Hanna Jangö

Introduction: Sexuality is integral to most women’s quality of life. However, pregnancy and childbirth often lead to biological, psychological, and relational challenges that can impact sexual health and wellbeing. Research has documented declines in sexual activity, functioning, and satisfaction during the postpartum period, particularly among women who sustained severe perineal injuries during delivery. However, these issues remain scientifically and clinically underrecognized. Objectives: Approximately 90% of primiparous women experience perineal tearing during vaginal delivery, with 5% sustaining an obstetric anal sphincter injury (OASI). This scoping review aims to synthesize existing evidence on the relationship between OASI and postpartum sexual health, focusing on three key dimensions: (1) sexual activity, (2) sexual functioning, and (3) sexual satisfaction. Understanding the impact of OASI on female sexual health is essential for providing tailored postpartum care and support. Methods: A comprehensive literature search was conducted in PubMed, Embase, Scopus, CINAHL, Cochrane, and “gray literature” sources to identify relevant peer-reviewed studies. The selection process involved three stages: screening of titles and abstracts, full-text evaluation, and final inclusion based on predefined criteria. Original quantitative studies presenting statistical evidence on the impact of OASI on postpartum sexual health were eligible for inclusion. Results: Based on 33 articles, the scoping review revealed that women with OASI experienced delayed resumption of sexual intercourse compared to those with no or minor perineal tears. In addition, most studies reported that OASI increased the risk of dyspareunia, potentially persisting for years after childbirth. Several studies also observed a temporary or long-term decrease in desire, lubrication, orgasm ability, and overall sexual satisfaction. OASI was further associated with a heightened risk of long-lasting complications such as anal incontinence, which could contribute to or exacerbate sexual problems. Conclusion: Women who sustain OASI during childbirth face an increased risk of postpartum sexual health issues. To mitigate these challenges, healthcare providers should encourage open discussions about sexual health and, when necessary, provide referrals to physiotherapy, couples therapy, or specialized sexological support.

Objective: To evaluate the effect of prophylactic antibiotics on the risk of wound complications after episiotomy or second degree tear. Design: Single centre, double blind, placebo controlled randomised trial. Setting: One university hospital in the Capital Region of Denmark. Participants were enrolled between March and December 2023. All initial clinical consultations were conducted between March 2023 and January 2024, and all long term follow-up consultations were conducted between March and November 2024. This article reports only data from the first consultation. Participants: 442 women with episiotomies or second degree tears were consecutively recruited at delivery. Exclusion criteria included treatment allergy (or risk of cross reactivity with related antibiotics), antibiotic use within 24 hours of delivery, non-Danish speakers, caesarean section, or episiotomy extension. Intervention: A computer generated program randomised participants to either three doses of amoxicillin (500 mg) with clavulanic acid (125 mg) or placebo starting within six hours post partum and repeated at eight hour intervals. Follow-up was conducted four to 14 days post partum. Physicians, the steering committee, and participants were blinded. Main outcome measures: Wound complications (primary outcome) and clinically relevant wound complications (secondary outcome). Results: The study ended as planned, in December 2024. 433 women completed follow-up and were included in the primary analysis. No significant difference was observed in overall wound complications (antibiotic 47/218, 22%; placebo 62/215, 29%; P=0.10), with a risk difference of −7.2% (95% confidence interval (CI) −15.4% to 0.8%) and a relative risk of 0.75 (0.54 to 1.04). For clinically relevant wound complications, significantly fewer events occurred in the treatment group (19/218, 9% v 36/215, 17%; P=0.01), with a risk difference of −8.0% (95% CI −14.3% to −1.8%) and a relative risk of 0.52 (0.31 to 0.88). For clinically relevant wound complications, the number needed to treat was 12 (95% CI 7 to 56). Exploratory outcomes show that the treatment group reported better self-evaluated health, received fewer additional antibiotic treatments, and had smaller average wound dehiscence among patients with dehiscence. No serious adverse reactions occurred. Conclusion: Although no significant effect was seen for overall wound complications, prophylactic antibiotics significantly reduced the risk of clinically relevant wound complications in women with episiotomies and second degree tears and should be considered in postpartum care. Trial registration: Clinical Trials Information System (euclinicaltrials.eu) 2022-501930-49-00 and ClinicalTrials.gov NCT05830162

Introduction and Hypothesis High birth weight increases the risk of obstetric anal sphincter injury. Macrosomia is a well-known complication in pregnancies complicated by gestational diabetes mellitus. The aim of this study was to investigate whether gestational diabetes is a risk factor for obstetric anal sphincter injury. We hypothesized that women with gestational diabetes have an increased risk of obstetric anal sphincter injury. Methods We performed a systematic review and meta-analysis using the PubMed and Embase databases. Studies including numbers on women with and without gestational diabetes and with and without obstetric anal sphincter injury were included. Studies were assessed using the SIGN-methodology checklist to evaluate the quality and risk of bias. Extracted data was analyzed using RevMan 5.4 and the statistical software R. Results Twelve cohort studies were included for the meta-analyses. Overall, we found a slightly increased prevalence of obstetric anal sphincter injury among the women with gestational diabetes of 2.40% (95% CI; 2.37–2.43) compared to 2.31% (95% CI; 2.30–2.32) in women without diabetes. The meta-analysis revealed increased risk of obstetric anal sphincter injury in the gestational diabetes-group (RR 1.24 [95% CI; 1.12–1.37]) with a high level of heterogeneity (I² = 94%). Primiparous women with gestational diabetes had an increased risk of obstetric anal sphincter injury 6.65% (95% CI; 6.18–7.14) compared to 4.98% (95% CI; 4.89–5.08) in the control group, whereas the risk was not significantly increased in multiparous women. Conclusions The risk of obstetric anal sphincter injury is increased in primiparous women with gestational diabetes mellitus compared to women without gestational diabetes.

