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Abstract

To investigate the impact of childbirth on the sexual health of primiparous women and identify factors associated with dyspareunia. Cross-sectional study using obstetric records, and postal survey six months after delivery. Department of Obstetrics and Gynaecology, St George's Hospital, London. All primiparous women (n = 796) delivered of a live birth in a six month period. Quantitative analysis of obstetric and survey data. Self reported sexual behaviour and sexual problems (e.g. vaginal dryness, painful penetration, pain during sexual intercourse, pain on orgasm, vaginal tightness, vaginal looseness, bleeding/irritation after sex, and loss of sexual desire); consultation for postnatal sexual problems. Of the 484 respondents (61% response rate), 89% had resumed sexual activity within six months of the birth. Sexual morbidity increased significantly after the birth: in the first three months after delivery 83% of women experienced sexual problems, declining to 64% at six months, although not reaching pre-pregnancy levels of 38% . Dyspareunia in the first three months after delivery was, after adjustment, significantly associated with vaginal deliveries (P = 0 x 01) and previous experience of dyspareunia (P = 0 x 03). At six months the association with type of delivery was not significant (P = 0 x 4); only experience of dyspareunia before pregnancy (P < 0 x 0001) and current breastfeeding were significant (P = 0 x 0006). Only 15% of women who had a postnatal sexual problem reported discussing it with a health professional. Sexual health problems were very common after childbirth, suggesting potentially high levels of unmet need.

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... Female sexual dysfunction (FSD), a disorder of desire, arousal, orgasm, and/or sexual pain resulting in personal distress, is a commonly reported problem with approximately 12% of women in the United States reporting distressful symptoms [1]. Sexual dysfunction is reported in higher rates in postpartum women with prevalence rates between 35 and 64% in the postpartum period [2][3][4]. One of the prevalent theories regarding increased sexual dysfunction postpartum includes hormonal changes such as hypoestrogenism [5]. ...
... One of the prevalent theories regarding increased sexual dysfunction postpartum includes hormonal changes such as hypoestrogenism [5]. While the postpartum period is associated with temporary hormonal changes, breastfeeding has specifically been associated with lower systemic estrogen levels, increased vaginal dryness, and increased dyspareunia [4][5][6]. While previous studies have documented increased sexual dysfunction in the postpartum population, few studies have directly compared breastfeeding to formula feeding using validated sexual function questionnaires. ...
... Our study echoes findings of other studies which report on the overall negative effect of breastfeeding and perineal laceration on sexual function with no effect based on mode of delivery [3,4,11,15,16,21,22]. Interestingly, participants using DMPA or etonogestrel releasing sub-dermal implants had significantly lower FSFI scores compared to those not using contraception. ...
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Purpose Postpartum women commonly experience sexual dysfunction; however, little is known regarding the effect of breastfeeding on sexual function and postpartum women’s interest in treatment. We aimed to evaluate sexual function and genitourinary symptoms based on infant-feeding status and assess desire for treatment. Methods Cross-sectional observational study of women 5–6 months postpartum following singleton delivery was performed. Participants were grouped based on self-reported infant-feeding status: (1) primarily breastfeeding (BF) and (2) primarily formula feeding (FF). Female Sexual Function Index (FSFI) and Day-to-day Impact on Vaginal Aging (DIVA) questionnaires and interest in treatment were compared. Results In total, 125 women were included with 61 (49%) breastfeeding and 64 (51%) formula feeding. Compared to FF women, BF women were less likely to identify as African American (47% vs 79%; SD 0.8) or have Medicaid (28% vs 66%; SD 0.9). No other large differences were noted. BF women had significantly lower FSFI score indicating poorer sexual function (20.8 (IQR 10, 24) BF vs 24.5 (IQR 19.5, 27.8) FF, p = 0.009). Both cohorts reported low bother from vaginal symptoms and low interest in treatment of symptoms with BF cohort reporting higher interest in use of vaginal lubricants (69% BF vs 30% FF, SD 0.8). Factors associated with lower FSFI score were BF, perineal laceration, use of progesterone long-acting reversible contraception, and single relationship status. Conclusion Both breastfeeding and formula feeding women experienced high rates of sexual dysfunction but low bother from vaginal symptoms and low interest in treatment. Further research is needed to explore these findings and assess postpartum sexual health.
... [3][4][5]7,[8][9][10][11][12][13][14][15][16][17][18][19][20] It is well documented that many patients, with or without PPGT, continue to experience perineal pain or dyspareunia 6 to 12 months after birth. 20,[25][26][27][28][29] A variety of factors have been associated with this type of chronic pain, including breastfeeding, vaginal atrophy, a higher degree of laceration, pelvic floor injuries, and scar tissue. 25,27,28 However, Beischer et al performed a prospective study in which they evaluated patients with persistent dyspareunia at 3 months postpartum and found that 43% of the patients had granulomata on a physical examination. ...
... 20,[25][26][27][28][29] A variety of factors have been associated with this type of chronic pain, including breastfeeding, vaginal atrophy, a higher degree of laceration, pelvic floor injuries, and scar tissue. 25,27,28 However, Beischer et al performed a prospective study in which they evaluated patients with persistent dyspareunia at 3 months postpartum and found that 43% of the patients had granulomata on a physical examination. 5 PPGT may be an underrecognized etiology for persistent pain or dyspareunia, especially if patients have just accepted these symptoms as a routine part of postpartum recovery and have not sought a clinical evaluation. ...
... Only 15% of patients with postnatal sexual problems report discussing them with a health care professional. 25 In addition, other studies have shown that symptomatic granulation tissue is most often diagnosed between 2 and 4 months following birth, a time after most patients have seen their perinatal provider for their last routine postpartum visit. 7,30 In our study, 45% of patients were diagnosed after 6 weeks postpartum. ...
Article
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Introduction Although the development of postpartum granulation tissue (PPGT) is an expected phase of healing of perineal and vaginal lacerations, the persistence of this tissue can result in delayed wound healing, pain, bleeding, and discharge. There is a paucity of information on the efficacy of the treatments used for pathologic PPGT. The objective of this study was to describe characteristics associated with the development of PPGT and the treatment methods currently used for management. Methods This was a retrospective cohort study of 140 patients diagnosed with PPGT within one year of birth from 2012 through 2022 within a single health care system. Patients were identified by International Classification of Diseases and Current Procedural Terminology codes. Demographics, birth characteristics, symptoms, and treatment information were obtained and assessed in frequencies and means. Treatments were compared with 95% CIs and P values. Time to resolution was assessed by the number of weeks and the number of visits. Results It was the first vaginal birth for 129 (92%) patients in the study cohort. The majority (84.3%) of patients presented with pain. Almost half of all patients (45%) were diagnosed after 6 weeks postpartum. 30.0% of patients were initially treated conservatively. 76.4% of patients were treated with silver nitrate, and 33.6% had an excisional procedure. Successful conservative management had the lowest average number of visits to resolution with 1.39 visits (95% CI, 1.15‐1.69), followed by silver nitrate alone with 1.95 visits (95% CI, 1.73‐2.19), and excision with or without silver nitrate with 2.40 visits (95% CI, 2.07‐2.78). Conservative management was unsuccessful 45% of the time, requiring additional treatment with silver nitrate or excision. 30% of patients treated with silver nitrate or excision continued to report pain even after the resolution of granulation tissue upon examination. Conclusion PPGT is commonly associated with first vaginal births, often presents beyond 6 weeks postpartum, and frequently requires treatment.
... 44 The presence of postpartum IDA may exacerbate existing sexual difficulties after childbirth, which are common, particularly during the first 6 months postpartum. 45 Between 41% and 83% of women experience sexual dysfunction in the first 2 to 3 months postpartum, [46][47][48][49][50] and up to 64% have sexual dysfunction at 6 or 12 months postpartum. 46,51 The most common form is sexual desire disorder, which accounts for 80% to 90% of sexual dysfunction after childbirth. ...
... 45 Between 41% and 83% of women experience sexual dysfunction in the first 2 to 3 months postpartum, [46][47][48][49][50] and up to 64% have sexual dysfunction at 6 or 12 months postpartum. 46,51 The most common form is sexual desire disorder, which accounts for 80% to 90% of sexual dysfunction after childbirth. 51,52 However, a substantial proportion of women also experience arousal problems, difficulty achieving orgasm, and pain during intercourse. ...
... 51,52 However, a substantial proportion of women also experience arousal problems, difficulty achieving orgasm, and pain during intercourse. 46,50,53,54 A very common form of sexual dysfunction in the postpartum period is dyspareunia, affecting about 40% to 60% of women in the first 3 months after delivery. 46,49,50 The incidence of dyspareunia is directly related to the degree of perineal trauma and may persist for longer than a few months or even >1 year in women with a history of nongenital chronic pain. ...
Article
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Introduction: Sexual dysfunction negatively affects approximately 40% to 50% of adult women across various stages of life. Common risk factors include sexual traumas, relationship problems, chronic conditions, medication side effects, and poor physical health, including iron deficiency. Objectives: This review summarizes a presentation from a symposium that discussed the types and causes of sexual dysfunction at key times in women's lives, focusing on the relationship between iron deficiency and sexual dysfunction. Methods: The symposium was held at the XV Annual European Urogynaecological Association Congress, Antibes, France, in October 2022. Symposium content was identified through literature searches of PubMed. Original research, review articles, and Cochrane analyses discussing sexual dysfunction in association with iron deficiency/anemia were included. Results: Iron deficiency in women is commonly caused by abnormal uterine bleeding, but women may develop iron deficiency anemia (IDA) because of increased iron needs or reduced iron intake/absorption. Treatment with oral iron supplementation has been shown to improve sexual function in women with IDA. Ferrous sulphate is considered as a standard of care for oral iron treatment; prolonged-release iron formulations have improved tolerability, enabling lower doses and better tolerability. Conclusion: IDA and sexual dysfunction are related, so the identification of sexual dysfunction or iron deficiency in a woman should prompt an investigation of the other condition. Testing for iron deficiency is an inexpensive and simple step that can be routinely included in the workup of women with sexual dysfunction. Once identified, IDA and sexual dysfunction in women should be treated and followed to optimize quality of life.
... Despite the high prevalence rates of problems with sexual wellbeing in pregnancy and the postpartum for birthing parents and their partners, a minority of birthing parents (i.e., 7% to 29%) report receiving any information from health-care professionals about potential sexual challenges during this period (Barrett et al., 2000;Bartellas et al., 2000;Woolhouse et al., 2014). The information that is shared between health-care professionals and gestational or birthing parents appears to be "glossed over" (Woolhouse et al., 2014), focusing solely on contraception and safe resumption of vaginal intercourse in the postpartum (Barrett et al., 2000). ...
... Despite the high prevalence rates of problems with sexual wellbeing in pregnancy and the postpartum for birthing parents and their partners, a minority of birthing parents (i.e., 7% to 29%) report receiving any information from health-care professionals about potential sexual challenges during this period (Barrett et al., 2000;Bartellas et al., 2000;Woolhouse et al., 2014). The information that is shared between health-care professionals and gestational or birthing parents appears to be "glossed over" (Woolhouse et al., 2014), focusing solely on contraception and safe resumption of vaginal intercourse in the postpartum (Barrett et al., 2000). While a combination of cultural and social factors may contribute to birthing parents feeling uncomfortable initiating discussions related to sexual well-being with healthcare professionals (reviewed in McBride & Kwee, 2017), the lack of information provided does not seem to be the result of couples declining information about changes to their sexual well-being when it is offered (Woolhouse et al., 2014). ...
... A recent study examining gaps between desired and received postpartum health-care information revealed that sexual health remains a key area that birthing parents report wanting, but not receiving, information about (Guerra-Reyes et al., 2017). Previous research assessing the quantity and content of perinatal sexuality information received by birthing parents is dated (Barrett et al., 2000;Bartellas et al., 2000), despite considerable research attention and new evidence about factors influencing perinatal sexuality in recent years (for a review, see Fitzpatrick et al., 2021). Moreover, previous research focuses solely on experiences of the gestational or birthing parent, neglecting partners and the interpersonal context. ...
Article
Up to 88% of expectant and new parents report problems with their sexual well-being, yet less than 30% of individuals receive information about potential sexual problems from health-care professionals. Lack of information may contribute to difficulty adjusting to sexual challenges, and in turn, to poorer sexual well-being. The current study examined the following: 1) the amount of perinatal sexual health information individuals receive/access; 2) gaps between desired and received information; 3) barriers to accessing information; and 4) links between the quantity of information received/accessed and sexual well-being outcomes in one sample of pregnant couples (N = 102) and another sample of couples in the postpartum (N = 102). Results revealed that most participants reported receiving/accessing little-to-no sexual health information, despite most participants wanting to receive a variety of information related to their perinatal sexuality. On average, expectant and new parents were indifferent regarding how easy/comfortable they felt discussing their sexuality with health-care professionals. Overall, when gestational parents received/accessed more pregnancy-related sexual health information and when either parent received/accessed more postpartum-related sexual health information, both members of the couples reported greater sexual well-being. Access to information might not only address couples’ needs and concerns but may also bolster sexual well-being during a vulnerable period.
