Risløkken Jeanette, Macedo Marthe Dalevoll, Bø Kari, Ellström Engh Marie, Siafarikas Franziska
Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.
Faculty of Medicine, Division Akershus University Hospital, University of Oslo, Oslo, Norway.
Acta Obstet Gynecol Scand. 2025 May;104(5):968-975. doi: 10.1111/aogs.15084. Epub 2025 Feb 27.
Childbirth-related injuries of the pelvic floor may impact women's sexual health with symptoms such as dyspareunia. A better understanding of dyspareunia based on tissue trauma severity in second-degree tears is needed. The primary aim of this study was to assess differences in dyspareunia according to the severity of perineal tears, with a focus on subcategories of second-degree tears at three and twelve months postpartum. The secondary aim was to assess the time to resumption of intercourse after birth according to the severity of second-degree tears.
This single-center observational cohort study was conducted between January 2021 and July 2022. Women meeting the inclusion criteria were included during pregnancy. After birth, all perineal tears were classified according to RCOG recommendation, and second-degree tears were further subcategorized based on the percentage of damage to the perineum (2A, 2B, 2C). Dyspareunia and time to resumption of intercourse were collected through an electronic questionnaire at three and twelve months postpartum.
Our study included 857 women; of them, 51.6% (n = 442) were primipara and 48.4% (n = 415) were multipara. The percentages of women reporting dyspareunia according to the degree of the tear at three months postpartum were as follows: no tear/first-degree tear 60%, 2A-tear 60%, 2B-tear 52%, 2C-tear 77%, and episiotomy 77%; and at twelve months postpartum: no tear/first-degree tear 52%, 2A-tear 50%, 2B-tear 40%, 2C-tear 69%, and episiotomy 64%. When comparing dyspareunia between the no tear/first-degree tear category and the second-degree subcategories, no statistically significant differences were found. Women in all second-degree subcategories resumed intercourse approximately 4.8 months postpartum, compared to 3.8 months postpartum for those with no tear or first-degree tear (p < 0.05).
There was no statistically significant association between the severity of second-degree tears and dyspareunia. The proportion of women reporting dyspareunia is noticeable for all perineal tear categories, with the highest rate among women with the most severe second-degree perineal tear. Women in all second-degree subcategories resumed intercourse approximately one month later than those with no tear or first-degree tear.
盆底分娩相关损伤可能会影响女性的性健康，出现性交困难等症状。需要根据二度撕裂伤的组织创伤严重程度，更好地了解性交困难。本研究的主要目的是评估根据会阴撕裂伤严重程度的性交困难差异，重点关注产后三个月和十二个月时二度撕裂伤的亚分类。次要目的是根据二度撕裂伤的严重程度评估产后恢复性交的时间。
本单中心观察性队列研究于2021年1月至2022年7月进行。符合纳入标准的女性在孕期被纳入研究。分娩后，所有会阴撕裂伤均根据英国皇家妇产科医师学院（RCOG）的建议进行分类，二度撕裂伤再根据会阴损伤百分比进一步细分（2A、2B、2C）。通过电子问卷在产后三个月和十二个月收集性交困难情况和恢复性交的时间。
我们的研究纳入了857名女性；其中，初产妇占51.6%（n = 442），经产妇占48.4%（n = 415）。产后三个月时，根据撕裂程度报告性交困难的女性百分比情况如下：无撕裂/一度撕裂为60%，2A度撕裂为60%，2B度撕裂为52%，2C度撕裂为77%，会阴切开术为77%；产后十二个月时：无撕裂/一度撕裂为52%，2A度撕裂为50%，2B度撕裂为40%，2C度撕裂为69%，会阴切开术为64%。在比较无撕裂/一度撕裂类别与二度亚分类之间的性交困难情况时，未发现统计学上的显著差异。所有二度亚分类的女性产后恢复性交的时间约为4.8个月，而无撕裂或一度撕裂的女性为3.8个月（p < 0.05）。
二度撕裂伤的严重程度与性交困难之间无统计学上的显著关联。所有会阴撕裂伤类别中报告性交困难的女性比例都很显著，其中二度会阴撕裂伤最严重的女性比例最高。所有二度亚分类的女性恢复性交的时间比无撕裂或一度撕裂的女性晚约一个月。
