Do women notice the impact of childbirth-related levator trauma on pelvic floor and sexual function? Results of an observational ultrasound study.
OBJECTIVE
The levator ani is thought to play an important role in sexual function; however, to date little literature has been published on the impact of delivery-related levator trauma on female sexual function. We hypothesised that delivery-related levator trauma has a negative impact on women's reports of pelvic floor and sexual function postpartum.


METHODS
In 294 primigravid women with a singleton pregnancy, four-dimensional (4D) translabial ultrasound imaging was used to assess delivery-related levator avulsion and levator hiatal over-distension, and postpartum pelvic floor and sexual function was assessed by an in-house validated questionnaire. Associations between questionnaire responses and levator avulsion and hiatal over-distension were investigated using standard linear modelling methods.


RESULTS
Levator avulsion was diagnosed in 14% of women (42 out of 292; 25 unilateral, 17 bilateral) and was found to be significantly associated with lower scores for the pelvic floor integrity and function domain of the questionnaire (P < 0.0005). Avulsion was associated with lower scores for this domain (no avulsion = 2.78, unilateral avulsion = 2.61, bilateral avulsion = 2.29). This association remained significant after controlling for potential confounders (p = 0.013). Avulsion was not associated with any of the other domains of sexual function and levator hiatal over-distension was not associated with scores for any of the questionnaire domains.


CONCLUSIONS
The effect of levator avulsion on pelvic floor and sexual function an average of 5.2 months after childbirth seems to be limited to a perception of increased vaginal and pelvic floor muscle laxity, and reduced pelvic floor muscle efficiency. The impact of levator hiatal over-distension on postpartum pelvic floor and sexual function appears to be negligible.
School of Rehabilitation Therapy, Queen's University, 31 George street, Kingston, Ontario, Canada, K7L 3N6, 8st31@queensu.ca.
Stéphanie
S
Thibault-Gagnon
Sara
S
Yusuf
Suzanne
S
Langer
Vivien
V
Wong
Ka Lai
KL
Shek
Andrew
A
Martin
Hans Peter
HP
Dietz
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000293:injuries; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D020073:Gravidity; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000503:physiopathology; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis / Q000453:epidemiology*; D012735:Sexual Dysfunction, Physiological / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014463:Ultrasonography