title: A comparison of urinary and sexual outcomes in women experiencing vaginal and Caesarean births.
abstract: OBJECTIVE
  To evaluate the urinary and sexual consequences of vaginal delivery compared with Caesarean section.
  
  
  METHODS
  We performed a cohort analysis of data from a randomized controlled trial of episiotomy conducted in 3 Montreal hospitals in 1990-1991. Of the 999 trial participants for whom follow-up data were available, 135 delivered by Caesarean section (CS), and 864 had a vaginal birth (VB). After stratifying for parity, we compared rates of urinary incontinence (UI) and sexual functioning at 3 months postpartum in women who had a VB with the rates in women who had a CS.
  
  
  RESULTS
  Primiparous women reported unspecified UI at 3 months postpartum more often (17.9%) in the VB group than in the CS group (6.4%). This difference remained significant whether or not there was a prior history of UI. Multiparous women showed no difference in rates of UI (VB 17.1% vs. CS 16.0%), whether there was a prior history of UI or not. Stress incontinence was greater among primiparous women in the VB group (VB 34.5% vs. CS 12.8%) regardless of prior UI history, but the proportion of women whose UI was severe enough to wear a pad was similar in primiparous women (VB 16.0%, CS 15.4%) and multiparous women (VB 23.8%, CS 25.0%). Women's sexual dissatisfaction was greater among primiparous women who had a vaginal birth (VB 70.1%, CS 54.5%), but in multiparous women, the rates of sexual dissatisfaction were similar (VB 64.2%, CS 71.4%). The frequency of dyspareunia for each mode of delivery was similar in primiparous women (VB 30.7%, CS 31.6%). Overall, both primiparous and multiparous women who had intact perineums after VB had less dyspareunia than those undergoing CS (VB 26.2, CS 40.7%). However, the proportion of women experiencing dyspareunia was greatest among those who had an episiotomy with or without forceps.
authors.affiliation: Department of Family Practice, University of British Columbia, Vancouver BC.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Klein
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
authors.forename: Tabassum
authors.initials: T
authors.lastname: Firoz
authors.forename: Maria
authors.initials: M
authors.lastname: Hubinette
authors.forename: Sally
authors.initials: S
authors.lastname: Jorgensen
authors.forename: Robert
authors.initials: R
authors.lastname: Gauthier
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D003075:Coitus; D036861:Delivery, Obstetric / Q000009:adverse effects; D004414:Dyspareunia / Q000209:etiology; D004841:Episiotomy / Q000009:adverse effects; D005113:Extraction, Obstetrical / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010298:Parity; D011247:Pregnancy; D012649:Self Concept; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D014549:Urinary Incontinence / Q000209:etiology*; D014550:Urinary Incontinence, Stress / Q000209:etiology