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Dyspareunia and childbirth: a prospective cohort study
Author(s) -
McDonald EA,
Gartland D,
Small R,
Brown SJ
Publication year - 2015
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13263
Subject(s) - medicine , obstetrics , childbirth , pregnancy , vaginal delivery , odds ratio , prospective cohort study , caesarean section , perineum , cohort study , gynecology , confidence interval , postpartum period , logistic regression , cohort , surgery , genetics , biology
Objective To investigate the relationship between mode of delivery, perineal trauma and dyspareunia. Design Prospective cohort study. Setting Six maternity hospitals in M elbourne, A ustralia. Sample A total of 1507 nulliparous women recruited in the first and second trimesters of pregnancy. Method Data from baseline and postnatal questionnaires (3, 6, 12 and 18 months) were analysed using univariable and multivariable logistic regression. Main outcome measure Study‐designed self‐report measure of dyspareunia at 18 months postpartum. Results In all, 1244/1507 (83%) women completed the baseline and all four postpartum questionnaires; 1211/1237 (98%) had resumed vaginal intercourse by 18 months postpartum, with 289/1211 (24%) women reporting dyspareunia. Compared with women who had a spontaneous vaginal delivery with an intact perineum or unsutured tear, women who had an emergency caesarean section (adjusted odds ratio [ aOR ] 2.41, 95% confidence interval [95% CI ] 1.4–4.0; P = 0.001), vacuum extraction ( aOR 2.28, 95% CI 1.3–4.1; P = 0.005) or elective caesarean section ( aOR 1.71, 95% CI 0.9–3.2; P = 0.087) had increased odds of reporting dyspareunia at 18 months postpartum, adjusting for maternal age and other potential confounders. Conclusions Obstetric intervention is associated with persisting dyspareunia. Greater recognition and increased understanding of the roles of mode of delivery and perineal trauma in contributing to postpartum maternal morbidities, and ways to prevent postpartum dyspareunia where possible, are warranted.