|Dyspareunia and childbirth: a prospective cohort study

ObjectiveTo investigate the relationship between mode of delivery, perineal trauma and dyspareunia. DesignProspective cohort study. SettingSix maternity hospitals in Melbourne, Australia. SampleA total of 1507 nulliparous women recruited in the first and second trimesters of pregnancy. MethodData from baseline and postnatal questionnaires (3, 6, 12 and 18months) were analysed using univariable and multivariable logistic regression. Main outcome measureStudy-designed self-report measure of dyspareunia at 18months postpartum. ResultsIn all, 1244/1507 (83%) women completed the baseline and all four postpartum questionnaires; 1211/1237 (98%) had resumed vaginal intercourse by 18months postpartum, with 289/1211 (24%) women reporting dyspareunia. Compared with women who had a spontaneous vaginal delivery with an intact perineum or unsutured tear, women who had an emergency caesarean section (adjusted odds ratio [aOR] 2.41, 95% confidence interval [95% CI] 1.4-4.0; P=0.001), vacuum extraction (aOR 2.28, 95% CI 1.3-4.1; P=0.005) or elective caesarean section (aOR 1.71, 95% CI 0.9-3.2; P=0.087) had increased odds of reporting dyspareunia at 18months postpartum, adjusting for maternal age and other potential confounders. ConclusionsObstetric intervention is associated with persisting dyspareunia. Greater recognition and increased understanding of the roles of mode of delivery and perineal trauma in contributing to postpartum maternal morbidities, and ways toprevent postpartum dyspareunia where possible, are warranted.