Table 1.
Basic characteristics of the included studies of this systematic review.
| Author, Year, Country of Origin |
Sample Size (n) | Mean Age ± SD * |
Type of Delivery Comparison (n of Group) | Measurements of Outcome of Interest | Main Results |
|---|---|---|---|---|---|
| Handelzalts, 2018, Israel | 376 | 30.8 ± 4.2 | CD (elective and emergency) (92), VD (spontaneous and instrumental) (284) | CPQ, ISS, SFQ-MIS | No direct effect of delivery mode on sexual function was found. Indirect effect of delivery mode was found for sexual functioning experience [B = −0.26, p = 0.023, 95% CI = (−0.40, −0.10)] and sexual satisfaction [B = 0.11, p = 0.013, 95% CI = (0.05, 0.21)] both mediated by childbirth experience. |
| Amiri, 2017, Iran | 203 | 24.91 ± 4.9 | CD (113), VD (90) | FSFI | No statistically significant difference was discovered between the groups of comparison. |
| Ghorat, 2017, Iran | 177 | 31.81 ± 6.31 | CD (54), SVD (123) | FSFI | No statistically significant difference was discovered between the groups of comparison (p = 0.23). |
| Lurie, 2013, Israel | 82 | 18–45 | Vaginal without episiotomy (16), vaginal with an episiotomy (14), instrumental delivery (16), emergent C-section (19), elective C-section (17) |
FSFI | Total scores of FSFI did not show significant difference at 6, 12 or 24 weeks postpartum. |
| De Souza, 2015, Australia | 131 | 30.70 | CD (28), SVD (77), OVD (26) | FSFI | In total or subscale scores of FSFI, no significant difference was found between groups at antenatal and 12 months postpartum assessments. |
| Banaei, 2018, Iran | 361 | 28.21 ± 4.22 | CD (181), VD (180) | FSFI | No significant difference was found between groups of comparison (p = 0.07). |
| Cappell, 2020, Canada | 49 | 31.45 ± 4.35 | CD (15), VD (16), Nulliparous (18) | Laser Doppler imaging was used to assess genital response while participants watched a neutral and erotic film, FSFI | Genital response and subjective sexual arousal/response was not significantly related to mode of delivery. VD group had significantly lower flux units compared to CD group (p = 0.05). |
| Song, 2014, Japan | 435 | 33.2 ± 4.4 | SVD (282), OVD (21), planned CD (23), emergency CD (27) | SFQ28 | Only the partner subscale of the instrument revealed significant difference between groups. |
| Hjorth, 2019, Denmark | 37,417 | 18–45 | SVD (25,646), OVD (5460), CD (6311) | Structured inquiry on sexual health, adapted from the Danish National Health Survey | Significantly fewer sexual problems only for the VD group following a C-section delivery. |
| Saleh, 2019, Egypt | 684 | 29.0 ± 6.2 | CD (364), VD (320) | FSFI | Women with a history of CS had statistically significant higher FSFI total score compared to VD (31.3 ± 3.8 vs. 30.23 ± 3.6, respectively; p < 0.001). |
| Barbara, 2016, Italy | 269 | 32.4 ± 4.9 | SVD (132), CD (92), OVD (45) | FSFI | OVD showed significantly lower FSFI total scores and subscales (arousal, lubrication, orgasm) compared to CD, and stat. sign. lower score in orgasm with SVD. The mode of delivery did not affect the resumption of sexual intercourse. |
| Kahramanoglu, 2017, Turkey | 403 | 18–45 | CD (138), VD and episiotomy (265) | FSFI | Significant within groups differences in specific subscales of FSFI at 3-month assessment. No significant difference between groups at 6-, 12-, or 24-month assessments. |
| Dabiri, 2014, Iran | 150 | 27.87 + 5.64 | CD (69), VD (81) | FSFI | No significant differences between mode of delivery and sexual functioning in total scores or subscales |
| Eid, 2015, Egypt | 200 | 29.1 ± 3.11 | CD (110), VD (90) | FSFI | The mode of delivery had insignificant effect on the FSFI at 12 weeks postpartum. |
| Saydam, 2019, Egypt | 142 | 18–45 | CD (77), VD (65) | FSFI | No difference was found between CD and VD groups. |
| de Sousa, 2021, Portugal | 196 | 26–36 | OVD(131), SVD(65) | FSFI | Significantly lower FSFI total score for the OVD group (21.3 ± 8.6 vs. 24.9 ± 7.9, p = 0.015) at 3 months. At 6 months, there were no differences in FSFI scores based on the type of delivery. At 12 months, similar total FSFI score between groups, except for the pain subscale (p = 0.004) in favor of the SVD group. Perineal trauma was independently associated with sexual dysfunction (p = 0.02) at 3 months. |
* Age is presented in mean ± standard deviation or minimum–maximum. ABBREVIATIONS: CD = cesarean delivery; VD = vaginal delivery (when not clarified if spontaneous or operative); OVD = operative vaginal delivery; SVD = spontaneous vaginal delivery; CPQ = Childbirth Perception Questionnaire; ISS = Index of Sexual Satisfaction; SFQ-MIS = Sexual Function Questionnaire’s Medical Impact Scale; FSFI = Female Sexual Function Index; SFQ28 = Female Sexual Function Questionnaire.