Predictors for sexual dysfunction in the first year postpartum: a systematic review and meta-analysis.

BACKGROUND: Pregnancy and childbirth increase the risk for pelvic floor dysfunction, including sexual dysfunction. So far, the mechanisms and the extent to which certain risk factors play a role, remain unclear. OBJECTIVES: In this systematic review of literature, we aimed to determine the risk factors for sexual dysfunction in the first year after childbirth. SEARCH STRATEGY: We searched MEDLINE, Embase and CENTRAL using the search strategy: Sexual dysfunction AND Obstetric events. SELECTION CRITERIA: We included original English, comparative studies that used validated questionnaires and the ICS/IUGA terminology for sexual dysfunction, dyspareunia and vaginal dryness. DATA COLLECTION AND ANALYSIS: We assessed the quality and the risk of bias of the included studies with the Newcastle Ottawa Scale. We extracted the reported data and we performed random-effects meta-analysis to obtain the summary Odds Ratios (OR) with 95% Confidence Intervals. Heterogeneity across studies was assessed using the I2 statistic. MAIN RESULTS: Anal sphincter injury was associated with increased odds for both sexual dysfunction (OR:3.00[1.28-7.03]) and dyspareunia (OR:1.92[1.47-2.52]). Episiotomy was associated with dyspareunia (OR:1.64[1.25-2.14]) but not with sexual dysfunction (OR:1.90[0.94-3.84]). Compared to spontaneous birth, caesarean section reduced the odds for dyspareunia (OR:0.68[0.54-0.86]), but not for sexual dysfunction (OR:1.14[0.89-1.46]). Instrumental vaginal birth increased the odds for sexual dysfunction (OR:1.70[1.05-2.76]), yet no difference was found for dyspareunia (OR:1.82[0.88-3.75]). One study of low quality reported on vaginal dryness and found no association with obstetric events. CONCLUSIONS: Perineal trauma, rather than the mode of birth, increases the odds for sexual dysfunction in the first year after childbirth.