS Research Group, Departamento de Enfermería y Fisioterapia, Universidad de León, Campus de Ponferrada s/n, 24400 Ponferrada, Spain; (R.G.-F.); (C.L.-P.)
| | - María Aurora Rodríguez-Borrego
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; (S.P.-M.); (A.J.-R.); (J.d.l.C.L.-C.); (A.M.C.-L.); (M.A.R.-B.); (P.J.L.-S.)
- Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, 14004 Córdoba, Spain
- Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain
| | - Cristina Liébana-Presa
- SALBIS Research Group, Departamento de Enfermería y Fisioterapia, Universidad de León, Campus de Ponferrada s/n, 24400 Ponferrada, Spain; (R.G.-F.); (C.L.-P.)
| | - Pablo Jesús López-Soto
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; (S.P.-M.); (A.J.-R.); (J.d.l.C.L.-C.); (A.M.C.-L.); (M.A.R.-B.); (P.J.L.-S.)
- Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, 14004 Córdoba, Spain
- Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain
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Trajectories of Dyspareunia From Pregnancy to 24 Months Postpartum. Obstet Gynecol 2022; 139:391-399. [PMID: 35115480 PMCID: PMC8843395 DOI: 10.1097/aog.0000000000004662] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022]
Abstract
Two distinct trajectories of dyspareunia were identified from pregnancy to 24 months postpartum; pain catastrophizing predicted inclusion in the moderate relative to minimal pain trajectory. To identify distinct trajectories of dyspareunia in primiparous women and examine biopsychosocial risk factors of these trajectories.
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Rossi MA, Vermeir E, Brooks M, Pierce M, Pukall CF, Rosen NO. Comparing Self-Reported Pain During Intercourse and Pain During a Standardized Gynecological Exam at 12- and 24-Month Postpartum. J Sex Med 2022; 19:116-131. [PMID: 36963976 DOI: 10.1016/j.jsxm.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is limited information about the physical indicators and biopsychosocial predictors of self-reported pain during intercourse and pain during a gynecological examination at 12- and 24-month following childbirth. AIM This longitudinal study aimed to (i) Compare the findings from gynecological exams at 12- and 24-month postpartum for women with minimal vs clinically significant pain during intercourse; (ii) Assess the biomedical and psychosocial correlates of self-reported pain during intercourse and the vestibular pain index (VPI) from the cotton-swab test at 12- and 24-month postpartum; (iii) Establish the relationship between self-reported pain during intercourse and the cotton-swab test. METHODS Women (N = 97 at 12 months postpartum and N = 44 at 24-month postpartum) recruited from a local women's hospital completed online surveys in their first trimester of pregnancy and at 12- and 24-month postpartum to assess pain during intercourse and biopsychosocial variables. Those with clinically significant (pain ≥4/10 on a visual analogue scale) were matched with those reporting minimal pain (pain <3/10) and underwent a gynecological exam including a cotton-swab test. Descriptive analyses, multiple regressions, and bivariate correlations were conducted to address each of the study aims, respectively. MAIN OUTCOME MEASURES (i) Findings from the gynecological examination (ii) Numerical rating scale for the VPI; (iii) Visual analogue scale of pain during intercourse. RESULTS The majority of women in both pain groups had normal physical findings in the gynecological exam. Greater sexual distress and pain catastrophizing at 12- and 24-month postpartum were significantly associated with greater pain during intercourse at each time-point, respectively. Greater pain catastrophizing at 12 months postpartum was significantly associated with greater pain during the cotton-swab test at that time-point. Lower relationship satisfaction at 12 months postpartum was associated with greater VPI ratings at 24 months postpartum. Pain during intercourse and the VPI were moderately and positively correlated. CLINICAL IMPLICATIONS Addressing psychosocial variables may interrupt the maintenance of postpartum pain. Following an initial assessment, self-reported pain intensity may be a suitable proxy for repeated examinations. STRENGTHS & LIMITATIONS This study is the first to describe the physical findings and psychosocial predictors of pain during intercourse and the VPI at 12- and 24-month postpartum. The homogenous and small sample may limit generalizability. CONCLUSION There were no observable physical indicators of clinically significant postpartum pain during intercourse. Psychosocial variables were linked to women's greater postpartum pain during intercourse and VPI ratings.
