Background
Methods
Study design
Sample
Ethical approval
Data collection and outcomes measures
Statistical analysis
Results
Characteristics of the study participants
Characteristics of study participants | Study participants | ||
---|---|---|---|
n | % | ||
Age | Up to 24 | 41 | 4.9 |
25 to 29 | 179 | 21.5 | |
30 to 34 | 376 | 45.2 | |
35 to 39 | 207 | 24.9 | |
40 and over | 29 | 3.5 | |
Place of birth | Irish | 566 | 68.1 |
Europe (excluding Ireland and UK) | 171 | 20.5 | |
UK | 45 | 5.4 | |
America | 17 | 2 | |
Asia | 10 | 1.2 | |
Africa | 8 | 0.9 | |
Australia | 3 | 0.4 | |
Missing | 12 | 1.4 | |
Highest level of education | School - second level | 89 | 10.7 |
Apprenticeship | 75 | 9.1 | |
Certificate or Diploma | 77 | 9.3 | |
Undergraduate degree | 254 | 30.5 | |
Postgraduate degree | 334 | 40.1 | |
Missing | 3 | 0.3 | |
Mode of birth | Spontaneous vaginal birth | 296 | 35.6 |
Vacuum birth | 172 | 20.7 | |
Forceps birth | 101 | 12 | |
Elective Caesarean Section | 74 | 8.9 | |
Emergency Caesarean Section | 189 | 22.7 | |
Perineal trauma | Intact | 268 | 32.2a |
1st degree tear | 43 | 5.2 | |
2nd degree tear | 168 | 20.2 | |
3rd degree tear | 26 | 3.1 | |
Episiotomy | 301 | 36.1 | |
Labial/vaginal wall tears | 26 | 3.1 |
Prevalence of self-reported sexual health issues over time
Pre pregnancy n (%) | Early pregnancy n (%) | 6 months pp. n (%) | 12 months pp. n (%) | |
---|---|---|---|---|
Lack of vaginal lubrication m = 174 | 241/658 (36.6) | 167/658 (25.4) | 283/658 (43) | 233/658 (35.4) |
Pain during sexual intercourse m = 203 | 184/629 (29.3) | 155/629 (24.6) | 236/629 (37.5) | 129/629 (20.5) |
Difficulty reaching orgasm m = 236 | 203/596 (34.1) | 156/596 (26.2) | 183/596 (30.7) | 140/596 (23.5) |
Unable to reach orgasm m = 254 | 114/578 (19.7) | 98/578 (17) | 90/578 (15.6) | 80/578 (13.8) |
Vaginal tightness m = 216 | 138/616 (22.4) | 130/616 (21.1) | 200/616 (32.5) | 107/616 (17.4) |
Vaginal looseness / lack of muscle tone m = 243 | 10/589 (1.7) | 10/589 (1.7) | 79/589 (13.4) | 53/589 (9) |
Loss of interest in sexual activity compared with before pregnancy m = 187 | 216/654 (33) | 349/654 (53.4) | 303/654 (46.3) | 260/654 (39.8) |
Univariate logistic regression analysis
Mode of birth as a risk factor for postpartum sexual health issues
6 months postpartum | 12 months postpartum | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
n/total | % | Unadjusted OR | 95% CI | p value | n/total | % | Unadjusted OR | 95% CI | p value | |
Dyspareunia | ||||||||||
Spontaneous vaginal birth | 108/279 | 38.7 | 1.0 (ref.) | 60/280 | 21.4 | 1.0 (ref.) | ||||
