title: Dyspareunia and childbirth: a prospective cohort study.
abstract: OBJECTIVE
  To investigate the relationship between mode of delivery, perineal trauma and dyspareunia.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Six maternity hospitals in Melbourne, Australia.
  
  
  METHODS
  A total of 1507 nulliparous women recruited in the first and second trimesters of pregnancy.
  
  
  METHODS
  Data from baseline and postnatal questionnaires (3, 6, 12 and 18 months) were analysed using univariable and multivariable logistic regression.
  
  
  METHODS
  Study-designed self-report measure of dyspareunia at 18 months postpartum.
  
  
  RESULTS
  In all, 1244/1507 (83%) women completed the baseline and all four postpartum questionnaires; 1211/1237 (98%) had resumed vaginal intercourse by 18 months postpartum, with 289/1211 (24%) women reporting dyspareunia. Compared with women who had a spontaneous vaginal delivery with an intact perineum or unsutured tear, women who had an emergency caesarean section (adjusted odds ratio [aOR] 2.41, 95% confidence interval [95% CI] 1.4-4.0; P = 0.001), vacuum extraction (aOR 2.28, 95% CI 1.3-4.1; P = 0.005) or elective caesarean section (aOR 1.71, 95% CI 0.9-3.2; P = 0.087) had increased odds of reporting dyspareunia at 18 months postpartum, adjusting for maternal age and other potential confounders.
  
  
  CONCLUSIONS
  Obstetric intervention is associated with persisting dyspareunia. Greater recognition and increased understanding of the roles of mode of delivery and perineal trauma in contributing to postpartum maternal morbidities, and ways to prevent postpartum dyspareunia where possible, are warranted.
authors.affiliation: Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.
authors.forename: E A
authors.initials: EA
authors.lastname: McDonald
authors.forename: D
authors.initials: D
authors.lastname: Gartland
authors.forename: R
authors.initials: R
authors.lastname: Small
authors.forename: S J
authors.initials: SJ
authors.lastname: Brown
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003075:Coitus / Q000523:psychology; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004414:Dyspareunia / Q000453:epidemiology* / Q000209:etiology* / Q000523:psychology; D004841:Episiotomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D010298:Parity; D036801:Parturition; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011446:Prospective Studies; D057566:Self Report; D013997:Time Factors; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000209:etiology*; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects
keywords: Cohort studies; delivery obstetric; dyspareunia; pain; perineum; postpartum period; prospective studies; sexual intercourse