妇女产后性生活变化及产后性问题

目的　了解妇女产后各种不同类型性问题的发生率以及产后性生活的变化。方法　采用横断面研究方法 ,以自行设计的《女性产后性健康调查表》 ,调查 2 0 0 0年 11月至 2 0 0 1年 7月在重庆医科大学附属第一医院产科分娩活胎的 4 6 0例初产妇 ,分析其产后 6个月性健康情况。结果　 94 74 %初产妇于产后 6个月内恢复性生活 ,但妇女性问题的发生率明显增加。其中产后 3个月内 ,70 5 9%的妇女存在性问题 ,产后 >3～ 6个月降为5 5 6 3% ,产后 6个月后降至 34 17% ,但未恢复到妊娠前 (7 17% )水平。产后妇女性生活的常见改变有 :性欲减退、性生活频率下降 ,性生活满意度和女方主动率明显降低。产后常见的女性性问题中 ,性交疼痛占第一位 ,产后3个月内发生率为 6 1 76 % ,产后 6个月后发生率为 13 2 1%。结论　产后性健康问题普遍存在 ,重视和研究性健康这一妇产科领域中重要而尚不完备的问题是目前紧迫的任务。     

妇女产后性问题与分娩方式

产后性问题发生率国外报道为 4 9%～ 83% ,其中最常见的是性交疼痛。一般认为病因是多因素的 ,其中心理因素占相当大比例。性交疼痛与哺乳、会阴损伤及阴道助娩正相关。本文就产后性问题与分娩方式的关系进行了探讨。虽对产后性问题的咨询与治疗的潜在需求极大 ,但产后保健服务中的性健康问题未得到应有的重视 ,更缺乏专业人员提供咨询与治疗。     

产后性生活质量与分娩方式的关系

目的 了解产后各种不同类型性生活质量问题的发生率,以及分娩方式与产后性生活质量的关系。方法 采用横断面研究方法,对在重庆医科大学临床学院产科分娩活婴的460例初产妇的产科住院记录和产后6个月内的性生活资料进行分析。结果 94．7％初产妇于产后6个月内恢复性生活。其中产后3个月内,存在性交疼痛、阴道干涩等性生活质量问题的妇女占70．6％,产后6个月时,降至34．2％,但未恢复到妊娠前(7．2％)的水平。分娩方式与妇女产后3～6个月内的性生活满意率、性生活中女方主动率、性欲水平、性交疼痛的发生率等无明显相关性。结论 产后性生活质量问题非常普遍,缺乏专业人员提供的咨询与治疗;产后3～6个月内性生活质量与分娩方式无关。     

口服米索前列醇防止产后出血的研究

产后出血是产科临床常见的严重并发症之一 ,是当前我国孕产妇死亡的首位原因。在产后出血的四大原因中 ,子宫收缩乏力性出血占首位 ,发生率为 5 0 % 75 % ,约占产后出血的 2 /3[1] 。因此积极防治子宫收缩乏力性出血是降低孕产妇病死率的关键。本文对应用米索前列醇防止产后出血进行了探讨。1　资料与方法1 1　一般资料　 1999年 4月至 2 0 0 0年 5月在我院住院产妇中 ,选择无前列腺素应用禁忌 ,无内、外科合并症和产科并发症的单胎头位足月妊娠阴道分娩的初产妇 2 0 0例 ,按序列随机设米索组和催产素组各 10 0例。两组在年龄、体重、孕次、…     

