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Abebe Gelaw K, Atalay YA, Yeshambel A, Adella GA, Walle BG, Zeleke LB, Gebeyehu NA. Prevalence and factors associated with early resumption of sexual intercourse among postpartum women: Systematic review and meta-analysis. PLoS One 2024; 19:e0288536. [PMID: 38232099 PMCID: PMC10793940 DOI: 10.1371/journal.pone.0288536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/21/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Postpartum sexual health is indicated by a resumption of sexual activity as well as arousal, desire, orgasm, and sexual satisfaction. The issue of resuming sexual intercourse after childbirth has received limited attention because healthcare professionals rarely provide adequate care to postnatal women. The present study aimed to ascertain the overall prevalence of early resumption of sexual intercourse among most women. METHODS Searches were conducted in PubMed, Web of Science, Science Direct, Google Scholar, African Journals Online, and the Cochrane Library. Data were extracted using Microsoft Excel, and STATA version 14 was used for analysis. Publication bias was checked by funnel plot, Egger, and Begg regression tests. A p-value of 0.05 was regarded to indicate potential publication bias. Using I2 statistics, the heterogeneity of the studies was evaluated. By country, a subgroup analysis was conducted. A sensitivity analysis was carried out to determine the effect of each study's findings on the overall estimate. The random effects model was used to assess the overall effect of the study and then measured using prevalence rates and odds ratio with 95% CI. RESULTS Twenty-one studies with 4,482 postpartum women participants were included in the study. The pooled prevalence of early resumption sexual intercourse among post-partum women was 57.26% (95% CI 50.14, 64.39) with significant heterogeneity between studies (I2 = 99.2%; P-value ≤ 0.000) observed. Current contraceptive use (AOR = 1.48, 95%CI = 1.03, 6.21), primipara (AOR = 2.88, 95%CI = 1.41, 5.89), and no history of severe genital injury on the last delivery (AOR = 2.27, 95%CI = 1.05, 4.93) were significantly associated with early resumption of sexual intercourse. CONCLUSION This study found that more than half of women resumed sexual intercourse early after giving birth. This suggests that a significant number of women may be at higher risk of unwanted pregnancies, short birth intervals, and postpartum sepsis. Thus, stakeholders should improve the integration of postpartum sexual education with maternal health services to reduce the resumption of postpartum sexual intercourse.
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Affiliation(s)
- Kelemu Abebe Gelaw
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Yibeletal Assefa Atalay
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Adisu Yeshambel
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Belete Gelaw Walle
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Liknaw Bewket Zeleke
- Health Science College, Debre Markos University, Debre Markos, Ethiopia
- School of Women's and Children's Health, University of New South Wales Sydney, Kensington, Australia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Lua-Mailland LL, Wallace SL, Yao M, Propst K. Sexual Function in Women at 6 and 12 Months After Obstetric Anal Sphincter Injury: Is Pelvic Floor Physical Therapy Associated With Improved Outcomes? UROGYNECOLOGY (PHILADELPHIA, PA.) 2023:02273501-990000000-00092. [PMID: 37093575 DOI: 10.1097/spv.0000000000001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
IMPORTANCE Women with obstetric anal sphincter injury (OASI) are at increased risk of postpartum sexual dysfunction. Risk persists beyond 3 years after perineal trauma in up to half of patients with OASI. OBJECTIVES The aims of this study were to determine if postpartum pelvic floor physical therapy (PFPT) is associated with improved sexual function after vaginal delivery with OASI and to describe sexual function in patients with OASI at 6 and 12 months postpartum. STUDY DESIGN This is a retrospective cohort study of patients with OASI. Women were grouped according to PFPT attendance. The Postpartum Pelvic Floor and Birth Questionnaire (PPFBQ), which compares current sexual function to baseline prepregnancy sexual function, and the Female Sexual Function Index (FSFI) were administered at 6 and 12 months, respectively, to evaluate postpartum sexual function. RESULTS Two hundred women were included. Sixty-four (32%) women attended PFPT; 136 (68%) did not attend PFPT. Patients reported worse-than-baseline sexual function at 6 months postpartum in the PPFBQ sexual activity domain, but the PFPT group had lower median score than the non-PFPT group (2.3 [2.0, 2.8] vs 2.7 [2.1, 3.1], P = 0.034), with scores <3.0 indicating worse-than-baseline functioning. The FSFI composite scores were similar between groups and showed 80.7% of the patients with OASI meeting the criteria for female sexual dysfunction at 12 months postpartum. Attendance of PFPT was not significantly associated with composite FSFI scores and most domains of PPFBQ. CONCLUSIONS Attendance of PFPT did not significantly impact overall sexual function in OASI patients at 6 and 12 months postpartum. Sexual function is complex and may be more effectively addressed in the postpartum period using a multidimensional approach.
