Pelvic floor dysfunction is one of the most common functional disorders of the female reproductive organs and increasingly affects younger women, especially during and after pregnancy. These include problems with descent, urinary incontinence, and sexual dysfunction. At 20 years postpartum, 47% of women complain of pelvic floor dysfunction with symptomatic lowering of the internal genitalia. Over 30% of pregnant women report uncontrolled urine leakage (>50% stressincontinence) postpartum, and a full 76% of these continue to do so at 12 years. 41-83% of women in labor are affected by sexual dysfunction 3-6 months postpartum. Over 2/3 of those affected postpartum do not disclose their dysfunction to gynecologic consultations. The lifetime risk for surgical pelvic floor reconstruction ranges from 11-20%, with one in three women requiring a follow-up surgical procedure. 
In addition to low quality of life and high levels of distress, affected women have significant health care costs and high urogynecologic care needs. The etiology of pelvic floor dysfunction is probably a multifactorial genesis as a combination of anatomical, genetic, lifestyle and reproductive factors, but not exclusively a disease of old age - pregnancy and childbirth are also attributed a high role in the development. 
So far, the data from Germany is limited. The aim of this pilot study is a detailed data collection of peri- and postpartum pelvic floor dysfunctions to better identify the risk population. In this way, the lack of knowledge about the topic can be increased and the networking of gynecology and obstetrics can be intensified in order to be able to proceed as protectively as possible.

Using validated questionnaires (including the German Pelvic Floor Questionnaire), different maternal and neonatal factors on the development of pelvic floor dysfunction are systematically recorded at the Women's Clinic of the University of Cologne for one year postpartum at four time points each. Bladder, bowel, and sexual function as well as descent symptoms are recorded and possible factors influencing these parameters are investigated prospectively.

To date, 316 patients have been recruited. In this collective, 48.6% were delivered vaginally. Again, 86.7% suffered a birth injury. Overall, 14.2% of respondents subjectively reported subsidence symptoms even before the recorded pregnancy, while 3 months after delivery this proportion increased to 17.9%. In multipara, descent problems seem to be more frequently troublesome in everyday life than in primipara. Prepartum, 45.8% of the women already reported urge or stress incontinence. Six months postpartum, this showed an increase of 11.8% as well as a significant increase in the frequency of involuntary urine leakage. 43% of the women in childbirth reported an increase in sexual complaints up to 6 months postpartum Here, first-time mothers are significantly more often affected 3 months postpartum, as well as women in childbirth with birth injuries.

Regression analysis showed a significant increase in the risk of postpartum pelvic floor dysfunction after vaginal births with perineal tears (OR 3.6 95% CI 1.1-12.1), as well as nicotine abuse, lack of exercise before or during pregnancy, and increased BMI and pre-existing urinary incontinence. Infant head circumference and birth weight, as well as parity, showed no influence, contrary to the literature.

Early recognition of symptoms of pelvic floor dysfunction is possible, and a high-risk population can be identified. Through more interdisciplinarity between obstetrics and gynecology, a protective approach can be taken, and pelvic floor-protective obstetrics can be practiced. Furthermore, the existing gap in care regarding pathological births and sexual health must be addressed. The connection to a specialized pelvic floor consultation can already help pregnant women but also women in childbirth.