Trajectories of Dyspareunia From Pregnancy to 24 Months Postpartum

Natalie O Rosen, Samantha J Dawson, Yitzchak M Binik, Marianne Pierce, Melissa Brooks, Caroline Pukall, Jill Chorney, Erna Snelgrove-Clarke, Ronald George, Natalie O Rosen, Samantha J Dawson, Yitzchak M Binik, Marianne Pierce, Melissa Brooks, Caroline Pukall, Jill Chorney, Erna Snelgrove-Clarke, Ronald George

Abstract

Objective: To identify distinct trajectories of dyspareunia in primiparous women and examine biopsychosocial risk factors of these trajectories.

Methods: This was a prospective cohort of 582 first-time mothers. Participants completed validated measures of dyspareunia at 20-24 (baseline) and 32-36 weeks of gestation and at 3, 6, 12, and 24 months postpartum. Risk factors were assessed at baseline and 3 months postpartum, with labor and delivery characteristics collected by medical record review. Latent class growth analysis was conducted to identify homogeneous subgroups with distinct trajectories of dyspareunia. Univariable and multivariable binomial logistic regressions examined whether predictors were associated with these trajectories.

Results: Overall, the prevalence of dyspareunia ranged from 31.4% at 3 months postpartum to 11.9% at 24 months. We identified two distinct classes of dyspareunia with 21% of women in the class with moderate dyspareunia and 79% in the class with minimal dyspareunia, with pain decreasing in both groups until 12 months postpartum and little change thereafter. Biomedical factors-prior chronic pain (including preexisting dyspareunia), labor epidural analgesia, induction, episiotomy, perineal laceration, mode of delivery, breastfeeding, and whether the woman had a new pregnancy during the postpartum period-did not significantly predict dyspareunia class. Greater fatigue (odds ratio [OR] 1.30; 95% CI 1.05-1.60) and depressive symptoms (OR 1.08; 95% CI 1.02-1.14) in pregnancy and fatigue (OR 1.27; 95% CI 1.04-1.56) and pain catastrophizing (OR 1.10; 95% CI 1.05-1.16) at 3 months postpartum increased the odds for the moderate relative to the minimal pain trajectory in univariable models. In a multivariable model, pain catastrophizing at 3 months postpartum (OR 1.09; 95% CI 1.04-1.15) was associated with the moderate relative to the minimal pain trajectory.

Conclusion: We identified two distinct trajectories of dyspareunia across pregnancy and postpartum. One in five nulliparous women experienced moderate dyspareunia. Pain catastrophizing at 3 months postpartum was associated with experiencing moderate relative to minimal levels of dyspareunia.

Conflict of interest statement

Financial Disclosure J. Chorney received funding from Lyceum Health for an unrelated study. R. George serves as an Advisory Board Consultant for OctaPharma Inc. and is an Associate Editor for the Canadian Journal of Anesthesia. N. O. Rosen is an Associate Editor of Archives of Sexual Behavior. The other authors did not report any potential conflicts of interest.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Fig. 1.. Participant flow and response rates.…
Fig. 1.. Participant flow and response rates. *Not fluent in English, delivering outside of province, medical illness not well managed.
Rosen. Trajectories of Dyspareunia. Obstet Gynecol 2022.
Fig. 2.. Trajectories of dyspareunia from 20…
Fig. 2.. Trajectories of dyspareunia from 20 weeks of gestation to 24 months postpartum.
Rosen. Trajectories of Dyspareunia. Obstet Gynecol 2022.

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