Background: We lack a comprehensive validated Danish questionnaire to evaluate symptoms and bother regarding anal incontinence (AI). The International Consultation on Incontinence Questionnaire‐Bowel (ICIQ‐B) is an internationally recommended questionnaire containing 21 items, of which 17 are scored in three subscales: bowel pattern, bowel control, and quality of life.Aims: To translate the ICIQ‐B into Danish and to validate the Danish version in pelvic floor disorder (PFD) patients with and without AI.Methods: The ICIQ‐B was translated by a panel of healthcare professionals followed by cognitive interviews with PFD patients attending an outpatient clinic. Revisions were undertaken using an iterative process, and a backward translation was performed for the final version. Pretesting and test‐retest of the ICIQ‐B were done online and administrated together with the St. Mark's score. Content, structural, convergent and discriminant validity were assessed, followed by an evaluation of relative and absolute reliability, including the smallest real difference (SRD).Results: Thirty cognitive patient interviews were performed, resulting in three revisions. The Danish ICIQ‐B was found to be comprehensible and relevant but lacked items addressing the psychological impact of bowel problems. The ICIQ‐B was completed online by 227 PFD patients with and without AI. The structural validity of the bowel pattern subscale could not be retrieved. Patients indicating AI had significantly higher ICIQ‐B and St. Mark's scores than patients without AI, and ICIQ‐B subscale scores correlated moderately with St. Mark's scores.Internal consistency was good except for the bowel pattern subscale. Seventy‐six patients completed test‐retest. Relative reliability was excellent for subscale scores and moderate or good for single items except for the item concerning stool consistency, which was weak. The SRD was found to be 2.8 for the bowel pattern subscale, 4.3 for bowel control subscale, and 3.6 for the quality‐of‐life subscale.Conclusion: The Danish version of the ICIQ‐B can be used for Danish patients with PFD, and discriminant validity is good. The structural validity and the internal consistency of the bowel pattern subscale are questionable, indicating that some items do not represent the underlying construct. Test‐retest reliability of the ICIQ‐B is acceptable, but the change needed to reflect a real change above the measurement error in each subscale is three to four points.

Background: Approximately 85% of women experience an obstetric tear at delivery and up to 25% subsequently experience wound dehiscence and/or infection. Previous publications suggest that intravenous antibiotics administrated during delivery reduces this risk. We do not know if oral antibiotics given after delivery can reduce the risk of wound dehiscence or infection. Our aim is to investigate whether three doses of oral antibiotics (amoxicillin 500 mg/clavulanic acid 125 mg) given after delivery can reduce the risk of wound dehiscence and infection in patients with a second-degree obstetric tear or episiotomy. Methods: We will perform a randomized, controlled, double-blinded study including 221women in each arm with allocation 1:1 in relation to the randomization. The study is carried out at Department of Obstetrics & Gynecology, Herlev University Hospital, Copenhagen, Denmark. The women will be included after delivery if they have had a second-degree tear or episiotomy. After inclusion, the women will have a clinical follow-up visit after 1 week. The tear and healing will be evaluated regarding signs of infection and/or dehiscence. The women will again be invited for a 1-year clinical examination including ultrasound. Questionnaires exploring symptoms related to the obstetric tear and possible complications will be answered at both visits. Our primary outcome is wound dehiscence and/or wound infection, which will be calculated using χ² tests to compare groups. Secondary outcomes are variables that relate to wound healing, as pain, use of painkillers and antibiotics, need for further follow-up, as well as outcomes that may be related to the birth or healing process, urinary or anal incontinence, symptoms of prolapse, female body image, and sexual problems. Discussion: Reducing the risk of wound dehiscence and/or infection would decrease the number of control visits, prevent the need for longer antibiotic treatment, and possibly also decrease both short-term and long-term symptoms. This would be of great importance so the mother, her partner, and the baby could establish and optimize their initial family relation. Trial registration: The conduction of this study is approved the 2/2–2023 with the EU-CT number: 2022–501930-49–00. ClinicalTrials.gov Identifier: NCT05830162.

Obstetric anal sphincter injury causes anal incontinence in half of the women affected. However, most symptoms are mild. The objective of this study was to evaluate the prevalence of anal incontinence and quality of life in women at long term after delivery with obstetric anal sphincter injury. We also wanted to identify a relevant cutoff level of the Wexner score (also known as the Cleveland Clinic Incontinence Score) to indicate affected quality of life in these women.