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Affiliation(s)
- Lannah L Lua-Mailland
- From the Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic
| | - Shannon L Wallace
- From the Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic
| | - Meng Yao
- Department of Quantitative Health Sciences, Section of Biostatistics, Cleveland Clinic, Cleveland, OH
| | - Katie Propst
- Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL
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Narice BF, Marks K, Jha S. Factors that influence pregnant women's decision on mode of delivery after previous obstetric anal sphincter injury. Eur J Obstet Gynecol Reprod Biol 2023; 281:32-35. [PMID: 36529064 DOI: 10.1016/j.ejogrb.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/09/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Maternal request for caesarean section (CS) is increasing. One common reason is following a previous obstetric anal sphincter injury (OASI). We aim to understand which factors bear the greatest influence in driving this women's decision-making process once they are pregnant after having sustained an OASI. METHODS Pregnant women with a previous OASIS who were attending their first antenatal appointment were deemed eligible and were asked to complete two questionnaires on their preferred mode of delivery (MoD) and ongoing pelvic floor symptomatology. Data were analysed with descriptive and inferential statistics using SPSS, and results were presented both quanti- and qualitatively. RESULTS Data from 63 participants was included in the final analysis. Most women had experienced 3A/3B OASIS (n = 49, 77.78 %), and they were more likely to report bladder pain and difficulties with voiding than those with major tears (p < 0.05). The type of tear did not impact directly on the preferred MoD. However, women still experiencing bladder pain were more likely to request a CS (p < 0.05). Even though all participants who attended a perineal trauma clinic postpartum found it helpful, they reported that ultimately the decision on how to deliver was theirs, and their ideas and concerns played the greatest influence. CONCLUSION Pregnant women with ongoing urinary symptoms rather than sexual or bowel dysfunction seem to favour a planned CS, regardless of the severity of their previous tear. Postpartum follow-up in a perineal trauma clinic is extremely valuable but even more is the need to understand women's motivations to support them make an informed decision.
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Affiliation(s)
- Brenda F Narice
- Academic Unit of Reproductive and Developmental Medicine, the University of Sheffield, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK; Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
| | - Kylie Marks
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
| | - Swati Jha
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK; Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK.
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When does oasis cause de novo pelvic floor dysfunction? role of the surgeon's skills. Int Urogynecol J 2023; 34:493-498. [PMID: 35467138 PMCID: PMC9036836 DOI: 10.1007/s00192-022-05205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/06/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Minorly skilled gynecologists are less likely to repair obstetric anal sphincter injuries (OASIS), and this can lead to higher rate of de novo onset of pelvic floor dysfunction (PFD). The aim of this study was to understand the impact of surgeon skills in OASIS repair on de novo incidence of PFDs. METHODS An observational prospective cohort study performed between January 2019 and December 2020. We included 116 women with OASIS. At 6-weeks from delivery, women were divided into two groups in relation to the onset of PFDs. Characteristics were compared; categorical and continuous variables were assessed with chi-squared test and the Mann-Whitney rank-sum test respectively. Factors involved in PFDs development were analysed with explorative univariate analysis; significant (p<0.05) or approaching significance (p≤0.10) variables were included in multivariable analysis. RESULTS Seventy-six women (76/116; 65.5%) reported at least one PFD symptom and anal incontinence was the most prevalent (44.73%; 34/76). OASIS management by a skilled gynaecologist resulted protective for PFDs [aOR 0.33 (0.13-0.61)]. Skilled surgeon reported fewer PFDs than less skilled surgeon (4% vs 82.4%; p<0.0001). Operative delivery was more performed (32.5% vs 15.8%; p= 0.03) and severe OASIS resulted more prevalent (60% vs 17.1%; p<0.0001) among women without PDFs, even if these didn't affect the incidence of de novo PFDs [aOR 1.03 (0.23-1.45) and 0.83 (0.13-1.45), respectively]. CONCLUSIONS Surgeons skilled in OASIS repair resulted the only protective factor for incidence of de novo PFDs in women with OASIS at 6 weeks of follow up. Improvement of training in OASIS repair is necessary.
