Hypothesis / aims of study
Vaginal delivery-related perineal trauma increases the risk of dyspareunia and sexual dysfunction in the postpartum period, with Obstetric Anal Sphincter Injuries (OASIS) causing the most severe symptoms (1). Evidence is scarce on how subsequent vaginal deliveries following OASIS may impact long-term sexual function. This study evaluates the long-term sexual function of women with a history of OASIS followed by an OASIS-free birth compared to women who have had at least two vaginal deliveries without OASIS.
Study design, materials and methods
This questionnaire-based retrospective observational study compared women with and without prior OASIS. The case group was identified through hospital records, identifying all patients registered with OASIS between 2002-2018. The control group comprised women with two or more OASIS-free vaginal deliveries within the same time-period. Inclusion criteria for the case group were a history of OASIS and at least one subsequent OASIS-free vaginal delivery; controls required at least two vaginal deliveries without OASIS. Exclusion criteria included < 18 years of age, OASIS or cesarean section only in subsequent pregnancies, and response to fewer than 50 % of questionnaire items. The women completed validated questionnaires on symptoms of anal and urinary incontinence as well as sexual function. This study was part of a larger study in which power-calculations and target 1:2 case/control ratio were based on long-term risks for urinary incontinence.
The primary outcome of this sub-study was sexual function, assessed using the validated Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), a condition-specific questionnaire on sexual function for both sexually active and non-active women with pelvic floor disorders, including anal incontinence (2).
The secondary outcome was dyspareunia, assessed by comparing responses to relevant isolated questions for both sexually active and non-active women.
Results
Of 7.466 invited, 1.520 (20.4 %) consented to study participation. After exclusions, 301 cases and 412 controls were included in the final analysis. Median follow-up time for both groups were 15 years (range 3-23). The total PISQ-IR score did not differ between the groups (p = 0.916). Univariate analyses showed that OASIS was associated with a lower score on the condition – specific subdomain regarding the impact of pelvic floor symptoms on sexual function among sexually active women (p = 0.05), but the difference disappeared after adjustment in the multiple linear regression model.
Sixty-six individuals (9.2%) were sexually inactive, with no significant association between OASIS and sexual inactivity found (OR = 1.06, 95% CI: 0.6-1.8).
Among sexually inactive women, those with previous OASIS more often reported dyspareunia as the reason for being sexual inactive (OR (for disagreement on the impact of dyspareunia) = 0.29, 95% CI: 0.09-0.89). However, no association was found between prior OASIS and the severity of dyspareunia in sexually active participants (OR 1.26, 95% CI: 0.9-1.7).
Interpretation of results
No significant long-term differences in sexual function scores were found between the cohorts, and prior OASIS was not associated with sexual inactivity. That sexually active women had lower scores in the condition- specific subdomain does not seem clinically relevant. Among sexually inactive women, those with a history of OASIS were more likely to report dyspareunia as the main reason for being sexually inactive.