妊娠期尿失禁患者产后自然转归

目的:探讨妊娠期尿失禁对产后远期盆底功能的影响。方法:选取2015年2月至2016年5月在绍兴市妇幼保健院产后门诊42天健康检查且接受问卷调查并于产后3月、6月、1年盆底功能随访的女性426例,其中初产妇325例(妊娠期未发生尿失禁264例为对照组,妊娠期发生尿失禁61例为观察组),二次分娩的经产妇101例(妊娠期未发生尿失禁70例为对照组,妊娠期发生尿失禁31例为观察组)。比较再生育组和初产组的尿失禁发生率,观察妊娠期尿失禁患者的产后自然转归。结果:妊娠期和产后1年,再生育妇女的尿失禁发生率明显高于初产妇,差异有统计学意义(P0.05);产褥期、产后3月、产后6月,再生育妇女的尿失禁发生率与初产妇比较,差异无统计学意义(P均0.05)。初产妇观察组产褥期和产后1年的尿失禁发生率分别为31.1%和18.0%,再生育产妇观察组分别为32.2%和38.7%;观察组产后各个阶段尿失禁发生概率均明显大于对照组,差异有统计学意义(P均0.05)。结论:再生育产妇妊娠期和产后远期的尿失禁发生率明显高于初产妇,妊娠期发生尿失禁产妇较未发生尿失禁产妇产后远期发生尿失禁的概率高。妊娠期尿失禁是产后远期尿失禁发生的一个预警信号。     

产后妇女骨密度影响因素及其与婴儿3月龄时身长和体质量的相关性

目的:探讨产后妇女骨密度影响因素及其与婴儿 3 月龄时身长和体质量的相关性。 方法: 回顾性分析 2015 年 1 月 1 日至 2020 年 7 月 31 日在天津市妇女儿童保健中心进行超声骨密度 T- Score(T - 值)筛查的 6806 例产后妇女,采用单因素分析、非参数检验 Kruskal-Wallis H 检验、多元线 性回归等方法对产后妇女骨密度的影响因素及其婴儿 3 月龄时身长和体质量的相关性进行分析。 结果:①6806 例产后妇女平均年龄 30. 41 ± 3. 68 岁,骨密度异常发生率为 51. 0% 。 ②不同年龄、孕 次、产次、民族、文化程度的产后妇女骨密度 T - 值差异有统计学意义(P < 0. 05)。 经产妇不同的两 次分娩间隔时间及产后 6 个月内不同检测时间的骨密度水平和骨量异常率差异无统计学意义(P > 0. 05)。 ③产后妇女骨密度与其婴儿 3 月龄时身长、体质量均无相关性(P > 0. 05)。 ④多元线性回 归分析示:年龄和经产妇为影响骨密度的保护性因素(B > 0,P < 0. 05),随年龄的增加,产后妇女的 骨密度相对更高,经产妇骨密度高于初产妇。 结论:半数产后妇女会发生骨密度异常,低龄以及初产 妇需要更加重视孕产期的骨骼健康。 建议产后常规进行骨密度筛查,尽早干预,防治女性骨质疏 松症。     

妇女生育后的性健康

本研究旨在调查生育对初产妇女性健康的影响 ,并阐明与性交困难相关的因素。采用横断面研究法。对伦敦圣乔治医院妇产科 6个月以内生产一活婴的所有初产妇 ( n=796)进行调查。将在产科住院和调查所得资料进行定量分析。主要评价方面包括 :产妇本人讲述的性行为方式和性问题 (如阴道干涩、插入疼痛、性交痛、性高潮痛、阴道紧张、阴道松弛、性交后出血、炎症及性欲缺乏 ) ;产后性问题的咨询。在 4 84例答题者中 ( 61%的回答率 ) ,80 %在产后6个月内恢复性生活 ,产后性问题明显增多 :产后前 3个月 83%的妇女经历过性问题。在 6个月时降至64% ,…     

晚期产后大出血的介入治疗

晚期产后大出血为妇产科较为常见的疾病 ,也为产科的严重并发症之一 ,是产妇死亡的主要原因之一。晚期产后出血是指分娩 2 4小时后至产褥期内发生的子宫大量出血或异常阴道出血。据报道晚期产后出血的发生率为0 2 8% [1] ,本院曾统计 31 8万例中 ,晚期产后出血 6 6例 ,其发生率为 0 2 1% ,与文献报道大致相符。　　晚期产后出血的主要原因是胎盘残留和 (或 )胎膜残留、宫腔感染、胎盘附着面的复旧不良及剖宫产术后子宫切口感染、不愈合导致晚期产后大出血 ,同时产道损伤也是导致晚期产后大出血的原因之一[2 ] 。在本院统计的晚期产后出血…     

