Original Question: What is the risk of dyspareunia after vaginal delivery with or without birth trauma?
PICO Format:Patient population – Retrospective cohort of Primiparous women – group 1 (n=211) intact perineum or first degree perineal tear, group 2 (n=336) second degree perineal tear, group 3 (n=68) third to fourth degree tear. 70% response rate to survey.
Intervention – intervention not made. surveys were sent to gather data for pre and post partum data (at 3 and 6 month intervals).
Comparison – collected surveys and gathered data on time to resuming sexual intercourse, dyspareunia, sexual satisfaction, sexual sensation, and likelihood of achieving orgasm. Surveys were collected for prior to pregnancy and postpartum data for 3 and 6 months.
Outcome – At 6 months post partum about one quarter of all primiparous women reported lessened sexual sensation, worsened sexual satisfaction, and less ability to achieve orgasm, as compared with these parameters before they gave birth. At 3 and 6 months post partum 41% and 22%, respectively, reported dyspareunia. Relative to women with an intact perineum, women with second-degree perineal trauma were 80% more likely (95% confidence interval, 1.2-2.8) and those with third- or fourth-degree perineal trauma were 270% more likely (95% confidence interval, 1.7-7.7) to report dyspareunia at 3 months post partum. At 6 months post partum, the use of vacuum extraction or forceps was significantly associated with dyspareunia (odds ratio, 2.5; 95% confidence interval, 1.3-4.8), and women who breast-fed were ≥4 times as likely to report dyspareunia as those who did not breast-feed (odds ratio, 4.4; 95% confidence interval, 2.7-7.0). Episiotomy conferred the same profile of sexual outcomes as did spontaneous perineal lacerations.
Searched Terms:sexual function post-partum delivery, perineal injury and dyspareunia, dyspareunia postpartum
Where searched:google –> pubmed –> back check of several article’s sources –> found my article
Answer:Women who delivered over an intact perineum reported the best outcomes overall, whereas perineal trauma and the use of obstetric instrumentation were factors related to the frequency or severity of post- partum dyspareunia.
Lisa B. Signorello, ScD,a, c Bernard L. Harlow, PhD,a Amy K. Chekos,a and John T. Repke, MD. Postpartum sexual functioning and its relationship to perineal trauma: A retrospective cohort study of primiparous women. Am J Obstet Gynecol 2001;184:881-90.
SORT :B Inconsistent or limited-quality patient-oriented evidence*
Completed by:Jess Knapp DO
Date last updated:5/10/2011
