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