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EMİNOV A, KAVLAK O, EMİNOV E, ERGENOĞLU A, İTİL İM. The effects of lavender oil and ice applications used in episiotomy care on episiotomy pain. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1209135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Aim: The present study investigates the effects of lavender oil and ice applications on episiotomy pain and wound healing.
Materials and Methods: This study was organized as a semi-randomized controlled type of research. A total of 96 term pregnant women who gave birth in the delivery service of Nazilli State Hospital and underwent episiotomy at birth, had a Visual Analog Skala (VAS) value greater than 3 and agreed to participate in the study were included in the study. The patient information form, the Visual Analog Scale, and the REEDA Scale were used for data collection. The research data was analyzed using number, percentage, the chi-square test, the Kruskal Wallis test, the Mann-Whitney U test, One-Way Anova test, Tukey HD test, and the Wilcoxon Signed Ranks test.
Results: The mean VAS values of the groups before the application were 7.90±0.92 for the lavender group, 8.29±1.03 for the ice group, and 8.00±1.00 for the control group. In addition, it was found that there was a statistically significant difference between the VAS values between the groups after the application (p<0.05), and the mean VAS values in the intervention groups decreased (Lavender group 6.84±1.08, ice group 5.70±1.53). While there was no statistically significant difference in the mean REEDA recovery scores between the groups before the application (p=0.912), there was a statistically significant difference in the REEDA recovery scores of the intervention groups and the control group after the application (p=0.000).
Conclusion: According to the findings of the study, lavender oil and ice applications used after labor reduce perineal pain and accelerate wound healing.
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Affiliation(s)
- Ayşe EMİNOV
- Ege University, Faculty of Medicine, Department of Obstetrics and Gynecology, Izmir, Türkiye
| | - Oya KAVLAK
- Ege University Faculty of Nursing, Department of Gynecology and Diseases, Izmir, Türkiye
| | - Elmin EMİNOV
- Ağrı İbrahim Çeçen University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ağrı, Türkiye
| | - Ahmet ERGENOĞLU
- Ege University Faculty of Medicine, Department of Obstetrics and Gynecology, Izmir, Türkiye
| | - İsmail Mete İTİL
- Ege University Faculty of Medicine, Department of Obstetrics and Gynecology, Izmir, Türkiye
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Agula C, Henry EG, Asuming PO, Obeng-Dwamena A, Toprah T, Agyekum MW, Shah I, Bawah AA. Postpartum contraceptive initiation and use: Evidence from Accra, Ghana. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221141290. [PMID: 36476194 PMCID: PMC9742708 DOI: 10.1177/17455057221141290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postpartum contraceptive use reduces unintended pregnancies and results in better health outcomes for children and women. However, there is a dearth of knowledge on postpartum contraceptive use in Ghana, particularly among women in low-income urban settings. To shed light on strategies that might enhance access to postpartum family planning services in low-income urban settings, we examined contraceptive use among postpartum women in Accra, Ghana, at 1, 3, 6, and 12 months following the birth and the methods used. The predictors of modern contraceptive use in the 12-month postpartum period were also examined. METHODS Data come from a cross-sectional survey conducted in 2018 among 624 women aged 16-44 years who reported giving birth in the past 13-31 months prior to the interview. We generated descriptive statistics to examine the prevalence of contraceptive use among postpartum women at 1, 3, 6, and 12 months after birth. We further estimated a binary logistic regression to examine the predictors of modern contraceptive use at 12 months postpartum. RESULTS Forty percent of postpartum women never used any contraceptive method during 1 year after birth and of those who used a method, 40% relied on traditional methods. Moreover, 29% of women started using a method the immediate 1 month post-birth. Results further show that postpartum modern contraceptive uptake was positively associated with higher education, having more live births, and being currently in a union. CONCLUSIONS Findings highlight that there may be opportunities to improve the quality of counseling during antenatal and postnatal care visits by clients to ensure fully informed choices regarding postpartum contraception. Community outreach by health providers/promoters or similar models should be promoted in low-income population settings to educate postpartum women on modern contraceptive use. Women who plan to use traditional methods should be provided with information on the consistent and correct use of these methods.
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Affiliation(s)
- Caesar Agula
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Elizabeth G Henry
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Patrick O Asuming
- University of Ghana Business School, University of Ghana, Accra, Ghana
| | - Akua Obeng-Dwamena
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Theophilus Toprah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | | | - Iqbal Shah
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ayaga A Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana,Ayaga A Bawah, Regional Institute for Population Studies, University of Ghana, P. O. Box LG 96, Legon, Accra, Ghana.
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Ghades S, Kaabia O, Fatnassi M. Impact de la voie d’accouchement sur la sexualité des primipares. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Alizadeh S, Ozgoli G, Riazi H, Majd HA. Development of sexual health promotion package in pregnancy: The Delphi method. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:31. [PMID: 35281373 PMCID: PMC8893089 DOI: 10.4103/jehp.jehp_298_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The World Health Organization recommendation requires the development and use of effective, brief, clear, and evidence-based education packages to improve health-care outcomes. No comprehensive sexual health improvement package exists for the pregnancy period in the Iranian health system. This study aimed to develop a package to promote sexual health in pregnancy. MATERIALS AND METHODS The present study is a qualitative study, which was conducted in 2019 in Tehran, Iran. Sexual health package during pregnancy was developed based on the National Institute for Health and Clinical Excellence (NICE) steps. The first step included reviewing of international guidelines, strategies, handbooks, education packages, and articles in this regard. The package was developed in the second step. In the third step, quality assessment was performed using expert opinion with the Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) tool, and validation was performed using Delphi method. RESULTS Package content was designed in two sections: for midwives and health-care providers and for pregnant mothers in three sessions (in each trimester of pregnancy). The quality assessment using the AGREE II guidelines revealed excellent quality (>89%). The package was validated based on expert opinion (>95%). CONCLUSION The sexual health promotion package during pregnancy was designed with high quality and validity based on NICE steps. It is recommended, midwives be performed this designed and validated package in routine pregnancy care to promote the couple's sexual health.
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Affiliation(s)
- Shiva Alizadeh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Giti Ozgoli
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hedyeh Riazi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mutia WON, Usman AN, Jaqin N, Prihantono, Rahman L, Ahmad M. Potency of complemeter therapy to the healing process of perineal wound; turmeric (Curcuma longa Linn) Infusa. GACETA SANITARIA 2021; 35 Suppl 2:S322-S326. [PMID: 34929843 DOI: 10.1016/j.gaceta.2021.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the effectiveness of yellow turmeric-infusa of 5% and 10% on the healing process of perineal wound grade II. METHOD The method used in this study is quasi-experiment with Pretest-Posttest Control Group design. The sampling technique is Exhaustive Sampling according to inclusion criteria. In this research consisted of three experimental groups with two intervention groups and one control group, with the number of subjects group was 15 people. Turmeric infusa is used daily by washing in the perineal wound area two times a day for 5 days postpartum. Monitoring of grade II perineal wound was performed three times, days 1, 5, and 7 postpartum using REEDA scale assessment. Data analysis used Kruskal-Wallis and Chi-Square tests. RESULTS The results showed that on the 5th and 7th postpartum days, there were differences in redness, edema, and approximation of wounds in each group (p<0.05) while the other REEDA parameters were not significantly different. There is also a difference in the time of perineal wound healing in each group, and it can be seen from the decrease and the total REEDA score. Turmeric infusa group 5% experienced healing on the 5th day postpartum, turmeric infusa 10% recovered on the 7th day postpartum, and the control group recovered more than 7 days. CONCLUSION Giving turmeric was proven to eliminate redness, edema, accelerate the closure, and perineal wound healing time, as seen from the p-value (p<0.05). However, turmeric infusa of 5% and 10% showed better effectiveness than turmeric infusa of 5%.
