性交困难患者的分娩方式-一项前瞻性研究。

Delivery in patients with dyspareunia-A prospective study.

机构信息

Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel.

Department of Physical Therapy, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2019 Jun;237:131-136. doi: 10.1016/j.ejogrb.2019.04.027. Epub 2019 Apr 19.

DOI:10.1016/j.ejogrb.2019.04.027

PMID:31035120

Abstract

OBJECTIVE

Despite the high prevalence of dyspareunia, published data focused on childbirth is scarce. This study aimed to evaluate the prevalence of dyspareunia in a random primiparae parturient population, characterize their features, and describe associated perinatal outcomes.

STUDY DESIGN

In this prospective observational study we approached primiparous women admitted to our labor ward. Women were asked to complete an interview, based on self-report of dyspareunia symptoms. Obstetrical outcomes were obtained and compared between women with (exposed) and without (controls) dyspareunia. Midwives completed a questionnaire regarding patients' cooperation, pain level, pelvic floor hypertonicity, difficulty with vaginal examinations and perceived anxiety level.

RESULTS

One hundred seventy-three women completed a detailed questionnaire querying dyspareunia symptoms. Of them, 41.6% (n = 72) reported a certain degree of dyspareunia. Exposed women did not differ in demographic or clinical characteristics as compared to controls. Of the exposed group, 40.3% reported primary dyspareunia, 25.4% secondary dyspareunia, and 34.3% could not recall its beginning. Only 34.3% had consulted a practitioner regarding this problem. Rates of vaginal deliveries, vacuum deliveries, and cesarean deliveries were comparable (p = 0.845). There were no differences between the two groups in rates of analgesia usage, epidural anesthesia, episiotomy, and second stage duration. However, the severity of dyspareunia correlated with the incidence of perineal tears (66.7% in patients with severe dyspareunia, and 41.1% in controls, p = 0.011). Logistic regression analysis revealed that dyspareunia was independently associated with perineal tears (p = 0.029). Higher rates of anxiety and pelvic floor hypertonicity were reported in patients reporting severe dyspareunia (≥3/10 times).

CONCLUSION

Dyspareunia is common among primiparous women, and these patients are more likely to suffer perineal tears and anxiety during delivery.

摘要

目的

尽管性交困难的发病率很高，但已发表的数据主要集中在分娩方面。本研究旨在评估随机初产妇人群中性交困难的患病率，描述其特征，并描述相关的围产结局。

研究设计

在这项前瞻性观察性研究中，我们接触了入住我们产房的初产妇。让女性根据性交困难症状的自我报告完成访谈。比较有（暴露）和无（对照组）性交困难的女性的产科结局。助产士完成了一份关于患者合作、疼痛程度、盆底紧张度、阴道检查困难和感知焦虑程度的问卷。

结果

173 名女性完成了详细的问卷查询性交困难症状。其中，41.6%（n=72）报告有一定程度的性交困难。与对照组相比，暴露组的女性在人口统计学或临床特征上没有差异。在暴露组中，40.3%报告原发性性交困难，25.4%报告继发性性交困难，34.3%无法回忆起其开始。只有 34.3%就这个问题咨询过医生。阴道分娩、真空分娩和剖宫产的比例相当（p=0.845）。两组在镇痛使用、硬膜外麻醉、会阴切开术和第二产程持续时间方面无差异。然而，性交困难的严重程度与会阴裂伤的发生率相关（严重性交困难的患者为 66.7%，对照组为 41.1%，p=0.011）。逻辑回归分析显示，性交困难与会阴裂伤独立相关（p=0.029）。报告严重性交困难（≥3/10 次）的患者焦虑和盆底紧张度较高。