Strengths and limitations
Despite our study’s cross-sectional design, which does not allow us to determine causality but only a relationship between variables, we have gathered important data on obstetrical outcomes, childbirth experiences and emotional adjustment in women with dyspareunia. The lack of effect of pain during pelvic exams on the study variables, further validates our findings, by demonstrating the specific effect of dyspareunia on women’s experiences. To our knowledge, the latter topics have not been addressed in the medical or psychosocial literature so far.
There are several limitations to this study. Firstly, we used a non-validated screening tool for dyspareunia assessment. The cohort included women in the immediate post-partum period, therefore we considered available validated tools unsuitable, as they are designed for non-pregnant women and inquire on sexual activity during the last few weeks. We therefore selected a questionnaire (11) specifically developed and utilized for post-partum women. Some questionnaire items indicate a possible aetiology for dyspareunia, nevertheless the condition was established according to self-report, which by itself does not allow a precise medical diagnosis. Potential recall bias is a major limitation, given the lack of pre-delivery comparative data. As for obstetrical parameters, selection bias of participants is plausible: for ethical reasons, we excluded women in critical conditions or with negative outcomes. Therefore, our cohort included mostly uncomplicated deliveries. Lastly, this is a convenience sample in a single study center, with understandable threat to external validity.