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Affiliation(s)
- Wa Ode Nurul Mutia
- Department of Midwifery, Postgraduate School, Hasanuddin University, Indonesia.
| | - Andi Nilawati Usman
- Department of Midwifery, Postgraduate School, Hasanuddin University, Indonesia
| | - Nur Jaqin
- Department of Midwifery, Postgraduate School, Hasanuddin University, Indonesia
| | - Prihantono
- Faculty of Medicine, Hasanuddin, University, Indonesia
| | | | - Mardiana Ahmad
- Department of Midwifery, Postgraduate School, Hasanuddin University, Indonesia
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Effects of Breastfeeding on Endometriosis-Related Pain: A Prospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010602. [PMID: 34682348 PMCID: PMC8535640 DOI: 10.3390/ijerph182010602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/01/2023]
Abstract
Endometriosis is a gynecological estrogen-dependent disease whose commonest pain symptoms are dysmenorrhea, dyspareunia, and acyclic chronic pelvic pain (CPP). Hormonal changes occurring during breastfeeding seem to reduce pain and disease recurrence. The aim of this observational prospective study was to assess the effect of breastfeeding on pain and endometriotic lesions in patients with endometriosis and to evaluate a possible correlation between the duration of breastfeeding, postpartum amenorrhea, and pain. Out of 156 pregnant women with endometriosis enrolled, 123 who breastfed were included in the study and were monitored for 2 years after delivery; 96/123 exclusively breastfed for at least 1 month. Mode of delivery, type and duration of breastfeeding, intensity of pain symptoms, and lesion size before pregnancy and during the 24-month follow-up were analyzed. All patients experienced a significant reduction in dysmenorrhea proportional to the duration of breastfeeding. CPP was significantly reduced only in women who exclusively breastfed. No significant improvement in dyspareunia was observed. Ovarian endometriomas were significantly reduced. Therefore, breastfeeding, particularly if exclusive, may cause improvement in dysmenorrhea and CPP proportional to the duration of breastfeeding, as well as a reduction in the size of ovarian endometriomas.
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Secondary Dyspareunia After Childbirth: A Pilot Study for Comparison Between Group of Women With Episiotomy and Women Without Perineal Trauma. INTERNATIONAL JOURNAL OF CHILDBIRTH 2021. [DOI: 10.1891/ijcbirth-d-20-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PROBLEMDyspareunia research following childbirth usually includes women who received an episiotomy during childbirth. Few studies have examined dyspareunia after childbirth in women who had no episiotomy or perineal trauma.PURPOSEThe purpose of this study was to compare the incidence of dyspareunia in women with perineal trauma related to childbirth to women without perineal trauma related to childbirth. The second aim was to assess risk factors for dyspareunia after childbirth.METHODSA quantitative cross-sectional study was designed and data were collected from a questionnaire that were sent via the internet (online). The study was performed in Slovenia. The study design included purposive and snowball sampling. Participants were assured anonymity.Analysis of data was conducted using SPSS 20.0. Factor analysis determined the validity and Cronbach's coefficient alpha determined the reliability of the questionnaire. The adequacy of a correlation matrix for factorization was assessed with the Kaiser–Meyer–Olkin (KMO) test and the Bartlett's test. To determine statistically significant differences, the chi-square (χ2) test was used. Kullback–Leibler divergence was used to measure how one probability distribution was different from the other probability distribution when the χ2 test was not satisfactory.FINDINGSThere were 387 respondents to the online questionnaire and 22% of the women who received an episiotomy prior to childbirth reported dyspareunia after childbirth; 13.69% reporteddyspareunia when they had no perineal trauma associated with childbirth. Dyspareunia persisted up to 18 months in 11% of participants who had an episiotomy and in 8% of women who experienced no perineal trauma.DISCUSSIONAfter an atraumatic childbirth, women can also experience dyspareunia. Pregnant women may benefit when their provider knows the risk factors for dyspareunia and limits episiotomy to those situations when there is a clear indication. Additional research may elucidate risk factors for dyspareunia following an atraumatic delivery.
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Korzeniewski R, Kiemle G, Slade P. Mothers’ experiences of sex and sexual intimacy in the first postnatal year: a systematic review. SEXUAL AND RELATIONSHIP THERAPY 2021. [DOI: 10.1080/14681994.2019.1671969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Gundi Kiemle
- Clinical Psychology Training Programme, University of Liverpool, Liverpool, UK
| | - Pauline Slade
- Clinical Psychology Training Programme, University of Liverpool, Liverpool, UK
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Postpartum perineal pain and dyspareunia related to each superficial perineal muscle injury: a cohort study. Int Urogynecol J 2020; 31:2367-2375. [DOI: 10.1007/s00192-020-04317-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/13/2020] [Indexed: 12/14/2022]
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Perceptions and Behaviors Related to Contraceptive Use in the Postpartum Period Among Women With Pregestational Diabetes Mellitus. J Obstet Gynecol Neonatal Nurs 2020; 49:154-166. [PMID: 31951814 DOI: 10.1016/j.jogn.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe perceptions and behaviors related to contraception and preconception care and to test the association between these perceptions and contraceptive use in the postpartum period among women with pregestational diabetes mellitus. DESIGN Cross-sectional, descriptive survey. SETTING Three high-risk obstetric clinics in the Southeastern United States. PARTICIPANTS Fifty-five women who were 18 years or older with pregestational Type 1 or Type 2 diabetes mellitus. METHODS Between 4 and 8 weeks after birth, we used investigator-developed items and psychometrically validated scales to measure participants' perceptions and behaviors related to contraception and preconception care. We dichotomized use of contraception in the postpartum period as procedure/prescription or nonprescription/no method. We used multiple logistic regression to test the hypothesis that perceptions are associated with contraceptive use. RESULTS When data were collected 4 to 8 weeks after birth, almost half (49%, n = 27) of the participants had resumed sexual activity; however, most (95%, n = 52) did not want another pregnancy in the next 18 months. Fifty-six percent (n = 31) of participants used procedure/prescription contraception, and 44% (n = 24) used nonprescription/no method. Those who perceived contraception use and preconception care to be beneficial were more likely to use procedure/prescription contraception (adjusted odds ratio = 1.52; 95% confidence interval [1.07, 2.17]). CONCLUSION When caring for women in the postpartum period, providers should be mindful that women's perceptions of the benefits of contraception and preconception care may have implications for whether their use aligns with their reproductive goals and optimizes outcomes for future pregnancies.
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Ogink H, Ringqvist AK, Bergqvist L, Nordin T, Nordenson A, Mårdby AC. A strategic tool to improve long-term health outcomes in clinical practice: SHOR driver and association diagram. Int J Qual Health Care 2019. [DOI: 10.1093/intqhc/mzz100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Quality problem or issue
An over-arching principle of healthcare governance in Sweden is to achieve as much health for as many patients as possible given the available resources. With high life expectancy and increased years lived with non-communicable diseases, more effective interventions in prevention and control of non-communicable diseases are needed in order to ensure high-quality healthcare.
Initial assessment
Few publications have described a generic and resource-effective method of implementing the perspective of health outcomes in relation to costs in a clinical Swedish university hospital context. To fill this gap, a generic method was developed at Sahlgrenska University hospital in Gothenburg, Sweden.
Choice of solution
A System-based driver and association diagram of Health Outcomes in relation to available Resources (SHOR) was developed. The SHOR driver and association diagram comprised different perspectives: health, patient, process, research and cost perspectives. It enabled the translation from long-term health outcomes to applications in clinical practice.
Implementation
Three patient groups exemplify the use and implementation of the method of SHOR association and driver diagram; bipolar disorder (psychiatry), primiparous women with spontaneous onset of labour, (obstetric care) and chronic obstructive pulmonary disease (somatic care).
Evaluation
The SHOR driver and association diagram enabled a structure to monitor and support quality development towards maximised health outcomes in relation to available resources and associated total costs for a specific patient group.
Lessons learned
This method has connected clinical practice, management and research and has been used for both strategic and operational purposes.
