Pregnancy is a phase in which several changes occur in the maternal organism. Among the main alterations are the postural changes that can result in muscular pain, as well as the effect of the gravid uterus on the pelvic floor muscles that can affect their functions, such as urinary and sexual functions. The hypothesis of the study is that the third gestational trimester exacerbates these conditions. Thus, the objective was to evaluate and compare the presence of urinary, sexual and pain symptoms of pregnant women in different gestational periods.

The study, approved by the Ethics Committee of the institution, was conducted in medical centers and all participants signed the consent form. The study included 60 pregnant women, divided according to the gestational trimester that they were in: 1st trimester (n = 13); 2nd trimester (n = 26) and 3rd trimester (n = 21). The participants were submitted to anamnesis to gather personal, socio-demographic, anthropometric and obstetric data. For the analysis of pain symptoms, the Visual Analogue Scale (VAS) was used, scaled from 0 to 10 points and considering the higher the score the greater the severity, as well as its region. In addition, three validated questionnaires were used, translated into Portuguese and recommended by the International Consultation on Incontinence Questionnaire (ICIQ), being: (1) ICIQ Urinary Incontinence-Short Form (ICIQ UI-SF), which qualifies and quantifies urinary loss, its scores ranges from 0 to 21 points, and the higher the score the greater the impairment; (2) ICIQ – Overactive Bladder (ICIQ-OAB) that evaluates symptoms of hyperactive bladder with scores ranging from 0 to 16 points, considering the higher the score the greater the severity of symptoms; and (3) Female Sexual Function Index (FSFI) that evaluates sexual function in women, consisting of six domains (desire, arousal, lubrication, orgasm, satisfaction and pain) with a score ranging from 2 to 36, considering the highest score being the best sexual function, and an equal or less than 26 score is indicative of risk for sexual dysfunction [1]. For statistical analysis, the Kolmogorov-Smirnov, Chi-Square, ANOVA, Kruskal-Wallis, Tukey test and Dunn's tests were used, adopting a significance level of 5%.

It was verified that the groups are homogeneous among themselves in relation to the variables age (p = 0.83), body mass index (P = 0.26), marital status (P = 0.19), skin color (p = 0.15), schooling (P = 0.05) and work activity (P = 0.83). The participants had a mean age of 31 ± 5 years, the majority had completed bachelor’s degree (73%), self-declared white (63%) and were married (75%). In addition, 45% of the participants were multiparous and the elective cesarean section was the prevalent previous type of delivery (56%). Statistical analyses for the variables pain during pregnancy, symptoms of hyperactive bladder, presence and severity of urinary incontinence, sexual symptoms and their domains are presented in table 1. Regarding the level of pain, most participants reported pain in the lumbar region (55%), followed by pain in more than one body region (22%), lower limbs (14%), abdomen (6%) and upper limbs (3%).

According to this study, pain symptom has a progressive increase with the advancement of gestation and is significantly more incident in the third gestational trimester when compared to the first, moreover, low back pain was most reported among the participants. Similarly, in the third gestational trimester, there was a significant presence of urinary incontinence and hyperactive bladder symptoms when compared to the first and second gestational trimesters. In the study by Smith et al [2], there was an association between lumbar pain and urinary incontinence in pregnant women, being explained by postural alterations, muscle control of the spine and connective tissue that lead to muscular imbalance and a disarray of the continence mechanism, corroborating the findings of this study. Regarding sexual symptoms, it was observed that there was a statistically significant worsening of this function as gestational age advances, and the third gestational trimester presented lower total score when compared to the second trimester, as well as in arousal, lubrication and pain domains. Only the satisfaction domain showed the worst statistically significant score in second-trimester-pregnant women when compared to the first gestational trimester. Agreeing with the results observed in this study, the study by Moretti et al [3] shows that pregnant women had some degree of sexual dysfunction independent of the gestational trimester, and explains that the relation between sexual function and the third gestational trimester is characterized by an increase in anxiety and abdominal volume, which consequently induces a physical discomfort hindering sexual intercourse.

Pregnant women who are in the third gestational trimester seem to be more prone to presenting pain, urinary incontinence, hyperactive bladder and sexual symptoms. In view of these findings, it is important to understand the adaptations and discomforts that affect pregnant women in each gestational trimester to guide the clinical practice and to implement preventive measures against the dysfunctions discussed.

Rosen R. Brown C. Heiman J, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208.
Smith, M. D., Russell, A., & Hodges, P. W. (2007). Is there a relationship between parity, pregnancy, back pain and incontinence? International Urogynecology Journal, 19(2), 205–211.
Moretti E, Barbosa L, Nascimento T, Carvalho I, Boaviagem A. Analysis of Sexual Function in Women During the Trimesters of Pregnancy: A Cross-Sectional Study. J Complement Med Alt Healthcare. 2017; 2(2): 555585.