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Affiliation(s)
- Meghan A Rossi
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Ella Vermeir
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Melissa Brooks
- Department of Obstetrics and Gynaecology, IWK Health Centre, Halifax, NS, Canada
| | - Marianne Pierce
- Department of Obstetrics and Gynaecology, IWK Health Centre, Halifax, NS, Canada
| | | | - Natalie O Rosen
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Department of Obstetrics and Gynaecology, IWK Health Centre, Halifax, NS, Canada
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Banaei M, Kariman N, Ozgoli G, Nasiri M. Bio-psychosocial factor of vaginismus in Iranian women. Reprod Health 2021; 18:210. [PMID: 34663378 PMCID: PMC8524876 DOI: 10.1186/s12978-021-01260-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background and aim Various physical, psychological, social and cultural factors contribute to vaginismus. Therefore, given the multidimensionality of this disorder and the need to pay more attention to all biological, psychological and social dimensions in its treatment, the present study was conducted to investigate the bio-psychological factors contributing to vaginismus. Methods This descriptive cross-sectional study was conducted on 180 Iranian women with vaginismus who had been referred to sexual health clinics of Tehran province in 2020. Multistage random sampling method was used in this study, and vaginismus was diagnosed in women by a specialist through using a questionnaire. Data collection tools included demographic and obstetric information form, valid and reliable Sexual Function Questionnaire, Depression Anxiety Stress Scales (DASS), Sex Fear Questionnaire, Vaginal Penetration Cognition Questionnaire, Sexual Self-Efficacy Scale, Sexual Knowledge and Attitude Scale, Sexual Quality of Life-Female, Inventory of Sexual Satisfaction, ENRICH Marital Satisfaction Scale, Sexual Intimacy Scale and Questionnaire for Diagnosis of Vaginismus. In order to determine the factors related to vaginismus, multiple linear regression model was used through SPSS software version 25 (SPSS Inc., Chicago, IL). Results Based on the results of the present study, the mean age of women and the mean duration of their marriage were 27.77 ± 5.36 and 4.07 ± 3.87 years respectively. As the results of multiple linear regression revealed, the variables of fear of sex (B = 0.141, P = 0.036), positive cognition (B = 0.197, P = 0.046), self-image (B = 0.651, P = 0.001), sexual intimacy (B = -0.116, P = 0.021), quality of sexual life (B = 0.115, P = 0.002) and education (B = 2.129, P = 0.024) from the bio-psychosocial model were the final predictors of vaginismus diagnosis score in women with this disorder. According to the results of multiple linear regression, 45.5% of the variance of vaginismus diagnosis total score was explained by these variables (R = 0.706, R2 = 0.498 and ADJ.R2 = 0.455). Conclusion The results of the present study showed that the variables of fear of sex, positive cognition and negative self-image, sexual intimacy, quality of sexual life and education were the final predictors of vaginismus diagnosis score. This disorder is, thus, considered to be multidimensional. As a sexual dysfunction, Vaginismus prevents sexual penetration through involuntary and frequent spasms of the muscles in the one-third of vagina's outer part. Factors such as negative beliefs about sex, cultural factors, fear of pain, injury, bleeding and so forth play significant roles in the prediction of vaginismus. Therefore, given the multidimensionality of vaginismus and the need to pay attention to all biological, psychological and social dimensions in treating it, and since the bio-psychosocial model is a strong framework for the factors contributing to sexual problems whose recognition will lead to the design of multidimensional treatments, the present study was conducted on 180 Iranian women with vaginismus to investigate the bio-psychological factors associated with vaginismus. The present study showed that the fear of sex, positive cognition and negative self-image, sexual intimacy, quality of sexual life and education from the bio-psychosocial model were the final predictors of vaginismus diagnosis score. Therefore, this model can be used in designing interventions for the treatment of vaginismus, especially in the psychological and interpersonal domains.
