title: Sexual activity and dyspareunia the first year postpartum in relation to degree of perineal trauma.
abstract: OBJECTIVE
  Knowledge on sexual complaints and time to sexual resumption after obstetric anal sphincter injury (OASI) is scarce. The aim of the study was to investigate self-reported sexual activity and coital problems 1 year postpartum in relation to perineal trauma, in addition to delivery mode.
  
  
  METHODS
  Among 2,846 women recruited during pregnancy, all women who delivered with OASI (n = 42, all third-degree perineal tears), in addition to 20 randomly selected controls per OASI case, a total of 882 women, were sent a self-administered questionnaire addressing time to coital resumption after delivery and potential coital difficulty 1 year postpartum.
  
  
  RESULTS
  By 8 weeks, half of the 561 responders (51.4 %) had resumed intercourse, increasing to 75.2 % by 12 weeks and 94.7 % 1 year postpartum. In multivariate regression analysis OASI was the strongest predictor for postponed coital onset, defined as after 8 weeks (aOR 5.52, CI 1.59-19.16). OASI was also the only significant predictor for dyspareunia 1 year after delivery (aOR 3.57, CI 1.39-9.19). Episiotomy was neither a risk factor for postponed coital onset nor for dyspareunia. There were no differences between episiotomy and second-degree laceration injury groups regarding postponed coital onset (p = 0.45) or dyspareunia (p = 0.67) 1 year postpartum.
  
  
  CONCLUSIONS
  Obstetric anal sphincter injury was a strong and independent predictor for both postponed coital resumption after delivery and for dyspareunia 1 year postpartum, whereas episiotomy and spontaneous second-degree lacerations were not. Our main finding of affected sexual activity after OASI further supports the need to reduce the rates of this obstetric injury to a minimum.
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway. kathrif@gmail.com.|Department of Obstetrics and Gynaecology, Oslo University Hospital, Ullevål, Postboks 4965, Nydalen, 0424, Oslo, Norway. kathrif@gmail.com.
authors.forename: Kathrine
authors.initials: K
authors.lastname: Fodstad
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway.|Department of Obstetrics and Gynaecology, Oslo University Hospital, Ullevål, Postboks 4965, Nydalen, 0424, Oslo, Norway.
authors.forename: Anne Cathrine
authors.initials: AC
authors.lastname: Staff
authors.affiliation: Department of Obstetrics and Gynaecology, Oslo University Hospital, Ullevål, Postboks 4965, Nydalen, 0424, Oslo, Norway.
authors.forename: Katariina
authors.initials: K
authors.lastname: Laine
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D016009:Chi-Square Distribution; D003075:Coitus; D036861:Delivery, Obstetric / Q000009:adverse effects; D004414:Dyspareunia / Q000209:etiology*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D022125:Lacerations / Q000209:etiology*; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012044:Regression Analysis; D057566:Self Report; D012746:Sexual Abstinence; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: Dyspareunia; Episiotomy; Obstetric anal sphincter injury; Sexual activity