Perineal Injury and Its Association with Postpartum Sexual Dysfunction among First Delivery Women



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Submitted May 17, 2021
Published Jun 17, 2021
10.24018/clinicmed.2021.2.3.74

Abstract viewed = 667 times

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Background: Female sexual dysfunction (FSD) following childbirth imposes significant burden to the marital institution around the world. The perineal injury may potentially be one of the main risk factors contributing to postpartum female sexual dysfunction (PPFSD). The study aimed to determine the effect of perineal injury and patients’ characteristics on PPFSD.

Methodology: This cross-sectional questionnaire study was conducted in six different health clinics in the district of Kuantan from April 2019 to October 2019. Eligible women who came to the family health clinics at 6 months postpartum were recruited as study population. The participants completed their biodata and socio-demographic form and the Malay-validated Female Sexual Function Index (MVFSFI) questionnaire given. A cut-off point of 26.55 and below on MVFSFI scoring system was used as a measure of the primary outcome of sexual dysfunction.

Results: Out of 240 women who delivered vaginally, 34 (14%) had intact perineum, 107 (44.6%) sustained 1st degree perineal tear, 96 (40%) 2nd degree tear and three (1.25%) 3rd degree tear. Among the respondents, 60.9% of the sexually active respondents who had vaginal delivery, reported to have PPFSD. The timing of sexual resumption does not correlate with the severity of perineal tear. The severity of perineal tear is significantly associated with age (p=0.018), duration of marriage (p=0.008), body mass index (BMI) (p=0.019) and instrumental delivery (p=0.025). The level of personnel skill whom performed the repair were also found to have a significant relationship to PPFSD (p= 0.001). The relationship of participants’ mean age (p=0.271), marriage duration (p=0.903), race (p=0.928), religion (p=0.852), education level (p=0.549), employment status (p=0.102), family income (p=0.460) and BMI(p=0.159) with presence of PPFSD were all found to be statistically not significant.

Conclusion: Occurrence of PPFSD is high among sexually active women who had vaginal delivery complicated by perineal tear, especially among those requiring instrumentation. The severity of perineal tear is associated with age, duration of marriage, BMI and mode of delivery. However, PPFSD does not significantly relate to the severity of perineal tear. None of the socio-demographic factors show a significant difference to sexual dysfunction.

Keywords: perineal tear postpartum female sexual dysfunction vaginal delivery instrumental delivery