... Although postpartum dyspareunia is a frequent complaint, it is estimated that only 15% of affected women seek medical care. 2 Dyspareunia following birth is multifactorial, including physical (organic) and psychosocial etiologies. 3 Several studies 2,4-9 have suggested that the mode of delivery is a main factor for postpartum dyspareunia due to obstetric trauma involving tears, 4,9,10 episiotomy, 4,5,10,11 method of laceration repair, 12,13 and damage to pelvic floor muscles. ...
... 14,15 Remarkably, avoidance of vaginal delivery does not decrease the risk of postpartum dyspareunia, and comparison between cesarean and vaginal deliveries showed no difference in its occurrence, 16,17 indicating that physical trauma during birth is not the only causative factor. Breastfeeding was noted as another potential cause for postpartum dyspareunia, [2][3][4]18,19 resultant of hormonal changes, reduced vaginal lubrication, and vulvovaginal atrophy, which may persist as long as breastfeeding continues. [20][21][22][23][24] Despite the high prevalence of postpartum dyspareunia and its negative impact on affected women, data are lacking regarding its clinical implications-specifically, clinical diagnosis of the different components of pain in affected women, the usefulness of recommended treatments, and its ...
... Findings on gynecologic examination included clinical diagnosis of vulvovaginal atrophy: presence of thinning, erythema, dryness, pH >5, and microscopic smear showing abundant parabasal cells. Vestibular tenderness was assessed via the Q-tip test by using a cottontip applicator and touching the vestibule in 4 defined points (2,4,8, and 10 o'clock) to localize vestibular tenderness at each point (yes/no) and to quantify pain intensity with a Numeric Pain Scale ranging from 0 to 10 at each point (0, no pain; 10, worst possible pain). The latter data were used to compare pain intensity in follow-up examinations. ...
Article
Background Dyspareunia affects approximately half of postpartum women and is attributed to multiple factors. Despite its high prevalence and resultant negative effects, data are lacking regarding the causes and different pain components, the usefulness of recommended treatments, and the prognosis. Aim To evaluate causes of postpartum dyspareunia, targeted treatment modalities, and their effectiveness. Methods A retrospective observational study was conducted of women diagnosed with postpartum dyspareunia between September 2008 and January 2017 at a single designated vulvovaginal disorder clinic. The inclusion criterion was complaint of painful intercourse commencing postdelivery. The cohort was divided into 4 groups based on the causes of dyspareunia: muscle hypertonicity, scar tenderness, vestibular tenderness, and atrophy. Outcomes The following were assessed for each group: patient background demographics, clinical and obstetric data, physical findings, recommended therapy, adherence to the suggested treatment, level of improvement at follow-up visits, and length of time until maximal improvement. Results A hundred women met the inclusion criterion; the majority (n = 60) presented with >1 causative factor. The most common finding was vestibular tenderness (n = 78, 78%), which was significantly associated with atrophy (adjusted odds ratio [aOR], 15.08; 95% CI, 2.45-93.35), contraceptive usage (aOR, 4.76; 95% CI, 1.07-21.39), and primiparity (aOR, 4.89; 95% CI, 1.01-23.88). Episiotomy was the only risk factor for scar tenderness (aOR, 5.43; 95% CI, 1.20-24.53), while the existence of a spontaneous perineal tear was not. No specific correlation was found with pelvic floor muscle hypertonicity. Targeted treatment resulted in significant improvement in most patients. Clinical Implications A targeted diagnostic and treatment approach for postpartum dyspareunia is effective and can be beneficial for caregivers treating postpartum women. Strengths and Limitations A uniform and consistent protocol for patient selection and management is a major strength, which magnifies the clinical implication of our findings. The retrospective nature of the study is the primary limitation. Conclusion Postpartum dyspareunia is a common problem; however, many women refrain from discussing it with their providers. Therefore, it is important to assess this condition with all women during the postpartum visit as targeted diagnosis and treatment can significantly improve outcomes.
... Additionally, changes in social dynamics within the couple's relationship, including shifts in intimacy, communication patterns, and division of caregiving responsibilities, can influence sexual satisfaction and overall relationship satisfaction. [3,[7][8][9] For measuring sexual function after postpartum, several measurement tools have been developed to assess women's sexual function during the postpartum period. For instance, female sexual function index (FSFI) is a validated questionnaire consisting of 19 items covering 6 domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. ...
... [73] A comprehensive instrument for evaluating sexual function after childbirth should ideally cover multiple domains to provide a thorough assessment of women's postpartum sexual health. [7,74] One of these domains is sexual desire. The interest or motivation of a woman to participate in sexual activity is evaluated in this category. ...
Article
Background Sexual health is a critical component of overall well-being, yet discussions around sexual function, especially in the context of postpartum recovery, are often taboo or sidelined. The aim was to review measurement tools assessing women’s sexual function/health during the postpartum period. Methods We did a systematic search according to preferred reporting items for systematic reviews and meta-analyses 2020 guidelines in different databases, including PubMed, Web of Science, Scopus, Embase, ProQuest and Open Access Thesis and Dissertations, and Google scholar search engine until June 2023. Also, the reference list of the related reviews has been screened. Eligible studies included observational studies or clinical trials that evaluated women`s sexual function during the postpartum period using existing tools. Data extraction covered study characteristics, measurement tools, and their validity and reliability. Results From 3064 retrieved records, after removing duplicates and excluding ineligible studies, and reviewing the reference list of the related reviews, 41 studies were included in this review. Tools measuring sexual function were developed from 1996 to 2017. Sexual activity questionnaire, female sexual function index (FSFI), sexual function questionnaire, short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire, sexual health outcomes in women questionnaire, shorter version of FSFI, and sexual function questionnaire’s medical impact scale and Carol scale. Conclusion Sexual activity questionnaire, FSFI, sexual function questionnaire, short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire, sexual health outcomes in women questionnaire, shorter version of FSFI, sexual function questionnaire’s medical impact scale, and Carol scale are valid and reliable measuring tools to assess sexual function or sexual health during postpartum period, which can be used in primary studies according to the study aim and objectives.
... Many women begin sexual activity within 3 months of delivery. One study found that postpartum sexual problems were experienced by 83% of women within the 3-month postpartum period, while the prevalence of sexual problems was 18%-30% at 6 months postpartum and 30%-52.5% after 6 months [12]. ...
... Barrett et al. [12] previously showed that women with a positive history for pre-pregnancy dyspareunia were four times more likely to develop dyspareunia in the first 6 months postpartum. Furthermore, another study reported that the risk of postpartum dyspareunia was 2.8 times higher for women with previous experience of dyspareunia [35]. ...
Article
Full-text available
Synopsis In a meta-analysis of 22 studies enrolling 11 457 women of reproductive age, the overall estimated prevalence of dyspareunia was 35%. Abstract Background: Dyspareunia is one of the most common postpartum sexual dysfunctions. Objectives: To estimate the prevalence of postpartum dyspareunia. Search strategy: Web of Science, Scopus, PubMed, and Embase databases were searched to July 2019 using keywords including 'perineal pain,' 'dyspareunia,' and 'sexual pain'. Selection criteria: Observational studies on the prevalence of postpartum dyspareunia were included. Data collection and analysis: Two authors independently reviewed articles and extracted data. Study heterogeneity was evaluated by I 2 index; publication bias by Egger and Begg tests. Main results: Twenty-two studies enrolling 11 457 women were included. Based on meta-analysis, the overall estimated prevalence of dyspareunia was 35% (95% confidence interval [CI], 29%-41%). The prevalence was 42% (95% CI, 26%-60%) at 2 months, 43% (95% CI, 36%-50%) at 2-6 months, and 22% (95% CI, 15%-29%) at 6-12 months postpartum. Begg test showed no significant bias in data related to the prevalence of postpartum dyspareunia (P=0.466). Conclusions: The prevalence of postpartum dyspareunia was 35% and decreased with increasing postpartum duration. Given the high prevalence and its impact on a woman's Accepted Article This article is protected by copyright. All rights reserved quality of life, special attention should be paid to this common complaint during the postpartum period.
... Many women begin sexual activity within 3 months of delivery. One study found that postpartum sexual problems were experienced by 83% of women within the 3-month postpartum period, while the prevalence of sexual problems was 18%-30% at 6 months postpartum and 30%-52.5% after 6 months [12]. ...
... Barrett et al. [12] previously showed that women with a positive history for pre-pregnancy dyspareunia were four times more likely to develop dyspareunia in the first 6 months postpartum. Furthermore, another study reported that the risk of postpartum dyspareunia was 2.8 times higher for women with previous experience of dyspareunia [35]. ...
Article
Synopsis In a meta-analysis of 22 studies enrolling 11 457 women of reproductive age, the overall estimated prevalence of dyspareunia was 35%. Abstract Background: Dyspareunia is one of the most common postpartum sexual dysfunctions. Objectives: To estimate the prevalence of postpartum dyspareunia. Search strategy: Web of Science, Scopus, PubMed, and Embase databases were searched to July 2019 using keywords including 'perineal pain,' 'dyspareunia,' and 'sexual pain'. Selection criteria: Observational studies on the prevalence of postpartum dyspareunia were included. Data collection and analysis: Two authors independently reviewed articles and extracted data. Study heterogeneity was evaluated by I 2 index; publication bias by Egger and Begg tests. Main results: Twenty-two studies enrolling 11 457 women were included. Based on meta-analysis, the overall estimated prevalence of dyspareunia was 35% (95% confidence interval [CI], 29%-41%). The prevalence was 42% (95% CI, 26%-60%) at 2 months, 43% (95% CI, 36%-50%) at 2-6 months, and 22% (95% CI, 15%-29%) at 6-12 months postpartum. Begg test showed no significant bias in data related to the prevalence of postpartum dyspareunia (P=0.466). Conclusions: The prevalence of postpartum dyspareunia was 35% and decreased with increasing postpartum duration. Given the high prevalence and its impact on a woman's Accepted Article This article is protected by copyright. All rights reserved quality of life, special attention should be paid to this common complaint during the postpartum period.
... One study found that 83% of women at 3 months postpartum reported sexual dysfunction, but only 15% of these women had ever discussed it with a health care provider. 2 Reasons for this may include patient and provider discomfort and a lack of training for maternity care providers in regard to sexual functioning during pregnancy and the postpartum period. [3][4][5] An increasing proportion of pregnancies are attended by registered midwives across Canada. ...
... Competence discussing sexual health with clients 10-point Likert 6.91 (1.90); 7 [2][3][4][5][6][7][8][9][10] Comfort discussing sexual health with clients* 10-point Likert 7.60 (2.04); 8 [3][4][5][6][7][8][9][10] Importance of addressing sexual health with clients 10-point Likert 9.02 (1.06); 9 [5-10] regularly screening all of their clients for sexual pain and desire. Previous research by Smith et al. ...
Article
Background: Pregnancy and the postpartum period raise many sexual health concerns for women. Registered midwives (RMs) care for an increasing proportion of Canadian pregnancies. The study objective was to assess RMs’ experiences providing sexual health counselling. Methods: A 22-item questionnaire exploring RMs’ experiences, competence, and comfort, as well as barriers to discussing sexual health, was distributed electronically to British Columbian RMs. Results: Of 330 RMs, 91 (28%) responded. The majority of midwives reported discussing sexual health concerns with greater than 75% of clients (49/91 [53.8%]). Most estimated the time spent was less than 30 minutes over the pregnancy (69/91 [76%]). Common topics were sexual activity postpartum (82/91 [90.1%]), contraception (89/91 [97.8%]), and cervical cancer screening (86/91 [94.5%]). Less than half discussed sexual problems, including pain or low desire. RMs rated themselves highly competent and comfortable addressing sexual health. However, many identified lack of training, time, and cultural differences as barriers. Respondents cited desire for community resources and training in the areas of contraception, pain and, low desire. Conclusions: British Columbian RMs feel confident addressing many sexual health concerns during pregnancy but cited lack of training as a common barrier. Investment in educational resources for RMs may help to improve sexual health care for all Canadian women. This article has been peer reviewed.
... 8 A history of dyspareunia is associated with persistent postpartum dyspareunia. 15,16 A study of 150 nulliparous women found that history of non-genito-pelvic pain may increase the risk of developing genitopelvic pain postpartum, and pain-related anxiety may increase the risk for higher intensity postpartum genito-pelvic pain. 17 The latter finding adds to the evidence that preexisting psychiatric conditions, psychosocial trauma and catastrophizing pain behavior also predict the increased susceptibility for persistent pain perception following childbirth. ...
... One such example is breastfeeding that is also known to be associated with postpartum dyspareunia. 16,68 Therefore, it will be worth considering some of the new pathways of antinociception that are investigated and might be introduced in peripartum analgesia in the future. ...
Article
Full-text available
Persistent postpartum pain is common and has a complex etiology. It has both somatic and psychosocial provoking factors and has both functional and psychological ramifications following childbirth. Pain that limits the functional capacity of a person who has the daunting task to take care of all the demands of managing a growing newborn and infant can have debilitating consequences for several people simultaneously. We will review the incidence of persistent postpartum pain, analyze the risk factors, and discuss obstetric, anesthetic, and psychological tools for prevention and management. Based on the current knowledge, early antenatal screening and management is described as the most likely measure to identify patients at risk for persistent postpartum pain. Such antenatal management should be based on the close collaboration between obstetricians, anesthesiologists, and psychologists to tailor peripartum pain management and psychological support-based individual needs.