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Affiliation(s)
- Helena Ogink
- Quality Strategy Department, Sahlgrenska University Hospital, Röda stråket 8, Gothenburg SE-413 45, Sweden
| | - Anna-Karin Ringqvist
- Department of Obstetric care, Sahlgrenska University Hospital, Diagnosvägen 15, SE-416 85 Gothenburg
| | - Liselotte Bergqvist
- Department of Obstetric care, Sahlgrenska University Hospital, Diagnosvägen 15, SE-416 85 Gothenburg
| | - Tobias Nordin
- General Psychiatry Clinic, Sahlgrenska University Hospital, Journalvägen 5, SE- 416 50 Gothenburg, Sweden
| | - Anita Nordenson
- COPD Center, Sahlgrenska University Hospital, Vita stråket 12, SE- 413 46 Gothenburg, Sweden
| | - Ann-Charlotte Mårdby
- Institute of Medicine, Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg SE-405 30, Sweden
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Åhlund S, Rådestad I, Zwedberg S, Lindgren H. Perineal pain the first year after childbirth and uptake of post-partum check-up- A Swedish cohort study. Midwifery 2019; 78:85-90. [DOI: 10.1016/j.midw.2019.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 07/04/2019] [Accepted: 08/04/2019] [Indexed: 12/18/2022]
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Banaei M, Alidost F, Ghasemi E, Dashti S. A comparison of sexual function in primiparous and multiparous women. J OBSTET GYNAECOL 2019; 40:411-418. [PMID: 31537138 DOI: 10.1080/01443615.2019.1640191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Childbirth is one of the most important influencing factors for sexual function. Therefore, this study was conducted with the aim of comparing sexual function in primiparous and multiparous women. This cross-sectional analytical study was performed using systematic random sampling on 420 women in the postpartum period who referred to Bandar Abbas health Centres in 2018. The data were collected using an interview method which consisted of a Female Sexual Function Index questionnaire and a demographic questionnaire. The data analysis was performed using the SPSS Version 23 software. The results showed that sexual dysfunction was lower in multiparous women compared to primiparous women (p = .006). Low sexual activity in primiparous women can be due to less privacy and more time and energy loss. Several factors including housing situation, monthly income, episiotomy incision, and the education level of the couple were influential in the sexual function of the primiparous women (p < .05). Sexual function differs between primiparous and multiparous women in postpartum period and the number of deliveries can affect sexual performance.IMPACT STATEMENTWhat is already known on this subject? Sexual function in humans is affected by a complexity of interactions. Childbirth is among the most one of the important factors that influences sexual function. Pregnancy and childbirth affect all organs of the female body, especially the genital tract, and the resulting changes may cause problems in sexual intercourse. Negative childbirth experiences from previous deliveries can affect sexual performance.What do the results of this study add? Regarding the high prevalence of sexual problems during the postpartum period and the direct impact of this on spousal relationship, and also given the controversial data on the relationship between parity and sexual dysfunction, the present study was conducted to compare postpartum sexual function between primiparous and multiparous women.What are the implications of these findings for clinical practice and/or further research? The sexual and emotional intimacy of couples may be affected due to the changes in women's sexual function as the result of physiological and anatomical changes during pregnancy and postpartum. Therefore, to improve the quality of sexual relations, screening and counselling for sexual disorders should not be limited to pregnancy and postpartum periods, but should also be included in pre-pregnancy counselling centres.
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Affiliation(s)
- Mojdeh Banaei
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farzane Alidost
- MSc of Midwifery, Department of Reproductive Health, Nursing and Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sareh Dashti
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Serrano Drozdowskyj E, Gimeno Castro E, Trigo López E, Bárcenas Taland I, Chiclana Actis C. Factors Influencing Couples' Sexuality in the Puerperium: A Systematic Review. Sex Med Rev 2019; 8:38-47. [PMID: 31447412 DOI: 10.1016/j.sxmr.2019.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Elena Serrano Drozdowskyj
- Perinatal Mental Health Unit, Consulta Dr Carlos Chiclana, Madrid, Spain; Universidad Pontificia de Comillas, Madrid, Spain
| | | | - Elena Trigo López
- Perinatal Mental Health Unit, Consulta Dr Carlos Chiclana, Madrid, Spain
| | - Inés Bárcenas Taland
- Perinatal Mental Health Unit, Consulta Dr Carlos Chiclana, Madrid, Spain; Universidad Francisco de Victoria, Madrid, Spain
| | - Carlos Chiclana Actis
- Perinatal Mental Health Unit, Consulta Dr Carlos Chiclana, Madrid, Spain; Universidad San Pablo CEU, Madrid, Spain
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Aquino CI, Saccone G, Troisi J, Guida M, Zullo F, Berghella V. Is Ritgen's maneuver associated with decreased perineal lacerations and pain at delivery? J Matern Fetal Neonatal Med 2019; 33:3185-3192. [PMID: 30696316 DOI: 10.1080/14767058.2019.1568984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: Different techniques have been studied to prevent the risk of perineal trauma during labor and post-partum pain. Limited information is available on the effect of Ritgen's maneuver. The aim of this review was to analyze whether Ritgen's maneuver during vaginal delivery has an effect on the risks of perineal trauma.Data sources: Electronic databases were searched from their inception until April 2018. No restrictions for language or geographic location were applied.Methods: We included all randomized controlled trials (RCTs) comparing the use of Ritgen's maneuver with a control group in women with singleton gestation and cephalic presentation at ≥37 weeks. Ritgen's maneuver was defined as an upward pressure from the coccygeal region to extend the head during vaginal delivery. Trials evaluating other technique (e.g. hands-on, perineal massage, warm compresses, etc.) were not included. All analyses were done using an intention-to-treat approach. The primary outcome was severe perineal laceration, defined as either third- or fourth-degree lacerations. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of either a relative risk (RR) with 95% confidence interval (CI).Results: Three trials including 1589 women were analyzed. Ritgen's maneuver was usually done by a midwife in the second stage during uterine contraction and/or during the crowning process. Pooled data showed no significant differences in the incidence of severe perineal lacerations (RR = 0.69, 95% CI = 0.10-4.61), and a higher risk of post-partum pain (RR = 1.95, 95% CI = 1.13-3.38).Conclusions: Ritgen's maneuver during labor is not protective for severe perineal lacerations and is associated with higher post-partum pain.
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Affiliation(s)
- Carmen Imma Aquino
- Department of Obstetrics and Gynecology, School of Medicine, University of Salerno, Salerno, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Jacopo Troisi
- Department of Obstetrics and Gynecology, School of Medicine, University of Salerno, Salerno, Italy.,Theoreo srl, Spin-off Company of the University of Salerno, Salerno, Italy
| | - Maurizio Guida
- Department of Obstetrics and Gynecology, School of Medicine, University of Salerno, Salerno, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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The influence of partnership quality and breastfeeding on postpartum female sexual function. Arch Gynecol Obstet 2018; 299:69-77. [PMID: 30327862 DOI: 10.1007/s00404-018-4925-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Female sexual dysfunction is known to have a huge impact on quality of life and is highly prevalent during the peripartum period. Several influencing variables were found to be associated with impaired sexual function postpartum, among them breastfeeding and partnership quality. However, little is known about the predictive value of these variables. Therefore, this longitudinal cohort study aimed to examine prospectively the influence of the two variables on sexual function 4-month postpartum. MATERIALS AND METHODS Questionnaires were administered to 330 women prenatally (TI, third trimester) and postpartum (TII, 1 week; TIII, 4 months). Medical data were collected from the respondents' hospital records. The Female Sexual Function Index (FSFI) was used to determine overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain perinatally. RESULTS At all timepoints, mean FSFI scores were below the critical FSFI-score of 26.55. Partnership quality, breastfeeding, high maternal education, and maternal depressive symptoms correlated significantly with FSFI scores postpartum. Further analyses confirmed antenatal partnership quality and breastfeeding behavior as strong predictors of sexual function 4-month postpartum, explaining 24.3% of variance. Women who stopped breastfeeding or never breastfed at all showed the highest FSFI scores. CONCLUSION Our findings indicate that exclusively breastfeeding women and those who report low partnership quality have an increased likelihood of sexual functioning problems 4-month postpartum. Health-care providers need to be encouraged to counsel on postpartum sexuality and influencing factors during prenatal classes to de-pathologize those changes and to foster a positive approach to peripartum sexuality.