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Dahlgren H, Jansson MH, Franzén K, Hiyoshi A, Nilsson K. Sexual function in primiparous women: a prospective study. Int Urogynecol J 2022; 33:1567-1582. [PMID: 34973088 PMCID: PMC9206602 DOI: 10.1007/s00192-021-05029-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this prospective study was to examine the impact of sociodemographic, pregnancy and obstetric characteristics on sexual function 12 months postpartum in primiparous women. We hypothesized that sexual function would decrease after childbirth. METHODS Between 1 October 2014 and 1 October 2017, all nulliparous women in early pregnancy registering for maternity health care in Region Örebro County, Sweden, were invited to participate in this prospective study. A total of 958 women were included. Sexual activity and function were measured at early pregnancy, 8 weeks postpartum and 12 months postpartum using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The associations between sociodemographic, pregnancy and obstetric characteristics and sexual activity and function from early pregnancy to 12 months postpartum were examined using linear and logistic models based on generalized estimating equations. RESULTS We found that the prevalence of sexually active women decreased from 98.0% in early pregnancy to 66.7% at 8 weeks postpartum, but increased to 90.0% at 12 months postpartum. Age ≥ 35 years, second-degree perineal tear and current breastfeeding were statistically significant risk factors for sexual inactivity at 12 months postpartum. Poor self-reported health in early pregnancy was statistically significantly associated with decreased sexual function at 12 months postpartum. CONCLUSIONS A majority of women resumed sexual activity at 8 weeks postpartum and most women at 12 months postpartum; the decrease in sexual function at 12 months postpartum was small and few risk factors were observed.
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Affiliation(s)
- Hedda Dahlgren
- Department of Obstetrics and Gynecology, Örebro University Hospital, Region Örebro County, PO Box 1613, SE-701 16, Örebro, Sweden.
| | - Markus H Jansson
- Department of Obstetrics and Gynecology, Örebro University Hospital, Region Örebro County, PO Box 1613, SE-701 16, Örebro, Sweden.,School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karin Franzén
- Department of Obstetrics and Gynecology, Örebro University Hospital, Region Örebro County, PO Box 1613, SE-701 16, Örebro, Sweden.,School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kerstin Nilsson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Cattani L, De Maeyer L, Verbakel JY, Bosteels J, Deprest J. Predictors for sexual dysfunction in the first year postpartum: a systematic review and meta-analysis. BJOG 2021; 129:1017-1028. [PMID: 34536325 DOI: 10.1111/1471-0528.16934] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/27/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pregnancy and childbirth increase the risk for pelvic floor dysfunction, including sexual dysfunction. So far, the mechanisms and the extent to which certain risk factors play a role remain unclear. OBJECTIVES In this systematic review of the literature we aimed to determine risk factors for sexual dysfunction in the first year after childbirth. SEARCH STRATEGY We searched MEDLINE, Embase and CENTRAL using the search strategy: sexual dysfunction AND obstetric events. SELECTION CRITERIA We included original, comparative studies, reported in English, that used validated questionnaires and the ICS/IUGA terminology for sexual dysfunction, dyspareunia and vaginal dryness. DATA COLLECTION AND ANALYSIS We assessed the quality and the risk of bias of the included studies with the Newcastle-Ottawa scale. We extracted the reported data and we performed random-effects meta-analysis to obtain the summary odds ratios (ORs) with 95% confidence intervals (95% CIs). Heterogeneity across studies was assessed using the I2 statistic. MAIN RESULTS Anal sphincter injury was associated with increased odds for both sexual dysfunction (OR 3.00, 95%CI 1.28-7.03) and dyspareunia (OR 1.92, 95% CI 1.47-2.52). Episiotomy was associated