Association between sexual dysfunction and avulsion of the levator ani muscle after instrumental vaginal delivery.

INTRODUCTION: The effects of levator ani muscle (LAM) avulsion after instrumental delivery on the sexual function of patients are currently unknown. Therefore, the objective of our study was to use a validated questionnaire, namely, the Female Sexual Function Index (FSFI), to compare the sexual function in patients with and without LAM avulsion after instrumental vaginal delivery.
MATERIAL AND METHODS: This was a prospective observational study of 112 primiparous women after instrumental (vacuum or forceps) vaginal delivery. The obstetric and general characteristics of the population were studied. At 6 months postpartum, the contraceptive method used and the occurrence of LAM avulsion (using 4D transperineal ultrasound) were determined, and the FSFI was administered.
RESULTS: A total of 100 patients (62 without avulsion and 38 with avulsion) completed the study. Thirty-eight (38%) were diagnosed with avulsion (42.1% after Kielland forceps delivery, 57.9% after Malmström vacuum delivery; p=0.837). Women with LAM avulsion had significantly lower scores for desire (2.9±1.2 vs 3.4±1.1; p=0.049), arousal (2.8±1.7 vs 3.6±1.4; p=0.014), lubrication (2.3±1.4 vs 3.0±1.2; p=0.011), orgasm (2.6±1.6 vs 3.3±1.2; p=0.006) and satisfaction (3.1±1.8 vs 3.9±1.5; p=0.051) than did women without LAM avulsion. The overall FSFI score was lower in patients with avulsion (16.7±8.9 vs 20.7±6.9, p=0.033). These results were obtained after controlling for confounders (delivery mode, induced labor, birth weight, perineal tears, avulsion degree, contraceptive method and group assignment for the parent study) in the multivariate analysis (F=4.974, p=0.001).
CONCLUSIONS: Patients with LAM avulsion present a higher degree of sexual dysfunction than patients without avulsion at 6 months after instrumental vaginal delivery. This article is protected by copyright. All rights reserved.