Vacuum birth | 83/163 | 50.9 | 1.6 | 1.1–2.4 |
0.013*
| 47/164 | 28.7 | 1.5 | 0.9–2.3 | 0.086 |
Forceps birth | 30/89 | 33.7 | 0.8 | 0.5–1.3 | 0.397 | 18/96 | 18.8 | 0.8 | 0.4–1.5 | 0.577 |
Elective CS | 16/66 | 24.2 | 0.5 | 0.3–0.9 |
0.03*
| 10/64 | 15.6 | 0.7 | 0.3–1.4 | 0.3 |
Emergency CS | 61/181 | 33.7 | 0.8 | 0.5–1.2 | 0.277 | 31/181 | 17.1 | 0.8 | 0.5–1.2 | 0.258 |
Lack of vaginal lubrication | ||||||||||
Spontaneous vaginal birth | 122/285 | 42.8 | 1.0 (ref.) | 93/286 | 32.5 | 1.0 (ref.) | ||||
Vacuum birth | 83/166 | 50 | 1.3 | 0.9–2.0 | 0.139 | 63/164 | 33 | 1.3 | 0.9–1.9 | 0.206 |
Forceps birth | 36/92 | 39.1 | 0.9 | 0.5–1.4 | 0.535 | 33/96 | 34.4 | 1.1 | 0.7–1.8 | 0.738 |
Elective CS | 22/65 | 33.8 | 0.7 | 0.4–1.2 | 0.187 | 20/64 | 31.3 | 0.9 | 0.5–1.7 | 0.845 |
Emergency CS | 77/181 | 42.5 | 1.0 | 0.7–1.4 | 0.955 | 69/185 | 37.3 | 1.2 | 0.8–1.8 | 0.287 |
Loss of interest in sexual activity | ||||||||||
Spontaneous vaginal birth | 145/285 | 50.9 | 1.0 (ref.) | 112/286 | 39.2 | 1.0 (ref.) | ||||
Vacuum birth | 88/165 | 53.3 | 1.1 | 0.7–1.6 | 0.615 | 69/165 | 41.8 | 1.1 | 0.8–1.6 | 0.579 |
Forceps birth | 40/95 | 42.1 | 0.7 | 0.4–1.2 | 0.139 | 40/96 | 41.7 | 1.1 | 0.7–1.8 | 0.664 |
Elective CS | 25/67 | 37.3 | 0.6 | 0.3–1.0 | 0.047 | 29/65 | 44.6 | 1.2 | 0.7–2.1 | 0.419 |
Emergency CS | 73/181 | 40.3 | 0.6 | 0.4–0.9 |
0.027*
| 63/179 | 35.2 | 0.8 | 0.6–1.2 | 0.391 |
Perineal trauma as a risk factor for postpartum sexual health issues
6 months postpartum | 12 months postpartum | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
n/total | % | Unadjusted OR | 95% CI | p value | n/total | % | Unadjusted OR | 95% CI | p value | |
Dyspareunia | ||||||||||
Intact | 77/252 | 30.6 | 1.0 (ref.) | 40/250 | 16 | 1.0 (ref.) | ||||
1st degree tear | 11/39 | 28.2 | 0.9 | 0.4–1.9 | 0.766 | 7/40 | 17.5 | 1.1 | 0.5–2.7 | 0.811 |
2nd degree tear | 66/161 | 41 | 1.6 | 1.0–2.3 |
0.03*
| 35/158 | 22.2 | 1.5 | 0.9–2.5 | 0.119 |
3rd degree tear | 13/21 | 61.9 | 3.7 | 1.5–9.3 |
0.005*
| 8/25 | 32 | 2.5 | 1.0–6.1 |
0.05*
|
Episiotomy | 121/281 | 43.1 | 1.7 | 1.2–2.5 |
0.003*
| 69/288 | 24 | 1.6 | 1.1–2.6 |
0.023*
|
Labial or vaginal wall tear | 10/24 | 41.7 | 1.6 | 0.7–3.8 | 0.267 | 7/24 | 29.2 | 2.1 | 0.8–5.6 | 0.109 |
Lack of vaginal lubrication | ||||||||||
Intact | 101/251 | 40.2 | 1.0 (ref.) | 91/254 | 35.8 | 1.0 (ref.) | ||||
1st degree tear | 16/39 | 41 | 1.0 | 0.5–2.1 | 0.926 | 14/42 | 33.3 | 0.89 | 0.5–1.8 | 0.754 |
2nd degree tear | 72/163 | 44.2 | 1.2 | 0.8–1.8 | 0.428 | 57/162 | 35.2 | 1.0 | 0.6–1.5 | 0.894 |