References

  1. McCool-Myers, M. (2018). Predictors of Female Sexual Dysfunction: A Systematic Review and Qualitative Analysis through Gender Inequality Paradigms. BMC Women’s Health, 18(1), 108. https://doi: 10.1186/s12905-018-0602-4.
     Google Scholar
  2. Abidin, A., Draman, N., Ismail, S., Mustaffa, I. & Ahmad, I (2016). Female Sexual Dysfunction among Overweight and Obese Women in Kota Bharu, Malaysia. Journal of Taibah University Medical Sciences, 11(2), 159-167. https://doi.org/10.1016/j.jtumed.2016.01.009.
     Google Scholar
  3. Ishak, I. H., Low, W. Y. & Othman, S. (2010). Prevalence, Risk Factors, and Predictors of Female Sexual Dysfunction in a Primary Care Setting: A Survey Finding. Journal of Sexual Medicine, 7(9), 3080-3087. https://doi: 10.1111/j.1743-6109.2010.01848.x.
     Google Scholar
  4. Sidi, H., Abdullah, N., Puteh, S. E. W. & Midin, M. (2007a). The Female Sexual Function Index (FSFI): Validation of the Malay Version. Journal of Sexual Medicine, 4(6), 1642-1654. https://doi: 10.1111/j.1743-6109.2007.00476.x.
     Google Scholar
  5. De Lima, H., Bento, J., De Sá Vieira Abuchaim et al (2014). Sexual Dysfunction and Associated Factors Reported in the Postpartum Period. ACTA Paulista de Enfermagem, 27(6), 573-578. https://doi.org/10.1590/1982-0194201400093.
     Google Scholar
  6. Abdool, Z., Thakar, R. & Sultan, A. H. (2009). Postpartum Female Sexual Function. European Journal of Obstetrics and Gynecology and Reproductive Biology, 145(2), 133-7. https://doi: 10.1016/j.ejogrb.2009.04.014.
     Google Scholar
  7. Doğan B, Gün İ, Özdamar Ö, Yılmaz A, Muhçu M. Long-term impacts of vaginal birth with mediolateral episiotomy on sexual and pelvic dysfunction and perineal pain. J Matern Fetal Neonatal Med. 2017 Feb;30(4):457-460. doi: 10.1080/14767058.2016.1174998. Epub 2016 Apr 25. PMID: 27112425.
     Google Scholar
  8. Hanan Abd Elwahab El Sayed, Soad Abd el Salam Ramadan, Heba Abdel-Fatah Ibrahim, Huda Abd Allah Moursi, The Effect of Mode of Delivery on Postpartum Sexual Function and Sexual Quality of Life in Primiparous Women, American Journal of Nursing Science. Vol. 6, No. 4, 2017, pp. 347-357. doi: 10.11648/j.ajns.20170604.19.
     Google Scholar
  9. Fodstad K, Staff AC, Laine K. Sexual activity and dyspareunia the first year postpartum in relation to degree of perineal trauma. Int Urogynecol J. 2016 Oct;27(10):1513-23. doi: 10.1007/s00192-016-3015-7. Epub 2016 May 16. PMID: 27185318.
     Google Scholar
  10. Chang, S. R., Chen, K. H, Lin, H. H, Chao, Y. M, Yeur-Hur, L. & Lai, Y. H. (2011). Comparison of the Effects of Episiotomy and No Episiotomy on Pain, Urinary Incontinence, and Sexual Function 3 Months Postpartum: A Prospective Follow-up Study. International Journal of Nursing Studies, 48(4), 409-418. https://doi. 10.1016/j.ijnurstu.2010.07.017.
     Google Scholar
  11. Leeman, L., Rogers, R., Borders, N., Teaf, D. & Qualls, C. (2016). The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women. Birth, 43(4), 293-302. https://doi: 10.1111/birt.12258.
     Google Scholar
  12. Kahramanoglu, I., Baktiroglu, M., Hamzaoglu, K., Kahramanoglu, O., Verit, F. F., Yucel, O. (2017). The Impact of Mode of Delivery on the Sexual Function of Primiparous Women: A Prospective Study. Archives of Gynecology and Obstetrics, 295(4), 907-916. https://doi: 10.1007/s00404-017-4299-7.
     Google Scholar
  13. Kadir, A. A., Nordin, R., Ismail, S. B. & Yaacob, M. J. (2004). Validation of the Malay Version of Edinburgh Postnatal Depression Scale for Postnatal Women in Kelantan, Malaysia. Asia Pacific Family Medicine, 3(1-2): 9-18. Khajehei, M., Doherty, M., Tilley, P. J. M. & Sauer, K. (2015). Prevalence and Risk Factors of Sexual Dysfunction in Postpartum Australian Women. Journal of Sexual Medicine, 12(6), 1415-1426. https://doi: 10.1111/jsm.12901.
     Google Scholar
  14. Mahidin, M. U. (2017). Laporan Penyiasatan Pendapatan Isi Rumah Dan Kemudahan Asas 2016. Sumber Statistik Rasmi Malaysia, https://dosm.gov.my.
     Google Scholar
  15. Nikpour, M., Delavar, M. A. & Abedian, Z. (2013). Type of Delivery and Self-Reported Postpartum Symptoms among Iranian Women. Clinical and Experimental Obstetrics and Gynecology, 40(1), 144-147.
     Google Scholar
  16. Lurie S, Aizenberg M, Sulema V, Boaz M, Kovo M, Golan A, Sadan O. Sexual function after childbirth by the mode of delivery: a prospective study. Arch Gynecol Obstet. 2013 Oct;288(4):785-92. doi: 10.1007/s00404-013-2846-4. Epub 2013 Apr 16. PMID: 23589124.
     Google Scholar
  17. Ola Gutzeit, Gali Levy, Lior Lowenstein. Postpartum Female Sexual Function: Risk Factors forPostpartum Sexual Dysfunction. Sex Med 2019;8:8e13.
     Google Scholar
  18. Hornemann A, Kamischke A, Luedders DW, Beyer DA, Diedrich K, Bohlmann MK. (2010). Advanced age is a risk factor for higher grade perineal lacerations during delivery in nulliparous women. Arch Gynecol Obstet.Jan;281(1):59-64. doi:10.1007/s00404-009-1063-7. Epub 2009 Mar 31. PMID: 19333610.
     Google Scholar
  19. Waldenström and Ekéus (2017). Risk of obstetric anal sphincter injury increases with maternal age irrespective of parity: a population-based register study. BMC Pregnancy and Childbirth17:306 DOI 10.1186/s12884-017-1473-7.
     Google Scholar
  20. Hasanpoor, S., Bani, S., Shahgole, R. & Gojazadeh, M. (2012). The Effects of Continuous and Interrupted Episiotomy Repair on Pain Severity and Rate of Perineal Repair: A Controlled Randomized Clinical Trial. Journal of caringsciences, 1(3), 165–171. https://doi: 10.5681/jcs.2012.024.
     Google Scholar
  21. Martínez-Galiano, J. M., Arredondo-López, B., Molina-Garcia, L., Cámara-Jurado, A.M., Cocera-Ruiz, E. & Rodríguez-Delgado, M. (2019). Continuous versus Discontinuous Suture in Perineal Injuries Produced during Delivery in Primiparous Women: A Randomized Controlled Trial. BMC Pregnancy and Childbirth, 19, 499. https://doi.org/10.1186/s12884-019-2655-2.
     Google Scholar
  22. De Lima, H., Bento, J., De Sá Vieira Abuchaim, E., Coca, K. P. & De Vilhena Abrão, A.C. F. (2014). Sexual Dysfunction and Associated Factors Reported in the Postpartum Period. ACTA Paulista de Enfermagem, 27(6), 573-578. https://doi.org/10.1590/1982-0194201400093.
     Google Scholar
  23. Adam, P. and Madlon-Kay, D. J. (2012). What Is the Prevalence of Vaginal Dryness Postpartum and What Is the Best Treatment? Evidence-Based Practice, 15(12), 8-9.
     Google Scholar
  24. Aşkin, M., Koç, E. M., Sözmen, M. K., Sahin, E. M. and Aydoğmuş, S. (2019). Evaluation of Factors Affecting Sexual Functions and Contraceptive Method Preferences of Women. Duzce Medical Journal, 21(3), 172–76. https:// doi: 10.18678/dtfd.593920.
     Google Scholar