Persistent Genital and Pelvic Pain after Childbirth
ABSTRACT 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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ABSTRACT: Sexual pain disorders refer to conditions of genital pain that interfere with intercourse. They often have a musculoskeletal component related to the pelvic floor and are included in the DSM-IV as sexual dysfunctions. Musculoskeletal pain (MP) that is not essentially genitally based often interferes with sex as well yet is not considered a distinct sexual dysfunction. MP is generally addressed by physiatrists, orthopedists, and rheumatologists who are not traditionally trained in sexual medicine, and therefore, the sexual concerns of women with MP often go unaddressed. The purposes of this review article were to describe how MP is perceived in the literature as affecting sexual function, illustrate how specific MP conditions prevalent in women may affect sexual function, and offer recommendations for clinical practice. PubMed and Medline searches were performed using the keywords "musculoskeletal pain and sex,"lower back pain and sex,"arthritis and sex," and "fibromyalgia and sex". Main Outcome Measure. Review of the peer-reviewed literature. Most studies cite fatigue, medication, and relationship adjustment as affecting sexuality much as chronic illness does. While musculoskeletal contributors to genital sexual response and pain are considered relevant to sexual function, little is understood about how MP syndromes specifically affect sexual activity. Lack of mobility and MP can restrict intercourse and limit sexual activity, and gender differences are noted in response to pain. Sexual and relationship counseling should be offered as a component of rehabilitative treatment. Physical therapists are uniquely qualified to provide treatment to address functional activities of daily living, including sexual intercourse, and offer advice for modifications in positioning.Journal of Sexual Medicine 09/2009; 7(2 Pt 1):645-53. DOI:10.1111/j.1743-6109.2009.01490.x · 3.15 Impact Factor
- International journal of obstetric anesthesia 12/2009; 19(1):1-2. DOI:10.1016/j.ijoa.2009.09.003 · 1.83 Impact Factor
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ABSTRACT: Sensory input from the female reproductive tract (FRT) plays a pivotal role in coordinating reproductive reflexes. Additionally, a number of disorders, especially chronic pelvic pain, may be due to disturbances in sensory processing of signals from the FRT. Our aim was to record synaptic responses in neurons from lumbar and sacral spinal cord segments during mechanical stimulation of the cervix. We developed an in vivo preparation of the mouse spinal cord to record synaptic potentials from superficial dorsal horn (SDH) neurons under whole-cell patch clamp recording conditions. We analyzed the strength and distribution of excitatory postsynaptic potentials in SDH neurons evoked during mechanical stimulation of the cervix and cutaneous sites. Resting membrane potential and neuronal input resistance was similar in thoracolumbar (TL, T13-L3) and lumbosacral (LS, L6-S2) segments. We elicited activity in 6/21 TL neurons and 15/39 LS neurons using mechanical stimulation of the cervix with a blunt probe. The majority of these neurons responded to cervix stimulation with bursts of subthreshold excitatory postsynaptic potentials (4/6 and 12/15 TL and LS neurons, respectively). The remainder responded with sufficient magnitude to generate action potentials (2/6 and 3/15 TL and LS neurons). Cutaneous synaptic inputs were also elicited in 11/21 TL neurons following stimulation of the flank/leg, 19/39 LS neurons by stimulation of the tail, and three LS neurons by perineal stimulation. Some neurons received convergent synaptic inputs from the cervix and cutaneous sites (4/6 TL and 4/15 LS). These data demonstrate that spinal projections of cervix afferents are widely dispersed in the SDH and considerable convergence exists between neurons innervating the cervix and cutaneous structures. Our results indicate that much of the synaptic activity evoked in SDH neurons following cervix stimulation is subthreshold.Journal of Sexual Medicine 03/2010; 7(6):2068-76. DOI:10.1111/j.1743-6109.2010.01768.x · 3.15 Impact Factor