3rd degree tear | 12/23 | 52.2 | 1.6 | 0.7–3.8 | 0.269 | 9/24 | 37.5 | 1.0 | 0.4–2.6 | 0.87 |
Episiotomy | 128/288 | 44.4 | 1.2 | 0.8–1.7 | 0.325 | 97/289 | 33.6 | 0.9 | 0.6–1.3 | 0.58 |
Labial or vaginal wall tear | 11/25 | 44 | 1.2 | 0.5–2.7 | 0.715 | 10/24 | 41.7 | 1.3 | 0.5–3.0 | 0.57 |
Loss of interest in sexual activity | ||||||||||
Intact | 103/253 | 40.7 | 1.0 (ref.) | 94/249 | 37.8 | 1.0 (ref.) | ||||
1st degree tear | 17/41 | 41.5 | 1.0 | 0.5–2.0 | 0.928 | 19/42 | 45.2 | 1.4 | 0.7–2.6 | 0.358 |
2nd degree tear | 88/163 | 54 | 1.7 | 1.1–2.5 |
0.008*
| 69/162 | 42.6 | 1.2 | 0.8–1.8 | 0.327 |
3rd degree tear | 15/24 | 62.5 | 2.4 | 1.0–5.8 |
0.044*
| 9/25 | 36 | 0.9 | 0.4–2.2 | 0.863 |
Episiotomy | 138/288 | 47.9 | 1.3 | 0.9–1.9 | 0.093 | 114/289 | 39.4 | 1.1 | 0.8–1.5 | 0.687 |
Labial or vaginal wall tear | 10/24 | 41.7 | 1.0 | 0.4–2.4 | 0.927 | 8/24 | 33.3 | 0.8 | 0.3–2.0 | 0.67 |
Breastfeeding as a risk factor for postpartum sexual health issues
6 months postpartum | 12 months postpartum | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
n/total | % | Unadjusted OR | 95% CI | p value | n/total | % | Unadjusted OR | 95% CI | p value | |
Dyspareunia | 139/292 | 47.6 | 1.9 | 1.3–2.6 |
< 0.001*
| 33/133 | 24.8 | 1.2 | 0.7–1.8 | 0.477 |
Lack of vaginal lubrication | 159/295 | 52.9 | 1.7 | 1.2–2.3 |
0.001*
| 55/135 | 40.7 | 1.3 | 0.9–1.9 | 0.221 |
Loss of interest in sexual activity | 168/298 | 56.4 | 1.7 | 1.3–2.3 |
0.001*
| 62/135 | 45.9 | 1.4 | 1.0–2.1 | 0.064 |
Pre-pregnancy dyspareunia as a risk factor for postpartum sexual health issues
6 months postpartum | 12 months postpartum | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
n/total | % | Unadjusted OR | 95% CI | p value | n/total | % | Unadjusted OR | 95% CI | p value | |
Dyspareunia | 126/234 | 53.8 | 2.5 | 1.8–3.5 |
< 0.001*
| 85/235 | 36.2 | 3.2 | 2.3–4.6 |
< 0.001*
|
Lack of vaginal lubrication | 123/242 | 50.8 | 1.6 | 1.1–2.1 |
0.004*
| 106/237 | 44.7 | 1.8 | 1.3–2.5 |
< 0.001*
|
Loss of interest in sexual activity | 127/242 | 52.5 | 1.4 | 1.0–1.9 |
0.025*
| 110/237 | 46.4 | 1.5 | 1.1–2.0 |
0.01*
|
Multivariable logistic regression analysis
Dyspareunia at 6 and 12 months postpartum
Associated factors | 6/12 postpartum | 12/12 postpartum | |||||
---|---|---|---|---|---|---|---|
Total n = 748 | Total n = 585 | ||||||
OR | 95% CI | p value | OR | 95% CI | p value | ||
Age Groups | 18–29 years | 1.0 (ref.) | 1.0 (ref.) | ||||
30–34 years | 0.7 | 0.4–1.0 | 0.059 | 0.7 | 0.4–1.2 | 0.222 | |
35+ years | 0.7 | 0.4–1.0 | 0.096 | 0.4 | 0.2–0.8 |
0.009*
| |
BMI Groups | Ideal | 1.0 (ref.) | 1.0 (ref.) | ||||
