Table 2.
Description of included studies with perineum injury morbidity as exposure
| Publication Authors Year of publication |
Type of study Outcome Assessment |
Period of data collection Location |
Participants | Outcomes |
|---|---|---|---|---|
| 1. Women´s sexual health after childbirth. Barret G et al., 2000 [37] |
Cross sectional Sexual problems (vaginal dryness, painful penetration, dyspareunia, vaginal tightness, vaginal looseness, bleeding/irritation after sex and loss of sexual desire) Mailed questionnaires. |
1st July to 31 December 1997 London, UK |
484 postpartum primiparous women. Evaluation at 3 and 6 months after delivery. |
Dyspareunia at 3 months after birth: Minor perineal laceration: 55 % (115/209) 3rd degree laceration: 64 % (7/11) Dyspareunia at 6 months after birth: Minor perineal laceration: 26 % (62/235) 3rd degree laceration: 33 % (4/12) |
| 2. Postpartum sexual functioning and its relationship to perineal trauma: A retrospective cohort study of primiparous women. Signorello LB et al., 2001 [38] |
Retrospective cohort 1. Time to resumption of sexual intercourse 2. Dyspareunia Sexual satisfaction Sexual sensation Likelihood of achieving orgasm. Mailed questionnaires. |
From August 1, 1996, and February 8, 1997. Boston, Massachusetts, USA. |
626 postpartum women (6 months) Group 1, n = 211 (intact perineum or first-degree perineal tear) Group 3, n = 68 (third- or fourth-degree perineal trauma) |
1. Resumption of sexual activity: In 7–8 weeks Group 1: 30.8 % (61/211) Group 3: 35.0 % (21/68) In 6 months: Group 1: 94.8 % (199/210) Group 3: 92.5 % (62/67) Time to resume in weeks (mean and SD): Group 1: 7.1 (3.3) Group 3: 9.3 (3.5)p < 0.001 2.Pain (dyspareunia) at first intercourse: Group 1: 57.8 % (115/211) Group 3: 77.4 % (48/68) (p < 0 .001). 3 months postpartum: Group 1: 32.8 % (60/211) Group 3: 51.4 % (35/68) (p trend < 0 .001) 6 months postpartum: Group 1: 18.6 % (37/211) Group 3: 26.7 % (16/68) 3. Sexual satisfaction, sexual sensation and achievement of orgasm. |
| 3. Which factors determine the sexual function 1 year after childbirth? van Brummen et al., 2006 [42] |
Prospective cohort MMQ-S scale Self-applied questionnaires at pregnancy (12 and 36w), and at 3 and 6 months postpartum. |
From January 2002 to July 2003. Netherlands |
377 women evaluated at 3 periods (pregnancy, 3 and 5 months postpartum) | Sexual activity 1 year after childbirth (resumption): YES: Intact/1st/2nd degree laceration: 46,3 % 3rd/4th degree laceration: 56,5 % NO: Intact/1st/2nd degree laceration: 53,7 % 3rd/4th degree laceration: 43,5 % MMQ-S questionnaire: No differences among groups (NS) |
| 4. Women’s health 18 years after rupture of the anal sphincter during childbirth: II. Urinary incontinence, sexual function, and physical and mental health. Otero et al., 2006 [44] |
Retrospective cohort. FSFI Mailed questionnaire |
18 years after childbirth that occurred between January 1st, 1982, and December 31th, 1983. Geneva, Switzerland |
453 women. Exposed: 230 (women who had had anal sphincter injury during childbirth) Not exposed: 223 (randomised postpartum women not exposed to the injury and with the same parity) |
FSFI <25: NS Anal Injury: 39/230 No injury: 38/223 RR 1,0 (CI 95 % 0,8-1,2 p = 0.75) |
| 5. Long Term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints. Mous et al., 2007 |
Retrospective cohort study Sexual complaints (including dyspareunia) |
2005 assessment of postpartum women who gave birth between 1995 and 1996. Rotterdam, Netherlands |
Total included in 2005: 119 cases (sphincter injury) 90 controls (no injury) |
Dyspareunia: Sphincter injury: 29 % (35/119) Controls: 13 % (12/90) |
| 6. Women's dyspareunia after childbirth: a case study in a hospital in Acapulco, Mexico. Solana-Arellano, et al., 2008 [40] |
Case control study. Dyspareunia. |
From October 2005 to January 2006 Acapulco, Mexico. |
Cases: 152 postpartum women who resumed sexual activity and referred pain or bleeding during intercourse. Controls: 152 postpartum women who resumed sexual activity and not referred the same symptoms. 2–6 months after childbirth. 27 women had perineal laceration. |
Perineal laceration: (27/152) 17.8 % in cases with dyspareunia (23/152) 15.1 % in controls without dyspareunia |
| 7. Sexual Function 6 Months After First Delivery. Brubaker et al., 2008 [43] |
Prospective cohort Resumption of sexual activity at 6 months Sexual Function Short Form Questionnaire (PISQ-12) |
