Persistent Genital and Pelvic Pain after Childbirth

Sex and Couple Therapy Service, McGill University Health Center, Montreal, Quebec, Canada
Journal of Sexual Medicine (Impact Factor: 3.15). 12/2008; 6(1):215 - 221. DOI: 10.1111/j.1743-6109.2008.01063.x


Introduction. Although genital pain and pelvic pain are common and well-documented problems in the early postpartum period, little is known about their course. The few published studies of such pain beyond 1 year postpartum have focused primarily on the perineum and have not assessed pain onset.
Aim. To investigate the prevalence and characteristics of all types of genital and pelvic pain in the second year postpartum, and to explore risk factors for their persistence.
Methods. Over a 6-month period, a questionnaire on genital/pelvic pain, sociodemographic and childbirth variables, breastfeeding, and chronic pain history was mailed to patients of the collaborating obstetrician at 12 months postpartum.
Main Outcome Measures. The prevalence, characteristics, and correlates of persistent genital/pelvic pain with postpartum onset.
Results. Almost half of the 114 participants (82% response rate; M = 14 months postpartum) reported a current (18%) or resolved (26%) episode of genital or pelvic pain lasting 3 or more months. Just under one in 10 (9%) mothers continued to experience pain that had begun after they last gave birth. This pain was described at various locations (e.g., vaginal opening and pelvic area), as moderate in intensity and unpleasantness, and most often as burning, cutting, or radiating. Although it was triggered by both sexual and nonsexual activities, none of the mothers affected were receiving treatment. Univariate analyses revealed that only past diagnosis with a nongenital chronic pain condition (e.g., migraine headache) was significantly correlated with (i) any history of chronic genital/pelvic pain or (ii) the persistence of pregnancy- or postpartum-onset genital or pelvic pain.
Conclusions. Postpartum genital and pelvic pain persists for longer than a year for a significant percentage of mothers. Women with a history of other chronic pain appear to be particularly vulnerable to developing persistent genital or pelvic pain. Paterson LQP, Davis SNP, Khalifé S, Amsel R, and Binik YM. Persistent genital and pelvic pain after childbirth. J Sex Med 2009;6:215–221.

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    • "Based on this, we can conclude that, in this sample, three months after delivery, episiotomy appears to continue having a negative interference on the pain felt during sexual intercourse. The existence of pain in the postpartum period may negatively affect sexual functioning, as is described in a study by Paterson et al. [21], who mention that the pain experienced by women, in this period had a negative (medium to moderate) impact on their sexual function. "
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    ABSTRACT: Objective: Despite the fact that a restrictive use of episiotomy has proven to be beneficial, it continues to be widely used in vaginal births. Our aim was to compare women with episiotomy, to women with an intact perineum, 3 months after delivery, regarding several sexual variables, namely: sexual desire, arousal, orgasm, pain, sexual satisfaction and sexual function. Methods: An exploratory, descriptive and quantitative study using a non-probabilistic, convenience sample of 147 Portuguese women, of which 54 belonged to a control group, was performed. The groups were not significantly different regarding socio-demographic aspects. Three instruments were used: the Female Sexual Function Index, a Socio-demographic and Clinical Questionnaire and the Female Sexual Function Questionnaire. Results: Most women mentioned a moderate level of sexual interest. Women with episiotomy present higher pain intensity, less sexual satisfaction, greater changes regarding the orgasm’s duration and intensity, lower levels of sexual arousal and total sexual function, than women with intact perineum. Discussion: We found no significant differences between women with episiotomy and women with an intact perineum in most variables. However, women with episiotomy presented higher levels of pain and a lower sexual satisfaction, being these significant differences.
    Health 02/2014; 6(5):356-363. DOI:10.4236/health.2014.65052 · 0.51 Impact Factor
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    • "During the first few days after childbirth, the breasts begin to produce milk, which is new and often uncomfortable. Genital, pelvic [31] and back pain [32] are also common after childbirth, which is known to further disturb sleep [33]. In addition to the physical changes, lifestyle changes and parenting responsibilities also contribute to the potential for sleep disruption. "
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    ABSTRACT: Background There is a high association between disturbed (poor quality) sleep and depression, which has lead to a consensus that there is a bidirectional relationship between sleep and mood. One time in a woman’s life when sleep is commonly disturbed is during pregnancy and following childbirth. It has been suggested that sleep disturbance is another factor that may contribute to the propensity for women to become depressed in the postpartum period compared to other periods in their life. Post Natal Depression (PND) is common (15.5%) and associated with sleep disturbance, however, no studies have attempted to provide a sleep-focused intervention to pregnant women and assess whether this can improve sleep, and consequently maternal mood post-partum. The primary aim of this research is to determine the efficacy of a brief psychoeducational sleep intervention compared with a control group to improve sleep management, with a view to reduce depressive symptoms in first time mothers. Method This randomised controlled trial will recruit 214 first time mothers during the last trimester of their pregnancy. Participants will be randomised to receive either a set of booklets (control group) or a 3hour psychoeducational intervention that focuses on sleep. The primary outcomes of this study are sleep-related, that is sleep quality and sleepiness for ten months following the birth of the baby. The secondary outcome is depressive symptoms. It is hypothesised that participants in the intervention group will have better sleep quality and sleepiness in the postpartum period than women in the control condition. Further, we predict that women who receive the sleep intervention will have lower depression scores postpartum compared with the control group. Discussion This study aims to provide an intervention that will improve maternal sleep in the postpartum period. If sleep can be effectively improved through a brief psychoeducational program, then it may have a protective role in reducing maternal postpartum depressive symptoms. Registration details This trial is registered with the Australian New Zealand Clinical Trials Register under the registration number ACTRN12611000859987
    BMC Pregnancy and Childbirth 12/2012; 12(1):155. DOI:10.1186/1471-2393-12-155 · 2.19 Impact Factor
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    • "The triggering of vulvar pain is a plausible theory because many women report pain with sex during the postpartum period [9]. In fact, a recent report found that women with persistent genital or pelvic pain were at increased risk of having pain for longer than 1 year after delivery [10]. "
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    ABSTRACT: Purpose: To examine pregnancy and delivery characteristics of women with and without vulvodynia. Methods: We analyzed 227 vulvodynia cases that were <45 years old at pain onset; controls were age-matched 1:1 to cases and had no history of vulvar pain. Pregnancy and delivery events were assessed after age at first vulvar pain onset in cases and a matched age in controls (called reference age). Results: We observed no significant difference between cases and controls in achieving pregnancy after reference age. Also, no difference in pregnancy outcome was observed between cases and controls (p=0.87). There was an indication that cases were more likely to receive a Caesarean-section delivery (p=0.07). In addition, 37.1% of cases who had vaginal delivery versus 11.3% of controls (p <0.01) reported pain at 2 months postpartum. Comparing only women with vulvodynia, women who had intermittent pain versus constant pain were more than twice as likely to have a pregnancy (adj. OR = 2.26, 95% CI: 1.10 – 4.60). Conclusions: Women with vulvodynia may be as likely as other women to carry their pregnancy to birth, however, they may experience higher rates of Caesarean-section delivery and could reflect a selection towards those women with vulvodynia who have inconsistent pain.
    07/2012; 1(1). DOI:10.1007/s40122-012-0002-7
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