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Crookall R, Fowler G, Wood C, Slade P. A systematic mixed studies review of women's experiences of perineal trauma sustained during childbirth. J Adv Nurs 2018; 74:2038-2052. [PMID: 29791012 DOI: 10.1111/jan.13724] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/15/2018] [Indexed: 12/14/2022]
Abstract
AIM To explore the quantitative/qualitative literature on women's experiences of perineal trauma sustained during childbirth and the impact it may have on psychological/emotional wellbeing BACKGROUND: Obstetric complications during childbirth can be a risk factor for postpartum psychological distress. Perineal trauma is one of the most frequent obstetric complications and it is important to understand any impact on psychological/emotional wellbeing. DESIGN A convergent qualitative design using a hybrid deductive-inductive thematic synthesis approach to data transformation was used. DATA SOURCES Web of knowledge, CINAHL, MEDLINE, AMED, PsyArticles, PsycInfo until May 2017. REVIEW METHODS Stage 1: transforming findings from the qualitative, quantitative and mixed methods studies into themes using thematic synthesis. Stage 2: integrating themes from the quantitative studies into those derived from the qualitative studies RESULTS: Records (N=2152) found of which 11 qualitative 22 quantitative and 1 mixed methods were included in this review. Five themes were derived from thematic synthesis of qualitative studies 'The mystery of perineal trauma', 'The misery of perineal suturing', 'The postnatal perineum', 'Normalisation and feeling dismissed' and 'Adjusting to a new normal - Coping and compromise' and five themes identified from the quantitative studies, experience of birth (N=4), Sexual functioning (N=12), Social functioning (N=2), Psychological health (N=8) and Quality of Life (N=5). CONCLUSION Perineal trauma can have a negative impact on psychological/emotional wellbeing, however the literature is conflicted and in need of clarification. Future research should clearly describe the perineal status of the women in the sample, use validated measures and consider the timing of such measures. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Gillian Fowler
- Consultant Urogynaecologist, Liverpool Women's NHS Foundation Trust
| | - Caroline Wood
- Specialist Urogynaecological link midwife, Liverpool Women's NHS Foundation Trust
| | - Pauline Slade
- Clinical Psychology/Consultant Clinical Psychologist, University of Liverpool
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The development and validation of a new postpartum sexual function and dyspareunia assessment tool: The Carol Scale. Midwifery 2017; 58:27-36. [PMID: 29277039 DOI: 10.1016/j.midw.2017.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/26/2017] [Accepted: 11/29/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim is to develop a new tool to evaluate postpartum sexual function and dyspareunia which will facilitate better evaluation of perineal pain in woman after vaginal delivery. DESIGN The development and validation of the Carol Postpartum Sexual Function and Dyspareunia Assessment Scale. SETTING The Obstetrics and Gynecology Service of a University Hospital in central Spain. PARTICIPANTS 102 women after being attended for vaginal birth, and 5 midwife assessors. FINDINGS 81women reinitiated sexual activity (with vaginal intercourse) during the first three months postpartum. The Carol Postpartum Sexual Function and Dyspareunia Assessment Scale (Carol Scale) was internally reliable with a Cronbach-α value of 0.79 (95%CI0.72-0.85). Cronbach-α coefficients for Carol Scale domains were: preparation for the sexual activity 0.69 (95%CI0.55-0.79), pain or discomfort on caressing the vulval area 0.86 (95%CI0.79-0.91), pain or discomfort related to vaginal intercourse 0.93 (95%CI0.90-0.95) and pain or discomfort after vaginal intercourse 0.86 (95%CI0.78-0.91). CONCLUSIONS The Carol Postpartum Sexual Function and Dyspareunia Assessment Scale is valid and reliable for measuring sexual function and postpartum dyspareunia in women after being attended for vaginal birth. IMPLICATIONS FOR PRACTICE The Carol Scale could be used both clinically and in research to improve the quality of care for the mother after childbirth. The scale could help to identify problems in the reinitiation of postpartum sexual activity and, therefore, could contribute to widening the clinical information about these women and help in decision making.
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19
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Fan D, Li S, Wang W, Tian G, Liu L, Wu S, Guo X, Liu Z. Sexual dysfunction and mode of delivery in Chinese primiparous women: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2017; 17:408. [PMID: 29212464 PMCID: PMC5719940 DOI: 10.1186/s12884-017-1583-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 11/17/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Up to now, there is controversy over the effect of delivery mode cesarean delivery and spontaneous vaginal delivery on sexual function. Therefore, we did a systematic review and meta-analysis in postpartum women to explore the mode of delivery, cesarean delivery, and spontaneous vaginal delivery and differences in postpartum sexual function (short- and long-term) in Chinese primiparous women. METHODS Comprehensive electronic searches of PubMed, EMBASE, Web of Science, Elsevier Science Direct, Cochrane Library, the Chinese Biological Medical Literature database and the Chinese National Knowledge Infrastructure database were conducted to identify any study in each database published to August 31, 2017. The primary outcome was the sexual satisfaction and the secondary outcomes were resumed intercourse and sexual pain in the postpartum. RESULTS We identified 10 studies with a total population of 2851 in the present meta-analysis. Five and six eligible articles were respectively included for sexual satisfaction in postpartum at 3- and 6 months. Compared with vaginal delivery group, two time points were all not found statistically significance (OR 1.53, 95%CI 0.93-2.49; OR 1.15, 95%CI 0.95-1.39, respectively) in cesarean and spontaneous vaginal delivery group; in resumed intercourse and sexual pain domains, they were all significantly, with an overall OR of 2.05 (95%CI 1.36-3.11) at 3 months, 1.50 (95%CI 1.04-2.16) at 6 months and 0.29 (95%CI 0.24, 0.36) at 3 months, 0.73 (95%CI 0.58, 0.93) at 6 months, respectively. With the passage of time, the gap was closing. Sensitivity analysis was indicated a good stability of the meta-analysis in each domain. CONCLUSIONS In conclusion, this meta-analysis indicated that the mode of delivery, cesarean and spontaneous vaginal delivery did not affect postpartum sexual satisfaction (short- and long-term) and appeared to have minimal effect on the long-term resumed intercourse and sexual pain in Chinese primiparous women. Primiparous women should be more cautious to choose cesarean section in order to preserve sexual function.
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Affiliation(s)
- Dazhi Fan
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China.,Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China.,Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Song Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China.,Chaohu Hospital Affiliated Anhui Medical University, Chaohu, Anhui, 238000, China
| | - Wen Wang
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China.,Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China
| | - Guo Tian
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, Zhejiang, 310003, China
| | - Li Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China.,The First Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, Zhejiang, 310003, China
| | - Song Wu
- School of Integrated Traditional and Western Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, 230038, China
| | - Xiaoling Guo
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China. .,Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China.
| | - Zhengping Liu
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China. .,Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China.
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20
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Kaya B, Usluogullari B, Yurttutan N, Sahan M, Güralp O, Malik E. Does ligation of internal iliac artery for postpartum hemorrhage affect clitoral artery blood flow and postpartum sexual functions? Eur J Obstet Gynecol Reprod Biol 2017; 219:124-128. [DOI: 10.1016/j.ejogrb.2017.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/23/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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The Effects of Cold Application to the Perineum on Pain Relief After Vaginal Birth. Asian Nurs Res (Korean Soc Nurs Sci) 2017; 11:276-282. [PMID: 29290275 DOI: 10.1016/j.anr.2017.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Perineal pain developing during the postpartum period affects women's relationships with their families and infants. The aim of this study was to determine the efficacy of cold gel pad application for relieving perineal pain and possibly increasing mothers' comfort after vaginal delivery. METHODS This experimental randomized controlled study was conducted in the postpartum department of obstetrics and gynecology hospital. A total of 200 mothers were included in the study. Cold gel pads were applied to the perineum of mothers in the experimental group for 20 minutes in the postpartum first 2 hours and 4 hours after the first application. All the data were collected by using an information form, the visual analog scale, and the postpartum comfort questionnaire. RESULTS In the experimental group, the first visual analog scale score was 6.73 ± 1.68; after cold gel pad application, the pain levels decreased to 2.59 ± 1.20 in both primiparous and multiparous mothers. In addition, the postpartum comfort questionnaire score increased from 2.58 ± 0.14 to 2.69 ± 0.14 in the second assessment after the cold gel pad application and the difference was statistically significant (p < .001). CONCLUSION The application of the cold gel pad to the perineum relieved perineal pain and increased postpartum comfort in all the women. The pain felt by the women during the recovery and the daily activities decreased. Postpartum perineal pain adversely affected daily activities such as lying down, sitting, and walking; infant care, breastfeeding, and urination; and comfort levels of the postpartum women.
