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Does the mode of delivery matter?

For some parents, resuming sexual intimacy after having a baby is a top priority. For others, Not that much — and night feedings and diaper changes may not be the only problems.

Dyspareunia (pain during intercourse) occurs in a significant number of women after childbirth, and recent research sheds light on how psychological and biomedical factors relate to this condition.

The mode of delivery, for example, may have less of an effect on sexual well-being than some people suspect.

Despite a perception that cesarean birth might affect sexual function less than vaginal delivery does, how mothers who gave birth didn’t affect how often they had sex after delivery or how much pleasure they got from it, according to published research in BJOG.

Eleven years after delivery, however, cesarean delivery was associated with a 74% increased odds of vaginal pain during intercourse, compared with vaginal delivery, the researchers found (odds ratio, 1, 74, 95% CI, 1.46-2.08).

The results suggest that cesarean delivery “might not help protect against sexual dysfunction, as previously thought,” said Flo Martin, an epidemiology doctoral student at the University of Bristol, UK, and lead author of the study. Press release.

For their study, Martin and colleagues analyzed data from more than 10,300 participants in the Avon Parent-Child Longitudinal Study, which recruited women in the United Kingdom who were pregnant in 1991 and 1992.

The researchers had data on pain during intercourse at age 11. They had data on sexual enjoyment and frequency at 33 months, 5 years, 12 years, and 18 years postpartum.

If women experienced pain during intercourse years after cesarean delivery, uterine scarring might have been a cause, Martin and colleagues suggested. Alternatively, women with prepartum dyspareunia may be more likely to undergo caesarean section, which could also explain the association.

Other studies have also found that different delivery modes generally lead to similar sexual well-being outcomes after birth.

“Several of my own longitudinal studies have shown limited associations between mode of delivery and various aspects of sexual well-being, including sexual satisfaction, sexual function, and sexual desire,” said Natalie O. Rosen, PhD, director of the Couples and Sexual Health Laboratory at Dalhousie University, Halifax, Nova Scotia, Canada.

However, other published studies have yielded conflicting results, so the question deserves further study, he said.

catastrophizing pain

A study by the Rosen group published this year in Obstetrics and Gynecology tracked sexual pain in 582 people from mid-pregnancy to 2 years after delivery.

About 21% of the participants experienced moderate pain during intercourse, determined by a mean pain score greater than 4 on a 0-10 point scale. The rest were classified as “minimal dyspareunia”.

Pain tended to peak at 3 months postpartum and then steadily decreased in the moderate and minimal pain groups.

Mode of delivery did not affect the odds of a participant having moderate dyspareunia. Neither breastfeeding nor previous chronic pain.

“But we found one key thing to note: Those who reported a lot of negative thoughts and feelings about pain, something called catastrophic pain, were more likely to experience moderate persistent pain during sex,” the researchers said in a video about their findings.

Pain catastrophizing 3 months after delivery was associated with a significantly increased odds of following a moderate pain trajectory (odds ratio, 1.09; 95% CI, 1.04-1.15).

Let’s talk about #postbabyhankypanky

Caring for a newborn while in a romantic relationship can be challenging, and “evidence-based research aimed at helping couples prevent and cope with changes in their postpartum sexual well-being is lacking,” Rosen said.

During the 2-year study, an increasing number of participants reported having sex less frequently over time. The percentage of women who had had sexual activity in the last 4 weeks was 99% at baseline (20-24 weeks’ gestation), 83.5% at 32 weeks’ gestation, 73.9% at 3 months postpartum, and 69.6% at 2 years postpartum

“A crucial way that couples maintain their connection is through their sexuality,” Rosen said. “Unfortunately, most new parents experience significant alterations in their sexual function,” such as decreased sexual desire or increased pain during intercourse.

Rosen’s group has created a series of videos related to this topic dubbed #postbabyhankypanky to facilitate communication about postpartum sex. She encourages women with dyspareunia to talk to a health care provider because treatments like cognitive behavioral therapy, pelvic floor physical therapy, and topical medications can help control pain.

‘Reassuring’ data

Veronica Gillispie-Bell, MD, MAS, director of quality services for women at Ochsner Health System in New Orleans, said she frequently sees patients with postpartum sexual pain.

Patients are usually instructed to rest their pelvis from delivery to 6 weeks postpartum.

At the 6-week appointment, she tells patients to be sure to use plenty of lubrication because vaginal dryness related to hormonal changes during pregnancy and breastfeeding can make intercourse more painful, regardless of mode of delivery .

For many patients, he also recommends pelvic floor physical therapy.

As the medical director of the Louisiana Perinatal Quality Collaborative, a network of care providers, public health officials and advocates that aims to improve outcomes for birthers, families and newborns, Gillispie-Bell is also focused in reducing the rate of cesarean deliveries. in the state. the BJOG A study showing an increased risk of dyspareunia after C-section serves as a reminder that there may be “long-term effects of having a C-section that may not be as obvious,” he said.

“C-sections are life-saving procedures, but they are not without risk,” Gillispie-Bell said.

Leila Frodsham, MBChB, spokesperson for the Royal College of Obstetricians and Gynaecologists, saying United Kingdom that it was “reassuring” to see “no difference in sexual enjoyment or sexual frequency at any time postpartum between women who delivered by cesarean section and those who delivered vaginally.”

“Women should be supported to make informed decisions about how they plan to give birth, and it is vital that health professionals respect their preferences,” Frodsham added.

Physicians should also be aware that sexual pain is also common during periods of subfertility, perimenopause, and early sexual activity.

Combinations of biological, psychological and social factors can influence pain during intercourse, and there’s also an interpersonal element to consider, Rosen noted.

“Pain during sexual intercourse is often triggered in the context of a partner relationship,” Rosen said. “This means that this is an inherently interpersonal problem: let’s not forget the partner who is affected and can affect the pain through their own responses.”

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