References

Barrett G, Pendry E, Peacock J, Victor C, Thakar R, Manyonda I Women's sexual health after childbirth. BJOG. 2000; 107:(2)186-95

Bernhard LA Sexuality and sexual health care for women. Clin Obstet Gynecol. 2002; 45:(4)1089-98

Brubaker L, Handa VL, Bradley CS Sexual function 6 months after first delivery. Obstet Gynecol. 2008; 111:(5)1040-4 https://doi.org/https://doi.org/10.1097/AOG.0b013e318169cdee

Buhling KJ, Schmidt S, Robinson JN, Klapp C, Siebert G, Dudenhausen JW Rate of dyspareunia after delivery in primiparae according to mode of delivery. Eur J Obstet Gynecol Reprod Biol. 2006; 124:(1)42-6

Carroli G, Mignini L Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2009; (1) https://doi.org/https://doi.org/10.1002/14651858.CD000081.pub2

Chang SR, Chen KH, Lin HH, Chao YM, Lai YH Comparison of the effects of episiotomy and no episiotomy on pain, urinary incontinence, and sexual function 3 months postpartum: a prospective follow-up study. Int J Nurs Stud. 2011; 48:(4)409-18 https://doi.org/https://doi.org/10.1016/j.ijnurstu.2010.07.017

Ejegård H, Ryding EL, Sjogren B Sexuality after delivery with episiotomy: a long-term follow-up. Gynecol Obstet Invest. 2008; 66:(1)1-7 https://doi.org/https://doi.org/10.1159/000113464

EURO-PERISTAT. 2013. http://tinyurl.com/ol8deks (accesssed 2 November 2016)

Fauconnier A, Goltzene A, Issartel F, Janse-Marec J, Blondel B, Fritel X Late post-partum dyspareunia: does delivery play a role?. Prog Urol. 2012; 22:(4)225-32 https://doi.org/https://doi.org/10.1016/j.purol.2012.01.008

Graham ID, Carroli G, Davies C, Medves JM Episiotomy rates around the world: an update. Birth. 2005; 32:(3)219-23

Hicks TL, Goodall SF, Quattrone EM, Lydon-Rochelle MT Postpartum sexual functioning and method of delivery: summary of the evidence. J Midwifery Womens Health. 2004; 49:(5)430-6

Klein K, Worda C, Leipold H, Gruber C, Husslein P, Wenzl R Does the mode of delivery influence sexual function after childbirth?. J Womens Health. 2009; 18:(8)1227-31 https://doi.org/https://doi.org/10.1089/jwh.2008.1198

Lede RL, Belizán JM, Carroli G Is routine use of episiotomy justified?. Am J Obstet Gynecol. 1996; 174:(5)1399-402

Makkii M, Yazdi NA Sexual dysfunction during primiparous and multiparous women following vaginal delivery. Tanzan J Health Res. 2012; 14:(4)263-8

McDonald EA, Gartland D, Small R, Brown SJ Dyspareunia and childbirth: a prospective cohort study. BJOG. 2015; 122:(5)672-9 https://doi.org/https://doi.org/10.1111/1471-0528.13263

Nyström K, Ohrling K Parenthood experiences during the child's first year: literature review. J Adv Nurs. 2004; 46:(3)319-30

Rosen R, Brown C, Heiman J The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000; 26:(2)191-208

Sartore A, De Seta F, Maso G, Pregazzi R, Grimaldi E, Guaschino S The effects of mediolateral episiotomy on pelvic floor function after vaginal delivery. Obstet Gynecol. 2004; 103:(4)669-73

Sayasneh A, Pandeva I Postpartum Sexual Dysfunction: A literature review of risk factors and role of mode of delivery. British Journal of Medical Practitioners. 2010; 3:(2)

Shirvani MA, Nesami MB, Bavand M Maternal sexuality after child birth among Iranian women. Pak J Biol Sci. 2010; 13:(8)385-9

