Sexual Function after Childbirth by the Mode of Delivery: A Prospective Study. Lurie S, Aizenberg A, et al. Arch Gynecol Obstet. 16 April 2013.

Pelvic Physiotherapy Think Tank

July 10, 2013 Michelle Spicka, DPT

Objective:  To evaluate sexual behavior longitudinally in the postpartum period by mode of delivery.

Study Design/Method: 

                Five groups were defined:

1.       Women who delivered vaginally without an episiotomy

2.       Women who delivered vaginally with an episiotomy

3.       Women who delivered by instrumental delivery

4.       Women who delivered by emergent cesarean section

5.       Women who delivered by an elective cesarean section

All of the participants were interviewed by telephone at 6, 12 and 24 weeks postpartum using the FSFI questionnaire (female sexual function index).

                The FSFI is a 19 item survey that assesses six domains of sexual function: desire, arousal, lubrication, orgasm, satisfaction and pain.

http://www.fsfi-questionnaire.com/

Outcome/Results:  

1.       Within 3 months, 95.1% of women reported resuming sexual intercourse

2.       Women in the vaginal delivery without an episiotomy group resumed sexual intercourse significantly earlier than women in the vaginal delivery with an episiotomy group

3.       At 6 weeks postpartum, none of the domain scores differed across types of delivery

4.       At 12 weeks postpartum, none of the domain scores differed across types of delivery

5.       At 24 weeks postpartum, none of the domain scores differed across types of delivery

6.       The FSFI total score changed over time but not across delivery modes

Conclusion:

1.       This study differed from previous studies on postpartum sexual function in that it directly and longitudinally compared sexual function by mode of delivery using a well validated questionnaire.

2.       Sexual function improved as time elapsed from delivery but did not differ significantly by mode of delivery at 6, 12 or 24 weeks postpartum

3.       A limitation is that pre-pregnancy sexual function was not documented but the authors felt that the rate of pre-pregnancy sexual  dysfunction would be about the same across the delivery methods

 

Thought Questions:

1.       This study is in disagreement with previous published studies that remarked that patients undergoing vaginal delivery note a significantly higher rate of dyspareunia at 3 months postpartum (although no significant differences were observed at 12 months, 24 months and 1 year postpartum).

2.       Will this study help women to make a more balanced decision regarding the referred mode of delivery?

3.       C-section rates have risen from 10% of all deliveries in the 1980s to a current figure of around 23.8%.  Approximately 75% of CS are emergency procedures and only 25% are elective planned deliveries (Practitioner. 2012 Mar; 256(1749):16-8,2-3.)

4.       Pelvic floor muscle training improved pelvic floor muscle function, and starting in the postpartum period, exercise appears to have positive effects on female sexual function (Acta Obstet Gynecol Scand. 2010 Jun;89(6):817-22)

5.       20 years after deliver, the prevalence of SUI, UUI, and MUI was higher and moderate to severe UI and bothersome UI were reported more often in vaginal delivery than c-section. (Gyhagen et al. BJOG. 2013 Jun 21 (epub ahead of print))