Perelmuter Sara, Stokes Cameron, Chapalamadugu Meghana, Drian Alexandra, Zusman Gabriela Lachter, Berdugo Jayden, Davide Melissa, Andy Caroline, Grant Raeven, Drew Taylor, Burns Ramzy, Meurer Janine, Shah Aashna, Contractor Sri, Messafi Alyse, Thompson Alexis, Krapf Jill, Rubin Rachel
Weill Cornell Medical College, New York, and the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; the Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas; the University of Miami Miller School of Medicine, Miami, and the Center for Vulvovaginal Disorders Florida, Obstetrics and Gynecology, Tampa, Florida; Fundacao Tecnico Educacional Souza Marques, Rio de Janeiro, Brazil; the Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada; the Hackensack Meridian School of Medicine, Clifton, New Jersey; the David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; the Loyola University Chicago Stritch School of Medicine and the University of Illinois at Chicago College of Medicine, Chicago, Illinois; the Department of Urology, Indiana University, Indianapolis, Indiana; the Sackler School of Medicine/Tel Aviv University, Tel Aviv, Israel; the Burrell College of Osteopathic Medicine, Las Cruces, New Mexico; and the Department of Urology, Georgetown University, Washington, DC.
Obstet Gynecol. 2025 May 15;146(1):59-72. doi: 10.1097/AOG.0000000000005940.
To consolidate the best available evidence on the prevalence of genitourinary syndrome of lactation and its associated symptoms, including vaginal dryness, vaginal atrophy, urinary symptoms, dyspareunia, and sexual dysfunction, among postpartum lactating individuals.
The systematic review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A comprehensive search of PubMed, Google Scholar, Scopus, ScienceDirect, and Cochrane Library databases was conducted through April 30, 2024. A search in ClinicalTrials.gov did not yield any studies. Search terms included combinations of "postpartum lactation" or "breastfeeding" and "genitourinary symptoms." Eligibility was limited to studies on postpartum individuals assigned female at birth without congenital vulvar abnormalities that were written in English. Studies on participants taking exogenous hormone therapy or with diagnosed hormonal disorders were excluded. Screening involved two independent reviewers, with conflicts resolved by a third reviewer. Data were analyzed with R software. Study quality was assessed with the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the JBI Critical Appraisal Checklist.
Of 1,550 studies initially screened, 65 met inclusion criteria. Among postpartum lactating individuals, the prevalence of vaginal atrophy and dryness was 63.9% (95% CI, 55.3-71.6%) and 53.6% (95% CI, 33.6-72.5%), respectively. Meta-analyses for dyspareunia at 3, 6, and 12 months postpartum revealed pooled prevalence estimates to be 60.0% (95% CI, 45.1-73.3%), 39.7% (95% CI, 28.9-51.5%), and 28.5% (95% CI, 26.3-30.9%) and pooled odds ratios to be 2.33 (95% CI, 1.92-2.83), 2.24 (95% CI, 1.62-3.10), and 1.45 (95% CI, 1.36-1.56) compared with women of reproductive age who were not postpartum, respectively. The pooled prevalence for sexual dysfunction was 73.5% (95% CI, 59.1-84.2%) and mean FSFI (Female Sexual Function Index) score was 21.5±1.83 (threshold for sexual dysfunction less than 26.55).
This systematic review highlights the significant effect of lactation-induced hormone deficiency on genitourinary health, with the majority reporting vaginal atrophy and dryness and a high proportion also experiencing sexual dysfunction.
PROSPERO, CRD42024519600.
整合关于产后哺乳期个体中泌乳期泌尿生殖综合征及其相关症状（包括阴道干燥、阴道萎缩、泌尿系统症状、性交困难和性功能障碍）患病率的最佳现有证据。
本系统评价遵循PRISMA（系统评价与Meta分析的首选报告项目）指南。截至2024年4月30日，对PubMed、谷歌学术、Scopus、ScienceDirect和Cochrane图书馆数据库进行了全面检索。在ClinicalTrials.gov上的检索未获得任何研究。检索词包括“产后泌乳”或“母乳喂养”与“泌尿生殖系统症状”的组合。纳入标准仅限于关于出生时被指定为女性且无先天性外阴异常的产后个体的英文研究。排除了关于接受外源性激素治疗或诊断为激素紊乱的参与者的研究。筛选由两名独立评审员进行，冲突由第三名评审员解决。使用R软件进行数据分析。研究质量采用牛津循证医学中心证据水平和JBI批判性评价清单进行评估。
在最初筛选的1550项研究中，65项符合纳入标准。在产后哺乳期个体中，阴道萎缩和干燥的患病率分别为63.9%（95%CI，55.3 - 71.6%）和53.6%（95%CI，33.6 - 72.5%）。对产后3个月、6个月和12个月时性交困难的Meta分析显示，合并患病率估计分别为60.0%（95%CI，45.1 - 73.3%）、39.7%（95%CI，28.9 - 51.5%）和28.5%（95%CI，26.3 - 30.9%），合并比值比分别为2.33（95%CI，1.92 - 2.83）、2.24（95%CI，1.62 - 3.10）和1.45（95%CI，1.36 - 1.56），与未产后的育龄妇女相比。性功能障碍的合并患病率为73.5%（95%CI，59.1 - 84.2%），女性性功能指数（FSFI）平均得分为21.5±1.83（性功能障碍阈值小于26.55）。
本系统评价强调了泌乳引起的激素缺乏对泌尿生殖系统健康的显著影响，大多数报告有阴道萎缩和干燥，且很大比例的人也存在性功能障碍。
PROSPERO，CRD42024519600。