... Barrett és mtsai tanulmányában a szülés utáni 3. és 6. hónapban a vizsgált nők 33%-a és 23%-a számolt be arról, hogy nehézségük támadt az orgazmus elérésében, ebből 14%-uk már a várandósság előtti időszakban is tapasztalta ezt a problémát. Az orgazmus hiánya esetén a nő izgalmának csökkenéséről számolnak be, amelynél a kockázati tényezők közé tartozik a korábbi esetleges dyspareunia miatti negatív tapasztalat, a figyelemelterelődés, a szexuális szorongás, a depresszió és a kimerültség [29]. Az újdonsült szülőknek egyaránt vannak szülés utáni szexuális kételyeik, aggodalmaik a megváltozott érzelmi és fizikai tényezők miatt. ...
... 6 hónapon belül a dyspareunia és a szülés típusa között nem volt szignifikáns összefüggés (p = 0,4). Azoknak a nőknek, akik a szülés után tapasztaltak valamilyen szexuális problémát, csupán a 15%-a kérte ki egészségügyi szakember véleményét [29]. McDonald és mtsai utánkövetéses kohorszkutatásában (n = 1507) a résztvevők 78%-a a szülés után 3 hónappal újrakezdte a vaginalis szexet, míg a 6. hónapra ez 94%-ra emelkedett, és csupán 2%-uk nem folytatta a szülés után 18 hónappal a szexuális életét [28]. ...
Article
Full-text available
A legtöbb nő nincs felkészülve arra, hogy a várandósság alatt, illetve szülés után megváltozik a szexuális egészsége, működése. Tanulmányunk célja, hogy átfogó összegzést adjunk nemzetközi közlemények és a jelenleg rendelkezésre álló hazai kutatások alapján arról, hogy a várandósság alatt zajló normatív változások, amelyek szomatikus és pszichés szinten éreztetik hatásukat, hogyan befolyásolják az egyén és a pár szexuális működését. Áttekintjük a várandósság alatti szexuális egészség jellegzetességeit, kitérve arra, hogy a várandósság előrehaladása során az egyes trimeszterekben hogyan változik meg a gravida szexuális aktivitása és érdeklődése, mik a jellegzetes szexuális diszfunkciók, és hogyan alakul át a párok szexuális szokása, pozitúraválasztása, milyen jellegzetes aggodalmak és hiedelmek térítik el a párokat a szexuális élet gyakorlásától. A szülés utáni hatások közül tanulmányunk kitér arra, hogy a szexuális működést miként befolyásolja a szülés módja, a gáttrauma és az episiotomia, továbbá hogy a szoptatás, a hormonális változások hogyan hatnak a szexuális életre. Javaslatokat fogalmazunk meg a reprodukcióval összefüggő szexuális problémák prevenciós és intervenciós lehetőségeivel kapcsolatban. Orv Hetil. 2023; 164(46): 1807–1816.
... reduced time and energy for sex and larger desire discrepancies between partners (Schlagintweit et al., 2016). The sudden and rapid nature of sexual changes together with the pervasive lack of information on how to deal with them (Barrett et al., 2000;Guerra-Reyes et al., 2017;Heidari et al., 2018) can contribute to sexual experiences being less satisfying and accompanied by sexual distress (i.e., negative emotions about one's sex life such as worry, frustration, guilt) for new parents (Derogatis et al., 2002;Rosen et al., 2020). ...
... As such, these women may hold overly positive expectations for their ability to navigate the challenges occurring during the transition, including sexual ones (e.g., expecting that their sexual lives will quickly return to what they were before). Indeed, most couples hold positive expectations regarding the impacts of the transition to their relationships (Lawrence et al., 2007) and very few (18%) expectant or new parents receive information regarding possible changes to their sexual lives following childbirth (Barrett et al., 2000;Guerra-Reyes et al., 2017). When faced with unexpected and novel sexual experiences (e.g., mismatches in sexual desire, persistent changes to own sexual function), women who hold more positive prenatal evaluations of their relationships may feel unprepared to deal with them and may resort to negative attributions as to why they are experiencing such changes, such as stable (e.g., "This problem will never go away") or partner (e.g., "This is his fault") attributions (Vannier et al., 2018). ...
Article
There is limited understanding of the dynamic between relational and sexual well-being as couples adjust to new parenthood, despite this being a vulnerable period for couples' relationships. This study was aimed at examining the bidirectional links between relationship quality and sexual well-being (i.e., sexual satisfaction, sexual distress) across the transition to parenthood. We assessed new parent couples (N = 257) across four time points (two prenatal) from mid-pregnancy through 6 months postpartum. Parallel dyadic latent growth curve modeling was employed to examine the associations between trajectories of perceived relationship quality, sexual satisfaction, and sexual distress. New parents' declines in relationship quality were associated with declines in own and partners' sexual satisfaction and with increases in own sexual distress. Mothers' prenatal relationship quality and sexual distress predicted subsequent changes in own sexual distress and fathers' relationship quality, respectively. Results indicate that changes to new parents' relational and sexual well-being mutually influence each other over time. Current results indicate that the impact of the transition on couples' relationships is partly determined by own and partners' prenatal factors, to which clinicians and researchers can attend to early on. Cross-domain links between relational and sexual well-being should be considered in research and clinical practice.
... reduced time and energy for sex and larger desire discrepancies between partners (Schlagintweit et al., 2016). The sudden and rapid nature of sexual changes together with the pervasive lack of information on how to deal with them (Barrett et al., 2000;Guerra-Reyes et al., 2017;Heidari et al., 2018) can contribute to sexual experiences being less satisfying and accompanied by sexual distress (i.e., negative emotions about one's sex life such as worry, frustration, guilt) for new parents (Derogatis et al., 2002;Rosen et al., 2020). ...
... As such, these women may hold overly positive expectations for their ability to navigate the challenges occurring during the transition, including sexual ones (e.g., expecting that their sexual lives will quickly return to what they were before). Indeed, most couples hold positive expectations regarding the impacts of the transition to their relationships (Lawrence et al., 2007) and very few (18%) expectant or new parents receive information regarding possible changes to their sexual lives following childbirth (Barrett et al., 2000;Guerra-Reyes et al., 2017). When faced with unexpected and novel sexual experiences (e.g., mismatches in sexual desire, persistent changes to own sexual function), women who hold more positive prenatal evaluations of their relationships may feel unprepared to deal with them and may resort to negative attributions as to why they are experiencing such changes, such as stable (e.g., "This problem will never go away") or partner (e.g., "This is his fault") attributions (Vannier et al., 2018). ...
Preprint
There is limited understanding of the dynamic between relational and sexual well-being as couples adjust to new parenthood, despite this being a vulnerable period for couples’ relationships. This study was aimed at examining the bidirectional links between relationship quality and sexual well-being (i.e., sexual satisfaction, sexual distress) across the transition to parenthood. We assessed new parent couples (N = 257) across four time-points (two prenatal) from mid-pregnancy through six months postpartum. Parallel dyadic latent growth curve modelling was employed to examine the associations between trajectories of perceived relationship quality, sexual satisfaction, and sexual distress. New parents’ declines in relationship quality were associated with declines in own and partners’ sexual satisfaction and with increases in own sexual distress. Mothers’ prenatal relationship quality and sexual distress predicted subsequent changes in own sexual distress and fathers’ relationship quality, respectively. Results indicate that changes to new parents’ relational and sexual well-being mutually influence each other over time. Current results indicate that the impact of the transition on couples’ relationships is partly determined by own and partners’ prenatal factors, to which clinicians and researchers can attend to early on. Cross-domain links between relational and sexual well-being should be considered in research and clinical practice.
... Callands et al. Questions drawn from a developed measure (Barrett et al., 2000), assessing sexual health, including resumption of vaginal sex and pain during sex after childbirth. ...
Article
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Introduction Intimate Partner Violence (IPV) significantly impacts adults' wellbeing, causing both physical and psychological harm. IPV has been consistently linked to adverse sexual health outcomes, including an increased risk of sexually transmitted infections, unintended pregnancies, and sexual dysfunction. This systematic review examines the evolving relationship between IPV and sexual health outcomes in adults from 2014 to 2024, addressing gaps in understanding across diverse populations and exploring the complex interplay between violence, sexuality, and health. Methods A comprehensive search of multiple databases was conducted for peer-reviewed articles published between January 2014 and February 2024. Studies examining the association between IPV and sexual health variables in adult populations (aged 18 and older) were included. The review followed PRISMA guidelines, and 27 articles met the inclusion criteria after full-text screening and quality assessment. Results IPV was consistently associated with poorer sexual health outcomes across diverse populations and contexts. Studies utilized various validated instruments to assess IPV and sexual health. Research primarily focused on cisgender heterosexual women, with limited studies on cisgender heterosexual men, men who have sex with men, and transgender individuals. IPV was linked to an increased risk of sexually transmitted infections, unintended pregnancies, sexual dysfunction, and decreased sexual satisfaction. The relationship between IPV and sexual health was influenced by factors such as gender identity, sexual orientation, and cultural context. Discussion The review highlights the complex relationship between IPV and sexual health, emphasizing the need for targeted interventions and culturally sensitive approaches. Significant research gaps exist, particularly regarding lesbian women and non-binary individuals. Future studies should employ mixed-methods approaches and consider intersectionality to provide a more comprehensive understanding of IPV's impact on sexual health across diverse populations.
... 2,3 Although the prevalence of sexual dysfunction diminishes as more time elapses following childbirth, it remains significantly high, with 64% of women still affected 6 months postpartum. 4 Pelvic floor disorders have a significant impact on different dimensions of sexual functioning, such as dyspareunia, but also decreased arousal and vaginal dryness. 5,6 Accordingly, the influence of the mode of delivery, as well as of perineal trauma on the pelvic floor and subsequent on sexual functioning postpartum, is discussed. ...
Article
Full-text available
Introduction The pelvic floor is exposed to differing stresses and trauma depending on the mode of birth. At the same time, the pelvic floor plays a crucial role in female sexual functioning (FSF). Whereby FSF encompasses different dimensions, from subjective satisfaction to physiological aspects, such as lack of pain and orgasm ability. The aim of the study presented here is to assess FSF in relationship to postpartum pelvic floor disorder based on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA‐Revised (PISQ‐IR), in a large convenience sample and to identify whether there is an association between mode of birth as well as perineal injuries and FSF of women up to 24 months postpartum. Material and Methods We conducted a cross‐sectional online survey and recruited via social media women up to 24 months after birth of their last child. FSF was surveyed using the PISQ‐IR. Details were also collected on all previous births and birth‐related perineal trauma, as well as current breastfeeding, obesity, and socio‐demographics. Multivariate models were then calculated to determine a possible association between FSF and birth mode. Results The data basis is the responses of 2106 survey participants within the first 24 months postpartum. Even 12–24 months postpartum, 21% of respondents are not sexually active, which burdens almost 44% of these women. With regard to mode of delivery, differences in FSF are only evident in individual dimensions of the PISQ‐IR. The dimensions “Condition Impact” and “Condition Specific” were significantly associated with more impairments in sexually active respondents up to 12 months postpartum whose last mode of delivery was forceps or vacuum extraction. If a perineal tear had occurred during last birth, this was significantly associated with a lower PISQ‐IR subscore in the “Condition Impact,” “Condition‐Specific,” “Global Quality,” “Partner‐Related,” and “Arousal” models. The low variance explanation shows that further relevant factors on female sexuality may exist. Conclusions The issue of impairments in FSF following childbirth, persisting for an extended period of time, is a significant postpartum concern. Due to the very different dimensions of FSF, the influence of the mode of delivery must be considered in a differentiated way.
... Women were more likely to seek help (30%), but only 3% to 4% of general practitioners' records contained an entry specifically documenting a sexual discussion. Among postpartum women, up to 25% report adverse sexual changes [12,13]. ...
... Sexual function and satisfaction do change during pregnancy and the postpartum period, due to breastfeeding, decreased estrogen levels, postpartum pelvic floor disorders, and dyspareunia (Malakouti et al., 2020). About 15% of postpartum women experience sexual problems, and most are reluctant to discuss such changes due to embarrassment (Barrett et al., 2000). ...
... Perineal pain or discomfort is quite common and might also impair normal sexual functioning. Dyspareunia (painful sex) following a vaginal delivery is reported to persist for a period of 3 months in around 60% individuals and for 6 months in 30% individuals, (5), while 15% of women experience dyspareunia even up to 3 years (6). Perineal trauma occurs mostly in nulliparous women, malposition of fetus and while delivering babies with increased head diameter and weight (7,8). ...
Article
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Objective: Vaginal births are associated with a certain degree of trauma to the genital tract, with significant short-term and long-term morbidity. Awareness of morbidity following perineal trauma has led to application of different interventions during the late first stage and second stage of labour to prevent severe perineal trauma. This includes techniques such as perineal massage, warm and cold compresses, and perineal management techniques. Objective of this meta-analysis is to evaluate the effect of perineal massage during the late first stage and second stage of labour on the rate of episiotomy and risk of perineal trauma. Materials and methods: Electronic databases (PubMed, Scopus, Cochrane Library and Science Direct) were searched from inception until August 2021. We included randomized controlled trials (RCTs) which compares perineal massage during labor (i.e., intervention group) with a control group in women with singleton gestation and cephalic presentation at ≥36 weeks. The primary outcome was severe perineal trauma and the rate of episiotomy. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of relative risk (RR) with 95% confidence interval (CI). Results: Ten trials including 4,088 women were analyzed. Women with perineal massage during labor had a significantly lower incidence of severe perineal trauma (RR: 0.52, 95% CI 0.29- 0.94) compared to the control group. The incidence of episiotomy was lower in the perineal massage group (RR: 0.71, 95% CI 0.52-0.98 p < 0.01) but was statistically insignificant (P>0.05). Conclusion: The finding of meta-analysis showed that perineal massage during labor could be effective in reducing the risk of severe perineal trauma, such as third- and fourth-degree spontaneous lacerations during labor.