阴道分娩产后出血量的精确测定与血液指标的关系研究

目的 :探讨产后出血量的测定与血液指标变化的关系。方法 :采用前瞻性研究方法。选择经阴道分娩的足月产妇共 6 30例 ,产后出血量的收集计量采用称重法 ,由专人精确测量从会阴切开至产后 2 4小时各阶段的出血量 ,再按血液比重换算成容积。血液容积 (ml) =血液重量 (g)÷ 1.0 5。在接产前及分娩后 4小时分别抽取肘静脉血 0 .5ml,即刻测定血红蛋白、红细胞计数、血小板数、血细胞比容。结果 :产后 2 4小时总出血量平均为 5 5 4.2± 2 73.1ml,其中产后 2小时内出血量为 42 0 .2± 2 5 9.1ml,占产后 2 4小时总出血量的 75 .8%,第三产程出血量为 2 12 .0± 180 .9ml,占产后 2小时内出血量的 5 0 .5 %。在 6 30例阴道分娩中 ,产后 2 4小时总出血量 >5 0 0ml者 ,共 319例 ,占 5 0 .6 %。产后 2 4小时总出血量 >10 0 0ml者 ,共 39例 ,占 6 .2 %。产后 4小时血红蛋白、红细胞计数、血细胞比容较产前下降 ,差异有显著性 (P <0 .0 1) ,尤以产后 2 4小时总出血量 >10 0 0ml者变化显著 ,而血小板的变化差异无显著性 (P >0 .0 5 )。结论 :以产后 2 4小时总出血量超过 5 0 0ml作为产后出血的诊断标准 ,则 6 30例产妇中有产后出血者 319例 ,产后出血的发生率为 5 0 .6 %。故是否需重新定义产后出血的量是值得研究的问题     

孕妇产后的避孕意愿及其影响因素

本文对上海市黄浦区、普陀区、青浦县、奉贤县 40 37名孕妇对产后避孕意愿及影响因素进行了分析。结果显示 :79.96 %的妇女考虑产后避孕。2 5～ 2 9岁的妇女较其它年龄段的妇女考虑产后避孕的比例要高。产后避孕意愿与本人文化程度及职业无关 ,而亲戚朋友的文化程度对产后避孕意愿有影响。工作单位要求在 1年内落实避孕措施、接受过有关避孕知识教育或为此进行咨询或查阅书籍的妇女考虑产后使用避孕方法的比例较高。单位或计划生育部门建议使用的避孕方法以宫内节育器最高 ,占 97.1 4% ,避孕套仅为 1 .0 2 % ;妇女自我选择的避孕方法中宫内节育器为多 ,占 82 .34% ;其次为避孕套 ,占 1 1 .2 1 %。 L ogistic回归分析表明 :年龄、文化程度、职业、家庭收入等对产后避孕意愿影响不大。产后愿意哺乳者、接受过避孕教育、咨询或查阅书籍者、了解避孕知识年龄较小者、知晓宫内节育器者对产后避孕意愿有正面作用。建议在计划生育服务中 ,今后需加强产后避孕教育 ,开展各种避孕方法知情选择的教育和咨询 ,指导妇女在产后选择最适合于自己的避孕方法 ,从而减少产后意外妊娠的发生     

Women's sexual health after childbirth

Objective To investigate the impact of childbirth on the sexual health of primiparous women and identify factors associated with dyspareunia.
Design Cross-sectional study using obstetric records, and postal survey six months after delivery.
Setting Department of Obstetrics and Gynaecology, St George's Hospital, London.
Population All primiparous women (   n = 796  ) delivered of a live birth in a six month period.
Methods Quantitative analysis of obstetric and survey data.
Main outcome measures Self reported sexual behaviour and sexual problems (e.g. vaginal dryness, painful penetration, pain during sexual intercourse, pain on orgasm, vaginal tightness, vaginal looseness, bleeding/irritation after sex, and loss of sexual desire); consultation for postnatal sexual problems.
Results Of the 484 respondents (61% response rate), 89% had resumed sexual activity within six months of the birth. Sexual morbidity increased significantly after the birth: in the first three months after delivery 83% of women experienced sexual problems, declining to 64% at six months, although not reaching pre-pregnancy levels of 38%. Dyspareunia in the first three months after delivery was, after adjustment, significantly associated with vaginal deliveries (   P = 0.01  ) and previous experience of dyspareunia (   P = 0.03  ). At six months the association with type of delivery was not significant (   P = 0.4  ); only experience of dyspareunia before pregnancy (   P < 0.0001  ) and current breastfeeding were significant (   P = 0.0006  ). Only 15% of women who had a postnatal sexual problem reported discussing it with a health professional.
Conclusions Sexual health problems were very common after childbirth, suggesting potentially high levels of unmet need.     

