Strengths and limitations
This is the first systematic review with critical
appraisal on sexual dysfunction including dyspareunia, vaginal dryness
and body image dissatisfaction as outcomes. We focused on studies which
used standardized validated tools and definitions consistent with the
IUGA/ICS terminology for the assessment of sexual health in women with
pelvic floor dysfunction, with the intention to pool comparable
results(1). Nonetheless, we acknowledge some limitations. First, we
could include only observational studies in the quantitative analysis.
Among those, only 44% were of high quality. As a result, the level of
the evidence is low. Second, we could include in the quantitative
synthesis, only studies were the outcome measurements were presented as
dichotomous. Studies reporting on sexual function as mean score were
excluded from quantitative analysis, as the individual data could not
been retrieved. A solution may be to conduct a meta-analysis with
individual patient data (if available). Moreover, not all eligible
studies performed multivariate analysis with logistic regression.
Therefore, in our meta-analysis we reported summary ORs from count data
and crude ORs, and the possible effect of confounders cannot be
excluded. Third, we retrieved few studies that discriminated between
elective and emergency cesarean section and among the types of operative
delivery, and their association with sexual function after delivery
(26-30). Fourth, there is only one study of low quality reporting on
vaginal dryness after delivery (26). Furthermore, only two studies
addressed body image dissatisfaction(26, 31). Their definition and
methodology differ and their findings are inconclusive, which makes is
difficult to make a statement about a possible correlation between
sexual dysfunction and body image in the first after delivery.