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22
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Saydam BK, Demireloz Akyuz M, Sogukpinar N, Ceber Turfan E. Effect of delivery method on sexual dysfunction. J Matern Fetal Neonatal Med 2017; 32:568-572. [DOI: 10.1080/14767058.2017.1387243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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McBride HL, Kwee JL. Sex After Baby: Women’s Sexual Function in the Postpartum Period. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0116-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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24
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Jawed-Wessel S, Sevick E. The Impact of Pregnancy and Childbirth on Sexual Behaviors: A Systematic Review. JOURNAL OF SEX RESEARCH 2017; 54:411-423. [PMID: 28166416 DOI: 10.1080/00224499.2016.1274715] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The purpose of this review was to examine and synthesize the available quality evidence to provide researchers, educators, and clinicians an overview of what is known about sexual behaviors during pregnancy and the year after childbirth. Search engines were used to identify peer-reviewed, English-language articles that met the inclusion criteria. A total of 56 prospective, retrospective, and qualitative studies published after 1996 were reviewed. A gradual decline in vaginal intercourse from prepregnancy to first trimester to third trimester was found. Most couples resume vaginal intercourse by eight weeks after childbirth, but this behavior does not occur at prepregnancy frequencies until closer to 12 months postchildbirth. Future studies should consider assessing sexual behaviors beyond vaginal intercourse and increase efforts in recruitment of diverse samples including non-White, nonheterosexual pregnant individuals, and partners of pregnant individuals.
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Affiliation(s)
| | - Emily Sevick
- a School of Health and Kinesiology, University of Nebraska at Omaha
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25
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Rezaei N, Azadi A, Sayehmiri K, Valizadeh R. Postpartum Sexual Functioning and Its Predicting Factors among Iranian Women. Malays J Med Sci 2017; 24:94-103. [PMID: 28381932 DOI: 10.21315/mjms2017.24.1.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 12/03/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Many women experience sexual dysfunction following childbirth but this has not been well investigated in Iran. The aim of this study was to evaluate women's sexual function in the postpartum period in Iran. It also sought to determine predicting factors associated with their sexual function. METHODS This was a cross-sectional study among 380 postpartum women attending 10 urban health centers in Ilam province in southwestern Iran. Participants were selected using random cluster sampling. Data was collected using the female sexual function index (FSFI) and a checklist of socio-demographic and maternal status for each of the women. Sexual dysfunction was classified according to an FSFI score of ≤ 28. Data were analysed using SPSS version 22. RESULTS The majority of participants (76.3%) had sexual dysfunction. Primiparity (adjusted odds ratio (aOR): 1.78 (95% Confidence Interval (CI): 1.11, 2.94); P = 0.006) and exclusive breastfeeding (aOR: 2.47 (95% CI: 1.21, 5.03); P = 0.012) were associated with increased odds of experiencing sexual dysfunction in the postpartum period. Other factors such as age, type of delivery, education, time since delivery and family income did not predict women's postpartum sexual function. CONCLUSION This study confirmed findings of previous studies on factors that may have an adverse effect on new mothers' sexual function in the postpartum period. However the effect of type of delivery on postpartum sexual function remains unclear.
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Affiliation(s)
- Nazanin Rezaei
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Arman Azadi
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Kourosh Sayehmiri
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Reza Valizadeh
- Psychiatry Department, Schools of Medicine, Ilam University of Medical Sciences, Ilam, Iran
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26
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Suto M, Takehara K, Misago C, Matsui M. Prevalence of Perineal Lacerations in Women Giving Birth at Midwife-Led Birth Centers in Japan: A Retrospective Descriptive Study. J Midwifery Womens Health 2016; 60:419-27. [PMID: 26255802 DOI: 10.1111/jmwh.12324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Perineal lacerations during birth can cause ongoing physical, psychological, and social problems. However, the prevalence of lacerations following normal spontaneous vaginal birth in women with low-risk pregnancies is unknown. We investigated the prevalence of perineal lacerations and factors associated with lacerations among low-risk Japanese women who had normal spontaneous vaginal births. METHODS Pregnant women who were cared for between January 1, 2008, and June 30, 2011, in 3 midwife-led birth centers in Tokyo, Japan, where invasive medical interventions are rarely applied, were included. We investigated the prevalence of perineal lacerations and conducted univariate and multivariate analyses on the relationship between the prevalence of lacerations and selected maternal and neonatal characteristics. RESULTS A total of 1881 pregnant women had initial antenatal care at one of the 3 study sites. Of these, 1521 were eligible for inclusion. Intact perineum rates were 49.5% (209/422) and 69.9% (768/1099) in nulliparous and multiparous women, respectively. First-degree lacerations occurred in 36.7% (155/422) of nulliparous women and 27.1% (298/1099) of multiparous women, and second-degree lacerations occurred in 13.5% (57/422) of nulliparous women and 3.0% (33/1099) of multiparous women. One multiparous woman experienced a third-degree laceration (0.1%). No women suffered fourth-degree or cervical lacerations. Logistic regression analyses showed that older age (≥ 35 years), the hands-and-knees position, and using a birthing chair during birth increased the risk of perineal laceration both in nulliparous and in multiparous women. In addition, waterbirths increased the risk of perineal laceration in multiparous women. DISCUSSION In normal spontaneous vaginal births among a low-risk population, it is possible to avoid episiotomy and achieve a high rate of intact perineum, with few second-degree and third-degree lacerations.
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Martínez-Martínez A, Arnau J, Salmerón JA, Velandrino AP, Martínez ME. The sexual function of women during puerperium: a qualitative study. SEXUAL AND RELATIONSHIP THERAPY 2016. [DOI: 10.1080/14681994.2016.1263389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - José Arnau
- Midwifery Teaching Unit, Nursery School, Campus Universitario de Espinardo, Murcia, Spain
| | - Juan Antonio Salmerón
- Department of Theory and Story of Education, Education School, Campus Universitario de Espinardo, Murcia, Spain
| | | | - Maria Emilia Martínez
- Department of Nursery, Nursery School, Campus Universitario de Espinardo, Murcia, Spain
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Factors Associated With Timing of Return to Intercourse After Obstetric Anal Sphincter Injuries. J Sex Med 2016; 13:1523-9. [PMID: 27497647 DOI: 10.1016/j.jsxm.2016.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/07/2016] [Accepted: 07/18/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The impact of obstetric perineal trauma on timing of return to intercourse is unclear, although sexual desire is clearly decreased in these women. In addition, studies examining timing of return to intercourse are cross-sectional and therefore cannot delineate potential reasons that patients might delay return to intercourse. AIM To identify factors associated with delayed return to intercourse after obstetric anal sphincter injuries. METHODS This was a planned secondary analysis of a prospective cohort study of women sustaining obstetric anal sphincter injuries during delivery of a full-term singleton infant. Patients completed the Fecal Incontinence Severity Index at every postpartum visit (1, 2, 6, and 12 weeks) and the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12 once resuming vaginal intercourse. Intercourse was considered "delayed" if patients did not resume intercourse by the 12-week visit. This cutoff was chosen because it was subsequent to the 6-week visit, when patients were instructed to return to normal pelvic activity. Continuous variables were compared using the Student t-test (parametric) or Mann-Whitney U-test (non-parametric). The χ(2) test was used for categorical variables. Statistical significance was assigned with a P value less than .05. MAIN OUTCOME MEASURES Primary outcome measurements were differences in pelvic floor symptoms on validated surveys between the "delayed" and "not-delayed" groups at the first postpartum visit and at the time the subjects returned to intercourse. We used the Patient Health Questionnaire-9 for depression, the Urinary Distress Inventory-6 and Incontinence Impact Questionnaire-7 for urinary symptoms, the visual analog scale for pain, the Fecal Incontinence Severity Index for bowel symptoms, and the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12 at the return to intercourse visit only. RESULTS One hundred ninety-nine women were included in this analysis. Most were Caucasian (77%) and primiparous (86%). One hundred nineteen women (60%) did not resume vaginal intercourse until after the 12-week visit and were deemed "delayed." Patients who delayed intercourse scored higher on the Fecal Incontinence Severity Index (more anal incontinence) than those who resumed intercourse before 12 weeks (15.4 ± 12.3 vs 12.0 ± 12.8, P = .02). The delayed group also had worse sexual function, shown as lower Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12 scores (35.4 ± 5.9 vs 38.4 ± 4.1, P ≤ .001) and persistently higher Fecal Incontinence Severity Index scores (4.1 ± 7.3 vs 1.6 ± 4.4, P = .001), at the first visit after returning to intercourse. CONCLUSION Patients with obstetric anal sphincter injuries who do not resume intercourse by 12 weeks postpartum report more severe anal incontinence symptoms and worse sexual function after return to coitus.
