title: Sexual life and dysfunction after maternal morbidity: a systematic review.
abstract: BACKGROUND
  Because there is a lack of knowledge on the long-term consequences of maternal morbidity/near miss episodes on women's sexual life and function we conducted a systematic review with the purpose of identifying the available evidence on any sexual impairment associated with complications from pregnancy and childbirth.
  
  
  METHODS
  Systematic review on aspects of women sexual life after any maternal morbidity and/or maternal near miss, during different time periods after delivery. The search was carried out until May 22(nd), 2015 including studies published from 1995 to 2015. No language or study design restrictions were applied. Maternal morbidity as exposure was split into general or severe/near miss. Female sexual outcomes evaluated were dyspareunia, Female Sexual Function Index (FSFI) scores and time to resume sexual activity after childbirth. Qualitative syntheses for outcomes were provided whenever possible.
  
  
  RESULTS
  A total of 2,573 studies were initially identified, and 14 were included for analysis after standard selection procedures for systematic review. General morbidity was mainly related to major perineal injury (3(rd) or 4(th) degree laceration, 12 studies). A clear pattern for severity evaluation of maternal morbidity could not be distinguished, unless when a maternal near miss concept was used. Women experiencing maternal morbidity had more frequently dyspareunia and resumed sexual activity later, when compared to women without morbidity. There were no differences in FSFI scores between groups. Meta-analysis could not be performed, since included studies were too heterogeneous regarding study design, evaluation of exposure and/or outcome and time span.
  
  
  CONCLUSIONS
  Investigation of long-term repercussions on women's sexual life aspects after maternal morbidity has been scarcely performed, however indicating worse outcomes for those experiencing morbidity. Further standardized evaluation of these conditions among maternal morbidity survivors may provide relevant information for clinical follow-up and reproductive planning for women.
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil. carlandrpld@gmail.com.|Federal University of Sao Carlos, Sao Carlos, Brazil. carlandrpld@gmail.com.
authors.forename: Carla B
authors.initials: CB
authors.lastname: Andreucci
authors.affiliation: Federal University of Sao Carlos, Sao Carlos, Brazil. jamilebussadori@gmail.com.
authors.forename: Jamile C
authors.initials: JC
authors.lastname: Bussadori
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil. rodolfopacagnella@gmail.com.
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Pacagnella
authors.affiliation: Reproductive Health Research unit, World Health Organization, Geneva, Switzerland. choud@who.int.
authors.forename: Doris
authors.initials: D
authors.lastname: Chou
authors.affiliation: London School of Hygiene and Tropical Medicine, University of London, London, England, UK. veronique.filippi@lshtm.ac.uk.
authors.forename: Veronique
authors.initials: V
authors.lastname: Filippi
authors.affiliation: Reproductive Health Research unit, World Health Organization, Geneva, Switzerland. sayl@who.int.
authors.forename: Lale
authors.initials: L
authors.lastname: Say
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil. cecatti@unicamp.br.
authors.forename: Jose G
authors.initials: JG
authors.lastname: Cecatti
mesh_terms: D004414:Dyspareunia / Q000209:etiology*; D005260:Female; D006801:Humans; D008427:Maternal Health Services; D009017:Morbidity; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D036801:Parturition; D010502:Perineum / Q000293:injuries*; D049590:Postpartum Period; D011247:Pregnancy; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology*