Skip to main content

Table 2 Description of included studies with perineum injury morbidity as exposure

From: Sexual life and dysfunction after maternal morbidity: a systematic review

Publication
Authors
Year of publication
Type of study
Outcome Assessment
Period of data collection
Location
Participants Outcomes
1. Women´s sexual health after childbirth.
Barret G et al., 2000 [37]
Cross sectional
Sexual problems (vaginal dryness, painful penetration, dyspareunia, vaginal tightness, vaginal looseness, bleeding/irritation after sex and loss of sexual desire)
Mailed questionnaires.
1st July to 31 December 1997
London, UK
484 postpartum primiparous women.
Evaluation at 3 and 6 months after delivery.
Dyspareunia at 3 months after birth:
Minor perineal laceration: 55 % (115/209)
3rd degree laceration: 64 % (7/11)
Dyspareunia at 6 months after birth:
Minor perineal laceration: 26 % (62/235)
3rd degree laceration: 33 % (4/12)
2. Postpartum sexual functioning and its relationship to perineal trauma: A retrospective cohort study of primiparous women.
Signorello LB et al., 2001 [38]
Retrospective cohort
1. Time to resumption of sexual intercourse
2. Dyspareunia
Sexual satisfaction
Sexual sensation
Likelihood of achieving orgasm.
Mailed questionnaires.
From August 1, 1996, and February 8, 1997.
Boston, Massachusetts, USA.
626 postpartum women (6 months)
Group 1, n = 211 (intact perineum or first-degree perineal tear)
Group 3, n = 68 (third- or fourth-degree perineal trauma)
1. Resumption of sexual activity:
In 7–8 weeks
Group 1: 30.8 % (61/211)
Group 3: 35.0 % (21/68)
In 6 months:
Group 1: 94.8 % (199/210)
Group 3: 92.5 % (62/67)
Time to resume in weeks (mean and SD):
Group 1: 7.1 (3.3)
Group 3: 9.3 (3.5)p < 0.001
2.Pain (dyspareunia) at first intercourse:
Group 1: 57.8 % (115/211)
Group 3: 77.4 % (48/68)
(p < 0 .001).
3 months postpartum:
Group 1: 32.8 % (60/211)
Group 3: 51.4 % (35/68)
(p trend < 0 .001)
6 months postpartum:
Group 1: 18.6 % (37/211)
Group 3: 26.7 % (16/68)
3. Sexual satisfaction, sexual sensation and achievement of orgasm.
3. Which factors determine the sexual function 1 year after childbirth?
van Brummen et al., 2006 [42]
Prospective cohort
MMQ-S scale
Self-applied questionnaires at pregnancy (12 and 36w), and at 3 and 6 months postpartum.
From January 2002 to July 2003.
Netherlands
377 women evaluated at 3 periods (pregnancy, 3 and 5 months postpartum) Sexual activity 1 year after childbirth (resumption):
YES:
Intact/1st/2nd degree laceration: 46,3 %
3rd/4th degree laceration: 56,5 %
NO:
Intact/1st/2nd degree laceration: 53,7 %
3rd/4th degree laceration: 43,5 %
MMQ-S questionnaire:
No differences among groups (NS)
4. Women’s health 18 years after rupture of the anal sphincter during childbirth: II. Urinary incontinence, sexual function, and physical and mental health.
Otero et al., 2006 [44]
Retrospective cohort.
FSFI
Mailed questionnaire
18 years after childbirth that occurred between January 1st, 1982, and December 31th, 1983.
Geneva, Switzerland
453 women.
Exposed: 230 (women who had had anal sphincter injury during childbirth)
Not exposed: 223 (randomised postpartum women not exposed to the injury and with the same parity)
FSFI <25: NS
Anal Injury: 39/230
No injury: 38/223
RR 1,0 (CI 95 % 0,8-1,2 p = 0.75)
5. Long Term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints.
Mous et al., 2007
Retrospective cohort study
Sexual complaints (including dyspareunia)
2005 assessment of postpartum women who gave birth between 1995 and 1996.
Rotterdam, Netherlands
Total included in 2005:
119 cases (sphincter injury)
90 controls (no injury)
Dyspareunia:
Sphincter injury: 29 % (35/119)
Controls: 13 % (12/90)
6. Women's dyspareunia after childbirth: a case study in a hospital in Acapulco, Mexico.
Solana-Arellano, et al., 2008 [40]
Case control study.
Dyspareunia.
From October 2005 to January 2006
Acapulco, Mexico.
Cases: 152 postpartum women who resumed sexual activity and referred pain or bleeding during intercourse.
Controls: 152 postpartum women who resumed sexual activity and not referred the same symptoms.
2–6 months after childbirth.
27 women had perineal laceration.
Perineal laceration:
(27/152) 17.8 % in cases with dyspareunia
(23/152) 15.1 % in controls without dyspareunia
7. Sexual Function 6 Months After First Delivery.
Brubaker et al., 2008 [43]
Prospective cohort
