Postpartum sexual function; the importance of the levator ani muscle

Abstract

Introduction and hypothesis Pelvic floor muscle function plays an important role in female sexual functioning. Smaller genital hiatal dimensions have been associated with sexual dysfunction, mainly dyspareunia. On the other hand, trauma of the levator ani muscle sustained during childbirth is associated with increased genital hiatus, which potentially can affect sexual functioning by causing vaginal laxity. This study aims to determine the association between levator hiatal dimensions and female sexual dysfunction after first vaginal delivery. Methods This is a secondary analysis of a prospective observational study. Two hundred four women who had a first, spontaneous vaginal delivery at term between 2012 and 2015 were recruited at a minimum of 6 months postpartum. Thirteen pregnant women were excluded. We analyzed the association of total PISQ-12 score, as well as individual sexual complaints (desire, arousal, orgasm and dyspareunia), with levator hiatal dimensions at rest, with maximum Valsalva and during pelvic floor muscle contraction as measured by 4D transperineal ultrasound. Statistical analysis was performed using linear regression analysis and Mann-Whitney U test. Results One hundred ninety-one women were evaluated at a median of 11 months postpartum. There was no significant association between total PISQ-12 score and levator hiatal dimensions. Looking at individual sexual complaints, women with dyspareunia had significantly smaller levator hiatal area and anterior-posterior diameter on maximum Valsalva. By using multivariate logistic regression analysis however we found dyspareunia was not independently associated with levator hiatal dimensions. Conclusions After first vaginal delivery sexual dysfunction is not associated with levator hiatal dimensions as measured by 4D transperineal ultrasound.

Pelvic floor dysfunction one year after first childbirth in relation to perineal tear severity

“…Trauma to the levator ani during vaginal childbirth is associated with female pelvic organ prolapse 31 and has been suggested but not confirmed to have an association with symptoms of urinary and anal incontinence 32 , 33 . Regarding sexual function, a recent study found no association between postpartum levator hiatus and sexual dysfunction 34 .…”

The predicting value of the ratio of levator hiatus diameter to fetal head circumference in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum

“…The study found that 13.00 %–14.00 % of primipara have postpartum levator ani muscle injury during delivery [ 23 ]. It is reported that the probability of levator ani injury after vaginal delivery of primipara in China is as high as 21.70 % [ 24 ]. Postpartum levator ani injury not only increases the pain of the parturient, but also affects the rapid recovery of the parturient.…”

Ultrasonography Comparison of Pelvic Floor and Abdominal Wall Muscles in Women with and without Dyspareunia: A Cross-Sectional Study

“…Narrowing of this APDH has been related to hypertonia [ 9 , 11 , 12 , 13 ]. USI measures of the APDH have been used to evaluate pelvic floor function in different statuses (rest, active contraction and Valsalva) and to assess pre-post treatment changes [ 14 ].…”

“…Several studies conducted in gynecological cancer survivors and patients with endometriosis showed differences in pelvic floor architecture related with DP [ 9 , 24 , 25 , 26 ]. APH and hiatus area have been explored in several studies in women after childbirth, concluding that no direct or isolated relation with DP could be found [ 14 , 27 ]. To the authors’ knowledge, abdominal wall features of this group have not been assessed up to this date.…”