Overweight | 1.0 | 0.6–1.6 | 0.947 | 0.9 | 0.5–1.7 | 0.773 | |
Obese | 1.1 | 0.6–1.8 | 0.841 | 0.8 | 0.4–1.7 | 0.545 | |
Underweight | 1.4 | 0.7–2.7 | 0.325 | 1.4 | 0.6–3.4 | 0.387 | |
Unknown BMI | 0.7 | 0.3–1.4 | 0.366 | 0.9 | 0.4–2.5 | 0.926 | |
Highest level of education | No degree | 1.0 (ref.) | 1.0 (ref.) | ||||
Primary degree | 1.4 | 0.9–2.1 | 0.11 | 1.3 | 0.7–2.3 | 0.35 | |
Postgrad qualification | 1.1 | 0.7–1.6 | 0.698 | 1.3 | 0.8–2.3 | 0.283 | |
Pre-existing dyspareunia | Yes | 2.6 | 1.8–3.6 |
< 0.001*
| 3.8 | 2.5–5.8 |
< 0.001*
|
Mode of birth | SVB | 1.0 (ref.) | 1.0 (ref.) | ||||
Vacuum birth | 1.7 | 0.9–2.7 | 0.053 | 1.5 | 0.7–2.8 | 0.225 | |
Forceps birth | 0.7 | 0.3–1.4 | 0.384 | 0.8 | 0.3–1.8 | 0.611 | |
Elective CS | 0.7 | 0.3–1.7 | 0.491 | 1.9 | 0.6–5.7 | 0.255 | |
Emergency CS | 1.1 | 0.6–2.2 | 0.605 | 1.537 | 0.6–3.7 | 0.344 | |
Perineal trauma | Intacta | 1.0 (ref.) | 1.0 (ref.) | ||||
2nd degree | 1.6 | 0.8–3.1 | 0.133 | 1.4 | 0.5–3.4 | 0.466 | |
3rd degree | 4.1 | 1.3–12.3 |
0.013*
| 2.7 | 0.7–10.1 | 0.143 | |
Episiotomy | 1.4 | 0.7–2.7 | 0.336 | 1.5 | 0.6–3.6 | 0.374 | |
Still breastfeeding | Yes | 1.9 | 1.3–2.7 |
< 0.001*
| 1.1 | 0.7–1.9 | 0.56 |
Perception of body image | Always satisfied | 1.0 (ref.) | 1.0 (ref.) | 0.993 | |||
Sometimes satisfied | 0.9 | 0.6–1.5 | 0.96 | 1.0 | 0.6–1.7 | 0.941 | |
Never satisfied | 1.4 | 0.8–2.4 | 0.211 | 1.0 | 0.5–2.2 | 0.905 |
Lack of vaginal lubrication at 6 and 12 months postpartum
Associated factors | 6/12 postpartum | 12/12 postpartum | |||||
---|---|---|---|---|---|---|---|
Total n = 758 | Total n = 591 | ||||||
OR | 95% CI | p value | OR | 95% CI | p value | ||
Age Groups | 18–29 years | 1.0 (ref.) | 1.0 (ref.) | ||||
30–34 years | 0.9 | 0.7–1.4 | 0.994 | 0.8 | 0.5–1.3 | 0.383 | |
35+ years | 0.9 | 0.6–1.4 | 0.799 | 0.7 | 0.4–1.1 | 0.149 | |
BMI Groups | Ideal | 1.0 (ref.) | 1.0 (ref.) | ||||
Overweight | 0.5 | 0.3–0.8 |
0.003*
| 0.7 | 0.3–1.1 | 0.129 | |
Obese | 0.5 | 0.3–1.0 |
0.038*
| 0.6 | 0.3–1.2 | 0.148 | |
Underweight | 1.5 | 0.8–2.9 | 0.226 | 1.8 | 0.9–3.7 | 0.117 | |
Unknown BMI | 0.6 | 0.3–1.2 | 0.182 | 0.9 | 0.4–2.0 | 0.896 | |
Highest level of education | No degree | 1.0 (ref.) | 1.0 (ref.) | ||||
Primary degree | 1.0 | 0.6–1.5 | 0.985 | 1.0 | 0.6–1.7 | 0.862 | |
Postgrad qualification | 1.1 | 0.8–1.7 | 0.496 | 1.2 | 0.8–2.0 | 0.332 | |
Pre-existing dyspareunia | Yes | 1.6 | 1.1–2.2 |
0.005*
| 1.7 | 1.2–2.5 |
0.004*
|
Mode of birth | SVB | 1.0 (ref.) | 1.0 (ref.) | ||||
Vacuum birth | 1.4 | 0.9–2.4 | 0.145 | 1.7 | 1.0–3.0 | 0.062 | |