Cesarean Section and Postnatal Sexual Health

ABSTRACT: Background: Cesarean delivery avoids perineal trauma and has therefore often been assumed to protect sexual function after childbirth. We sought to examine this assumption by using data from a study of women's sexual health after childbirth to assess whether women who underwent cesarean section experienced better sexual health in the postnatal period than women with vaginal births. Methods: A cross‐sectional study was conducted of 796 primiparous women, employing data from obstetric records and a postal survey 6 months after delivery. Results: Any protective effect of cesarean section on sexual function was limited to the early postnatal period (0–3 months), primarily to dyspareunia‐related symptoms. At 6 months the differences in dyspareunia‐related symptoms, sexual response‐related symptoms, and postcoital problems were much reduced or reversed, and none reached statistical significance. Conclusions: Outcomes from this study provide no basis for advocating cesarean section as a way to protect women's sexual function after childbirth. (BIRTH 32:4 December 2005)     

Postnatal depression and sexual health after childbirth

OBJECTIVE: To investigate the sexual health experiences of depressed and nondepressed postnatal women within a 6-month postnatal period. METHODS: This cross-sectional study used obstetric records and postal survey 6 months after delivery from a cohort of primiparous women (n = 796) delivering a live-born infant at St. George's NHS Trust, London. Women self-reported sexual problems and sexual behaviors and completed the Edinburgh Postnatal Depression Scale. RESULTS: Of the 796 parturients, 484 responded (61%), and 468 completed the survey questions on depression and sexual health (97%). Of the latter, 57 (12%) fit the Edinburgh Postnatal Depression Scale criteria. Comparing the depressed with nondepressed women, resumption of sexual activity occurred with 77% versus 90% (P =.003), and the median number of specific sexual problems reported was two versus one, respectively (P =.009). CONCLUSION: Sexual health problems were common after childbirth in both depressed and nondepressed women; however, depressed women were less likely to have resumed intercourse at 6 months and more likely to report sexual health problems. Given the frequency of sexual health problems, postnatal sexual morbidity cannot be assumed to be simply a product of the depressed mental state.     

Physical health after childbirth and maternal depression in the first 12 months post partum: Results of an Australian nulliparous pregnancy cohort study

Objectiveto investigate the relationship between maternal physical health problems and depressive symptoms in the first year after childbirth.Designprospective pregnancy cohort study.SettingMelbourne, Victoria, Australia.Population1507 nulliparous women.Methodswomen were recruited from six public hospitals between six and 24 weeks gestation. Written questionnaires were completed at recruitment and at three, six and 12 months post partum.Outcome measuresEdinburgh Postnatal Depression Scale (EPDS); standardised measures of urinary and faecal incontinence, a checklist of symptoms for other physical health problems.Resultsoverall, 16.1% of women reported depressive symptoms during the first 12 months post partum, with point prevalence at three, six and 12 months post partum of 6.9%, 8.8% and 7.8% respectively. The most commonly reported physical health problems in the first three months were tiredness (67%), back pain (47%), breast problems (37%), painful perineum (30%), and urinary incontinence (29%). Compared with women reporting 0–2 health problems in the first three months post partum, women reporting 5 or more health problems had a six-fold increase in likelihood of reporting concurrent depressive symptoms at three months post partum (Adjusted OR=6.69, 95% CI=3.0–15.0) and a three-fold increase in likelihood of reporting subsequent depressive symptoms at 6–12 months post partum (Adjusted OR=3.43, 95% CI 2.1–5.5).Conclusionspoor physical health in the early postnatal period is associated with poorer mental health throughout the first 12 months post partum. Early intervention to promote maternal mental health should incorporate assessment and intervention to address common postnatal physical health problems.     