... Other studies such as that of Griffiths and Berrett have also had such a recommendation. 38,39 Furthermore, the present study results showed that the most important source of acquisition of information about the appearance and function of the genitalia in the group of women with a history of female genital procedures included gynecologists and midwives. This result indicates the importance of the existence of a suitable educational program for midwives and gynecologists to increase their knowledge about the wide range of normal appearance of the female genitalia, the effect of genital cosmetic procedures on the women's sexual function, familiarity with the complications of these procedures, and increase in the competence for providing proper and effective counseling, which can be one of the best solutions for raising proper awareness among women about the female genital cosmetic procedures. ...
Article
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Background Despite the increasing growth of female genital cosmetic procedures, the long-term effects of these procedures are not clearly understood. This study was conducted to compare the genital self-image and sexual function in women with and without female genital cosmetic procedures. Methods This cross-sectional study was conducted on 315 participants (210 women without a history of genital cosmetic surgery and 105 women with it) in Alborz province, Iran, from early February 2023 to mid-May 2023. The sampling was done conveniently. Data collection instruments were Female Genital Self Image Scale and Female Sexual Function Index. Statistical analysis was done in SPSS 16 software using t-test, chi-square, and logistic regression, and P<0.05 was considered statistically significant. Results The use of laser to tighten the vagina with 77.77% and Perineoplasty with 29.2% were the main cosmetic procedures. The mean duration passed from the surgical procedures was 4.79±3.60 years, while it was 1.13±0.74 years for non-surgical procedures. Women with a history of genital procedures had a higher mean age (39.45±10.38, P=0.023). However, they were lower regarding the level of education (P<0.001), family income (P<0.001), and exercise (P<0.001). Also, they showed a higher number of pregnancies (P<0.001), deliveries (P<0.001), vaginal delivery (P<0.001), episiotomy (P<0.001), and neonates with a weight of ≥3.5 kg (P=0.002). In both groups, midwives and doctors were the most important sources of information about the appearance and function of reproductive system. However, the genital self-image and sexual function of the two groups did not differ significantly (P>0.05). Conclusion No difference in sexual self-image and lack of difference in sexual function after cosmetic procedures show the need to pay attention to recommending and selecting these procedures. Public awareness about the diverse and natural forms of the female genitalia, education about the variety of the factors affecting sexual function, reduction of unnecessary interventions, increase in physiological births, retraining doctors and midwives, and multidimensional counseling can help to choose more appropriate candidates for cosmetic procedures.
... [1][2][3][4] Sexual difficulties (eg, lubrication difficulties, loss of sexual desire, genitopelvic pain) are frequent in the postpartum period and may interfere with the psychological, relational, and sexual well-being of mothers. [5][6][7] Specifically, the prevalence of genitopelvic pain is estimated at 8% to 10% in women in the general population and up to 45% in mothers at 6 months postpartum. 8,9 Genitopelvic pain before or during pregnancy, perineal trauma during childbirth (eg, tearing, laceration, incision of the perineum), and breastfeeding are likely to increase the risk of postpartum genitopelvic pain. ...
Article
Background Genitopelvic pain following childbirth is common and likely to challenge the psychological, relational, and sexual well-being of new mothers. While genitopelvic pain generally decreases during the postpartum period, personal and interpersonal characteristics may explain why genitopelvic pain persists beyond the period of physical recovery in some mothers. Body image concerns, increased stress, and relationship challenges would be particularly salient during pregnancy and the postpartum period, which could put new mothers at greater risk of sexual difficulties. Also, mothers may display a negative appraisal regarding genitopelvic pain and doubt their ability to cope with it, which may contribute to the pain. Aim The current study aimed to examine the role of perfectionism, body image concerns, and perceived intimacy in the occurrence and change in genitopelvic pain in new mothers in postpartum. Methods A total of 211 new mothers and their partners were recruited for a larger prospective dyadic study on the transition to parenthood. Outcomes Mothers completed a single item assessing genitopelvic pain, in addition to brief validated questionnaires measuring perfectionism, body image concerns, and perceived couple intimacy during pregnancy and at 4, 8, and 12 months postpartum. Results Five multilevel modeling analyses revealed that adaptive perfectionism, maladaptive perfectionism, and body image concerns were associated with a higher occurrence of genitopelvic pain from 4 to 12 months postpartum. Mothers’ and partners’ perceived intimacy was not significantly related to new mothers’ genitopelvic pain. None of the predictors modified the trajectory of genitopelvic pain over time. Clinical Implications Raising awareness among health care professionals regarding the role of perfectionism and body image concerns in genitopelvic pain may help them identify new mothers at risk of chronic genitopelvic pain, while offering a new avenue of intervention. Strengths and Limitations There has been little research examining the role of perfectionism, body image concerns, and intimacy in postpartum genitopelvic pain. Based on a longitudinal prospective approach, this study identified perfectionism and body image concerns as significant predictors of postpartum genitopelvic pain. However, prepregnancy genitopelvic pain, genitopelvic pain intensity, and sexual distress were not measured. Conclusion Adaptive and maladaptive perfectionism and body image concerns are associated with new mothers’ genitopelvic pain up to 12 months postpartum.
... A study of women in the UK found that sexual dysfunction incidences increased after delivery and that painful intercourse was associated with vaginal delivery. Furthermore, the study highlighted the need to address areas of unexplored and unrealized health and well-being of pregnancy and postpartum-related sexuality [6]. A longitudinal study found that there were time-related differences and distinctness in sexual health perspectives among US women after delivery. ...
Article
Background: A woman’s sexual life during pregnancy is subject to many physiological and psychological changes. In this regard, there are inconsistencies in some aspects, while some are yet to be explored. This study aimed to obtain a detailed account of the fears, beliefs and practices of pregnant women and their associated factors in Saudi Arabia regarding their sexual life during pregnancy and after birth. Methods: A convenience sample of pregnant women (n=439) attending antenatal clinics at purposefully selected hospitals completed a self-report questionnaire of her fears, beliefs and practices regarding her sexual life during pregnancy. This was a cross-sectional study performed by a team of researchers at King Khalid University Hospital from August 2021 to August 2022. Results The majority of the pregnant women recorded • A decrease in libido • That Kegel exercises improved sexual function • That vaginoplasty is important after vaginal delivery • Fear of dyspareunia, vaginal laxity, and changes in the sexual relationship • Dependence on unverified sources for information regarding female sexual issues. A large proportion of the participants • Thought that delivery-related vaginal laxity needed medical consultation • Thought that vaginal laxity was associated with episiotomy • Relied on traditional herbs for managing sexual health issues. Among pregnant women in Saudi Arabia, sexual health-related fears, attitudes and practices were associated with age, marital status and educational level, and participants relied on past experience and social media for information. Conclusion: Decreased libido and painful intercourse are common among pregnant women regardless of parity. Sexual health concerns and education should be part of antenatal care visits.
... Although it is documented in the literature that one of the advantages of utilizing a digital portfolio as a continuing, available archive of activities for professional development maintained by the teacher is the ability to show growth over time. 20 However, our needs assessment survey on the domain of the "performance" section revealed that respondents reported needing improved evaluation processes. The majority reported relatively low satisfaction levels with the departmental review processes they are subject to. ...
Article
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Purpose The Digital faculty portfolio (DFP) is a well-established Teaching Portfolio, a tool that combines student evaluations with teaching materials, narrative reflections, and evidence of pedagogical effectiveness. The research aimed to test the DFP concept and determine whether faculty find it useful for integrating faculty activities, including teaching and extracurricular activities. Thus, the main aim is to identify key technical details that must be addressed before creating a larger DFP platform. Methods This research study adopted a six-step theory- and evidence-based approach of an Intervention Mapping (IM) protocol to assess the need for a DFP-like program at the College of Medicine, King Saud Abdulaziz University for Health Sciences and the efficacy of the pilot DFP program. The study was done in three steps: 1) Evaluation of educational needs; 2) Design of the “DFP” program; and 3) Validation and refinement of the designed program. The college conducted the needs assessment using a validated survey with full-time faculty members. Eighty-two survey participants comprised the sample. We described to them the DFP implementation procedure, design, and advantages. Results The DFP is valuable to most users (60%) and has inherent benefits that boost professional competency (80%). Nearly 73% were willing to keep using and/or updating their DFP periodically. The created program was validated by sharing the findings with designated specialists in health professions education. Based on their comments, the program was further refined and ready for piloting. Conclusion To maximize the potential of the platform’s success, its capabilities should be consistently enhanced in addition to resolving technical issues. This program has managed to effectively identify new avenues for working on enhancing methods for effective communication, coordination and enhance the scope of evaluation process.
... Specifically, perineal trauma following birth can cause pain, which is usually overlooked by women and their caregivers who may not recognize it as a health problem [4]. Incontinence of urine and feces [5] and sexual dysfunction [6], which are also neglected and not of concern during perinatal or postnatal period by midwives or women themselves [7,8].These issues can lead to reduced engagement in baby care activities and other daily activities of women [5]. Additionally, research findings have shown that the physical symptoms caused by perineal trauma could significantly influence the women's postnatal psychological symptoms [9,10]. ...
Article
Full-text available
Non-pharmaceutical midwifery techniques, including perineal warm compresses, to improve maternal outcomes remain controversial. The aims of this study are to assess the effects of perineal warm compresses on reducing perineal trauma and postpartum perineal pain relief. This systematic review included randomized controlled trials (RCTs). We searched seven bibliographic databases, three RCT register websites, and two dissertation databases for publications from inception to 15 March 2023. Chinese and English publications were included. Two independent reviewers conducted the risk of bias assessment, data extraction, and the evaluation of the certainty of the evidence utilizing the Cochrane risk of bias 2.0 assessment criteria, the Review Manager 5.4, and the online GRADEpro tool, respectively. Seven RCTs involving 1362 primiparous women were included. The combined results demonstrated a statistically significant reduction in the second-, third- and/or fourth- degree perineal lacerations, the incidence of episiotomy, and the relief of the short-term perineal pain postpartum (within two days). There was a potential favorable effect on improving the integrity of the perineum. However, the results did not show a statistically significant supportive effect on reducing first-degree perineal lacerations and the rate of perineal lacerations requiring sutures. In summary, perineal warm compresses effectively reduced the second-, third-/or fourth-degree perineal trauma and decreased the short-term perineal pain after birth.
... The postpartum period witnesses a gradual resumption of sexual activity, with 80-93% of new mothers engaging in intercourse within three months of delivery [13]. However, this period is also marked by challenges, as two out of three women encounter difficulties related to sexual functioning, including decreased libido, difficulty achieving orgasm, vaginal dryness, and dyspareunia [14]. Factors contributing to reduced postnatal sexual activity include diminished interest in sex, postpartum pain, tender breasts, and lactationrelated concerns (for example, uncontrolled milk leakage may be the reason for avoiding sexual intercourse for fear of the partner's reactions) [5,[15][16][17][18]. ...
Article
Full-text available
Citation: Szablewska, A.W.; Michalik, A.; Czerwińska-Osipiak, A.; Zdończyk, S.A.;Śniadecki, M.; Bukato, K.; Kwiatkowska, W. Breastfeeding vs. Formula Feeding and Maternal Sexuality among Polish Women: A Preliminary Report. Healthcare 2024, 12, 38. https://doi.org/10.3390/ healthcare12010038 Academic Editors: Abstract: Although postpartum sexual problems are common, there is a poor understanding of the underlying influencing factors and the impact of the infant feeding method on the mother's sexual life. A cross-sectional control study was conducted with a group of 253 women during their postpartum period. This study aimed to investigate the effects of different infant feeding methods on female sexual life after childbirth. The study followed the STROBE guidelines for cross-sectional control analysis. The study design included a questionnaire characterizing sociodemographic, obstetric and breastfeeding variables and the PL-FSFI (Female Sexual Function Index). The authors collected the data in compliance with the CAWI (Computer-Assisted Web Interview) research methodology-an interview conducted via an Internet channel. Each respondent received and completed the survey provided to them via the same online link. This study included women in the postpartum period: 170 breastfeeding women (study group) and 83 formula-feeding women (control group). There were statistically significant difference between the groups that practiced different types of breastfeeding. Out of all the PL-FSFI-assessing domains, the highest average score for the whole group correlated with satisfaction and the lowest score correlated with lubrication use. Our findings indicate that women practicing only breastfeeding are more likely to develop sexual problems. In order to maintain sexual health and promote long-term breastfeeding, extensive and professional counseling is needed for couples about postpartum sexuality and the factors that affect it, such as breastfeeding.
