Predictors for sexual dysfunction in the first year postpartum: a
systematic review and meta-analysis
Abstract
Background Pregnancy and childbirth increase the risk for pelvic floor
dysfunction, including sexual dysfunction. So far, the mechanisms and
the extent to which certain risk factors play a role, remain unclear.
Objectives In this systematic review of literature, we aimed to
determine the risk factors for sexual dysfunction in the first year
after delivery. Search Strategy We searched MEDLINE, Embase and CENTRAL
using the search strategy: Sexual dysfunction AND Obstetric events.
Selection Criteria We included original English, comparative studies
that used validated questionnaires and the ICS/IUGA terminology for
sexual dysfunction, dyspareunia and vaginal dryness. Data Collection and
Analysis We assessed the quality and the risk of bias of the included
studies with the Newcastle Ottawa Scale. We extracted the reported data
and we performed random-effects meta-analysis to obtain the summary Odds
Ratios (OR) with 95% Confidence Intervals. Heterogeneity across studies
was assessed using the I2 statistic. Main Results We found no
significant difference in the odds for both sexual dysfunction and
dyspareunia between cesarean section and spontaneous delivery
(OR:1.17[0.88-1.57] and OR:0.75[0.53-1.07]) and between
operative delivery and spontaneous delivery (OR:1.56[0.87-2.79] and
OR:1.35[0.75-2.42]). Anal sphincter injury was associated with
increased odds for both sexual dysfunction (OR:3.00[1.28-7.03]) and
dyspareunia (OR:1.71[1.09-2.67]). Episiotomy was associated with
dyspareunia (OR:1.65[1.20-2.29]) but not with sexual dysfunction
(OR:1.90[0.94-3.84]). We retrieved one study of low quality which
reported on vaginal dryness and found no significant association with
obstetric events.