Mode of delivery linked to painful intercourse

A first-of-its-kind prospective study by researchers from Australia shows that women who have operative deliveries may be at increased risk of dyspareunia during the postpartum period. Published in BJOG, the findings also highlight a need for clinicians to consider intimate partner abuse as an underlying factor in women when dyspareunia is persistent.

In the study, 1244 first-time mothers from six maternity hospitals in Australia completed questionnaires at baseline and at 3, 6, 12 and 18 months. Mean gestational age at enrollment was 15 weeks. By 18 months postpartum, 98% of the women had resumed vaginal intercourse, 24% of whom reported dyspareunia.

After adjusting for maternal age and other risk factors, risk of dyspareunia at 18 months postpartum was doubled in the women who had an emergency cesarean delivery (adjusted odds ratio (aOR] 2.41, 95% confidence interval [95% CI] 1.4-4.0; P=0.001) or vacuum extraction (aOR 2.28, 95% CI, 1.3-4.1, P=0.005), compared with those who had spontaneous vaginal deliveries with intact perineum or an unsutured tear.

ACOG Guidelines: Management of Late-Term and Postterm Pregnancies

Overall, 49% of the women had spontaneous vaginal births, two-thirds of whom sustained a sutured tear and/or episiotomy; 10.8% had a vacuum extraction; and 10.7% were forceps-assisted. Nearly 22% of the births were cesarean (9.7% elective and 19.9% emergency).

Sixteen percent of the women experienced intimate partner abuse in the first 12 months postpartum, of whom 32.4% reported dyspareunia at 18 months postpartum, compared with 20.7% of those who did not experience intimate partner violence.

Obstetric intervention, the authors concluded, is associated with persistent 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,” they said. 

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