Dyspareunia - pain associated with sexual intercourse - affects the majority of women at some point during their lives.
Researchers report that women who had babies delivered with surgical procedures such as cesarean section or vacuum extraction were twice as likely to report dyspareunia than women who had spontaneous vaginal delivery with intact perineum or unsutured tear.
Dyspareunia is a condition that affects many women - the American College of Obstetricians and Gynecologists (ACOG) state that pain during intercourse affects nearly three-quarters of women at some point during their lives.
Dyspareunia can be a symptom of many gynecological conditions, including endometriosis and ovarian cysts. The aim of the new study, published in BJOG, was to assess what role obstetric risk factors such as mode of delivery played in postpartum dyspareunia - pain associated with intercourse following a pregnancy.
"Almost all women experience some pain during first sexual intercourse following childbirth," states Dr. Ellie McDonald, co-author of the study from the Murdoch Childrens Research Institute, Victoria, Australia.
Observing different modes of delivery
The researchers surveyed 1,244 first-time mothers seen at six maternity hospitals in Melbourne, Australia. The participants completed a series of questionnaires; one at the start of the study and then successive questionnaires at 3, 6, 12 and 18 months following the birth of their children.
Among the participants, 49% had a spontaneous vaginal birth. Of these women, two-thirds sustained a sutured tear, episiotomy or both. The other participants had the following modes of delivery:
- Vacuum extraction - 10.8%
- Forceps-assisted - 10.7%
- Elective cesarian section - 9.7%
- Emergency cesarian section -19.9%.
Three months after delivery, 78% of the participants resumed sexual intercourse. This figure increased to 94% by 6 months, 97% by 12 months and 98% by 18 months.
The vast majority of participants (85.7%) experienced dyspareunia during their first vaginal intercourse in the 12 months following childbirth.
Reported rates of dyspareunia fell over time. Three months after delivery, 44.7% of participants experienced dyspareunia. This figure decreased to 43.4% at 6 months, 28.1% at 12 months and 23.4% at 18 months.
Around a third of women reporting dyspareunia at 6 months continued to experience dyspareunia 18 months after childbirth.
'Not enough is known about the long-term health impact of obstetric procedures'
After adjusting for risk factors such as maternal age, the researchers found that women who had vacuum extraction, elective cesarian section or emergency cesarian section were twice as likely to report dyspareunia 18 months after childbirth than women who had spontaneous vaginal delivery with intact vaginal delivery or unsutured tear.
Other influential factors reported by the researchers included experiencing dyspareunia prior to pregnancy, maternal fatigue and abuse from partners. Dyspareunia after 18 months was experienced by 32.4% of women experiencing abuse from an intimate partner, compared with 20.7% of women who did not experience abuse.
McDonald states that their findings show that the extent to which women report persisting dyspareunia 6 and 18 month after childbirth is influenced by events during labor and birth. She continues:
"Not enough is known about the longer-term impact of obstetric procedures on maternal health. The fact that dyspareunia is more common among women experiencing operative procedures points to the need for focusing clinical attention on ways to help women experiencing ongoing morbidity, and increased efforts to prevent postpartum morbidity where possible."
The deputy editor-in-chief of BJOG, Patrick Chien, suggests that future research could look at ways of preventing dyspareunia.
Recently, Medical News Today reported on a study finding that rates of episiotomy had fallen between 2006 and 2012, following recommendations from various experts for restricted use of the procedure.