The Relationship Between Levator Ani Integrity and Postpartum Sexual Dysfunction: A Systematic Review

Vaginal delivery may impact both the structures and function of the pelvic floor, including the levator ani muscle (LAM). In addition to urinary incontinence and prolapse, sexual dysfunction and pelvic pain may occur. We aimed to systematically review the literature on a potential association between LAM avulsion or hiatal dimensions and sexual dysfunction after childbirth.

We systematically searched the PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science Core Collection, CENTRAL (Cochrane), Clinicaltrials.gov, and databases. The principal aim was to identify reports studying the association between LAM avulsion or hiatal dimensions and sexual dysfunction within 24 months of childbirth. LAM had to be determined by imaging, and the latter had to be documented through questionnaires. Risk-of-bias assessment was evaluated using the Risk of Bias in Non-randomized Studies of Interventions tool. A meta-analysis was intended but not performed due to methodological differences among the studies.

Of 7621 studies identified, 9 were eventually included, reporting on 1623 women. For LAM assessment, 8 studies used transperineal ultrasound and 1 study utilized magnetic resonance imaging. Sexual function was evaluated using eight different questionnaires. The International Consultation on Incontinence Questionnaire-Vaginal Symptoms was used twice; all others used a variety of methods. Two studies demonstrated an adverse relationship between LAM avulsion and sexual dysfunction; in the other studies no such relationship was present.

The current data are scarce and methods diverse. Little evidence was found to suggest an association between LAM-avulsion and sexual dysfunction in women within 24 months after vaginal delivery.