Resumption of sexual activity at 6 months
Sexual Function Short Form Questionnaire (PISQ-12)
September 2002 and September 2004
USA
536 postpartum primiparous women at term, 459 sexually active.
Sphincter tear: 198
Vaginal controls: 200
Cesarean controls: 61
Interviewed at 6 weeks and 6 months after childbirth.
Resumption of sexual activity at 6 months:
Sphincter tear: 88 % (171/198)
Vaginal controls: 93.9 % (13/200)
Cesarean controls: 85.9 % (51/61)
p = 0.028
Mean PISQ-12 scores at 6 months: 39 ± 4
p = 0.92 NS
8. Tears in the Vagina, Perineum, Sphincter Ani, and Rectum and First Sexual Intercourse after Childbirth: A Nationwide Follow-up.
Rådestad I et al., 2008 [48]
Prospective cohort
Resumption of sexual activity
Mailed questionnaire
Between 1999 and 2000
Sweden
2,134 postpartum women at 2 months and 1 year after childbirth (vaginal delivery).
Tears in sphincter ani/rectum: 59
Resumption of sexual activity:
Tears in sphincter:
≥3 Months: 49.2 %
≤3 Months: 23,3 %
RR = 2.1 (CI 1.6–2.8)
p < 0.001
No tears in sphincter:
≥3 Months: 23.3 %
≤3 Months: 76.7 %
RR = 1
Difference between groups: 25.8 % (49.2 %–23.3 %)
NNH: 3.9 (CI 95 % 2.6-7.7)
Tears in sphincter:
≥6 Months: 13.6 %
≤6 Months: 86.4 %
RR = 1.8 (CI 0.9–3.5)
p = 0.130
No tears in sphincter:
≥6 Months: 7.6 %
≤6 Months: 92.4 %
RR = 1
Difference between groups: 6.0 % (13.6 %–7.6 %)
NNH: 16.8 (CI 95 % 6.8-35.2)
At 12 Months: 4 % NO sexual activity (NS)
9. Sexual Function in Women 3 Days and 6 Weeks After Childbirth: A Prospective Longitudinal Study Using the Taiwan Version of the Female Sexual Function.
Chang, et al., 2010 [45]
Prospective longitudinal
FSFI
From November 2007 to April 2009
Taipei, Taiwan
356 postpartum women
199 vaginal delivery (no intact perineum)
FSFI Day3:
1st/2nd degree laceration (182/199) LSM = 7.0
3rd or 4th degree: (17/199) LSM = 7.1
p = 0.984 (NS)
FSFI Week 6:
1st/2nd degree (158/172) LSM = 13.6
3rd or 4th degree (14/172 ) LSM = 15.1
p = 0.7 (NS)
Sexual activity score Day 3:
1st/2nd degree laceration (182/199) LSM = 15.0
3rd or 4th degree: (17/199) LSM = 14.1
p = 0.8548 (NS)
Sexual activity score Week 6:
1st/2nd degree laceration (182/199) LSM = 18.8
3rd or 4th degree: (17/199) LSM = 20.9
p = 0.7193 (NS)
Satisfaction score Day 3:
1st/2nd degree laceration (182/199) LSM = 51.7
3rd or 4th degree: (17/199) LSM = 56.0
p = 0.6691 (NS)
Satisfaction score Week 6:
1st/2nd degree laceration (182/199) LSM = 151.1
3rd or 4th degree: (17/199) LSM = 166.5
p = 0.4723 (NS)
Desire score Day 3:
1st/2nd degree laceration (182/199) LSM = 6.2
3rd or 4th degree: (17/199) LSM = 31.4
p = 0.1703 (NS)
Desire score Week 6:
1st/2nd degree laceration (182/199) LSM = 271,0
3rd or 4th degree: (17/199) LSM = 233.8
p = 0.3056 (NS)
10. Obstetric anal sphincter injury in the UK and its effect on bowel, bladder and sexual function.
Marsh F et al., 2010
Prospective cohort
Resumption of sexual activity
Dyspareunia
From 2004 to 2009
Leeds, UK
435 postpartum women with obstetric anal injury (up to 3 Months after delivery) Resumption of sexual activity:
57 % (134/235)
Dyspareunia: 32 % (75/235)
11. Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery.
Baud et al., 2011 [46]
Case–control study
FSFI
From 1996 to 2006
Lausanne, Switzerland
Cases: 66 postpartum women with anal injury (1,5 % from 13,213)
Controls: 192 without anal injury.
Up to 6 years postpartum.
FSFI ≤ 25 (severe dysfunction): NS
Data not available: contact authors.
FSFI total scores:
Cases: 26.1 + 6.8
Controls: 27.3 + 5.9
p = 0.185
12. The effects of mode delivery on postpartum sexual function: a prospective study.
De Souza et al., 2015 [47]
Prospective cohort
FSFI
Self-applied questionnaire
From January 2010 to July 2011
Melbourne, Australia
391 women interviewed during pregnancy and after 6 and 12 months after childbirth
Completed 3 interviews:
9/264 (4.8 %) women with 3rd degree laceration
82/264 (44.1 %) with minor perineal injury
FSFI score (means):
Pregnancy: 24.22
6 months: 22.79
12 months: 25.06
No differences associated to type of laceration
Arousal domain, means (maximum 6):
Pregnancy: 3.46
6 months: 3.44
12 months: 3.97
p = 0.007
12 months highest score related to perineal injury
p = 0.019
Orgasm domain, means (maximum 6):
Pregnancy: 4.23
6 months: 4.20
12 months: 4.66
p = 0.026
6 months/12 months = 0.015
No interaction over time due to perineum status
(p = 0.108)
FSFI scores < 25 not showed