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.