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Sexual activity and dyspareunia the first year postpartum in relation to degree of perineal trauma. Int Urogynecol J 2016; 27:1513-23. [PMID: 27185318 DOI: 10.1007/s00192-016-3015-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/19/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Knowledge on sexual complaints and time to sexual resumption after obstetric anal sphincter injury (OASI) is scarce. The aim of the study was to investigate self-reported sexual activity and coital problems 1 year postpartum in relation to perineal trauma, in addition to delivery mode. METHODS Among 2,846 women recruited during pregnancy, all women who delivered with OASI (n = 42, all third-degree perineal tears), in addition to 20 randomly selected controls per OASI case, a total of 882 women, were sent a self-administered questionnaire addressing time to coital resumption after delivery and potential coital difficulty 1 year postpartum. RESULTS By 8 weeks, half of the 561 responders (51.4 %) had resumed intercourse, increasing to 75.2 % by 12 weeks and 94.7 % 1 year postpartum. In multivariate regression analysis OASI was the strongest predictor for postponed coital onset, defined as after 8 weeks (aOR 5.52, CI 1.59-19.16). OASI was also the only significant predictor for dyspareunia 1 year after delivery (aOR 3.57, CI 1.39-9.19). Episiotomy was neither a risk factor for postponed coital onset nor for dyspareunia. There were no differences between episiotomy and second-degree laceration injury groups regarding postponed coital onset (p = 0.45) or dyspareunia (p = 0.67) 1 year postpartum. CONCLUSIONS Obstetric anal sphincter injury was a strong and independent predictor for both postponed coital resumption after delivery and for dyspareunia 1 year postpartum, whereas episiotomy and spontaneous second-degree lacerations were not. Our main finding of affected sexual activity after OASI further supports the need to reduce the rates of this obstetric injury to a minimum.
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[What do we know about perinatal sexuality? A scoping review on sexoperinatality - Part 2]. ACTA ACUST UNITED AC 2016; 45:809-820. [PMID: 26989006 DOI: 10.1016/j.jgyn.2015.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/30/2015] [Accepted: 11/04/2015] [Indexed: 02/04/2023]
Abstract
The intimate and sexual dimension of future and new parenting couples' relationship is the most affected and the most vulnerable during the transition to parenthood. The purpose of this scoping review is to present the portrait of perinatal sexuality through 123 empirical articles published in the last 15 years. This second article in a series of two is about sexuality during labor and birth, during the postpartum, and in relation to breastfeeding. A total of 29 sexual variables were analyzed. Sexuality during the intrapartal and postnatal periods is very diversified. Some recurring items, however, can be identified: a period of non-sexuality in the first postnatal months, followed by a gradual return of sexuality from 3 to 6 months postpartum and continuing until 12 months or more. Sexuality during the intrapartum is considered taboo and couples' experiences can be at opposite ends: some couples' experiences are sensual and erotic during childbirth, while others experience birth trauma with a negative sexual impact postnatally. Sexuality during breastfeeding is also taboo with a negative impact on women's sexuality. In all of these circumstances, women's and men's sexuality are affected and a multitude of simultaneous physiological and psychological factors affect their experiences. Fluctuations in the intimate and sexual dimensions of the conjugal relationship are considered as a natural phenomenon but temporary. Sexoperinatal interventions should be part of holistic perinatal health care in order to help couples maintain a positive intimate and sexual relationship.
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Perineal body stretch during labor does not predict perineal laceration, postpartum incontinence, or postpartum sexual function: a cohort study. Int Urogynecol J 2016; 27:1193-200. [PMID: 26874524 DOI: 10.1007/s00192-016-2959-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/18/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The perineum stretches naturally during obstetrical labor, but it is unknown whether this stretch has a negative impact on pelvic floor outcomes after a vaginal birth (VB). We aimed to evaluate whether perineal stretch was associated with postpartum pelvic floor dysfunction, and we hypothesized that greater perineal stretch would correlate with worsened outcomes. METHODS This was a prospective cohort study of primiparous women who had a VB. Perineal body (PB) length was measured antepartum, during labor, and 6 months postpartum. We determined the maximum PB (PBmax) measurements during the second stage of labor and PB change (ΔPB) between time points. Women completed functional questionnaires and had a Pelvic Organ Prolapse Quantification (POP-Q) system exam 6 months postpartum. We analyzed the relationship of PB measurements to perineal lacerations and postpartum outcomes, including urinary, anal, and fecal incontinence, sexual activity and function, and POP-Q measurements. RESULTS Four hundred and forty-eight women with VB and a mean age of 24 ± 5.0 years with rare (5 %) third- or fourth-degree lacerations were assessed. During the second stage of labor, 270/448 (60 %) had perineal measurements. Mean antepartum PB length was 3.7 ± 0.8 cm, with a maximum mean PB length (PBmax) during the second stage of 6.1 ± 1.5 cm, an increase of 65 %. The change in PB length (ΔPB) from antepartum to 6 months postpartum was a net decrease (-0.39 ± 1.02 cm). PB change and PBmax were not associated with perineal lacerations or outcomes postpartum (all p > 0.05). CONCLUSIONS PB stretch during labor is unrelated to perineal laceration, postpartum incontinence, sexual activity, or sexual function.
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Andreucci CB, Bussadori JC, Pacagnella RC, Chou D, Filippi V, Say L, Cecatti JG. Sexual life and dysfunction after maternal morbidity: a systematic review. BMC Pregnancy Childbirth 2015; 15:307. [PMID: 26596506 PMCID: PMC4657322 DOI: 10.1186/s12884-015-0742-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/17/2015] [Indexed: 12/13/2022] Open
Abstract
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 22nd, 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 (3rd or 4th 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.
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Affiliation(s)
- Carla B Andreucci
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil. .,Federal University of Sao Carlos, Sao Carlos, Brazil.
| | | | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
| | - Doris Chou
- Reproductive Health Research unit, World Health Organization, Geneva, Switzerland.
| | - Veronique Filippi
- London School of Hygiene and Tropical Medicine, University of London, London, England, UK.
| | - Lale Say
- Reproductive Health Research unit, World Health Organization, Geneva, Switzerland.
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
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Seijmonsbergen-Schermers AE, Sahami S, Lucas C, Jonge AD. Nonsuturing or Skin Adhesives versus Suturing of the Perineal Skin After Childbirth: A Systematic Review. Birth 2015; 42:100-15. [PMID: 25864727 DOI: 10.1111/birt.12166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Suturing of perineal trauma after childbirth can cause problems such as pain, discomfort because of tight sutures, the need for suture removal, and dyspareunia. It is unclear whether leaving the perineal skin unsutured or using skin adhesives might prevent these problems. METHODS CENTRAL, MEDLINE, EMBASE, CINAHL, and prospective trial registers until January 2013 were searched for (quasi-)randomized controlled trials comparing nonsuturing of the perineal skin or skin adhesives versus suturing of the skin when repairing a second-degree perineal tear or episiotomy. Primary outcome measure was short-term and long-term pain and need for analgesic medication. RESULTS Four randomized and two quasi-randomized controlled trials (involving 2,922 women) with heterogeneity in contexts, designs, and methodological quality were included. Nonsuturing of the skin leads to less short-term and long-term pain compared to suturing and an increased rate of skin separation. Skin adhesives lead to less short-term pain without an increased rate of skin separation. Nonsuturing or skin adhesives lead to less complaints and there are no other adverse effects. CONCLUSIONS Nonsuturing of the skin or the use of skin adhesives appears preferable in terms of pain. Nonsuturing could lead to more short-term skin separation when no adhesives are used, but there is no evidence for the clinical importance of skin separation. There is a need for studies with a follow-up of at least 6 months, in which pain is measured homogeneously and for studies comparing the use of skin adhesives with nonsuturing of the skin with the focus on long-term cosmetic results.
