Predictors for sexual dysfunction in the first year postpartum: a systematic review and meta-analysis.

Abstract

BACKGROUND\nPregnancy and childbirth increase the risk for pelvic floor dysfunction, including sexual dysfunction. So far, the mechanisms and the extent to which certain risk factors play a role, remain unclear.\n\n\nOBJECTIVES\nIn this systematic review of literature, we aimed to determine the risk factors for sexual dysfunction in the first year after childbirth.\n\n\nSEARCH STRATEGY\nWe searched MEDLINE, Embase and CENTRAL using the search strategy: Sexual dysfunction AND Obstetric events.\n\n\nSELECTION CRITERIA\nWe included original English, comparative studies that used validated questionnaires and the ICS/IUGA terminology for sexual dysfunction, dyspareunia and vaginal dryness.\n\n\nDATA COLLECTION AND ANALYSIS\nWe assessed the quality and the risk of bias of the included studies with the Newcastle Ottawa Scale. We extracted the reported data and we performed random-effects meta-analysis to obtain the summary Odds Ratios (OR) with 95% Confidence Intervals. Heterogeneity across studies was assessed using the I2 statistic.\n\n\nMAIN RESULTS\nAnal sphincter injury was associated with increased odds for both sexual dysfunction (OR:3.00[1.28-7.03]) and dyspareunia (OR:1.92[1.47-2.52]). Episiotomy was associated with dyspareunia (OR:1.64[1.25-2.14]) but not with sexual dysfunction (OR:1.90[0.94-3.84]). Compared to spontaneous birth, caesarean section reduced the odds for dyspareunia (OR:0.68[0.54-0.86]), but not for sexual dysfunction (OR:1.14[0.89-1.46]). Instrumental vaginal birth increased the odds for sexual dysfunction (OR:1.70[1.05-2.76]), yet no difference was found for dyspareunia (OR:1.82[0.88-3.75]). One study of low quality reported on vaginal dryness and found no association with obstetric events.\n\n\nCONCLUSIONS\nPerineal trauma, rather than the mode of birth, increases the odds for sexual dysfunction in the first year after childbirth.