Impact of Obstetric Anal Sphincter Injuries on Postpartum Sexual Function: A Prospective Cohort Study

Sexual dysfunction, which is common in the postpartum period, often does not resolve by 6 months and is likely more severe in women with severe obstetric lacerations.

The aims are to describe sexual function at 6 months postpartum in women who experienced obstetric anal sphincter injury (OASI) and to compare sexual function between women with mild and severe OASI.

This is a prospective cohort study of women with OASI. At 6 months postpartum, women were surveyed regarding sexual function using the Postpartum Pelvic Floor Birth Questionnaire, which compares current sexual function to sexual function before vaginal birth.

One hundred fifty-one women were included. Eighty-one (53.6%) women had spontaneous vaginal delivery, and 70 (46.4%) had operative vaginal delivery. One hundred seventeen (77.5%) experienced a mild OASI, and 34 (22.5%) experienced a severe OASI. On the Postpartum Pelvic Floor Birth Questionnaire sexual activity domain, median score for all women was 2.6 (interquartile range, 2.1-3.0) with scores <3.0, indicating worse functioning. The sexual activity domain median scores were 2.4 (1.9-3.0) for mild OASI and 2.8 (2.6-3.0) for severe OASI ( P = 0.011), indicating worse scores for women with mild OASI. Within the sexual activity domain, women with mild OASI had worse median scores than women with severe OASI when reporting on enjoyment of sexual activity, frequency of intercourse, and enjoyment during sexual intercourse.

Women who experience OASI have worse sexual function compared with predelivery. Discussion of sexual function is critical for postpartum women, especially for those who are at increased risk after experiencing OASI.