Vulvar Pain During Pregnancy and After Childbirth
Pregnancy is a special period in a woman’s life. The childbirth involves significant physical, hormonal, psychological, social, and cultural changes that may influence her own sexuality as well as the health of the couple’s sexual relationship.
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Vulvar Pain During Pregnancy and After Childbirth
Pregnancy is a special period in a woman’s life. The childbirth involves significant physical, hormonal, psychological, social, and cultural changes that may influence her own sexuality as well as the health of the couple’s sexual relationship. Vulvar pain is often sadly neglected during pregnancy and particularly after delivery, despite its frequent comorbidity with introital dyspareunia in this vulnerable phase of a woman’s life. Women’s sexual dysfunctions are frequently reported after childbirth. Among them, dyspareunia carries the highest risk of long-term systemic, genital, sexual, and relational consequences. Therefore, the twin problem “vulvar pain and dyspareunia” requires a very committed clinical approach, with specific medical/gynecological attention to its biological basis, as well as careful evaluation of the delivery outcome and the condition of the pelvic floor. This chapter is prominently focused on the biological etiology of vulvar pain and dyspareunia, while psychosexual and contextual factors will be considered when appropriate for a balanced vision of the vulvar pain scenario at pregnancy and after childbirth.
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Vulvovaginal Pain During Pregnancy
Vulvovaginal pain during pregnancy may have three major timing reading, according to the author’s clinical experience. It may: • Be rooted in previous vulvar vestibulitis/provoked vestibulodynia, inadequately diagnosed and addressed before pregnancy • Be the exacerbation of a vulvar pain caused by a previous delivery and remained untreated/insufficiently cured • Have the first onset during the current pregnancy
© Springer International Publishing Switzerland 2017 A. Graziottin, F. Murina, Vulvar Pain, DOI 10.1007/978-3-319-42677-8_7
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7 Vulvar Pain During Pregnancy and After Childbirth
Vulvovaginal discomfort usually varies across pregnancy. In the first trimester, higher percentages of this symptom may be attributed to the concerns and anxiety related to the onset of the new pregnancy. In the second trimester, it is usually reported as significantly milder, coherently with the mother’s adaptation to pregnancy. Fears of early labor and the emotional alert toward the delivery tend to increase again the perception of it in the third trimester. It was demonstrated that 76–79 % of women enjoyed sexual intercourse before pregnancy (7–21 % not at all), while this decreased to 59 % in the first trimester, 75–84 % in the second trimester, and 40–41 % in the third trimester (Johnson 2011). Moreover, coital frequency tends to decline with advancing gestational age. This trend is further negatively influenced by dyspareunia and decreased orgasmic quality (Leeman and Rogers 2012). As pregnancy progresses, vaginal discomfort may become more pronounced as a result of changes in vaginal physiology in response to hormonal changes wherein the connective tissue of the vagina decreases and the muscle fibers of the vaginal wall increase in size in preparation for delivery (Erol et al. 2007). During the
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