Signorello LB, Harlow BL, Chekos AK, Repke JT Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. Am J Obstet Gynecol. 2001; 184:(5)881-90

ÚZIS: Prague; 2013

van Brummen HJ, Bruinse HW, van de Pol G, Heintz AP, van der Vaart CH Which factors determine the sexual function 1 year after childbirth?. BJOG. 2006; 113:(8)914-8

Wang HY, Xu XY, Yao ZW, Zhou Q Impact of delivery types on women's postpartum sexual health. Reproduction and Contraception. 2003; 14:(4)237-42

Williams A, Herron-Marx S, Carolyn H The prevalence of enduring postnatal perineal morbidity and its relationship to perineal trauma. Midwifery. 2007; 23:(4)392-403

Episiotomy and women's sexual function 2–5 years after childbirth: A study from the Czech Republic

02 December 2016
12 min read
Volume 24 · Issue 12

Abstract

Background:

Episiotomy is one of the most common interventions during the second stage of labour. Some studies have identified episiotomy as a risk factor for pain during sexual intercourse.

Aims:

The aim of this cross-sectional study was to establish the effect of episiotomy on the sexual function of women 2–5 years after a vaginal birth.

Methods:

Women with episiotomy were compared with four control groups: women with intact perineum, women with first-degree perineal tear, women with second-degree perineal tear and women with third- and fourth-degree perineal tear. Data were collected from 13 private gynaecological clinics in three regions in the Czech Republic during August–September 2013. The Female Sexual Function Index (FSFI) was used. Response rate was 41% (246/600 questionnaires); 35 questionnaires were excluded, so the final sample was 211 women. The Kruskal–Wallis test was performed on all women in the study (n = 211) and then again for only the primiparous women (n = 112).

Findings:

In all samples in women with second-degree perineal tears, lower score values were found in the domains of arousal and orgasm, and these women had a lower total FSFI score compared to those with first-degree perineal tears and women who received an episiotomy. However, in primiparous women only, there was no difference between these groups.

Conclusions:

Further research is required to establish the effect of episiotomy on women's sexual function.

The birth of a baby brings a range of phy sical, emotional and social changes. A woman's sexual life is also changed (Nyström and Ohrling, 2004). Various researchers have explored how childbirth affects women in relation to sex. In a study by Buhling et al (2006), it was found that 47% (n = 298/636) of women resumed sexual intercourse within 8 weeks after giving birth, while another study reported that about 90% of the 509 participating women were sexually active within half a year after giving birth (Brubaker et al, 2008). More recently, McDonald et al (2015) reported that 98% of women (n = 1211/1239) had resumed vaginal intercourse by 18 months postpartum.

Sexual problems are very common in the postpartum period. Wang et al (2003) reported that 71% of 460 women had some sexual difficulties in the third month after birth. In another study, 83% of 484 women reported some sexual problems at 3 months, and after 6 months this fell to 64% (Barrett et al, 2000). Following childbirth, women may experience a decrease in sexual desire and have problems with arousal and orgasmic disorders. The most common type of postpartum sexual dysfunction is dyspareunia or painful intercourse (Sayasneh and Pendeva, 2010). In their prospective study, McDonald et al (2015) found that, in a sample of 1239 women, dyspareunia was reported by 45% of women at 3 months, 43% at 6 months, 28% at 12 months and 23% at 18 months postpartum. Sexual problems, especially pain, are more common in women after vaginal births (Barrett et al, 2000; Klein et al, 2009), operative vaginal births (Barrett et al, 2000; Signorello et al, 2001; Hicks et al, 2004; Buhling et al, 2006; McDonald et al, 2015), and in women who have suffered extensive perineal tears (Signorello et al, 2001; van Brummen et al, 2006). Some studies have identified episiotomy as a risk factor for pain disorder (Sartore et al, 2004; Ejegård et al, 2008; Sayasneh and Pendeva, 2010; Chang et al, 2011).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month