Abstract
Objective: Our goal was to evaluate the relationship between obstetric perineal trauma and postpartum
sexual functioning. Study Design: Our study was carried out with a retrospective cohort design in 3 groups of primiparous
women after vaginal birth: Group 1 (n = 211) had an intact perineum or first-degree
perineal tear; group 2 (n = 336) had second-degree perineal trauma; group 3 (n = 68)
had third- or fourth-degree perineal trauma. These sample sizes reflect a 70% response
rate. Outcomes were time to resuming sexual intercourse, dyspareunia, sexual satisfaction,
sexual sensation, and likelihood of achieving orgasm. Results: At 6 months post partum about one quarter of all primiparous women reported lessened
sexual sensation, worsened sexual satisfaction, and less ability to achieve orgasm,
as compared with these parameters before they gave birth. At 3 and 6 months post partum
41% and 22%, respectively, reported dyspareunia. Relative to women with an intact
perineum, women with second-degree perineal trauma were 80% more likely (95% confidence
interval, 1.2-2.8) and those with third- or fourth-degree perineal trauma were 270%
more likely (95% confidence interval, 1.7-7.7) to report dyspareunia at 3 months post
partum. At 6 months post partum, the use of vacuum extraction or forceps was significantly
associated with dyspareunia (odds ratio, 2.5; 95% confidence interval, 1.3-4.8), and
women who breast-fed were ≥4 times as likely to report dyspareunia as those who did
not breast-feed (odds ratio, 4.4; 95% confidence interval, 2.7-7.0). Episiotomy conferred
the same profile of sexual outcomes as did spontaneous perineal lacerations. Conclusions: Women whose infants were delivered over an intact perineum reported the best outcomes
overall, whereas perineal trauma and the use of obstetric instrumentation were factors
related to the frequency or severity of postpartum dyspareunia, indicating that it
is important to minimize the extent of perineal damage incurred during childbirth.
(Am J Obstet Gynecol 2001;184:881-90.)
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Article info
Footnotes
☆Reprint requests: John T. Repke, MD, Chris J. and Marie A. Olson Professor of Obstetrics and Gynecology, Chairman, Department of Obstetrics and Gynecology, University of Nebraska Medical Center, 983255 Nebraska Medical Center, Omaha, NE 68198-3255. E-mail: [email protected]
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
