Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis

Manresa, Margarita; Pereda, Ana Antoranz; Bataller, Eduardo; Terré-Rull, Carmen; Ismail, Khaled M.; Webb, Sara

doi:10.1007/s00192-019-03894-0

Cited by 52 publications

(56 citation statements)

References 35 publications

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“…Therefore, it can be concluded that the complexity of the diagnosis and treatment of dyspareunia requires a dedicated multidisciplinary team to share their findings so as to understand the causes of dyspareunia [33]. Physical therapists may therefore greatly contribute to treating dyspareunia signs and symptoms.…”

Section: Discussionmentioning

confidence: 99%

Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial

et al. 2019

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Introduction and hypothesis Dyspareunia, the symptom of painful sexual intercourse, is a common sexual dysfunction in reproductive-aged women. Because of its multifactorial etiology, a multidisciplinary approach may be required to treat it. Musculoskeletal factors play an important role; thus, rehabilitating the pelvic floor and modifying the tone of the pelvic floor muscles (PFMs) may be an effective way to treat this dysfunction. The aim of this randomized controlled clinical study was to evaluate the effects of pelvic floor rehabilitation techniques on dyspareunia. Methods Of 84 women, assessed for eligibility, 64 women with dyspareunia were randomized into two groups: the experimental group (n = 32) received electrotherapy, manual therapy, and PFM exercises and the control group (n = 32) had no treatment while on the waiting list. Evaluations of PFM strength and endurance, sexual function, and pain were made directly before and after 3 months of treatment and at the 3-month follow-up. Results Between-group changes showed significant improvement in the experimental group in comparison with control group. Mean difference in the PFM strength (according to the 0-5 Oxford scale) between groups was 2.01 and the mean difference of endurance was 6.26 s. Also, the mean difference in the Female Sexual Function Index score (the score ranges from 2 to 95) was 51.05, and the mean difference in the VAS score was 7.32. All of the changes were statistically significant (p < 0.05). Conclusions According to the results, pelvic floor rehabilitation is an important part of a multidisciplinary treatment approach to dyspareunia.

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Section: Discussionmentioning

confidence: 99%

Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial

et al. 2019

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“…Perineal pain is a common consequence of episiotomy and affects up to 97% of women on day 1 postpartum [5,6] and up to 70% of women at days 7 to 10 postpartum [7][8][9], and it may persist until at least 5 months postpartum [10,11]. Pain after the perineal wound (apart from episiotomy) is also reported but less studied because of the high variability of the localization and the depth of the tear.…”

Section: Introductionmentioning

confidence: 99%

Ropivacaine 75 mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women – the ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trials

Cardaillac

Ploteau

Thuaut

et al. 2020

Trials

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Background: Perineal pain due to episiotomy is commonly reported and can be severe enough to disturb the mother-infant dyad during the postpartum period. Its incidence at day 7 postpartum varies from 63% to 74%. Recent studies have investigated the analgesic efficacy of perineal infiltration of ropivacaine after episiotomy but have only focused on the immediate postpartum period (at 24 and 48 h after birth). Large, adequately powered, multicenter, randomized controlled trials are required to evaluate the impact of ropivacaine infiltration on perineal pain and mid-and long-term quality of life before the widespread use of ropivacaine to prevent perineal pain after episiotomy can be recommended. Methods/design: The ROPISIO study is a two-center, randomized, double-blind, placebo-controlled trial being conducted in La Roche sur Yon and Nantes, France. It will involve 272 women with vaginal singleton delivery and mediolateral episiotomy at term (≥ 37 weeks). Perineal infiltration (ropivacaine 75 mg or placebo) will be administrated just after vaginal birth and before episiotomy repair. The primary outcome will be the analgesic efficacy at day 7 postpartum (midterm), defined by the Numeric Pain Rating Scale (NPRS) strictly superior to 3/10 on the perineal repair area. Secondary outcomes will be the analgesic efficacy (NPRS) and the impact of pain on daily behavior, on the quality of life (36-item Short Form Health Survey), on the occurrence of symptoms of postpartum depression (Edinburgh Postnatal Depression Scale), and on sexual health (Female Sexual Function Index) at 3 and 6 months (long-term) using validated online questionnaires. This study will have 90% power to show approximately 30% relative risk reduction in the incidence of perineal pain at day 7, from 70.0% to 50.0%.

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“…Perineal pain is a common consequence of episiotomy and affects up to 97% of women on day 1 postpartum [5,6], up to 70% of women at day 7 to 10 postpartum [7][8][9] and may persist until at least 5 months postpartum [10,11]. Pain after perineal wound (apart from episiotomy) are also reported but less studied because of the high variability of the localization and the depth of the tear.…”

Section: Introductionmentioning

confidence: 99%

Ropivacaine 75mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women- The ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trial.

Cardaillac

Ploteau

Thuaut

et al. 2020

Preprint

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Background Perineal pain due to episiotomy is commonly reported and can be severe enough to disturb the mother-infant dyad during the postpartum period. Its incidence at day 7 postpartum varies from 63% to 74%. Recent studies have already investigated the analgesic efficacy of perineal infiltration of ropivacaine after episiotomy, but have only focused on the immediate postpartum period (at 24 and 48 hours after birth). Large, adequately powered, multicenter, randomized controlled trials are required to evaluate the impact of ropivacaine infiltration on perineal pain and mid- and long-term quality of life before the widespread use of ropivacaine to prevent perineal pain after episiotomy can be recommended. Methods The ROPISIO study is a two-center, randomized, double-blind, placebo-controlled trial in La Roche sur Yon and Nantes, France. It will involve 272 women with vaginal singleton delivery and mediolateral episiotomy at term (≥ 37 weeks). Perineal infiltration (ropivacaine 75mg or placebo) will be administrated just after vaginal birth and before episiotomy repair. The primary outcome will be the analgesic efficacy at day 7 postpartum (mid-term), defined by the numerical rating scale of pain (ENS NRS) strictly superior to 3/10 on the perineal repair area. Secondary outcomes will be the analgesic efficacy (ENS NRS), the impact of pain on daily behavior, on the quality of life (36-Item Short Form Health Survey), on the occurrence of symptoms of postpartum depression (Edinburgh Postnatal Depression Scale) and on sexuality (Female Sexual Function Index) at 3 and 6 months (long-term) using validated online questionnaires. This study will have 90% power to show approximately 30% relative risk reduction in the incidence of perineal pain at day 7, from 70.0% to 50.0%. Discussion Ropivacaine is a promising candidate drug, inexpensive, easy to administer, and would be suitable to include in the routine management of deliveries in labor ward. This study will investigate if perineal ropivacaine infiltration just after birth can reduce mid- and long-term postpartum pain and increase quality of life in women with mediolateral episiotomy.

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Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis

Cited by 52 publications

References 35 publications

Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial

Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial

Ropivacaine 75 mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women – the ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trials

Ropivacaine 75mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women- The ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trial.

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