... However, the sense of sexual satisfaction changes at different periods of a woman's life-especially in pregnancy [2]. Problems with sexuality may occur at any stage of pregnancy, peaking at 80% in the third trimester, puerperium and early motherhood [3,4]. The situation results from both biological changes occurring in the woman's body during pregnancy and childbirth, as well as psychological and social changes related to the change of social roles in the relationship and adaptability of the couple [5]. ...
Article
Full-text available
The aim of the study was to assess the impact of breastfeeding-related fatigue and family support on the sexuality and quality of life of mothers during early motherhood. A cross-sectional preliminary study was conducted between 1 October 2021 and 15 May 2022 in 65 women being in early postpartum period. We used the authors’ questionnaire developed for the purposes of the study; the Sexual Satisfaction Scale for Women—SSS-W; the Mell–Krat scale for women; and the General Health Questionnaire—GHQ28. A significant negative correlation was found between the age of the patients and the reduction in somatic symptoms (GHQ28 questionnaire) (r = −0.315, p = 0.011). Women working professionally achieved significantly higher results in the SSS-W contentment category (r = 0.313, p = 0.014). Frequent sexual activity reduced disorders in social functioning (the GHQ28 questionnaire) (r = −0.107, p = 0.283). Women who breastfed up to 5 times a day (p = 0.033) reached significantly higher SSS-W scores in terms of communication. The partner’s help significantly contributed to higher sexual satisfaction in the aspect of compatibility (p = 0.004) and the overall level of satisfaction determined with the SSS-W questionnaire (p = 0.016). The presented study suggests that older mothers who are employed and supported by a partner have a higher level of contentment, sexual satisfaction and quality of life.
... The participants in this study also showed how the 6week mark, which usually includes an appointment with their health care provider, was interpreted as a time when participants felt they should be feeling ready to resume sexual activities, though many did not feel ready and believed that the 6-week mark felt 'arbitrary'. The 6-week check-up has been previously described by other researchers as a time when postpartum women often feel that they are not ready to resume sexual intercourse, though value input and assessment by their health care providers (Barrett et al., 2000). Researchers have also described how the 6-week mark is not in line with realistic patient needs or desires, specifically as it relates to contraception and timing of the associated return to sexual activities (Glazer et al., 2011). ...
Article
Full-text available
There exists a lack of literature surrounding how postpartum individuals define feeling ‘ready’ to resume sexual activities after childbirth. Many factors may influence feelings of desire or readiness for sexual activities, such as breastfeeding. Therefore, it is important to understand why and how postpartum individuals understand and make meaning of their experiences surrounding postpartum sexual activities, as well as how those experiences are influenced or negotiated through relations of power. This study was guided by feminist poststructuralism and discourse analysis. Eleven participants who were between 1 and 6 months postpartum and living in Nova Scotia, Canada, were interviewed using semi-structured interviews. Participants challenged certain discourses surrounding sexual activities postpartum, including the social discourse that positions sexual activities as a requirement within romantic relationships and the discourse that positions health care providers as the authority on postpartum sexual health. ‘Feeling ready’ centered on four main issues: (1) navigating physical recovery; (2) personal knowing and emotional readiness; (3) the 6-week check; and (4) redefining intimacy. This article describes one branch of the findings within the overall study. Choosing to resume sexual activities postpartum, or feeling ready to do so, is individual, fluid, and complex. This research has important implications for practice and policy, specifically as it pertains to postpartum care.
... Specifically, perineal trauma following birth can cause pain, which is usually overlooked by women and their caregivers who may not recognize it as a health problem [4]. Incontinence of urine and feces [5] and sexual dysfunction [6], which are also neglected and not of concern during perinatal or postnatal period by midwives or women themselves [7,8].These issues can lead to reduced engagement in baby care activities and other daily activities of women [5]. Additionally, research findings have shown that the physical symptoms caused by perineal trauma could significantly influence the women's postnatal psychological symptoms [9,10]. ...
Preprint
Background: Perineal trauma during childbirth and postpartum perineal pain significantly affected the new mother’s physical, psychological, and social experiences toward spontaneous vaginal birth. The effects of perineal warm compresses remain inconclusive. Objectives: To assess the effects of perineal warm compresses during the second stage of labor on reducing perineal trauma and postpartum perineal pain relief. Search Strategy: We searched seven bibliographic databases, three register websites of randomized controlled trials (RCTs), and two dissertation databases for publications from inception to March 15, 2023. Selection Criteria: RCTs published in Chinese and English. Data Collection and Analyses: Two independent reviewers conducted the risk of bias assessing, data extraction, and the certainty of the evidence evaluation utilizing the Cochrane risk of bias 2.0 assessment criteria, the Review Manager 5.4, and the online GRADEpro tool respectively. Main Results: Seven RCTs involving 1362 primiparous women were included. The combined results demonstrated a statistical reduction on the second-(RR=0.40, 95 %CI: [0.27,0.59]), third- and/or fourth- degree perineal lacerations(RR=0.34, 95 %CI: [0.20,0.57]), the incidence of episiotomy (RR=0.69, 95 %CI: [0.58,0.83]) and relief on the short-term perineal pain postpartum (within two days) (MD=-0.94, 95 %CI: [-1.10,-0.77]); a potential favorable effect on improving the integrity of perineum (RR=3.36, 95 %CI: [1.22,9.27]); did not show a statistically significant supportive effect on reducing the first-degree perineal lacerations ((RR=1.43, 95 %CI: [1.05,1.95])) and the rate of perineal lacerations requiring suture (RR=0.68, 95 %CI: [0.45,1.02]). Conclusions: Perineal warm compresses effectively reduced the second-, third-/or fourth-degree perineal trauma and decreased the short-term perineal pain after birth.
... The sexual health of women during pregnancy and the postpartum pe-riod might be neglected at postpartum follow-ups [6]. Studies show that the incidence of reporting problems with sexual function among pregnant women varies between 36 % and 88 % [7][8][9][10] and is most prevalent in the 3rd month after birth [11,12]. The biological (e. g., hormones, mode of delivery), psychological (e. g., stress, fatigue), social (e. g., identity, role changes), and interpersonal (e. g., partner responsiveness) changes during the perinatal period affected sexual function in women [12]. ...
Article
Objective The mental, physical and sexual health of women as well as maternal and fetal health should be considered during the prenatal and postnatal periods. Investigating the effect of clinical Pilates exercises and prenatal education (CPE & PE) on obstetric and neonatal outcomes as well as the mental, physical, and sexual health of women was intended. Methods In the second trimester, mothers with singleton pregnancies who attended (n=79, study group) or did not attend (n=80, control group) CPE & PR were recruited to this prospective cohort study, and were evaluated in the prenatal and postnatal periods. Depression was assessed with Beck Depression Inventory (BDI), sexual functions with Female Sexual Function Index (FSFI), muscle strength with Gross Muscle Scales (GMS), and labor pain with Visual Analogue Scale (VAS). In addition, the presence of low back pain (LBP) was questioned. Results No significant association of CPE & PE with obstetric outcomes such as cesarean rates, preterm birth, and neonatal outcomes such as birth weight and Apgar scores were identified. Changes in VAS scores, the incidence of perineal trauma, and episiotomy were not associated with CPE & PE. However, CPE & PE was associated with lower BDI scores, a gradual increase in the total scores of FSFI, increased GMS, and reduced LBP. Conclusion CPE & PE had no adverse effects on obstetric and neonatal outcomes and was associated with improved mental, physical, sexual health scores during pregnancy and postpartum.
... 5 The incidence of dyspareunia increases after childbirth, and postpartum pelvic floor or perineal pain persists for more than a year for a significant percentage of mothers. 6 Recent studies have reported that, at 12 months postpartum, the prevalence of perineal pain and dyspareunia are 10%-12% and 22%-38%, respectively. [7][8][9] Additionally, the severity of perineal injury at birth affects postpartum perineal pain, dyspareunia, and sexual function. ...
Article
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Introduction Pelvic floor pain and dyspareunia are both important entities of postpartum pelvic pain, often concomitant and associated with perineal tears during vaginal delivery. The association between postpartum sonographic anal sphincter defects, pelvic floor pain, and dyspareunia has not been fully established. We aimed to determine the prevalence of postpartum anal sphincter defects using three‐dimensional endoanal ultrasonography (3D‐EAUS) and evaluate their association with symptoms of pelvic floor pain and dyspareunia. Material and methods This prospective cohort study followed 239 primiparas from birth to 12 months post delivery. Anal sphincters were assessed with 3D‐EAUS 3 months postpartum, and self‐reported pelvic floor function data were obtained using a web‐based questionnaire distributed 1 year after delivery. Descriptive statistics were compared between the patients with and without sonographic defects, and the association between sonographic sphincter defects and outcomes were analyzed using logistic regression. Results At 3 months postpartum, 48/239 (20%) patients had anal sphincter defects on 3D‐EAUS, of which 43 (18%) were not clinically diagnosed with obstetric anal sphincter injury at the time of delivery. Patients with sonographic defects had higher fetal weight than those without defects, and a perineum <2 cm before the suture was a risk factor for defects (odds ratio [OR], 6.9). Patients with sonographic defects had a higher frequency of dyspareunia (OR, 2.4), and pelvic floor pain (OR, 2.3) than those without defects. Conclusions Our results suggest an association between postpartum sonographic anal sphincter defects, pelvic floor pain, and dyspareunia. A perineal height <2 cm, measured by bidigital palpation immediately postdelivery, was a risk factor for sonographic anal sphincter defect. We suggest offering pelvic floor sonography around 3 months postpartum to high‐ risk women to optimize diagnosis and treatment of perineal tears and include perineum <2 cm prior to primary repair as a proposed indication for postpartum follow‐up sonography.
... The relation between mode of delivery and postpartum dyspareunia, according to our study, is significant (p˂0.001). This finding is apposed by Barrett G et al [8] & Dabiri F et al [9] results. Postpartum dyspareunia is significantly associated with episiotomy, infection, scar tissue formation at episiotomy site. ...
... In the literature, the frequency of postpartum sexual dysfunction is approximately 70-80% in the first 3 months and 30-60% in the 6 th month. In more than one third of women (38%), postpartum sexual life does not reach pre-pregnancy levels (4,5). ...
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Objective: Postpartum sexual functions may be affected in women who have had a vaginal delivery by performing an episiotomy. The aim of this study is to compare the frequency of sexual dysfunction between women who were delivered with a mediolateral episiotomy and those who were delivered without an episiotomy. Method: A total of 179 women who gave birth in a tertiary center were included in the prospective study. The patients were divided into two groups as women with and without mediolateral episiotomy. The groups were compared in terms of age, body mass index, educational status, duration of active phase of labor and Arizona sexual experiences scale (ASEX). Mediolateral episiotomy increases the risk of sexual dysfunction. Results: Labor and duration of active phase of labor are associated with sexual dysfunction in patients undergoing mediolateral episiotomy (p<0.001 and p=0.01, respectively). But the duration of delivery is not an independent factor. However, performing an episiotomy increases the risk of sexual dysfunction 2.5 times (odds ratio: 2.35, confidence interval: 1.45-3.83, p=0.001). In evalutaion of ASEX subscores according to the presence of episitomy; patients with episiotomy had significantly higher scores in sex drive, ability to reach orgasm and satisfaction from the orgasm (p<0.001 for all). Besides arousal and lubrication was not affected by presence of episiotomy. Conclusion: According to the results of our study, performing mediolateral episiotomy during vaginal delivery increases the frequency of sexual dysfunction in postpartum women. Amaç: Bu çalışmanın amacı, mediolateral epizyotomi ile doğum yapan kadınlar ile epizyotomi yapılmadan doğum yapan kadınlar arasındaki cinsel işlev bozukluğu sıklığını karşılaştırmaktır. Yöntem: Bu prospektif çalışmaya üçüncü basamak bir merkezde doğum yapan toplam 179 kadın dahil edildi. Hastalar mediolateral epizyotomi yapılan ve yapılmadan vajinal doğum yapan kadınlar olarak iki gruba ayrıldı. Gruplar yaş, vücut kitle indeksi, eğitim durumu, doğum için hastanede kalış süresi ve Arizona cinsel deneyimler ölçeği (ASEX) açısından karşılaştırıldı. Bulgular: Mediolateral epizyotomi uygulanan hastalarda doğum eylemi ve doğum süresi cinsel işlev bozukluğu ile ilişkili bulundu (sırasıyla p<0,001 ve p=0,01). Ancak doğum için geçen süre seksüel disfonksiyon açısından bağımsız bir faktör değildir. Ancak epizyotomi yapılması cinsel işlev bozukluğu riskini 2,5 kat artırmaktadır. (olasılık oranı: 2.35, güven aralığı: 1,45-3,83, p=0,001). ASEX subskorlarının epizitomi varlığına göre değerlendirilmesinde; epizyotomili hastaların cinsel dürtü, orgazma ulaşma ve orgazmdan tatmin olma puanları anlamlı olarak daha yüksekti (tümü için p<0,001). Ayrıca epizyotomi yapılanlarda cinsel uyarılma ve lubrikasyon etkilenmedi. Sonuç: Çalışmamızın sonuçlarına göre vajinal doğum sırasında mediolateral epizyotomi yapılması, doğum sonrası kadınlarda cinsel işlev bozukluğu sıklığını artırmaktadır. Anahtar kelimeler: Arizona cinsel deneyimler ölçeği, cinsel işlev bozukluğu, epizyotomi, mediolateral epizyotomi Abstract Öz
... Obstetric anal sphincter injury (OASI) has an incidence rate of 3% ranging from 3-6% in primiparous women and 0. 8-1.7% in multiparous women (1,2). Damage to the anal sphincter complex can have devasting effects on quality of life due to faecal incontinence (FI), perineal pain and dyspareunia (3)(4)(5)(6). ...