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Affiliation(s)
- Mojdeh Banaei
- Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nourossadat Kariman
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Giti Ozgoli
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maliheh Nasiri
- Department of Biostatistics, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Doke PP, Vaidya VM, Narula APS, Patil AV, Panchanadikar TM, Wagh GN. Risk of non-resumption of vaginal sex and dyspareunia among cesarean-delivered women. J Family Med Prim Care 2021; 10:2600-2607. [PMID: 34568142 PMCID: PMC8415658 DOI: 10.4103/jfmpc.jfmpc_2482_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/21/2021] [Accepted: 03/12/2021] [Indexed: 12/15/2022] Open
Abstract
Context: Many women have postpartum sexual dysfunction. The mode of delivery is an important determinant. Aims: To calculate the risk ratio of non-resumption of vaginal sex and dyspareunia during the postpartum period among cesarean-delivered women. Settings and Design: This large multisite study was conducted in 13 selected hospitals in Pune District during 2017–19. Methods and Material: A total of 3,112 women (half cesarean delivered and half vaginally) were interviewed by trained health workers using a structured questionnaire. Women were interviewed at 4 weeks, 6 weeks, and 6 months. Statistical analysis used: Chi-square test was applied. A risk ratio with a 95% confidence interval was calculated. Results: At 6 weeks, the risk ratio of non-resumption of vaginal sex was significantly high among cesarean-delivered participants (1.14). Cesarean-delivered women had a lesser risk ratio of dyspareunia at both follow-ups (0.59, 0.49). Even at 6 months, about one-third vaginally delivered women had dyspareunia. The proportion of women non-resuming vaginal sex gradually decreased from 6 weeks to 6 months. The proportion of women having dyspareunia also decreased from 6 weeks to 6 months following childbirth. Residence in the rural area and cesarean delivery were the significant determinants of an early resumption of vaginal sex. Dyspareunia was significantly high among vaginal delivered than cesarean. About 25% of women continued to have dyspareunia up to 6 months. Conclusions: A large number of women suffer from dyspareunia; hence antenatal and postnatal care should include some counseling and management about the resumption of sex and dyspareunia.
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Affiliation(s)
- Prakash Prabhakarrao Doke
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Varsha Mahesh Vaidya
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Arvinder Pal Singh Narula
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | | | | | - Girija Narendra Wagh
- Department of Obstetrics and Gynecology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
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Effect of Epidural Analgesia on Pelvic Floor Dysfunction at 6 Months Postpartum in Primiparous Women: A Prospective Cohort Study. Sex Med 2021; 9:100417. [PMID: 34419692 PMCID: PMC8498962 DOI: 10.1016/j.esxm.2021.100417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Epidural analgesia has become a universal intervention for relieving labor pain, and its effect on the pelvic floor is controversial. AIM To investigate the effect of epidural analgesia on pelvic floor dysfunction (PFD) in primiparous women at 6 months postpartum. METHODS We performed a prospective cohort study involving 150 primiparous women in preparation for vaginal delivery, with 74 (49.3%) receiving epidural analgesia. Baseline demographic and intrapartum data were collected. At 6 months postpartum, PFD symptoms, including stress urinary incontinence, overactive bladder, defecation disorder, pelvic organ prolapse, and 4 kinds of sexual dysfunction (arousal disorder, low sexual desire, dyspareunia, and orgasm disorder), were evaluated. Pelvic floor muscle (PFM) function and postpartum depression were also assessed. Multivariate logistic regression was applied to identify factors associated with the PFD symptoms affected by epidural analgesia. MAIN OUTCOME MEASURE PFD symptoms and sexual dysfunction were evaluated through Pelvic Floor Distress Inventory-20 (PFDI-20) and Female Sexual Function Index (FSFI-12). PFM function was examined with palpation and surface electromyography (sEMG). Postpartum depression was assessed using Self-Rating Depression Scale (SDS). RESULTS At 6 months postpartum, women who delivered with epidural analgesia had a higher incidence of dyspareunia (43.2% vs 26.3%, P <0.05) and longer first, second, and total stage of labor durations (P <0.01) than those who without. No significant difference in other PFD symptoms or PFM function was found between the 2 groups (P >0.05). Multivariate logistic regression revealed that epidural analgesia (OR = 3.056, 95% CI = 1.217-7.671) and SDS scores (OR = 1.066, 95% CI = 1.009-1.127) were independent risk factors for dyspareunia. CONCLUSION At 6 months postpartum in primiparous women, epidural analgesia was associated with an increased risk of postpartum dyspareunia and longer labor durations, which deserves attention for rehabilitation after delivery. Future studies with a larger sample size are needed to evaluate the impact of epidural analgesia on other PFD symptoms. Du J, Ye J, Fei H, et al. Effect of Epidural Analgesia on Pelvic Floor Dysfunction at 6 Months Postpartum in Primiparous Women: A Prospective Cohort Study. Sex Med 2021;9:100417.
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Barger MK. Current Resources for Evidence-Based Practice, July/August 2021. J Midwifery Womens Health 2021; 66:540-547. [PMID: 34338411 DOI: 10.1111/jmwh.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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