Leeman et al. Perineal pain Prospective Discharge from hospital, 3 months postpartum 565 midwifery patients, all parities 81% at discharge 9.3% at 3 months Increased perineal trauma at discharge was associated with more pain at discharge, but not at 3 months Thompson et al. Perineal pain Prospective 4 days, 2, 4, and 6 months 1193, all parities 24% at 2 months 6% at 4 months 4% at 6 months Vaginal and instrumental deliveries associated with more perineal pain Primiparas reported more perineal pain compared to multiparous Brown & Lumley Perineal pain Retrospective 6-7 months 1336, all parities 21% Instrumental deliveries, primiparous associated with greater perineal pain
Eisenach et al. , Pain in pelvis, perineum, or abdomen that started childbirth Prospective 36 hrs, 2, 6, and 12 months 1288, all parities 10% (9.8-10.1%) at 2 months 2.8% (1.4-5.3%) at 6 months 0.9% (0.3-1.2%) at 12 months Severity of acute pain at 36 hrs increased risk of pain at 2 months Mode of delivery did not predict pain at 2 months History of pain (in pregnancy or menstruation), degree of tissue damage were related to acute pain at 36 hrs, but unrelated to pain at 2 months Sample size not great enough to examine predictors of pain at 6 and 12 months Kainu et al. Pain in birth canal (vulva or anus) or incision site Retrospective 12 months 600, all parities 10% Pain at 12 months more common in women with history of other types of pain or chronic illness, and who recalled more pain on day after delivery Patterson et al. Genital-pelvic pain Retrospective 12 months 114, all parities 9% Past diagnosis with a nongenital chronic pain condition predicted likelihood of pain at 12 months Mode of delivery, tearing, episotomy, breastfeeding, maternal age, parity status did not differentiate between women who reported postpartum onset of genital or pelvic pain and those who did not
Table 2. Studies of postpartum dyspareunia Study Study Design N/Parity Prevalence Risk factors Andrews et al. Prospective 1 day, 5 days, 7 weeks 241, primiparous 12% at 7 weeks Breastfeeding not associated with dyspareunia Greater perineal trauma associated with more dyspareunia at 7 weeks. Signorello et al. Retrospective 3 and 6 months 615, primiparous 41% at 3 months 22% at 6 months At 3 months, degree of perineal trauma predicted dyspareunia At 6 months, instrumental delivery, breastfeeding, history of dyspareunia predicted dyspareunia Barrett et al. Retrospective 3 and 6 months 484, primiparous 62% in 1st 3 months 31% at 6 months (12% reported dyspareunia was present in pregnancy) At 3 months, dyspareunia was associated with instrumental delivery, dyspareunia before pregnancy At 6 months, dyspareunia was associated with breastfeeding, history of dyspareunia (instrumental delivery no longer significant) Connolly et al. Prospective Pre-pregnancy (retrospective), enrollment (retrospective for prior 7 days) 2 and 6 weeks, 3 and 6 months 150, primiparous 30% at 3 months 17% at 6 months Breastfeeding at 3 months predicted dyspareunia at 6 months Mode of delivery and episiotomy were not associated with dyspareunia
Lal et al. Retrospective 10 months 284, primiparous 46% vaginal delivery 28% for caesarean Perineal trauma did not increase risk Stress incontinence was associated with dyspareunia Safarinejad et al. Prospective 3, 6, and 12 months 912, primiparous Vaginal delivery 3 months: 27.8% 6 months: 18.3% 12 months: 11.2% Vaginal with episiotomy 3 months: 57.4% 6 months: 26.3% 12 months: 16.8% Instrumental vaginal 3 months: 75.2% 6 months: 41.2% 12 months: 24.8% Cesarean 3 months: 13.2% 6 months: 10.8% 12 months: 3.6% Instrumental delivery associated with highest rates of dyspareunia across all time points Serati et al. Prospective 6 and 12 months 336, all parities 24% at 6 months 8% at 12 months Episiotomy, perineal tears, parity, fetal weight, labour induction, duration of labour, breastfeeding, epidural were not associated with dyspareunia Bertozzi et al. Retrospective 12 months 602, all parities 16.2% More severe tearing, instrumental delivery, previous dyspareunia, recurrent urogenital infections, urge incontinence, associated with dyspareunia at 12 months
Table 3. Studies of postpartum genito-pelvic pain and dyspareunia Types of pain Study Design N/Parity Prevalence Risk Factors Declercq et al. Perineal pain and dyspareunia Retrospective 2 and 6 months 1573, all parities Perineal At 2 months: Primiparous 72.5% vaginal 77.4% instrumental 12.3% cesarean Multiparous 36.9% vaginal 52.2% instrumental 12.3% cesarean At 6 months: Primiparous 2% vaginal 15% instrumental Multiparous 1% vaginal 0% instrumental Dyspareunia At 2 months: Primiparous 47.7% vaginal 55.8% instrumental 31.1% cesarean Multiparous 26.5% vaginal 36.2% instrumental Episiotomy predicted perineal pain in multiparous only at 2 months Instrumental deliveries predicted perineal pain at 2 and 6 months later (N = 40) Instrumental deliveries and primiparae associated with dyspareunia at 2 months Risk factors for dyspareunia at 6 months were not reported
29.7% cesarean Hannah et al. Genital pain and dyspareunia Randomized of planned cesarean vs. vaginal delivery 3 months 1596, all parities 1.8-5.5% genital pain 18% dyspareunia 25-27% any pain Planned vaginal delivery was associated with higher risk for genital pain No differences between cesarean and vaginal delivery for dyspareunia Kennedy et al. Vulvar pain and dyspareunia Prospective Pregnancy to 3 months postpartum 63-103, all parities At 3 months postpartum (N = 63) 8% vulvar pain 39% dyspareunia Increase in of dyspareunia postpartum Vaginal deliveries associated with dyspareunia (but not vulvar pain) Glazener27 Perineal pain and dyspareunia Retrospective 2 months and 2-18 months 1116 at 2 months 438 at months (reflecting on time between months), all parities Perineal: 22% at 2 months 10% between 2-18 months Dyspareunia: 28% at 2 months 19.7% between 2-18 months Perineal pain persisting after 2 months was associated with instrumental delivery Did not report risk factors for dyspareunia Williams et al. , Perineal pain and dyspareunia Retrospective 12 months 482, all parities 32.6% for perineal pain 30.3% for dyspareunia Instrumental delivery and being of Asian descent associated with greater perineal pain Older age, perineal trauma associated with dyspareunia (but not mode of delivery) Note. “Instrumental deliveries” to vaginal deliveries by vacuum or forceps. Studies are listed in order of the length of follow-up.
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