Article
Problem: Little is known about the influences on postnatal sexual health conversations from the midwife’s perspective. Background: Women frequently experience sexual health challenges in the postnatal period. Women have stated that midwives do not enquire about postnatal sexual health challenges, and when concerns are raised, unhelpful advice is received. The lack of recognition from midwives leaves women feeling isolated, ashamed, and as though their experiences are abnormal. Question: What are Australian midwives’ experiences providing sexual health information to women in the postnatal period? Methods: A qualitative descriptive study utilising purposive sampling and individualised semi-structured interviews to collect data from registered midwives (n=7) working across various contexts in Australia. Data was analysed using Braun and Clarke’s method. Findings: Four major themes were identified from the data: 1) The medicalisation of birth, 2) Postnatal sexual health: It’s complicated, 3) In our interest but whose responsibility? And 4) Enhancing the provision of postnatal sexual health information. Discussion: Although the midwife participants acknowledged the importance of discussing postnatal sexual health, the findings of this study highlight the various barriers Australian midwives face when providing sexual health information to postnatal women. Conclusion: There are various influences on a midwife’s ability to provide sexual health information to women in the postnatal period. The barriers of the medical system, inadequate training and professional development and an undefined role in sexual health create challenges for Australian midwives to effectively provide sexual health information.
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Introduction Symptoms after second-degree tears and in particular episiotomies are common. Our aim was to investigate the prevalence and degree of dyspareunia and level of satisfaction with the outcome of the perineal repair after a spontaneous second-degree tear compared to an episiotomy. Further, we aimed to identify risk factors for dyspareunia and dissatisfaction with the outcome. Material and methods This register-based cohort study included 5 328 primiparous women who sustained a spontaneous second-degree tear (n = 4 323) or an episiotomy (n = 1005) between 2014 and 2019 in Sweden. The primary outcomes were self-reported degree of dyspareunia and level of satisfaction with the outcome of the perineal repair at one year. Data were collected from national health and quality registers and online questionnaires at eight weeks and one year. Logistic regression was used and results are presented by Odds Ratios (OR) with 95% confidence intervals (CI) after adjustment for age, body mass index and mode of delivery. Results 30.0% of women with a spontaneous tear and 29.1% of women with an episiotomy reported mild or moderate dyspareunia, while 2.4% of women with a spontaneous tear compared to 3.8% of women with an episiotomy reported strong or unbearable dyspareunia (aOR 1.5; CI 0.9–2.4). 73.4% of women with a spontaneous tear and 67.1% with episiotomy were satisfied or very satisfied with their outcome, while 6.7% with an episiotomy compared to 3.7% with a spontaneous tear were dissatisfied (aOR 1.8; CI 1.2–2.6). Postpartum infection, scar dehiscence, re-suturing and perineal pain at eight weeks were risk factors for dyspareunia and dissatisfaction at one year. Conclusions Approximately one-third of women with either a spontaneous tear or an episiotomy reported mild or moderate dyspareunia at one year, while strong or unbearable pain was uncommon in both groups. The majority of women were satisfied or very satisfied with the outcome although episiotomy more often predicted dissatisfaction.
Article
Background The genitourinary syndrome of menopause (GSM) is a well-documented condition characterized by a range of genitourinary symptoms in peri- and postmenopausal women. As with GSM, postpartum lactating women experience reduced estrogen and androgen levels. However, there is limited research on the impact of symptoms during the postpartum breastfeeding period. Objectives The aim was to review the literature for genitourinary health in the postpartum breastfeeding population and summarize key findings and potential treatments. Methods We performed a comprehensive literature review in PubMed, Google Scholar, and Scopus from inception of database to November 2023 using the following keywords individually and in combination: “physiology of postpartum” or “physiology of lactogenesis” or “vulvovaginal health” or “vaginal atrophy” or “vaginal dryness” or “dyspareunia” or “urinary incontinence” or “lactation” or “breastfeeding” or “vaginal estrogen.” All identified articles published in English were considered. Relevant studies were extracted, evaluated, and analyzed. The work presented in this article represents a summative review of the identified literature. Results During lactation, high levels of prolactin inhibit estrogen and androgen secretion via negative feedback, which leads to an increased prevalence of vulvovaginal atrophy, vaginal dryness, dyspareunia, and urinary incontinence in lactating postpartum women. Despite these highly prevalent and potentially devastating symptoms, there is a lack of consistent screening at postpartum visits and no treatment guidelines available to health care providers. Conclusion Postpartum breastfeeding women experience similar physiology and symptoms to the postmenopausal phase, as seen in GSM. We propose the introduction of a novel term to describe the genitourinary changes seen in postpartum breastfeeding individuals: genitourinary syndrome of lactation. The diagnostic use of genitourinary syndrome of lactation will equip health care providers with an all-encompassing term to bring awareness to the symptoms experienced by postpartum breastfeeding individuals and lead to improved screening and treatment for the high numbers of individuals experiencing these genitourinary changes.
Chapter
Patient Reported Outcomes (PROs) and Measures (PROMs) are important tools for assessing and monitoring the physical, psychological, and social impact of childbirth on pelvic floor function and associated quality of life. A range of PROMs have been developed and are in use across many domains of pelvic floor and associated function, however, it is important to understand whether they have been validated, and in what cohorts, to ensure the PROMs are relevant, valid and provide meaningful information, whether used in a research or clinical setting. This chapter reviews the role and validation process for PROMs in childbirth-related pelvic floor trauma (CBRPFT), the domains of postpartum function included in the currently available PROMs and guidance for their use.
Chapter
For most women, sexuality is affected at some point in the peripartum. Sexual function declines in pregnancy, reaching a nadir in the third trimester, and for some women sexual function continues to be compromised for more than a year and a half after birth. These changes in sexual function become dysfunction, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), when they result in personal distress. There are many established risk factors contributing to the development of sexual dysfunction postpartum and include operative vaginal birth, higher order perineal lacerations, breastfeeding and depression. Other contributing factors include waning pregnancy hormones, disrupted sleep, stress, body image changes, relationship factors, sequelae from birth, and concurrent pelvic floor dysfunction. It is important for an obstetric provider to offer anticipatory guidance on changing sexual function antepartum and revisit sexual function postpartum, as patients may not voluntarily disclose their concerns otherwise. When sexual dysfunction and/or dyspareunia are identified, a patient-centered approach to discussing the natural history, individualized goals, and tailored therapies is essential to helping women achieve healthy, satisfying sexual relationships.
Chapter
Many new mothers experience at least one health problem in the first 8 weeks postpartum, and these problems can persist for up to 18 months after birth. Unfortunately, most women do not consult a health professional and suffer in silence. In this chapter, we address common issues in the postpartum period including management of perineal pain, haematomas, anal fissures, haemorrhoids, constipation, and urinary retention. Similarly, we address the management of pelvic floor disorders in the peripartum period including urinary incontinence, faecal incontinence and pelvic organ prolapse. Lastly, we present data supporting the need and benefit of specialised maternal perineal/maternal recovery clinics.
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Sexual health is a vital part of physical, emotional, and relational well-being among adults across the life span. While patients are reluctant to discuss their sexual concerns, Obstetrics and Gynecology providers are especially well positioned to improve sexual functioning and satisfaction through screening, education, prevention and early intervention, treatment, and integrating behavioral health and sexual medicine services in their clinical practices. This article sets out to provide applied information and perspectives to foster the development of interprofessional sexual medicine services in Obstetrics and Gynecology practices in hospital and community settings.
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Objectives The objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors. Design A longitudinal study with follow-ups from 42 days to 6 months after delivery. Settings and participants A total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis. Methods Postpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation. Results Postpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (β=0.028, p=0.049), higher education level (β=0.153, p=0.005) and higher body mass index (BMI) (β=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (β=0.030, p=0.033) and 6 months (β=0.050, p<0.001) in the dimension of personal needs and fatigue. Postpartum stress levels were significantly higher in women with depression or anxiety symptoms. Conclusions Postpartum stress continuously declined from 42 days to 6 months after delivery. Postpartum women with older age, higher education levels, higher BMI and anxiety or depression symptoms should be the target population for early intervention.
Article
Introduction and hypothesis: Antenatal perineal massage for obstetric anal sphincter injury prevention is not routinely performed in Thailand. Due to the cultural conservatism in the country, attitudes and acceptability need to be evaluated before procedure implementation. This research was conducted to evaluate knowledge, attitudes, and acceptability of antenatal perineal massage and identify associated factors for acceptability in antenatal perineal massage among Thai pregnant women. Methods: A cross-sectional study was conducted in the antenatal clinic at King Chulalongkorn Memorial Hospital, Bangkok, Thailand between July 2021 and June 2022. Thai women with singleton pregnancies at 22 weeks or more of gestation without an indication for cesarean section were enrolled. Knowledge, attitudes, and acceptability of antenatal perineal massage were assessed using a self-administered questionnaire. In-depth interviews with pregnant women who were not interested in antenatal perineal massage were also completed. Results: A total of 144 pregnant women were enrolled with 119 participants (83%) having an accepting attitude about antenatal perineal massage. Results on knowledge included 22 (15%) participants aware of this practice, 46 participants (31.9%) knew it should be practiced after GA 34 weeks, 52 participants (36.1%) knew the massage should be maintained for 5-10 min, and 37 participants (25.7%) knew it should be performed daily. Factors associated with acceptability of antenatal perineal massage were prior interest in perineal massage and trust in the benefit of the perineal massage in facilitating vaginal delivery. Reasons for disagreeing in antenatal perineal massage included never hearing of perineal massage, concern about pregnancy complications, fear of pain, believing it to be a useless procedure, and previous successful vaginal delivery. Conclusions: We found high acceptability for antenatal perineal massage. This program should be routinely explained and offered to Thai pregnant women to prevent severe perineal trauma and postpartum complications.
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Purpose: Childbirth is a known risk factor for postpartum sexual dysfunction. Perineal massage and warm compresses technique during second stage of labor could reduce perineal trauma. However, women experience perineal pain and dyspareunia regardless of the presence or absence of perineal trauma after spontaneous vaginal birth. Although the influence of this perineal technique protection in sexual dysfunction never was investigated. Compare postpartum sexual function in women undergoing combined perineal massage and warm compresses and those undergoing hands-on technique during second stage of labor. Methods: An randomised controlled trial (PeMWaC - Perineal Massage and Warm Compresses) was enrolled at Hospital of Braga from March 1st, 2019 to December 31st, 2020. Eight hundred forty eight women were recruited, of whom 496 (62%) completed the Female Sexual Function Index (FSFI) at 3 and 6 months postpartum. A sub-analisys of primary data was performed to assess postpartum sexual dysfunction the FSFI Score was applied at 3 and 6 months postpartum. Sexual dysfunction was defined by FSFI score <26.55. Results: At 3 months postpartum, overall FSFI scores were not statistically different between the intervention and control groups. When evaluating by each FSFI domain, satisfaction domain had significant lower scores in satisfaction (p=0.048) at 3 months postpartum. At 6 months postpartum, overall FSFI scores were not statistically different between the intervention and control groups. The perineal trauma in relation to perineal protection techniques was not significantly associated with sexual dysfunction at 3 and 6 months postpartum. FSFI scores at 3 or 6 months postpartum was not statistically different between exclusive breastfeed and not exclusive breastfeed women. Conclusion: PeMWac was not associated with postpartum sexual dysfunction.
Article
Introduction and hypothesis: Persistent sexual dysfunction (SD) after childbirth is common, but many patients do not receive adequate care, for unknown reasons. The aim of this study is to examine correlates for health care-seeking behavior for SD within 3 years after birth. Methods: Subjects filled out an electronic survey regarding sexual function, obstetric, relationship, and demographic characteristics. The Sexual Function Questionnaire's Medical Impact Scale) as well as a number of novel, targeted survey questions were used to measure the impact of childbirth on sexual function. Patients were stratified into those without SD, and those with SD, both seeking and not seeking care. These domains were then compared in a series of univariate, bivariate, and multivariate analyses. Results: Of 531 patients who completed the survey, 449 women (84.5%) reported some form of SD after birth. Only 16.0% of those with SD sought care for SD. Variables associated with care seeking include difficulty with perineal healing (adjusted odds ratio [aOR]=4.53, 95% confidence interval [CI]: 1.54-13.38), transfusion after birth (aOR=3.71, 95% CI: 1.44-9.56), current dyspareunia (aOR=3.41, 95% CI: 1.31-8.87). Factors associated with decreased probability of seeking care include children under 18 years in the home (aOR=0.61 per child, 95% CI: 0.43-0.88), number of cesarean births (aOR=0.46 per delivery, 95% CI: 0.29-0.74). Conclusions: This study highlights that many more women suffer from SD after childbirth than seek care, and identified several important risk factors associated with decreased care seeking. Future work should focus on decreasing the difficulty of accessing care for SD after childbirth.
