Women Health Center, Clalit Health Organization, Modiin, Israel.
J Low Genit Tract Dis. 2020 Oct;24(4):411-416. doi: 10.1097/LGT.0000000000000548.
Breastfeeding-related hypoestrogenic state has been reported as a possible risk factor for postpartum dyspareunia. This study aimed to evaluate the prevalence and characteristics of postpartum vulvovaginal atrophy according to 3 different diagnostic methods and to estimate its association with postpartum dyspareunia and daily vulvovaginal symptoms.
This is a prospective cohort study of puerperal women attending a routine postpartum checkup. Participants completed a questionnaire and underwent a gynecological examination. Atrophy was diagnosed separately according to gynecologist impression, vaginal pH measurement (≥5.1), and cytologic vaginal maturation index. Patients were followed up with a telephone survey 2-3 months later, inquiring about symptoms possibly associated with atrophy.
Of 117 participants, vaginal atrophy was diagnosed in 48% by gynecological examination, 62% by a pH level of 5.1 or greater, and 40.2% had cytological atrophy. Of the 35.9% of women who had resumed sexual intercourse (42/117), 69% reported dyspareunia. No significant association was found between dyspareunia and atrophy parameters. There was no difference in the rates of dyspareunia among women who were exclusively breastfeeding (21/27 = 78%), partially breastfeeding (4/7 = 57%), or not breastfeeding (4/8, 50%). Atrophy was more common in breastfeeding women according to the 3 criteria (gynecological examination: 57.6% vs 16.7%, p = .006; pH: 70% vs 22%, p < .001; vaginal maturation index: 51.1% vs 0%, p < .001). Of the 117 participants, 47% reported daily vulvovaginal symptoms. Those with daily symptoms reported more dyspareunia as compared with those without daily symptoms (85% vs 52%, p = .025).
A high prevalence of atrophy was observed in puerperal women in association with breastfeeding. There was no significant association between atrophy and dyspareunia or daily vulvovaginal symptoms.
据报道，母乳喂养相关的低雌激素状态是产后性交痛的一个可能危险因素。本研究旨在评估根据 3 种不同诊断方法产后外阴阴道萎缩的患病率和特征，并估计其与产后性交痛和日常外阴阴道症状的关系。
这是一项对产后常规检查的产妇进行的前瞻性队列研究。参与者完成了一份问卷并接受了妇科检查。萎缩分别根据妇科医生的印象、阴道 pH 值（≥5.1）和细胞学阴道成熟指数进行诊断。患者在 2-3 个月后通过电话调查进行随访，询问可能与萎缩相关的症状。
在 117 名参与者中，48%通过妇科检查、62%通过 pH 值为 5.1 或更高、40.2%通过细胞学检查诊断为阴道萎缩。在恢复性生活的 35.9%（117/327）的女性中，69%报告性交痛。性交痛与萎缩参数之间没有显著关联。完全母乳喂养（27/42 = 64.3%）、部分母乳喂养（7/4 = 17.5%）或不母乳喂养（8/4 = 20%）的女性中，性交痛的发生率没有差异。根据 3 种标准，母乳喂养的女性中萎缩更为常见（妇科检查：57.6%比 16.7%，p =.006；pH 值：70%比 22%，p <.001；阴道成熟指数：51.1%比 0%，p <.001）。在 117 名参与者中，47%报告日常外阴阴道症状。与无日常症状的女性相比，有日常症状的女性报告更多的性交痛（85%比 52%，p =.025）。
产后女性中观察到较高的萎缩患病率与母乳喂养有关。萎缩与性交痛或日常外阴阴道症状之间无显著关联。
