Eligibility criteria
We included all randomized clinical trials, controlled clinical trials,
cohort, cross-sectional and case-control studies, comparing potential
obstetric risk factors for developing sexual dysfunction up to one year
after delivery. Duplicate records, reviews, case reports, incomplete
reports, book chapters, conference abstracts, letters to the editor and
comments were excluded. We used language restrictions due to the lack of
resources for translation(14); only studies written in English were
retrieved in the full text format. The PICO format was used to identify
studies and data to be extracted(15).
PATIENT/POPULATION: All childbearing women without age and ethnicity
restrictions.
INTERVENTION/EXPOSURE: Childbirth irrespective of the mode of delivery
COMPARATOR(S)/CONTROL(S) were the following categories:
- Delivery mode, either cesarean section, vacuum extraction, forceps
extraction, instrumental delivery (if the previous is unknown), fundal
pressure versus spontaneous vaginal delivery
- Obstetric anal sphincter injury (III-IV grade) versus no tear or minor
vaginal tear (I-II grade)(9)
- Episiotomy: mediolateral or median versus no episiotomy
- Maternal age at first delivery, as a continuous variable or
categorized as either ≥35 or <35 years(16)
- Maternal BMI, categorized as either ≥30 kg/m2(obesity) or <30 kg/m2(17)
- Pre-pregnancy dyspareunia present vs. not present
- Primiparous vs. multiparous
- Breastfeeding vs. no breastfeeding
- Contraception use vs. no contraception use
- Prolonged second stage of labour, including the definition used(18)
OUTCOMES: Primary outcomes were sexual dysfunction anddyspareunia consistent with the ICS/IUGA Terminology(1) and
assessed with validated and standardized tools. Secondary outcomes werevaginal dryness(1) and body image dissatisfaction(19-21) .
When Female Sexual Function Index (FSFI) scores were available, the
total score was retrieved or calculated by addition of the separate
subscores. An FSFI total score of ≤26.55 was used as a cut off for
differentiating women with and without sexual dysfunction(22).