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Episiotomy is one of the most commonly performed operative procedures and yet little information is available on the subjective reactions in the puerperium to this procedure. The present study was designed to furnish information on the attitudes of patients, levels of pain, and of course recovery by studying a consecutive series of 101 Caucasian primiparea who received episiotomies at delivery. Women were interviewed within 24 hours of delivery and then, at three months after delivery, completed a questionnaire. The high level of pain experienced was noteworthy. Labour pain and episiotomy pain were uncorrelated, indicating the importance of distinguishing between them. Several women were experiencing problems at the three-month follow-up, with some attributing these to the episiotomy repair. The data are presented in the framework of providing women in the postpartum period with systematic information on the nature of postepisiotomy pain and subsequent recovery to facilitate their adjustment.
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One thousand women were allocated at random to one of two perineal management policies, both intended to minimise trauma during spontaneous vaginal delivery. In one the aim was to restrict episiotomy to fetal indications; in the other the operation was to be used more liberally to prevent perineal tears. The resultant episiotomy rates were 10% and 51% respectively. An intact perineum was more common among those allocated to the restrictive policy. This group experienced more perineal and labial tears, however, and included four of the five cases of severe trauma. There were no significant differences between the two groups either in neonatal state or in maternal pain and urinary symptoms 10 days and three months post partum. Women allocated to the restrictive policy were more likely to have resumed sexual intercourse within a month after delivery. These findings provide little support either for liberal use of episiotomy or for claims that reduced use of the operation decreases postpartum morbidity.
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The sexuality of Kuwaiti Muslim women before pregnancy, during pregnancy, and 6 months after childbirth was studied. A group of 220 women attending the prenatal clinic of the Maternity Hospital Kuwait were randomly selected; 40 (18.2%) declined at the outset, 10 (4.6%) withdrew due to miscarriage and 10 (4.6%) due to failure to attend interviews. The semistructured interview was conducted by a female obstetrician at 4-week intervals starting from 12 weeks pregnancy to 6 months after childbirth. The study led to the following observations: (i) All the women were religious and abided by the Islamic rules and way of life. (ii) The diagnosis of pregnancy led to a decline in sexuality that continued throughout the pregnancy, with a second and early third trimester increase in sexuality but still below the prepregnancy baseline. (iii) Each woman had a consistent pattern of sexuality during pregnancy reflecting her prepregnancy level of sexuality. (iv) Younger age group, multiparity, low-level of education, lesser duration of marriage, and intention of breast-feeding characterized the sexuality pattern positively, as did attitudes towards sexuality during pregnancy and after childbirth. Breast-feeding mothers exceeded their prepregnancy level of sexuality earlier than bottle-feeding mothers.
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Objective: Our purpose was to compare consequences for women of receiving versus not receiving median episiotomy early and 3 months post partum on the outcomes perineal pain, urinary and pelvic floor functioning by electromyography, and sexual functioning and to analyze the relationship between episiotomy and third- and fourth-degree tears. Study design: A secondary cohort analysis was performed of participants within a randomized clinical trial, analyzed by type of perineal trauma and pain, pelvic floor, and sexual consequences of such trauma, while controlling for trial arm. The study was conducted in three university or community hospitals; 356 primiparous and 341 multiparous women were studied. Results: Early and 3-month-postpartum perineal pain was least for women who gave birth with an intact perineum. Spontaneous perineal tears were less painful than episiotomy. Sexual functioning was best for women with an intact perineum or perineal tears. Postpartum urinary and pelvic floor symptoms were similar in all perineal groups. At 3 months post partum those delivered with an intact perineum had the strongest pelvic floor musculature, those with episiotomy the weakest. Among primiparous women third- and fourth-degree tears were associated with median episiotomy (46/47). After forceps births were removed and 21 other variables potentially associated within such tears were controlled for, episiotomy was strongly associated with third- and fourth-degree tears (odds ratio +22.08, 95% confidence interval 2.84 to 171.53). Physicians using episiotomy at high rates also used other procedures, including cesarean section, more frequently. Conclusion: Perineal and pelvic floor morbidity was greatest among women receiving median episiotomy versus those remaining intact or sustaining spontaneous perineal tears. Median episiotomy was causally related to third- and fourth-degree tears. Those using episiotomy at the highest rates were more likely use other interventions as well. Episiotomy use should be restricted to specified fetal-maternal indications.
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In a two-stage screening procedure using the Edinburgh Postnatal Depression Scale and Goldberg's Standardised Psychiatric Interview, 232 women six months after delivery were compared with control women individually matched for age, marital status and number of children, obtained from general practitioner lists, who were not pregnant nor had had a baby in the previous 12 months. No significant difference in the point prevalence of depression at six months was found between the postnatal (9.1%) and control women (8.2%) nor in the six-month period prevalence (13.8% postnatal, 13.4% controls), but a threefold higher rate of onset of depression was found within five weeks of childbirth. The possible explanations relate to the long duration of depression in women with young children, and the stressful effect of childbirth and its psychosocial sequelae.
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To investigate the factors associated with long term backache after childbirth, to assess all women reporting new onset long term backache, and to investigate any relation with pain relief in labour. Data collected from obstetric records and postal questionnaires or telephone interviews on morbidity after childbirth from all women delivering their first baby between March 1990 and February 1991, followed by analysis of data collected from outpatient consultations. St Thomas's Hospital, London. Questionnaires were sent to 1615 women who had delivered their first baby in the defined period; 1015 either replied by post or were contacted by telephone. 299 women (29.5% of responders) reported backache lasting more than six months and of these 156 (15.4%) said they had had no back problems previously. Those women who had received epidural analgesia in labour were significantly more likely to report new onset backache (17.8%; 95% confidence interval 14.8% to 20.8%) than those who did not (11.7%; 8.6% to 14.8%). Younger women, unmarried women, and those reporting other antenatal symptoms were significantly more likely to report new long term backache. The 156 women reporting new backache were asked to attend an outpatient clinic and 36 (23%) did so. The majority had a postural backache which was not severe. Psychological factors were present in 14 women. Though new long term backache is reported more commonly after epidural analgesia in labour, it tends to be postural and not severe. There were no differences in the nature of the backache between those who had or had not received epidural analgesia in labour.
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A pilot study was carried out investigating women's sexual health in the postnatal period. Postal questionnaires were sent to a cohort of 158 primiparous women approximately 7 months after delivery. Women who had resumed sexual intercourse were asked a detailed set of questions about problems experienced, sexual practices, frequency of intercourse, satisfaction with sex life, and consultation for postnatal sexual problems. All women were asked about the information they received on postnatal health prior to the birth and any information or help and advice they received from health professionals on the subject after the birth. Ninety-eight women (62%) responded. Women experienced significant levels of morbidity in the postnatal period; 3 months after delivery 58% experienced dyspareunia, 39% experienced vaginal dryness, and 44% suffered loss of sexual desire. These figures had reduced to 26, 22, and 35%, respectively, by the time of answering the questionnaire (approximately 8 to 9 months after delivery). Compared to before pregnancy, there was a decrease in frequency and satisfaction with sexual intercourse, although sexual practices changed little. Of the 67 women who reported a postnatal sexual problem, only 19% discussed this with a health professional. Conversations with health professionals in routine postnatal health contacts were mainly about contraception, and only rarely discussed problems with intercourse.
Article
This article shows, for the first time, the extent, severity and effect of health problems experienced after childbirth. It also confirms the findings of earlier studies with regard to the high levels of morbidity persisting after birth.
Article
A sample of 25 primiparous women recorded feeding patterns and sexual activity in weekly diaries for six months post partum. Six women discontinued breast feeding before six weeks. None of their babies woke for a night feed at 24 weeks compared with nine breast fed babies. Sexual activity declined during pregnancy and returned slowly after childbirth. A reduction in sexual interest compared with pre-pregnancy levels was reported by 16 mothers and six (all breast feeders) reported severe loss. Mothers whose babies continued waking for a night feed had slower resumption of sexual intercourse.
Article
Twice during pregnancy and at one and six months postnatally, 70 couples of mixed parity completed questionnaires which included several marital variables. Although there was a tendency for affection to decrease between first-time parents, the greatest overall change was in interdependence patterns. The resolution of dependency needs was shown to be a challenge for several months after the birth. Only women married less than five years experienced significant change in sexual interest; and there was a trend toward a more egalitarian balance in dominance patterns during pregnancy. It was concluded that every pregnancy poses a challenge to the parental relationship.
Article
The pattern of sexuality during the third trimester of pregnancy and early puerperium were investigated prospectively in 342 white women attending the Maternity section of the J. G. Strijdom Hospital, in Johannesburg. The data were compared to the immediate prepregnant period, information that was retrospectively obtained before the 12th week of gestation. The response rate was 81.6% during the third trimester of pregnancy (between 30 and 40 weeks gestation) and 53.4% at the 6-week postpartum check up visit. Sexual enjoyment, libido, orgasm and frequency of sexual intercourse all decreased significantly late in pregnancy and during the early puerperium, when compared to the immediate prepregnant period. The magnitude of the decrease, in the present study, ranged from 9.03 to 16.51% late in pregnancy and 3.8 to 11.68% during the early puerperium. The pregnant and puerperal women perceived acutely the change in their sexual life observed during the investigated periods. The multivariate analysis performed allows us to conclude that marital status, age and parity did not influence the pattern of sexuality found in the late pregnancy and early puerperium.
Article
Yes, as long as the woman is fully informedSara Paterson-Brown, consultant in obstetrics and gynaecology (s.paterson-brown@rpms.ac.uk)Queen Charlotte's and Chelsea Hospital, London W6 0XGDepartment of Obstetrics and Gynaecology, Leicester General Hospital, Leicester LE5 4PWDepartment of Obstetrics and Gynaecology, Grimsby Hospital, Grimsby DN33 2BASurgery is performed by doctors when they believe it is clinically justified and in accordance with accepted medical practice. In obstetrics an elective caesarean section in an uncomplicated pregnancy has traditionally been considered inappropriate, and any request for such a procedure has been refused.1 However, the view that this procedure is clinically unjustifiable has been challenged,2 and over the past decade or so prophylactic caesarean section has been gaining credence. 3 4 The balance of benefit versus harm between caesarean section and vaginal delivery is crucial to this debate; although the evidence is incomplete, it challenges the dogma that vaginal delivery is almost always better.Evidence of risksThe strongest argument against caesarean section relates to maternal complications. However, evidence supporting this for elective operations under regional blockade with antibiotic cover and thromboprophylaxis is poor. Data on mortality from caesarean section relate to procedures performed for medical or obstetric reasons, often emergencies and often under general anaesthesia. 5 6 These are not comparable to the elective procedure, which most practising obstetricians consider safe. Recent evidence of maternal morbidity after caesarean section and normal and instrumental vaginal delivery challenges some deep rooted obstetric and midwifery teachings: normal vaginal deliveries can cause damage to the pelvic floor,7 and instrumental vaginal deliveries are associated with slower recovery8 and greater pelvic floor damage and incontinence9 than normal delivery and caesarean section. Previous caesarean section does compromise future obstetric performance, 10 11 but evidence is limited and, with reduced family size, this has … Correspondence to: Dr Bolaji
Article
Objective To examine the relation between obstetric factors and the prevalence of urinary incontinence three months after delivery. Design 2134 postal questionnaires sent between August 1989 and June 1991. Setting Teaching hospital in Dunedin, New Zealand. Subjects All women three months postpartum who were resident in the Dunedin area. Main outcome measure Prevalence of urinary incontinence. Results 1505 questionnaires were returned (70.5% response rate). At three months postpartum 34.3% of women admitted to some degree of urinary incontinence with 3.3% having daily or more frequent leakage. There was a significant reduction in the prevalence of incontinence for women having a caesarean section, in particular in primiparous women with a history of no previous incontinence (prevalence of incontinence following a vaginal delivery 24.5%, following a caesarean section 5.2% P = 0.002). There was little difference between elective caesarean sections and those carried out in the first and second stages of labour. The odds ratios for women having a caesarean section were 0.4 (95% confidence interval (CI) 0.2–0.7) (all women and all primiparae) and 02 (95% CI 0.0–0.6) (primipara with no previous incontinence) in comparison with those having a normal vaginal delivery. The prevalence of incontinence was also significantly lower in women having had two caesarean sections (23.3%; P = 0.05) but similar in those women having three or more caesarean sections (38.9 YO) in comparison with those women who delivered vaginally (37.7%). Other significant independent odds ratios were found for daily antenatal pelvic floor exercises (PFE) (0.6, 95% CI 0.4–09), parity ≥5 (2.2, 95% CI 1.0–4.9) and pre‐pregnancy body mass index (1.07, 95% CI 1.04–1.10). Conclusions Adverse risk factors for urinary incontinence at three months postpartum are vaginal delivery, obesity and multiparity (2 5). Caesarean section and daily antenatal PFE appear to be protective, although not completely so.
