Results
One hundred and fourteen (29.3%) participants reported having experienced some extent of pain during intercourse. Of them, 69 (60.5%) women reported superficial dyspareunia and 16 (14%) reported deep dyspareunia. Eighteen participants (15.8%) reported primary dyspareunia, eight (7.0%) secondary dyspareunia, and 88 participants (77.2%) did not recall the timing of pain onset, or did not respond. Only 24 participants (17.4%) had consulted with a practitioner regarding dyspareunia. Eleven women (8.0%) had received a diagnosis, including yeast infection, vulvovaginitis, vaginal dryness, PVD, vaginismus, pelvic floor overactivity, retroverted uterus, uterine leiomyoma. Ten women (7.2%) had received treatment, including pelvic floor physiotherapy, local creams, psychosexual treatment or vulvar vestibulectomy. Seventy-one women (18.3%) reported dyspareunia in at least one-third of intercourse episodes. According to this cutoff, participants were classified into the dyspareunia group (n=71,18.3%) or the comparison group (n=317, 81.7%).
More women in the dyspareunia group suffered pain during transvaginal ultrasound and pelvic exam, as compared to comparisons (34.3% vs 14.6%, p<0.001; 39.4% vs 13.6%, p<0.001, respectively). In addition, more women in the dyspareunia group reported experiencing pain while performing internal checks and inserting tampons, as compared to comparisons (8.6% vs 1%, p<0.001; 8.5% vs 3.2%, p<0.001, respectively).
The participants’ demographic data and obstetric outcomes are shown in Table 1 and Table 2. The two groups did not differ in demographic and clinical characteristics. History of ART was similar between groups [13 (18.3%) vs. 34 (10.9%), p=0.09]. As for obstetric outcomes, more participants from the dyspareunia group had premature delivery versus comparisons (14.1% vs 5.6%, p=0.02, respectively), and in accordance, the mean birthweight was lower in the former group (BW=3100.76±550.73 vs. 3253.95±482.45, p=0.01, respectively).
No difference between groups was found in prevalence of high-risk pregnancies [18 (26.5%) vs. 70 (23.6), p=0.61] and labour induction (Table 2). Type of analgesia used during labour, rate of cesarean sections, operative vaginal deliveries and perineal tears were similar between groups (Table 2).
Participants’ perceptions of childbirth experience are presented in Table 3. Although the two groups did not differ in their reports on pain and perceived threat to their lives or that of the baby during delivery, participants in the dyspareunia group reported lower levels of sense of control (p=0.01) and perceived support (p<0.001), as compared to comparisons.
Table 4 presents the participants’ emotional reactions and adjustment during and following childbirth. Participants in the dyspareunia group reported higher levels of perinatal dissociation (p<0.001), ASD symptoms (p<0.001), depression (p=0.02), negative affect (p<0.001), lower levels of bonding with the baby (p<0.001), and anticipated maternal self-efficacy (p=0.01). The two groups did not differ in their reported levels of positive affect.
Further analyses examined the associations between participants’ reports on pain during pelvic exams and obstetrical characteristics, birth perceptions, and adjustment following childbirth. Pain during pelvic exam was not related to preterm delivery (p = 0.68), birthweight (p = 0.74), route of delivery (p = 0.86), type of analgesia (p = 0.47), and perineal tears (p = 0.68). Pain during pelvic exams was associated, with nature of labour onset: more participants who did not experience pain had spontaneous labour onset (n=90, 53.9%) as compared to those who reported always (n=21, 31.8%) or occasionally (n=59, 44.1%) experiencing pain during pelvic exams. Fewer participants who did not report pain on pelvic exams had cervical ripening (n=11, 6.6%) as compared to those who reported always (n=9, 13.6%), or occasionally (n=18, 15.3%) experiencing pain during pelvic exams (p=0.02).
Pain experienced during pelvic exams was not related to participants’ reports regarding pain during delivery (p = 0.66), perceived threat for their life (p = 0.75), or that of the baby during delivery (p = 0.41), sense of control during delivery (p = 0.28), perceived support from the staff (p = 0.17), ASD symptoms (p = 0.67), dissociation (p = 0.18), depression symptoms (p = 0.07), positive affect (p = 0.66), bonding to the baby (p = 0.92), and maternal self-efficacy (p = 0.39). Participants reporting pain during examinations had higher levels of negative affect, as compared to those who do not experience pain (1.81 ± 0.86 vs. 1.55 ± 0.63, p=0.03).