September 2002 and September 2004 USA |
536 postpartum primiparous women at term, 459 sexually active. Sphincter tear: 198 Vaginal controls: 200 Cesarean controls: 61 Interviewed at 6 weeks and 6 months after childbirth. |
Resumption of sexual activity at 6 months: Sphincter tear: 88 % (171/198) Vaginal controls: 93.9 % (13/200) Cesarean controls: 85.9 % (51/61) p = 0.028 Mean PISQ-12 scores at 6 months: 39 ± 4 p = 0.92 NS |
| 8. Tears in the Vagina, Perineum, Sphincter Ani, and Rectum and First Sexual Intercourse after Childbirth: A Nationwide Follow-up. Rådestad I et al., 2008 [48] |
Prospective cohort Resumption of sexual activity Mailed questionnaire |
Between 1999 and 2000 Sweden |
2,134 postpartum women at 2 months and 1 year after childbirth (vaginal delivery). Tears in sphincter ani/rectum: 59 |
Resumption of sexual activity: Tears in sphincter: ≥3 Months: 49.2 % ≤3 Months: 23,3 % RR = 2.1 (CI 1.6–2.8) p < 0.001 No tears in sphincter: ≥3 Months: 23.3 % ≤3 Months: 76.7 % RR = 1 Difference between groups: 25.8 % (49.2 %–23.3 %) NNH: 3.9 (CI 95 % 2.6-7.7) Tears in sphincter: ≥6 Months: 13.6 % ≤6 Months: 86.4 % RR = 1.8 (CI 0.9–3.5) p = 0.130 No tears in sphincter: ≥6 Months: 7.6 % ≤6 Months: 92.4 % RR = 1 Difference between groups: 6.0 % (13.6 %–7.6 %) NNH: 16.8 (CI 95 % 6.8-35.2) At 12 Months: 4 % NO sexual activity (NS) |
| 9. Sexual Function in Women 3 Days and 6 Weeks After Childbirth: A Prospective Longitudinal Study Using the Taiwan Version of the Female Sexual Function. Chang, et al., 2010 [45] |
Prospective longitudinal FSFI |
From November 2007 to April 2009 Taipei, Taiwan |
356 postpartum women 199 vaginal delivery (no intact perineum) |
FSFI Day3: 1st/2nd degree laceration (182/199) LSM = 7.0 3rd or 4th degree: (17/199) LSM = 7.1 p = 0.984 (NS) FSFI Week 6: 1st/2nd degree (158/172) LSM = 13.6 3rd or 4th degree (14/172 ) LSM = 15.1 p = 0.7 (NS) Sexual activity score Day 3: 1st/2nd degree laceration (182/199) LSM = 15.0 3rd or 4th degree: (17/199) LSM = 14.1 p = 0.8548 (NS) Sexual activity score Week 6: 1st/2nd degree laceration (182/199) LSM = 18.8 3rd or 4th degree: (17/199) LSM = 20.9 p = 0.7193 (NS) Satisfaction score Day 3: 1st/2nd degree laceration (182/199) LSM = 51.7 3rd or 4th degree: (17/199) LSM = 56.0 p = 0.6691 (NS) Satisfaction score Week 6: 1st/2nd degree laceration (182/199) LSM = 151.1 3rd or 4th degree: (17/199) LSM = 166.5 p = 0.4723 (NS) Desire score Day 3: 1st/2nd degree laceration (182/199) LSM = 6.2 3rd or 4th degree: (17/199) LSM = 31.4 p = 0.1703 (NS) Desire score Week 6: 1st/2nd degree laceration (182/199) LSM = 271,0 3rd or 4th degree: (17/199) LSM = 233.8 p = 0.3056 (NS) |
| 10. Obstetric anal sphincter injury in the UK and its effect on bowel, bladder and sexual function. Marsh F et al., 2010 |
Prospective cohort Resumption of sexual activity Dyspareunia |
From 2004 to 2009 Leeds, UK |
435 postpartum women with obstetric anal injury (up to 3 Months after delivery) | Resumption of sexual activity: 57 % (134/235) Dyspareunia: 32 % (75/235) |
| 11. Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery. Baud et al., 2011 [46] |
Case–control study FSFI |
From 1996 to 2006 Lausanne, Switzerland |
Cases: 66 postpartum women with anal injury (1,5 % from 13,213) Controls: 192 without anal injury. Up to 6 years postpartum. |
FSFI ≤ 25 (severe dysfunction): NS Data not available: contact authors. FSFI total scores: Cases: 26.1 + 6.8 Controls: 27.3 + 5.9 p = 0.185 |
| 12. The effects of mode delivery on postpartum sexual function: a prospective study. De Souza et al., 2015 [47] |
Prospective cohort FSFI Self-applied questionnaire |
From January 2010 to July 2011 Melbourne, Australia |
391 women interviewed during pregnancy and after 6 and 12 months after childbirth Completed 3 interviews: 9/264 (4.8 %) women with 3rd degree laceration 82/264 (44.1 %) with minor perineal injury |
FSFI score (means): Pregnancy: 24.22 6 months: 22.79 12 months: 25.06 No differences associated to type of laceration Arousal domain, means (maximum 6): Pregnancy: 3.46 6 months: 3.44 12 months: 3.97 p = 0.007 12 months highest score related to perineal injury p = 0.019 Orgasm domain, means (maximum 6): Pregnancy: 4.23 6 months: 4.20 12 months: 4.66 p = 0.026 6 months/12 months = 0.015 No interaction over time due to perineum status (p = 0.108) FSFI scores < 25 not showed |