Women who undergo caesarean section can experience pain during or after sexual intercourse for up to 18 months following childbirth, a new Australian study has found.
Researchers found that operative birth is associated with persisting pain during or after sexual intercourse, known as dyspareunia.
Researchers set out to investigate the contribution of obstetric risk factors, including mode of delivery and perineal trauma to postpartum dyspareunia.
A cohort of 1,244 first time mothers across six maternity hospitals in Melbourne was studied. Data were taken from baseline and postnatal questionnaires at 3, 6, 12 and 18 months. The mean gestational age of the study participants at the time of enrolment was 15 weeks.
Of the women sampled, 49 per cent had a spontaneous vaginal birth, two thirds of whom sustained a sutured tear and/or episiotomy, 10.8 per cent had an operative vaginal birth assisted by vacuum extraction and 10.7 per cent gave birth assisted by forceps.
Additionally, 9.7 per cent were delivered by elective caesarean section and 19.9 per cent were delivered by emergency caesarean section.
Results showed that 78 per cent of the study population had resumed sexual intercourse by 3 months, 94 per cent by 6 months, 97 per cent by 12 months and 98 per cent by 18 months postpartum.
With regards to dyspareunia following childbirth, most of the women (85.7 per cent) who had resumed sex by 12 months postpartum experienced pain during first vaginal sex after childbirth.
Dyspareunia was reported by 44.7 per cent of women at 3 months postpartum, 43.4 per cent at 6 months, 28.1 per cent at 12 months and 23.4 per cent at 18 months postpartum.
Of the women who reported dyspareunia at 6 months postpartum, a third (32.7 per cent) reported persisting dyspareunia at 18 months postpartum.
Compared to women who had a spontaneous vaginal delivery with intact perineum or unsutured tear, women who had an emergency caesarean section, vacuum extraction or elective caesarean section had double the risk of reporting dyspareunia at 18 months postpartum.
Other factors associated with dyspareunia at 18 months postpartum include pre-pregnancy dyspareunia, intimate partner abuse and maternal fatigue.
"Almost all women experience some pain during first sexual intercourse following childbirth," said Ellie McDonald from the Murdoch Childrens Research Institute, Victoria, Australia and co-author of the study.
"However, our findings show the extent to which women report persisting dyspareunia at 6 and 18 months postpartum is influenced by events during labour and birth, in particular caesarean section and vacuum extraction delivery," McDonald said.
The study was published in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG).
