Mode of delivery and pain during intercourse in the postpartum period: Findings from a developing country

Highlights

• Pain during intercourse is commonly experienced in the postpartum period.

• Women are reluctant to seek care despite of reporting pain during intercourse during the postpartum period.

• Cesarean deliveries may result in higher risk for reporting of pain during intercourse in the postpartum period.

• Prenatal and postpartum care needs to address women's sexual health problems during the postpartum period.

Abstract

Objective

This study examines the association of the reporting of pain during intercourse in the postpartum period with mode of delivery, and describes women's reports of pain during intercourse and their health care seeking behavior over a period of 40 days–6 months postpartum.

Methods

A cross-sectional study recruited women in their 2nd and 3rd trimester of pregnancy from private obstetric clinics affiliated with 18 hospitals in two regions of Lebanon. Face-to-face interviews using a structured questionnaire were conducted at the women's homes from 40 days to 6 months postpartum. Verbal, informed consent was obtained from all women participating in the study before the interview.

Results

In a sample of 238 women, 67% reported experiencing pain during intercourse postpartum and 72.3% did not seek care. Women having a cesarean delivery (1.96; CI (1.29–2.63)), who were primiparous (OR = 2.44; CI (2.05–2.83)) and residing in the Mount Lebanon region (OR = 1.25; CI (1.09–1.40)) were significantly more likely to report pain during intercourse postpartum.

Conclusions

Cesarean births may increase the chances of reporting of pain during intercourse postpartum among primiparous women. Given that the increasing cesarean section rates worldwide are perceived to be protective of women's sexual health, prenatal and postpartum care need to address women's sexual health problems.

Introduction

Sexual health in the postpartum period is an important concern for mothers and, despite some research efforts pointing to changes in sexual relationships postpartum and to the commonality of experiencing pain during intercourse [1], [2], [3], [4], the extent of these problems and their underlying contributing factors remain largely understudied, especially in developing country settings.

The literature reveals a significant proportion of women reporting discomfort and/or pain during intercourse in different postpartum periods [1], [5], [6], [7], [8]. Some studies indicate the persistence of pain during intercourse throughout the first year postpartum and beyond. Reports from Scotland [2], Sweden [8] and Italy [9] show that 19.7%, 10.7% and 16.2% of women respectively reported pain during intercourse or difficulty in having sexual intercourse up to 1 year and 18 months postpartum. Furthermore, information about the health care seeking behavior of women for sexual health problems is scarce in the literature, except in a few reports [3], [10] indicating that women rarely seek care for this problem and rarely discuss it with a health professional.

Despite the presence of a limited number of studies looking at sexual dysfunction related to cesarean section [11] it is presumed that cesarean sections protect women from perineal trauma therefore from sexual dysfunctions. This argument has been used as a perceived benefit for elective cesarean sections in contexts of increased patient autonomy. There is a certain consistency in the literature suggesting an association between assisted vaginal delivery and sexual dysfunction including pain during intercourse [2], [3], [10], [12], [13]. Nevertheless, reported associations between pain during intercourse and cesarean deliveries remains largely inconclusive [10]. In Glazener's study with Scottish women [2] no difference in reporting of pain during intercourse was found between those having spontaneous vaginal delivery and cesarean delivery. Similar findings are reported from a multicenter, international controlled trial on breech presentation at term [7]. A study among primiparous women in England reported that cesarean deliveries were protective against pain during intercourse at 3 months postpartum compared to vaginal birth; however, these differences between the groups disappeared over the long-term. In contrast, a cohort analysis from a randomized controlled trial found that pain during intercourse was more common among women who had cesarean births compared to those having vaginal births [14]. Similarly, Goetsch [15] has reported a substantial proportion of women (29%) who had a cesarean delivery to be suffering from pain during intercourse in the postpartum period.

Other studies looking into different factors associated with pain during intercourse in the postpartum period point to a consistent association with parity, with the complaints being more common in primiparous than in multiparous women [8], [16], [17].

Although our knowledge about the scope and persistence of sexual health problems in the postpartum period is improving, it is mainly based on studies from Western countries and much research is needed from different regions of the world to reveal the extent of this problem and to inform practice in ways to improve women's postpartum quality of life. This needs to be considered, especially in view of the dramatic increase in the rate of cesarean sections in many developing countries including Lebanon, where reported rates are exceeding 40% of births [18], and the use of postpartum care services remains unsatisfactory (51% only, in Lebanon [19]). The current study examines the association of reporting of pain during intercourse in the postpartum period with the mode of delivery and describes women's reports of pain during intercourse and their health care seeking behavior over a period of 40 days–6 months postpartum.