Postpartum perineal pain and dyspareunia related to each superficial perineal muscle injury: a cohort study
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ORIGINAL ARTICLE
Postpartum perineal pain and dyspareunia related to each superficial perineal muscle injury: a cohort study Margarita Manresa 1 & Ana Pereda 1 & Josefina Goberna-Tricas 2 & Sara S. Webb 3,4 & Carmen Terre-Rull 2 & Eduardo Bataller 5 Received: 21 January 2020 / Accepted: 13 April 2020 # The International Urogynecological Association 2020
Abstract Objective To assess the association between superficial perineal muscle trauma and perineal pain and dyspareunia. Materials and methods Prospective cohort study of 405 women with a spontaneous vaginal birth comparing an intact perineum and first-degree perineal trauma group (n = 205) with a second-degree perineal trauma and episiotomy group (n = 200). Perineal pain was measured at 2 days, 10 days, 7 weeks, 3 months and 6 months postpartum. Dyspareunia was assessed at 7 weeks, 3 months and 6 months postpartum. Results All second-degree perineal traumas and episiotomies involved damage to the bulbospongiosus muscle (BSM), but not always to the superficial transverse perineal muscle (STPM). In case of second-degree trauma or episiotomy, the odds of pain at 10 days and dyspareunia at 6 months postpartum were four- and five-fold greater, respectively, than if the perineum had remained intact or suffered a first-degree perineal trauma [OR 4.4 (95% CI: 2.8–6.9) and OR 5.5 (95% CI: 2.8–10.9), respectively]. When comparing injuries where > 50% BSM ± STPM against those with < 50% BSM torn, pain was significantly higher at 10 days postpartum [OR 1.9 (95% CI: 1.1–3.6], with no difference at 7 weeks, while dyspareunia was significantly higher at 6 months postpartum [OR 3.3 (95% CI: 1.4–7.8)]. There was no difference in perineal pain or dyspareunia when comparing first-degree with < 50% BSM traumas. Conclusion When perineal muscle trauma encompasses > 50% BSM ± STPM, perineal pain and dyspareunia persisted until 10 days and 6 months postpartum, respectively. Keywords Bulbospongiosus muscle . Superficial transverse perineal muscle . Second-degree perineal trauma . Perineal pain . Dyspareunia
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-020-04317-1) contains supplementary material, which is available to authorized users. * Margarita Manresa [email protected] 1
Hospital General de Granollers, Carrer Francesc Ribas, s/n, 08402 Granollers, Barcelona, Spain
2
Faculty of Medicine and Health Sciences: Nursing School, University of Barcelona, Barcelona, Spain
3
Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
4
Birmingham Women’s & Children’s NHS Foundation Trust, Edgbaston, Birmingham, UK
5
Hospital Clinic de Barcelona, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
Abbreviations BSM Bulbospongiosus muscle EPDS Edinburgh Postnatal Depression Scale LAM Levator ani muscle NRS Numerical rating scale OASI Obstetric anal sphincter injury REEDA Redness, Edema, Ecchymosis, Discharge and Approximation STPM Sup
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