Evaluation of sexual function after obstetric anal sphincter injury: a 12-year follow-up cohort study.

Abstract

Introduction: Obstetric anal sphincter injuries (OASIS) may lead to pelvic floor complications, including sexual dysfunction. While short- and medium-term studies have reported increased dyspareunia and decreased sexual pleasure, desire, lubrication, and orgasm ability following OASIS, evidence on long-term sexual function remains limited.

Aims: This longitudinal follow-up cohort study aimed to assess sexual function 12 years after vaginal delivery in women with and without OASIS, and to evaluate its evolution over time.

Methods: The questionnaire used in our previous study, including patients' sociodemographic characteristics and the Female Sexual Function Index (FSFI), was mailed to the same cohort of women previously included in a case-control study. The FSFI is a validated questionnaire assessing female sexual function across 6 domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Mean FSFI total scores, domain scores, and individual item scores were compared between women with and without OASIS. Changes in sexual function were also evaluated in comparison with the results obtained 6 years after the index delivery.

Results: Completed questionnaires were returned by 52 women in the OASIS group and 141 women in the control group, with an overall participation rate of 79.8%. Mean FSFI total scores and domain scores were similar between women with and without OASIS. However, lubrication during sexual activity for less than half of the time (19.6% vs 8.5%, P = .033) and pain during vaginal penetration for about half of the time or more (13.7% vs 5.0%, P = .041) were reported more frequently in women with OASIS. In contrast to findings at 6 years, difficulty reaching orgasm was no longer significantly different between groups (10.0% vs 5.0%, P = .212). No significant changes were detected over time in individual FSFI items, domain scores, or total score.

Conclusion: Overall sexual function does not appear to differ between women with and without OASIS 12 years after vaginal delivery. However, women with OASIS continue to report more frequent pain during vaginal penetration and reduced lubrication during sexual activity in the long term.