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Affiliation(s)
- Anna E Seijmonsbergen-Schermers
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Saloomeh Sahami
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Cees Lucas
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
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O'Malley D, Higgins A, Smith V. Postpartum sexual health: a principle-based concept analysis. J Adv Nurs 2015; 71:2247-57. [PMID: 25996569 DOI: 10.1111/jan.12692] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study is to report an analysis of the concept of postpartum sexual health. BACKGROUND Postpartum sexual health is a minimally understood concept, most often framed within physical/biological dimensions or as a 'checklist' task in postpartum information provision. This has the potential to leave women unprepared to manage transient or normative sexual health changes after childbirth. For meaningful discussions, clarity and understanding of postpartum sexual health is required. DESIGN A principle-based method of concept analysis. DATA SOURCES The databases of PubMed, CINAHL, Maternity and Infant Care, PsychInfo, Web of Science, EMBASE, SCOPUS and Social Science Index were systematically searched, from their earliest dates, using a combination of key terms, including; 'sexual health', 'sexual function', 'dyspareunia', 'sexuality', 'sexual desire', 'sexual dysfunction', 'postnatal' and 'postpartum', resulting in a final included dataset of 91 studies. METHODS Using the principle-based approach, postpartum sexual health was analysed under the four philosophical principles of epistemological, pragmatic, linguistic and logical. RESULTS Philosophically, postpartum sexual health is underdeveloped as a concept. A precise theoretical definition remains elusive and, presently, postpartum sexual health cannot be separated theoretically from sexuality and sexual function. Identified antecedents include an instrument free birth, an intact perineum and avoidance of episiotomy. Attributes include sexual arousal, desire, orgasm, sexual satisfaction and resumption of sexual intercourse. Outcomes are sexual satisfaction and a satisfying intimate relationship with one's partner. CONCLUSION Postpartum sexual health is conceptually immature with limited applicability in current midwifery practice.
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Affiliation(s)
| | - Agnes Higgins
- School of Nursing & Midwifery, Trinity College Dublin, Ireland
| | - Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, Ireland
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Faisal-Cury A, Menezes PR, Quayle J, Matijasevich A, Diniz SG. The Relationship Between Mode of Delivery and Sexual Health Outcomes after Childbirth. J Sex Med 2015; 12:1212-20. [DOI: 10.1111/jsm.12883] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Holanda JBDL, Abuchaim EDSV, Coca KP, Abrão ACFDV. Disfunção sexual e fatores associados relatados no período pós-parto. ACTA PAUL ENFERM 2014. [DOI: 10.1590/1982-0194201400093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivo Estimar a prevalência e os fatores associados à disfunção sexual no período pós-parto.Métodos Estudo transversal com 200 puérperas que retomaram a vida sexual ativa. Os dados foram coletados, em local privado, por meio de entrevista e registrados em formulário contendo informações pertinentes a vida sexual das puerperas.Resultados Dentre as mulheres pesquisadas verificou-se que 33,5%, 76,0% e 43,5% apresentavam disfunções sexuais antes da gravidez, durante e após o parto, respectivamente. Os tipos de disfunção identificados com maior frequência foram a dispareunia, seguida do vaginismo, disfunção do desejo, orgásmica e excitação. Os fatores significativamente associados foram as religiões católica ou evangélica, o parto vaginal com sutura, a dispareunia durante a gravidez, o vaginismo antes da gravidez e uma jornada de trabalho além de 8 horas/diárias.Conclusão A prevalência das disfunções sexuais foi alta e os fatores associados foram: religião, jornada de trabalho, história prévia de disfunção e tipo de parto.
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Colson MH. [Female sexuality and parenthood]. ACTA ACUST UNITED AC 2014; 42:714-20. [PMID: 25262091 DOI: 10.1016/j.gyobfe.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/27/2014] [Indexed: 10/24/2022]
Abstract
From the child conception to the early years of life, couples generally present less sexual activity. Parenthood constraints are a burden for the couple's relationships. Generally, persistent sexual difficulties six months after delivery, despite those generated by depression or altered health raise the question of an alteration in the quality of the couple's relationships and lack of satisfaction of the mother with her partner's involvement in family life. Numerous parameters can be implied, especially with persistent trouble of desire, such as fatigue, body image problems and libido lessening of the partner due to modifications of his status. Women who presented sexual difficulties before pregnancy remain the same. In all cases, appropriate information can avoid the intimacy's difficulties and contribute to maintain pleasure and intimacy even when vaginal penetration remains difficult.
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Affiliation(s)
- M-H Colson
- Hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France.
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Komorowski LK, Leeman LM, Fullilove AM, Bedrick EJ, Migliaccio LD, Rogers RG. Does a large infant head or a short perineal body increase the risk of obstetrical perineal trauma? Birth 2014; 41:147-52. [PMID: 24698200 PMCID: PMC4032593 DOI: 10.1111/birt.12101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Perineal trauma after vaginal delivery can have significant long-term consequences. It is unknown if a larger infant head circumference or smaller maternal perineal anatomy are risk factors for perineal trauma after vaginal delivery. METHODS We conducted a prospective cohort study of low-risk nulliparous women. Data collected included maternal characteristics, antepartum Pelvic Organ Prolapse Quantification measurements of the perineal body and genital hiatus, labor characteristics, perineal trauma, and infant head circumference. Perineal trauma was defined as trauma that extended into the muscles of the perineum (second-degree or deeper). Univariate and multivariate logistic models were created to calculate odds ratios (OR) and 95 percent confidence intervals (CI). RESULTS We observed 448 vaginal births. Multivariate analysis demonstrated a significant association between infant head circumference at birth and perineal trauma: OR 1.22 for each increase of 1 cm in head circumference (95% CI 1.05-1.43). There was no association between perineal body or genital hiatus length and perineal trauma. CONCLUSIONS In nulliparous low-risk women a larger infant head circumference at birth increases the likelihood of perineal trauma, although the effect is modest. Antenatal perineal body and genital hiatus measurements do not predict perineal trauma. These results do not support alteration in mode of delivery or other obstetric practices.
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Affiliation(s)
| | - Lawrence M. Leeman
- The Department of Family and Community Medicine; The University of New Mexico; Albuquerque NM USA
- The Department of Obstetrics and Gynecology; The University of New Mexico; Albuquerque NM USA
| | - Anne M. Fullilove
- The Division of Urogynecology; The University of New Mexico; Albuquerque NM USA
| | - Edward J. Bedrick
- The Department Internal Medicine; The University of New Mexico; Albuquerque NM USA
| | - Laura D. Migliaccio
- The Department of Obstetrics and Gynecology; The University of New Mexico; Albuquerque NM USA
| | - Rebecca G. Rogers
- The Division of Urogynecology; The University of New Mexico; Albuquerque NM USA
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Yee LM, Kaimal AJ, Nakagawa S, Houston K, Kuppermann M. Predictors of postpartum sexual activity and function in a diverse population of women. J Midwifery Womens Health 2013; 58:654-61. [PMID: 24325662 DOI: 10.1111/jmwh.12068] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The purpose of this study was to identify predictors of postpartum sexual activity and functioning in a diverse population of women using the Sexual Health Outcomes in Women Questionnaire (SHOW-Q). METHODS This was a prospective study of 160 postpartum women assessing relationships between demographic factors, mode of birth, depression, breastfeeding, and sexual activity and function. Questionnaires were administered over the telephone 8 to 10 weeks postpartum and in person 6 to 8 months postpartum. Primary outcomes were sexual activity at 8 to 10 weeks postpartum and global and subscale SHOW-Q scores at 6 to 8 months postpartum; the primary predictor was mode of birth. Associations were assessed using multiple linear and logistic regression analyses. RESULTS Seventy-five percent of this population (n = 140 at 8-10 weeks, n = 129 at 6-8 months) gave birth vaginally, and 60.7% resumed sexual activity by 8 to 10 weeks postpartum. Only multiparity was associated with increased odds of having resumed sexual activity by 8 to 10 weeks postpartum (adjusted odds ratio [aOR], 2.44; P = .03), whereas older age was associated with decreased odds (aOR, 0.92; P = .02) of having resumed sexual activity. Women who were depressed (effect estimate, -13.3; P = .01), older (-1.1, P = .01), or exclusively breastfeeding (-16.5, P < .001) had significantly poorer sexual satisfaction, whereas multiparous women reported better sexual satisfaction (11.1, P = .03). A significant relationship between mode of birth and SHOW-Q scores did not emerge, although we did observe a trend toward lower SHOW-Q scores among women who underwent cesarean compared with those giving birth vaginally. DISCUSSION Multiparity and younger age predict early resumption of sexual activity, whereas depression and breastfeeding are associated with poorer postpartum sexual functioning. The relationship between mode of birth and resumed sexual activity or postpartum sexual function remains uncertain.
