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).