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Postpartum perineal pain and dyspareunia related to each superficial perineal muscle injury: a cohort study

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International Urogynecology Journal Aims and scope Submit manuscript

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.

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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:

Superficial transverse perineal muscle

SVB:

Spontaneous vaginal birth

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Acknowledgments

The authors thank the women who participated in the study and the midwives and doctors at Hospital General de Granollers whose contributions made our research possible, especially Ms. A Rodriguez-Biosca, Dr. M Girvent, Dr. M Perez-de-Puig and Ms. P Castro.

Funding

This study was supported by the Department of Health, Government of Catalonia, no. SLT006/17/117, and by the Faculty of Medicine and Health Sciences, Nursing School, Universitat de Barcelona, no. PREI016-I.

Author information

Authors and Affiliations

  1. Hospital General de Granollers, Carrer Francesc Ribas, s/n, 08402, Granollers, Barcelona, Spain

    Margarita Manresa & Ana Pereda

  2. Faculty of Medicine and Health Sciences: Nursing School, University of Barcelona, Barcelona, Spain

    Josefina Goberna-Tricas & Carmen Terre-Rull

  3. Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK

    Sara S. Webb

  4. Birmingham Women’s & Children’s NHS Foundation Trust, Edgbaston, Birmingham, UK

    Sara S. Webb

  5. Hospital Clinic de Barcelona, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain

    Eduardo Bataller

Authors
  1. Margarita Manresa
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  2. Ana Pereda
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  3. Josefina Goberna-Tricas
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  4. Sara S. Webb
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  5. Carmen Terre-Rull
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Contributions

M Manresa: Project development, Conduct of trial, Data collection, Manuscript writing/editing.

A Pereda: Data collection/management, Manuscript writing/editing.

J Goberna-Tricas: Manuscript writing/editing.

SS Webb: Manuscript writing and editing.

C Terre-Rull: Project development, Data analysis, Manuscript writing/editing.

E Bataller: Project development, Manuscript writing/editing.

Corresponding author

Correspondence to Margarita Manresa.

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Conflict of interests

M Manresa: None.

A Pereda: None.

J Goberna-Tricas: None.

SS Webb: None.

C Terre-Rull: None.

E Bataller: Personal fees from Boston Scientific, personal fees from Lacer, personal fees from Astellas, outside the submitted work.

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Manresa, M., Pereda, A., Goberna-Tricas, J. et al. Postpartum perineal pain and dyspareunia related to each superficial perineal muscle injury: a cohort study. Int Urogynecol J 31, 2367–2375 (2020). https://doi.org/10.1007/s00192-020-04317-1

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  • DOI: https://doi.org/10.1007/s00192-020-04317-1

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