Hospital General de Granollers, Carrer Francesc Ribas, s/n, 08402, Granollers, Barcelona, Spain.
Faculty of Medicine and Health Sciences: Nursing School, University of Barcelona, Barcelona, Spain.
Int Urogynecol J. 2020 Nov;31(11):2367-2375. doi: 10.1007/s00192-020-04317-1. Epub 2020 May 13.
To assess the association between superficial perineal muscle trauma and perineal pain and dyspareunia.
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.
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.
When perineal muscle trauma encompasses > 50% BSM ± STPM, perineal pain and dyspareunia persisted until 10 days and 6 months postpartum, respectively.
评估会阴浅层肌肉损伤与会阴疼痛和性交困难的关系。
对 405 名自然分娩的妇女进行前瞻性队列研究，比较会阴完整且会阴Ⅰ度损伤组（n=205）与会阴Ⅱ度损伤和会阴侧切组（n=200）。产后 2 天、10 天、7 周、3 个月和 6 个月时测量会阴疼痛。产后 7 周、3 个月和 6 个月时评估性交困难。
所有的会阴Ⅱ度损伤和会阴侧切均损伤球海绵体肌（BSM），但并不总是损伤会阴浅横肌（STPM）。如果发生会阴Ⅱ度损伤或会阴侧切，与会阴完整或会阴Ⅰ度损伤相比，产后 10 天疼痛和产后 6 个月性交困难的可能性分别增加 4 倍和 5 倍[比值比（OR）分别为 4.4（95%可信区间：2.8-6.9）和 5.5（95%可信区间：2.8-10.9）]。当比较 BSM 和 STPM 撕裂＞50%的损伤与撕裂＜50%的损伤时，产后 10 天的疼痛明显更高[OR 1.9（95%可信区间：1.1-3.6]，而在产后 7 周时没有差异，而产后 6 个月时性交困难明显更高[OR 3.3（95%可信区间：1.4-7.8）]。会阴Ⅰ度损伤与撕裂＜50%的 BSM 损伤比较时，会阴疼痛或性交困难没有差异。
当会阴肌肉损伤累及＞50%的 BSM 和 STPM 时，会阴疼痛和性交困难分别持续至产后 10 天和 6 个月。
