Peripartum predictors of postpartum dyspareunia: a longitudinal observational cohort study

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Abstract
Purpose To assess postpartum changes in dyspareunia, and to explore the prediction of postpartum dyspareunia by obstetrical outcomes and peripartum emotional reactions. Methods In this longitudinal observational study, postpartum women were recruited at the maternity ward of a single medical center (T1) two days postpartum, during April 2018-August 2020. Participants filled questionnaires addressing demographic and reproductive background, pre-partum dyspareunia, pain during labor, peripartum dissociation, sense of control and birth-induced acute stress disorder (ASD). Three months postpartum (T2), participants who reported resuming sexual activity filled questionnaires addressing dyspareunia, breastfeeding and depression. Obstetrical information was obtained from clinical records. Results At T1, we recruited 440 participants, among whom 240 (54%) reported resuming sexual activity at T2 and filled the dyspareunia questionnaire at both times. At T2, 52 (21.7%) women reported dyspareunia. Thirty-four (14.2%) women experienced new-onset dyspareunia, 18 (7.5%) had persistent dyspareunia, and 23 (9.6%) reported dyspareunia resolution. ASD symptoms at T1 predicted dyspareunia severity at T2 (B = 0.59, SE = 0.28, p = 0.004). Women with persistent dyspareunia reported greater dyspareunia severity, more dissociation, birth-induced ASD, lower sense of control during labor. At T2, nineteen (59.4%) women with new-onset dyspareunia reported breastfeeding vs. four (22.2%) women with persistent dyspareunia (p = 0.02). Conclusion We observed an association between negative peripartum experiences and postpartum dyspareunia. This finding highlights the importance of incorporating sexual history into prenatal care. Improving obstetric practices enhancing women’s control during childbirth and early detection of ASD symptoms, could lead to interventions reducing postpartum dyspareunia.

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