title: Prevalence and predictors of genito-pelvic pain in pregnancy and postpartum: the prospective impact of fear avoidance.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Glowacka
authors.forename: Natalie
authors.initials: N
authors.lastname: Rosen
authors.forename: Jill
authors.initials: J
authors.lastname: Chorney
authors.forename: Erna
authors.initials: E
authors.lastname: Snelgrove Clarke
authors.forename: Ronald B
authors.initials: RB
authors.lastname: George
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001362:Avoidance Learning; D001942:Breast Feeding / Q000523:psychology; D058443:Catastrophization / Q000523:psychology; D004841:Episiotomy / Q000523:psychology; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D036801:Parturition / Q000523:psychology; D017699:Pelvic Pain / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000523:psychology; D012307:Risk Factors; D055815:Young Adult
keywords: Catastrophizing; Childbirth; Dyspareunia; Fear Avoidance; Genito-Pelvic Pain; Hypervigilance to Pain; Pain-Related Anxiety; Postpartum Pain