Article
To describe the prevalence of maternal physical and emotional health problems six to seven months after birth. Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth. All women who gave birth in a two-week period in Victoria, Australia in September 1993 except those who had a stillbirth or known neonatal death. The response rate was 62.5% (n = 1336). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of nonEnglish speaking background were under-represented. One or more health problems in the first six postnatal months were reported by 94% of the women; a quarter had not talked to a health professional about their own health since the birth. Of women reporting health problems, 49% would have liked more help or advice. The most common health problems were tiredness (69%), backache (43.5%), sexual problems (26.3%), haemorrhoids (24.6%) and perineal pain (21%); 16.9% of women scored as depressed. Compared with spontaneous vaginal births, women having forceps or ventouse extraction had increased odds for perineal pain (OR 4.69 [95% CI 3.2-6.8]), sexual problems (OR 2.06 [95% CI 1.4-3.0]), and urinary incontinence (OR 1.81 [95% CI 1.1-2.9]). These differences remained significant after adjusting for infant birthweight, length of labour and degree of perineal trauma. Physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them.
Article
To assess the influence of various risk factors on long term anal incontinence in women with a complete obstetric tear of the anal sphincter. Postal questionnaire. Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark. 152 women with complete obstetric tear of the anal sphincter. Occurrence and duration of anal incontinence in relation to any delivery. 56 of 121 respondents had experienced a subsequent vaginal delivery; 23 (41%) of these had had transient anorectal incontinence directly after the complete tear and four (7%) had permanent anorectal incontinence. In the 23 women with transient anorectal incontinence directly after the complete tear, 9 (39%; 95% CI 19%-59%) developed anorectal incontinence after the next delivery, and this was permanent in four (17.4%; 95% CI 2%-33%). In the 29 women without anorectal incontinence after complete tear, two had transient incontinence of flatus but for less than 14 days after the next delivery. Transient anal incontinence after a complete tear is a predictor of anal incontinence after subsequent vaginal delivery. The major long term problem in our study of premenopausal women was incontinence of flatus. This possibility should be discussed with the women when a further pregnancy is planned.
Article
The aim was to investigate the possible association between parity, as indicated by the number of childbirths, and prevalence of urinary incontinence in an adult female population sample. A sample of 3114 women aged 30-59 years was selected at random from the population of Aarhus, Denmark, and mailed a self administered questionnaire on urinary incontinence and, among other things, parity. A total of 2631 questionnaires was returned (85%) with a slight but significant decrease in respondency by age. The 1987 urinary incontinence period prevalence was 17%. Seventy eight percent were parous, and 24% had had three or more childbirths. In women aged 30-44 years, the prevalence of urinary incontinence was found to be associated with parity and, in women aged 45 years and more, with three or more childbirths. In parous women 30-44 years of age, the prevalence of urinary incontinence increased with age at least childbirth and, in women aged 45 years and over, it increased with increasing parity but decreased with increasing age at first childbirth. In parous women, no association was found with time since last childbirth. Among clinical types of urinary incontinence, stress incontinence consistently showed the strongest associations with indicators of parity. In women aged 30-44 years, nearly two thirds of the 1987 prevalence of stress incontinence could be attributed to parity. These findings support the hypothesis that pregnancy and childbirth are potent causes of female urinary incontinence, so that they exert considerable impact on the level of population urinary incontinence prevalence. In the individual woman, the effect seems to be cumulative and long lasting but fades with age.
Article
Urinary leakage was reported in 53.5% of our patients at least once during pregnancy. Multigravidae and women older than 30 were affected more often than primigravidae or women younger than 30. 6.2% of all women, who were continent before pregnancy, developed permanent stress incontinence after vaginal delivery. As a conclusion, it can be said, that vaginal delivery itself predisposes for permanent stress urinary incontinence (SUI). Factors, which increase the trauma to the pelvic floor (tear, no episiotomy, forceps or vacuum extraction), show a higher incidence of postpartum persisting SUI without statistic significance. Labour management with epidural anaesthesia showed a statistically proven lower incidence of postpartum persisting SUI in comparison to the pudendal block.
Article
This prospective study examined the time for 93 women to cease to feel discomfort in their perineal areas after the births of their first babies. Sixty-two of the women had experienced a spontaneous delivery that did not require forceps assistance. In 58 patients, an episiotomy was performed. Of the 35 women in whom an episiotomy was not performed, 24 women required sutures and only four women did not suffer any perineal damage. The median time for perineal comfort in general (including walking and sitting) was one month (range, zero to six months); 20% of women took more than two months to achieve general perineal comfort. For comfort during sexual intercourse, the median time was three months (range, one to more than 12 months); 20% of women took longer than six months to achieve comfort during sexual intercourse. Factors that were associated with discomfort for longer than the median time were delivery by forceps; spontaneous vaginal (not perineal) tears; and, in the three to four days after the birth, oedema and the breakdown of muscle or skin sutures. There was no significant difference in these times between patients who did not undergo an episiotomy and those who underwent an episiotomy without a forceps delivery.
Article
Women who had participated in a randomised controlled trial of policies of restricted (10%) versus liberal (51%) episiotomy during spontaneous vaginal delivery were recontacted by postal questionnaire three years after delivery. Altogether 674 out of 1000 responded, and there was no evidence of a differential response rate between the two trial groups. Similar numbers of women in the two groups reported further deliveries, almost all of which had been vaginal and spontaneous. Fewer women allocated to restrictive use of episiotomy required perineal suturing after subsequent delivery, but this difference was not significant. Pain during sexual intercourse and incontinence of urine were equally reported in the two groups. The similarity in incontinence rates persisted when severity, type of incontinence, and subsequent deliveries were taken into account. Liberal use of episiotomy does not seem to prevent urinary incontinence or increase long term dyspareunia.
Article
Sexual function following childbirth was studied by means of a retrospective postal questionnaire. Dyspareunia measured on an analogue scale relative to pre-pregnancy values (mean values) was significantly greater three months after a mediolateral episiotomy (35%) than after vaginal delivery with intact perineum (9%) or Caesarean Section (16%) and similar to the value following second degree perineal laceration (29%). At 12 months the latter had returned to pre-pregnancy values, while that following episiotomy remained significantly elevated (17%).
Article
The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.
Article
The postpartum period is one of sexual adjustment for parents. A prospective study of a convenience sample of 194 women ascertained their perceptions of physical, social, and emotional aspects of spousal relationships at one, three, and six months postpartum. Attrition resulted in 131, 114, and 104 women remaining in the study at those time periods, respectively. Open-ended questions and rating scales were self-administered in the women's homes and returned in the stamped, addressed envelopes provided. Although perceptions of the spousal relationships changed little, sexual interest of the women declined over six months. The few women who responded to these questions felt positively about their mates' changed sexual interest in them. Of these women, the majority felt that breastfeeding did not affect their sexual enjoyment. At three and six months postpartum, the condom was the contraceptive method most frequently reported.
Article
Of 25 primiparous women, investigated prospectively for six months post-partum, 19 persisted with breast feeding and six changed to artificial during the first six weeks. Sexual activity, mood, and feeding patterns were recorded in weekly diaries. Hormones were measured from weekly urine samples (oestrogen and pregnanediol) and fortnightly blood samples (prolactin, testosterone, androstenedione, and sex hormone binding globulin). In breast-feeding women, testosterone and androstenedione levels were significantly lower in those who reported severe reduction in sexual interest. Changes in sexuality or mood were not related to levels of prolactin or oestrogen, or to the return of follicular activity, which was delayed in persistent breast feeders. The relationships of mood, sexuality, and hormones are discussed.
Article
Ratings of sexual behaviour and feelings were obtained regularly from subjects of a longitudinal study of psychiatric status and psychological change in pregnancy and the first postnatal year. The results are consistent with previous research, showing a reduction in frequency of sexual intercourse and in interest and satisfaction with sex over the course of pregnancy. Coitus was resumed after childbirth within six weeks by nearly 60% of women, and within three months by eighty. In most cases, ratings of interest in and satisfaction with sex also returned to early pregnancy levels by three months postnatal. Despite clear trends in the group as a whole there was considerable individual variation, investigated using tests of association with measures of subject characteristics and psychological status.
Article
A group of first-time mothers (119) were interviewed repeatedly at fixed intervals during their pregnancies and until their babies were a year old; they were then followed up at four years. A similar investigation was carried out on 38 other primiparae and 39 multiparae, but only postnatally. The incidence of depressive neurosis rose significantly in early pregnancy and in the first three months after delivery (10 per cent and 14 per cent of the main sample respectively). Subjects mainly suffered either from antenatal or postnatal depression, not both. Marital conflict and severe doubts about having the baby were associated with depression at either time. Bereavement and preterm birth were the only life events to relate with the onset of depression and bereavement had a greater impact during pregnancy. Depressed mothers were more likely to express negative or mixed feelings about their three-month-old babies. Many who had become depressed for the first time in their lives continued to experience psychological problems for up to four years after childbirth.
Article
We interviewed 128 women regularly during pregnancy and the first postnatal year. Psychiatric interviews identified eight 'cases' of psychiatric disorder (6 per cent) in early pregnancy and twenty 'cases' (16 per cent) at six weeks after birth. Postnatal affective disorder, which accounted for 15 of these cases, was significantly associated with dissatisfaction with the marital relationship and also with previous psychiatric history. The implications of the term 'postnatal depression' are considered in terms of the course of the disorder in the 29 women (23 per cent) who had episodes of affective disorder at some time during pregnancy and the postnatal year. We found that the majority of episodes of affective disorder could be understood in terms of previous psychiatric history and/or reaction to life-events, including the stress of childbirth itself.
Article
Episiotomy is one of the most commonly performed operative procedures and yet little information is available on the subjective reactions in the puerperium to this procedure. The present study was designed to furnish information on the attitudes of patients, levels of pain, and of course recovery by studying a consecutive series of 101 Caucasian primiparea who received episiotomies at delivery. Women were interviewed within 24 hours of delivery and then, at three months after delivery, completed a questionnaire. The high level of pain experienced was noteworthy. Labour pain and episiotomy pain were uncorrelated, indicating the importance of distinguishing between them. Several women were experiencing problems at the three-month follow-up, with some attributing these to the episiotomy repair. The data are presented in the framework of providing women in the postpartum period with systematic information on the nature of postepisiotomy pain and subsequent recovery to facilitate their adjustment.
Article
A two-stage cross-sectional community survey has been conducted of non-psychotic psychiatric disorders in women a year after childbirth. In the first stage a sample of 820 women were screened using the General Health Questionnaire. Probable prevalence of psychiatric disorder was estimated as 19.7%. There was a significant association between high scores on the GHQ and being young, unmarried and of lower social class. In the second stage, 71 GHQ probable cases and 71 probable non-cases matched on demographic criteria were interviewed. Most probable cases were suffering from depression and over a third (35%) reported a disorder beginning early in the puerperium and persisting throughout the post-partum year. Factors associated with morbidity were a history of general practitioner consultation for psychiatric symptoms, lack of marital support and reports of a difficult baby.
Article
Information about sexual activity, enjoyment and libido was obtained at intervals from 119 primiparous women during a longitudinal survey of maternal emotional health in pregnancy and for a year after delivery. Most subjects described some reduction in the frequency of sexual intercourse and a diminution of libido and sexual enjoyment during pregnancy; this was most marked in the third trimester. After delivery, about a third of subjects had resumed intercourse by 6 weeks and nearly everyone had done so by 3 months. Nevertheless, 77% of the women were having intercourse less often at 3 months post-natally in comparison with the month before they became pregnant. A few subjects described very marked and persistent reductions in sexuality and, overall, at a year post-natally about a fifth of the sample were having intercourse less than once weekly as compared with 6% in the 3 months before they conceived. Except during the third trimester when most women reported having infrequent or no intercourse, individual levels of sexual activity and enjoyment remained very firmly related to the subjects' own pre-pregnancy “baselines”.Selected variables (personal, social, medical) were examined for relationships with a low, or reduced frequency of intercourse and with a lack of enjoyment. Significant associations were found with particular measures at different times before conception, in pregnancy and post-natally; such variables included aspects of maternal personality and childhood relationships, marital conflict, maternal depression, previous miscarriages, difficulties in conceiving and fears of harming the foetus. Factors such as nausea and vomiting during pregnancy, the mode of delivery and related obstetric and medical variables, breast-feeding, characteristics of the baby, did not appear to significantly influence maternal sexuality.
Article
To describe the prevalence and causes of postnatal maternal morbidity. Questionnaire survey of postnatal patients. Further data extracted from SMR1 returns, case records and the Aberdeen Maternity and Neonatal Databank. Postnatal care in a teaching maternity hospital, midwife delivery hospital, general practitioner maternity units and in the community. Twenty percent random sample of deliveries (1249 women) surveyed one week, eight weeks and 12 to 18 months after delivery. Incidence of self reported maternal morbidity, treatment received, readmission rates and causes for readmission. Of mothers in the sample 85% (99% CI 82-88%) reported at least one health problem in hospital, rising to 87% (84-90%) of those at home; 76% (71-81%) reported at least one health problem after eight weeks post-delivery. Maternal morbidity is extensive and under-recognised after delivery. Measures to reduce and alleviate it must be sought.
Article
Women with postpartum health problems do not readily initiate consultation, making it necessary for those providing care to devise methods by which problems can be identified. By taking detailed accounts of each woman's labour and delivery details when planning postpartum care, some morbidity could be preempted and its effect limited. Postnatal care requires a planned structure which could be modelled on current antenatal care organisation. All women could routinely be seen at three or six months post-delivery. Care could be given by midwives, with referral to GPs where necessary. Fatigue could put women at greater risk of developing postpartum depression, but few women spontaneously report fatigue as a health problem. Limiting the effects of childbirth on maternal health will have important implications for the future use of the medical services.