with dyspareunia (OR 1.64, 95% CI 1.25-2.14), but not with sexual dysfunction (OR 1.90, 95% CI 0.94-3.84). Compared with spontaneous birth, caesarean section reduced the odds for dyspareunia (OR 0.68, 95% CI 0.54-0.86) but not for sexual dysfunction (OR 1.14, 95% CI 0.89-1.46). Instrumental vaginal birth increased the odds for sexual dysfunction (OR 1.70, 95% CI 1.05-2.76), yet no difference was found for dyspareunia (OR 1.82, 95% CI 0.88-3.75). One study of low quality reported on vaginal dryness and found no association with obstetric events. CONCLUSIONS Perineal trauma, rather than mode of birth, increases the odds for sexual dysfunction in the first year after childbirth. TWEETABLE ABSTRACT Perineal trauma, rather than mode of birth, correlates with sexual dysfunction and dyspareunia postpartum. #dyspareunia #OASI #episiotomy.
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Affiliation(s)
- L Cattani
- Department of Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - L De Maeyer
- Department of Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - J Y Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - J Bosteels
- Department of Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium
| | - J Deprest
- Department of Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Research Department of Maternal Fetal Medicine, Institute for Women's Health, University College London, London, UK
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Roos AM, Speksnijder L, Steensma AB. Postpartum sexual function; the importance of the levator ani muscle. Int Urogynecol J 2020; 31:2261-2267. [PMID: 32095955 PMCID: PMC7561550 DOI: 10.1007/s00192-020-04250-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/29/2020] [Indexed: 12/17/2022]
Abstract
Introduction and hypothesis Pelvic floor muscle function plays an important role in female sexual functioning. Smaller genital hiatal dimensions have been associated with sexual dysfunction, mainly dyspareunia. On the other hand, trauma of the levator ani muscle sustained during childbirth is associated with increased genital hiatus, which potentially can affect sexual functioning by causing vaginal laxity. This study aims to determine the association between levator hiatal dimensions and female sexual dysfunction after first vaginal delivery. Methods This is a secondary analysis of a prospective observational study. Two hundred four women who had a first, spontaneous vaginal delivery at term between 2012 and 2015 were recruited at a minimum of 6 months postpartum. Thirteen pregnant women were excluded. We analyzed the association of total PISQ-12 score, as well as individual sexual complaints (desire, arousal, orgasm and dyspareunia), with levator hiatal dimensions at rest, with maximum Valsalva and during pelvic floor muscle contraction as measured by 4D transperineal ultrasound. Statistical analysis was performed using linear regression analysis and Mann-Whitney U test. Results One hundred ninety-one women were evaluated at a median of 11 months postpartum. There was no significant association between total PISQ-12 score and levator hiatal dimensions. Looking at individual sexual complaints, women with dyspareunia had significantly smaller levator hiatal area and anterior-posterior diameter on maximum Valsalva. By using multivariate logistic regression analysis however we found dyspareunia was not independently associated with levator hiatal dimensions. Conclusions After first vaginal delivery sexual dysfunction is not associated with levator hiatal dimensions as measured by 4D transperineal ultrasound.
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Affiliation(s)
- Anne-Marie Roos
- Department of Obstetrics and Gynecology, Division of Urogynaecology, Erasmus Medical Centre, Doctor Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.
| | - Leonie Speksnijder
- Department of Obstetrics and Gynecology, division of Urogynaecology, Amphia Hospital, Breda, The Netherlands
| | - Anneke B Steensma
- Department of Obstetrics and Gynecology, Division of Urogynaecology, Erasmus Medical Centre, Doctor Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
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