Prevalence and Predictors of Genito-Pelvic Pain in Pregnancy and Postpartum: The Prospective Impact of Fear Avoidance

Abstract

Introduction There is limited knowledge regarding the symptom profile of genito-pelvic pain in pregnancy and postpartum, and potential psychosocial predictors of this pain. Prior studies have reported a positive association between prepregnancy pain and postpartum genito-pelvic pain. Greater fear avoidance has been associated with increased genital pain intensity in women, unrelated to childbirth. This relationship has not been examined prospectively in a postpartum population. Aims The study aims were to examine the symptom profile of genito-pelvic pain during pregnancy and at 3 months postpartum, and the impact of prepregnancy nongenito-pelvic pain and fear avoidance in pregnancy on genito-pelvic pain at 3 months postpartum. Methods First-time expectant mothers (N = 150) completed measures of fear avoidance (pain-related anxiety, catastrophizing, hypervigilance to pain), prepregnancy nongenito-pelvic pain, childbirth-related risk factors (e.g., episiotomy), and breastfeeding. Main Outcome Measures Those reporting genito-pelvic pain in pregnancy and/or at 3 months postpartum answered questions about the onset (prepregnancy, during pregnancy, postpartum) and location (genital, pelvic, or both) of the pain and rated the intensity and unpleasantness of the pain on numerical rating scales. Results Of 150 women, 49% reported genito-pelvic pain in pregnancy. The pain resolved for 59% of women, persisted for 41%, and 7% of women reported a new onset of genito-pelvic pain after childbirth. Prepregnancy nongenito-pelvic pain was associated with an increased likelihood of postpartum onset of genito-pelvic pain. Greater pain-related anxiety was associated with greater average genito-pelvic pain intensity at 3 months postpartum. Conclusions Results suggest that about half of women may develop genito-pelvic pain during pregnancy, which will persist for about a third, and a subset will develop this pain after childbirth. Prior recurrent nongenito-pelvic pain may enhance the risk of developing genito-pelvic pain postpartum, while greater pain-related anxiety in pregnancy may increase the risk for greater intensity of postpartum genito-pelvic pain.

Examining to what extent pregnancy-related physical symptoms worry women in the first trimester of pregnancy: a cross-sectional study in general practice

“…Half the women with these symptoms were worried, and such worries might affect the further progression of the pregnancy. 13,30 The large Norwegian Mother and Child Cohort showed that severe pelvic girdle pain combined with emotional distress was associated with non-recovery after delivery. 30 Furthermore, pain-related anxiety in pregnancy has been shown to be associated with greater pain intensity and unpleasantness of postpartum genital-pelvic pain.…”

“…30 Furthermore, pain-related anxiety in pregnancy has been shown to be associated with greater pain intensity and unpleasantness of postpartum genital-pelvic pain. 13 It is possible that some of these women could be helped earlier and maybe not suffer from lack of recovery from pelvic girdle pain postpartum, if addressed at the first prenatal care visit.…”

“…[5][6][7][8][9][10] Frequencies in the order of 25%-50% have also been described for symptoms such as vulvar itching, vaginal bleeding, and pelvic cavity pain. [11][12][13] Pelvic girdle pain and low back pain (or, in some studies, a combination of these two symptoms referred to as 'lumbo-pelvic pain') are often reported for all three trimesters, with a prevalence of 20%-65%. [14][15][16][17] While some symptoms might be pathological, [18][19][20] most will be signs of a healthy pregnancy and be caused by physiological changes in the women's endocrine system and physical status.…”

Bio-Psycho-Social Factors Affecting Women's Sexual Function during Pregnancy: A Narrative Review

“…Hormonal changes (Koshaka, 1998;Kitzinger, 1983); Nausea and fatigue (Kitzinger, 1983); Weight gain and big belly (Erol, 2007); Big breasts and breast pain (Kitzinger, 1983); Painful intercourse (Glowacka, 2014); Anatomical changes in the urinary tract and pelvic floor (Change, 2014); Pregnancy age and number of pregnancies and deliveries (Eryilmaz, 2004;Tosun, 2014).…”

Sexual Activity during Pregnancy in Childbirth and after Childbirth

“…This pelvic congestion may lead to a marked increase in the intensity of a woman's orgasm. Many women who never have experienced orgasm during intercourse have their first orgasms during this time; women who previously have been orgasmic may have the experience of multiple orgasms [30].…”