Forceps birth | 1.0 | 0.6–1.9 | 0.932 | 1.4 | 0.7–2.9 | 0.308 | |
Elective CS | 0.7 | 0.3–1.5 | 0.339 | 1.2 | 0.5–2.9 | 0.677 | |
Emergency CS | 0.9 | 0.5–1.7 | 0.874 | 1.3 | 0.6–2.7 | 0.405 | |
Perineal trauma | Intacta | 1.0 (ref.) | 1.0 (ref.) | ||||
2nd degree | 1.0 | 0.5–1.8 | 0.963 | 1.0 | 0.5–2.0 | 0.945 | |
3rd degree | 1.4 | 0.5–3.7 | 0.55 | 1.2 | 0.4–3.8 | 0.787 | |
Episiotomy | 0.8 | 0.4–1.5 | 0.449 | 0.7 | 0.3–1.4 | 0.325 | |
Still breastfeeding | Yes | 2.1 | 1.5–2.9 |
< 0.001*
| 1.3 | 0.8–1.9 | 0.27 |
Perception of body image | Always satisfied | 1.0 (ref.) | 1.0 (ref.) | ||||
Sometimes satisfied | 1.8 | 1.2–2.8 |
0.005*
| 1.2 | 0.7–1.9 | 0.444 | |
Never satisfied | 2.4 | 1.4–4.0 |
0.001*
| 1.5 | 0.8–2.8 | 0.233 |
Loss of interest in sexual activity at 6 and 12 months postpartum
Associated factors | 6/12 postpartum | 12/12 postpartum | |||||
---|---|---|---|---|---|---|---|
Total n = 762 | Total n = 588 | ||||||
OR | 95% CI | p value | OR | 95% CI | p value | ||
Age Groups | 18–29 years | 1.0(ref.) | 1.0(ref.) | ||||
30–34 years | 0.8 | 0.6–1.2 | 0.396 | 1.0 | 0.7–1.6 | 0.836 | |
35+ years | 0.8 | 0.5–1.3 | 0.436 | 1.2 | 0.7–2.0 | 0.441 | |
BMI Groups | Ideal | 1.0(ref.) | 1.0(ref.) | ||||
Overweight | 0.9 | 0.6–1.4 | 0.562 | 0.7 | 0.4–1.3 | 0.276 | |
Obese | 1.6 | 1.0–2.8 | 0.07 | 0.8 | 0.4–1.5 | 0.42 | |
Underweight | 0.9 | 0.5–1.9 | 0.982 | 0.9 | 0.4–2.0 | 0.882 | |
Unknown BMI | 0.7 | 0.4–1.4 | 0.337 | 0.9 | 0.4–2.1 | 0.931 | |
Highest level of education | No degree | 1.0(ref.) | 1.0(ref.) | ||||
Primary degree | 1.0 | 0.7–1.5 | 0.916 | 1.3 | 0.8–2.0 | 0.326 | |
Postgrad qualification | 1.5 | 1.0–2.3 |
0.021*
| 1.3 | 0.8–2.0 | 0.249 | |
Pre-existing dyspareunia | Yes | 1.4 | 1.0–1.9 |
0.05*
| 1.3 | 0.9–1.9 | 0.127 |
Mode of birth | SVB | 1.0(ref.) | 1.0(ref.) | ||||
Vacuum birth | 1.1 | 0.7–1.8 | 0.686 | 1.4 | 0.8–2.4 | 0.235 | |
Forceps birth | 0.7 | 0.4–1.3 | 0.244 | 1.3 | 0.6–2.5 | 0.489 | |
Elective CS | 0.7 | 0.4–1.6 | 0.446 | 1.0 | 0.4–2.2 | 0.933 | |
Emergency CS | 0.8 | 0.4–1.5 | 0.464 | 0.7 | 0.3–1.3 | 0.266 | |
Perineal trauma | Intacta | 1.0(ref.) | 1.0(ref.) | ||||
2nd degree | 1.6 | 0.9–2.9 | 0.125 | 1.0 | 0.5–2.0 | 0.941 | |
3rd degree | 2.6 | 0.9–7.2 | 0.065 | 0.9 | 0.3–2.8 | 0.853 | |
Episiotomy | 1.2 | 0.6–2.3 | 0.595 | 0.7 | 0.3–1.4 | 0.272 | |
Still breastfeeding | Yes | 2.2 | 1.6–3.0 |
< 0.001*
| 1.6 | 1.0–2.4 |
0.029*
|
Perception of body image | Always satisfied | 1.0(ref.) | 1.0(ref.) | ||||
Sometimes satisfied | 1.6 | 1.0–2.4 |
0.035*
| 1.5 | 0.9–2.3 | 0.082 | |
Never satisfied | 2.8 | 1.6–4.6 |
< 0.001*
| 3.6 | 1.9–6.7 |
< 0.001*
|