Persistent Genital and Pelvic Pain after Childbirth
Sex and Couple Therapy Service, McGill University Health Center, Montreal, Quebec, Canada Journal of Sexual Medicine
(Impact Factor: 3.15).
12/2008; 6(1):215 - 221. DOI: 10.1111/j.1743-6109.2008.01063.x
Introduction. Although genital pain and pelvic pain are common and well-documented problems in the early postpartum period, little is known about their course. The few published studies of such pain beyond 1 year postpartum have focused primarily on the perineum and have not assessed pain onset. Aim. To investigate the prevalence and characteristics of all types of genital and pelvic pain in the second year postpartum, and to explore risk factors for their persistence. Methods. Over a 6-month period, a questionnaire on genital/pelvic pain, sociodemographic and childbirth variables, breastfeeding, and chronic pain history was mailed to patients of the collaborating obstetrician at 12 months postpartum. Main Outcome Measures. The prevalence, characteristics, and correlates of persistent genital/pelvic pain with postpartum onset. Results. Almost half of the 114 participants (82% response rate; M = 14 months postpartum) reported a current (18%) or resolved (26%) episode of genital or pelvic pain lasting 3 or more months. Just under one in 10 (9%) mothers continued to experience pain that had begun after they last gave birth. This pain was described at various locations (e.g., vaginal opening and pelvic area), as moderate in intensity and unpleasantness, and most often as burning, cutting, or radiating. Although it was triggered by both sexual and nonsexual activities, none of the mothers affected were receiving treatment. Univariate analyses revealed that only past diagnosis with a nongenital chronic pain condition (e.g., migraine headache) was significantly correlated with (i) any history of chronic genital/pelvic pain or (ii) the persistence of pregnancy- or postpartum-onset genital or pelvic pain. Conclusions. Postpartum genital and pelvic pain persists for longer than a year for a significant percentage of mothers. Women with a history of other chronic pain appear to be particularly vulnerable to developing persistent genital or pelvic pain.
Available from: Liora Kempler
- "During the first few days after childbirth, the breasts begin to produce milk, which is new and often uncomfortable. Genital, pelvic  and back pain  are also common after childbirth, which is known to further disturb sleep . In addition to the physical changes, lifestyle changes and parenting responsibilities also contribute to the potential for sleep disruption. "
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There is a high association between disturbed (poor quality) sleep and depression, which has lead to a consensus that there is a bidirectional relationship between sleep and mood. One time in a woman’s life when sleep is commonly disturbed is during pregnancy and following childbirth. It has been suggested that sleep disturbance is another factor that may contribute to the propensity for women to become depressed in the postpartum period compared to other periods in their life. Post Natal Depression (PND) is common (15.5%) and associated with sleep disturbance, however, no studies have attempted to provide a sleep-focused intervention to pregnant women and assess whether this can improve sleep, and consequently maternal mood post-partum. The primary aim of this research is to determine the efficacy of a brief psychoeducational sleep intervention compared with a control group to improve sleep management, with a view to reduce depressive symptoms in first time mothers.
This randomised controlled trial will recruit 214 first time mothers during the last trimester of their pregnancy. Participants will be randomised to receive either a set of booklets (control group) or a 3hour psychoeducational intervention that focuses on sleep. The primary outcomes of this study are sleep-related, that is sleep quality and sleepiness for ten months following the birth of the baby. The secondary outcome is depressive symptoms. It is hypothesised that participants in the intervention group will have better sleep quality and sleepiness in the postpartum period than women in the control condition. Further, we predict that women who receive the sleep intervention will have lower depression scores postpartum compared with the control group.
This study aims to provide an intervention that will improve maternal sleep in the postpartum period. If sleep can be effectively improved through a brief psychoeducational program, then it may have a protective role in reducing maternal postpartum depressive symptoms.
This trial is registered with the Australian New Zealand Clinical Trials Register under the registration number ACTRN12611000859987
Available from: Ruby H.N. Nguyen
- "The triggering of vulvar pain is a plausible theory because many women report pain with sex during the postpartum period . In fact, a recent report found that women with persistent genital or pelvic pain were at increased risk of having pain for longer than 1 year after delivery . "
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ABSTRACT: Purpose: To examine pregnancy and delivery characteristics of women with and without vulvodynia.
Methods: We analyzed 227 vulvodynia cases that were <45 years old at pain onset; controls were age-matched 1:1 to cases and had no history of vulvar pain. Pregnancy and delivery events were assessed after age at first vulvar pain onset in cases and a matched age in controls (called reference age).
Results: We observed no significant difference between cases and controls in achieving pregnancy after reference age. Also, no difference in pregnancy outcome was observed between cases and controls (p=0.87). There was an indication that cases were more likely to receive a Caesarean-section delivery (p=0.07). In addition, 37.1% of cases who had vaginal delivery versus 11.3% of controls (p <0.01) reported pain at 2 months postpartum. Comparing only women with vulvodynia, women who had intermittent pain versus constant pain were more than twice as likely to have a pregnancy (adj. OR = 2.26, 95% CI: 1.10 – 4.60).
Conclusions: Women with vulvodynia may be as likely as other women to carry their pregnancy to birth, however, they may experience higher rates of Caesarean-section delivery and could reflect a selection towards those women with vulvodynia who have inconsistent pain.
- "Chronic pelvic and genital area pain in 18% and chronic episodes of pain in this area, have been reported 26% after the delivery. 9% of mothers mentioned the start of the pains to be after the childbirth. Intermittent perineal tears cause pain and require more preventive policies to be carried out. "
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ABSTRACT: Many women suffer from perineal trauma during the normal vaginal delivery. Perineal trauma is mainly associated with pain and complications after the childbirth. Perineal management techniques can play a significant role in perineal trauma reduction. This study aimed to compare the effects of perineal management techniques (hands-off technique, Ritgen maneuver and perineal massage using a lubricant during delivery) on the labor complications.
This quasi-experimental clinical trial was conducted on 99 primiparous women who referred to Daran Hospital, Isfahan, Iran for normal vaginal delivery in 2009. The subjects were selected using a convenient method and randomly assigned to three groups of Ritgen maneuver, hands-off technique and perineal massage with lubricant. A questionnaire was used to determine the demographic characteristics of the participants and complications after birth. The short form of McGill Pain Questionnaire and the visual analogue scale for pain were also employed. The incidence and degree of perineal tears were evaluated immediately after delivery. Moreover, the incidence and severity of perineal pain were assessed 24 hours and also 6 weeks after delivery.
In the Ritgen maneuver group, the frequency of tears, the relative frequency of tear degrees, the severity of perineal pain 24 hours after delivery and the frequency of pain and perineal pain severity 6 weeks after delivery were significantly different from the other two methods.
Hands-off technique during parturition of the neonate's head was associated with fewer complications after delivery. It was even better than perineal massage during the parturition.
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