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Hipp LE, Kane Low L, van Anders SM. Exploring Women's Postpartum Sexuality: Social, Psychological, Relational, and Birth‐Related Contextual Factors. J Sex Med 2012; 9:2330-41. [DOI: 10.1111/j.1743-6109.2012.02804.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Perineal pain following childbirth: Prevalence, effects on postnatal recovery and analgesia usage. Midwifery 2012; 28:93-7. [DOI: 10.1016/j.midw.2010.11.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 11/15/2010] [Accepted: 11/21/2010] [Indexed: 11/20/2022]
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Acele EÖ, Karaçam Z. Sexual problems in women during the first postpartum year and related conditions. J Clin Nurs 2011; 21:929-37. [PMID: 22008061 DOI: 10.1111/j.1365-2702.2011.03882.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate the sexual problems in women during the first postpartum year and related conditions. BACKGROUND In the postpartum period, women encounter numerous physical, psychological and sociocultural factors. These factors negatively affect both the sexual function and the quality of life of woman. DESIGN A descriptive survey. METHODS In this study, 230 women were included. The study was conducted between September 2007 and December 2008 in Izmir, Turkey. A questionnaire form developed by authors, the Arizona Sexual Experience Scale-female version and the Beck depression inventory were applied for participants. RESULTS The women began to have sexual intercourse within 7·06 weeks after delivery. Of the women, 58·3% reported that they had dyspareunia in the postpartum period. According to Arizona Sexual Experience Scale, the total score was ≥ 11 in 91·3% of women and they had sexual problems in the first postpartum year. The results of the multivariate analysis revealed that the increase in age, the presence of sexual problems during pregnancy and the increase in time after delivery significantly increased the possibility of postpartum sexual problems. CONCLUSION This study revealed that the majority of the women had postpartum sexual problems and the possibility of postpartum sexual problems increased with the increase in age, the presence of sexual problems during pregnancy and the increase in time after delivery. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should evaluate women in terms of their sexual functions during both pregnancy and postpartum period. Health education, counselling, referral services for early diagnosis and treatment might contribute to the protection and improvement of the sexual health of women during the postpartum period.
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Affiliation(s)
- Elif Özge Acele
- Department of Mental Health and Psychiatric, Medical Faculty Hospital, Ege University, Izmir, Turkey.
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Elharmeel SM, Chaudhary Y, Tan S, Scheermeyer E, Hanafy A, van Driel ML. Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention. Cochrane Database Syst Rev 2011:CD008534. [PMID: 21833968 DOI: 10.1002/14651858.cd008534.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Perineal tears commonly occur during childbirth. They are sutured most of the time. Surgical repair can be associated with adverse outcomes, such as pain, discomfort and interference with normal activities during puerperium and possibly breastfeeding. Surgical repair also has an impact on clinical workload and human and financial resources. OBJECTIVES To assess the evidence for surgical versus non-surgical management of first- and second-degree perineal tears sustained during childbirth. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 May 2011), CENTRAL (The Cochrane Library 2011, Issue 2 of 4) and MEDLINE (Jan 1966 to 2 May 2011). We also searched the reference lists of reviews, guidelines and other publications and contacted authors of identified eligible trials. SELECTION CRITERIA Randomised controlled trials (RCTs) investigating the effect on clinical outcomes of suturing versus non-suturing techniques to repair first- and second-degree perineal tears sustained during childbirth. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and assessed trial quality. Three review authors independently extracted data. MAIN RESULTS We included two RCTs (involving 154 women) with a low risk of bias. It was not possible to pool the available studies. The two studies do not consistently report outcomes defined in the review. However, no significant differences were observed between the two groups (surgical versus non-surgical repair) in incidence of pain and wound complications, self-evaluated measures of pain at hospital discharge and postpartum and re-initiation of sexual activity. Differences in the use of analgesia varied between the studies, being high in the sutured group in one study. The other trial showed differences in wound closure and poor wound approximation in the non-suturing group, but noted incidentally also that more women were breastfeeding in this group. AUTHORS' CONCLUSIONS There is limited evidence available from RCTs to guide the choice between surgical or non-surgical repair of first- or second-degree perineal tears sustained during childbirth. Two studies find no difference between the two types of management with regard to clinical outcomes up to eight weeks postpartum. Therefore, at present there is insufficient evidence to suggest that one method is superior to the other with regard to healing and recovery in the early or late postnatal periods. Until further evidence becomes available, clinicians' decisions whether to suture or not can be based on their clinical judgement and the women's preference after informing them about the lack of long-term outcomes and the possible chance of a slower wound healing process, but possible better overall feeling of well being if left un-sutured.
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Affiliation(s)
- Suzan Ma Elharmeel
- Department of Obstetrics and Gynaecology, Gold Coast Hospital, 108 Nerang Street, Gold Coast, Queensland, Australia, 4215
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Dionisi B, Senatori R. Effect of transcutaneous electrical nerve stimulation on the postpartum dyspareunia treatment. J Obstet Gynaecol Res 2011; 37:750-3. [PMID: 21395897 DOI: 10.1111/j.1447-0756.2010.01425.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This article will evaluate the safety and efficacy of intravaginal transcutaneous electrical nerve stimulation (TENS) for the treatment of vulvar pain and dyspareunia during the postpartum period related to perineal trauma caused by episiotomy. METHODS From January 2007 to January 2009, 45 women presenting with postpartum dyspareunia related to perineal trauma after a vaginal delivery were educated on the importance of the pelvic floor and its part in continuing dyspareunia. The treatment consisted of weekly applications of intravaginal TENS in an outpatient setting and daily home therapy with myofascial stretching and exercises of the pelvic floor musculature. The results were evaluated using the cotton swab test, the Marinoff Dyspareunia Scale and the Visual Analog Scale, and the anovulvar distance was assessed prior to and at the end of the treatment period. RESULTS Of the women included in the study, 84.5% reported an improvement of dyspareunia after only five applications of TENS, with a total remission of symptoms (in 95% of patients) at the end of the protocol. At follow-up, eight months after the end of treatment, all patients were pain free. CONCLUSIONS Therapy with intravaginal transcutaneous nerve stimulation and pelvic floor relaxation exercises is safe and effective in the improvement of vulvar pain and dyspareunia in women with postpartum perineal trauma due to episiorrhaphy, after spontaneous delivery.
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Affiliation(s)
- Barbara Dionisi
- Outpatient Department of Pelvic Floor Rehabilitation and Vulvar Disease, Nursing Home Holy Family, Rome, Italy.
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Serati M, Salvatore S, Siesto G, Cattoni E, Zanirato M, Khullar V, Cromi A, Ghezzi F, Bolis P. Female Sexual Function during Pregnancy and after Childbirth. J Sex Med 2010; 7:2782-2790. [PMID: 20626601 DOI: 10.1111/j.1743-6109.2010.01893.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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