Impact of Levator Ani Injury Following Vaginal Delivery on Sexual Function: Preliminary Findings from an Interventional Study

Caramazza D1, Campagna G1, Mastrovito S1, Panico G1, Vacca L1, Marturano M1, Natale F1, Arrigo D1, Ercoli A2, Scambia G1

Research Type

Clinical

Abstract Category

Pregnancy and Pelvic Floor Disorders

Abstract 677
Open Discussion ePosters
Scientific Open Discussion Session 36
Friday 29th September 2023
15:55 - 16:00 (ePoster Station 2)
Exhibit Hall
Sexual Dysfunction Imaging Pelvic Floor Quality of Life (QoL) Prevention
1. Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Chirurgia Ginecologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia, 2. PID Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Università degli studi di Messina, Policlinico G.Martino, Messina, Italia
Presenter
Links

Abstract

Hypothesis / aims of study
Postpartum sexual health is a topic of increasing interest, though often under-discussed in clinical practice. Despite a recent increase of literature data regarding this topic, the impact of pelvic floor injuries following vaginal delivery on sexual function remains unclear. Pelvic floor ultrasound assessment has proven to be able to identify most pelvic floor defects, including levator ani injury associated with parity. Specifically, modifications in the levatorl hiatus area after delivery have been identified as a risk factor for sexual distress. The primary objective of our study is to evaluate the prevalence of sexual dysfunction in women after spontaneous delivery. Our secondary goal is to investigate potential correlations between sexual dysfunction and pelvic floor defects, through the help of pelvic floor ultrasound assessment.
Study design, materials and methods
We conducted a retrospective analysis of prospectively collected data from 115 primiparous women who delivered at term. Participants were recruited regardless of whether they received an episiotomy, experienced perineal laceration, or had an intact perineum. During the third trimester examination, all patients completed the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-revised (FSDS-r) questionnaires to evaluate prior sexual dysfunctions. Twelve months after delivery, all participants completed the same questionnaires, underwent a complete urogynecological examination, and had a 3D transvaginal ultrasound to measure the levator hiatus area and assess Levator Ani Muscle (LAM) defects. Statistical analysis was performed to identify any correlation between LAM lesions and sexual distress, with a multivariate analysis conducted to identify specific risk factors for this condition.
Results
One year after delivery, sexual function demonstrated a worsening trend, as indicated by poor scores on the FSFI and FSDS-r questionnaires after spontaneous delivery (p < 0.001 and p = 0.004, respectively). Our data suggests that pelvic floor injuries may contribute to the development of sexual distress, with FSDS-r results showing more severe distress in patients with greater levator hiatal areas observed on ultrasound scans (p = 0.003). Additionally, we conducted a multivariate analysis, that showed how episiotomy seems associated to worse scores compared to women with spontaneous lacerations (RR=1.250, CI: 0.274-5.708, p>0.05; versus RR=0.457, CI: 0.105-0.1980, p>0.05, respectively).
Interpretation of results
Pelvic floor defects associated with vaginal delivery such as LAM injury and hiatal enlargement may lead to sexual distress. Identifying patients with those lesions might allow urogynecologists to set a prevention plan (i.e. pelvic floor rehabilitation) after a spontaneous delivery.
Concluding message
Pelvic floor ultrasound seems to be a good tool to detect LAM lesions. Further studies will allow us to establish the right relationship between LAM injuries and sexual function after delivery.
Disclosures
Funding No funding or grant Clinical Trial No Subjects Human Ethics Committee Fondazione Policlinico Universitario A. Gemelli IRCCS Helsinki Yes Informed Consent Yes
23/11/2024 07:51:00