The Relationship Between Mode of Delivery and Sexual Health Outcomes after Childbirth

IntroductionSeveral factors are implicated in the women's sexuality after childbirth. Nevertheless, there is conflicting evidence about the influence of mode of delivery (MD)AimTo prospectively evaluate the relationship between MD and sexual health outcomes after childbirthMethodsA prospective cohort study conducted between May 2005 and March 2007 included 831 pregnant women recruited from primary care clinics of the public sector in São Paulo, Brazil. The exposure variable was MD: uncomplicated vaginal delivery (spontaneous vaginal delivery without episiotomy or any kind of perineal laceration); complicated vaginal delivery (either forceps or normal, with episiotomy or any kind of perineal laceration) and cesarean delivery. Socio-demographic and obstetric data were obtained through a questionnaire applied during the antenatal and postnatal period. Crude and adjusted risk ratios, with 95% confidence intervals, were calculated using Poisson regression to examine the associations between MD and sexual health outcomes.Main Outcome MeasuresThe three main sexual health outcomes were later resumption of sexual life, self-perception of decline of sexual life (DSL), and presence of sexual desire.ResultsOne hundred and forty-one women (21.9%) resumed sexual life 3 or more months after delivery. Although 87.1% of women had desire, DSL occurred in 21.1% of the cohort. No associations were found between MD and sexual health outcomes.ConclusionsWomen's sexuality after childbirth were not influenced by the type of delivery. Efforts to improve the treatment of sexual problems after childbirth should focus beyond MD. Faisal-Cury A, Menezes PR, Quayle J, Matijasevich A, and Diniz SG. The relationship between mode of delivery and sexual health outcomes after childbirth. J Sex Med 2015;12:1212–1220.     

Postpartum sexual functioning and method of delivery: summary of the evidence

Short-term postpartum sexual problems are highly prevalent, ranging from 22% to 86%; however, there are few studies that address how mode of delivery affects sexual functioning after childbirth. The objective of this study was to perform a systematic review of the literature on selected postpartum sexual function outcomes as affected by cesarean, assisted vaginal, and spontaneous vaginal delivery. We searched PubMed, CINAHL, and Cochrane databases from January 1990 to September 2003 and focused on mode of delivery and the most commonly reported sexual health outcomes, which included perineal pain, dyspareunia, resumption of intercourse, and self-reported perception of sexual health/sexual problems. The studies all showed increased risks of delay in resumption of intercourse, dyspareunia, sexual problems, or perineal pain associated with assisted vaginal delivery. Some studies showed no differences in sexual functioning between women with cesarean delivery and those with spontaneous vaginal delivery, whereas others reported less dyspareunia for women with cesarean delivery. A systematic review of the literature suggests an association between assisted vaginal delivery and some degree of sexual dysfunction. Reported associations between cesarean delivery and sexual dysfunction were inconsistent. Continued research is necessary to identify modifiable risk factors for sexual problems related to method of delivery.     

Postnatal morbidity after childbirth and severe obstetric morbidity

Objective To identify the impact of pregnancy and childbirth, and severe obstetric morbidity on outcome 6 to 12 months postpartum.
Design Questionnaire assessment of postnatal outcome in a cohort study.
Setting South East Thames, UK.
Population All women resident in South East Thames and delivering between 1st March 1997 and 28th February 1998.
Methods Questionnaire study of a cohort of women who experienced a severe obstetric morbidity during pregnancy or labour (cases), compared with a cohort of women who did not (controls).
Main outcome measures Assessment of postnatal depression risk [Edinburgh Postnatal Depression Scale (EPDS)], general health [Short Form 36 (SF-36)], sexual activity and use of health services between 6 and 12 months postpartum.
Results There were 331 cases and 1339 controls out of 48,262 deliveries. Six to 12 months after delivery, 77 (23.3%) of cases and 272 (20.5%) of the controls were at risk of postnatal depression (   P = 0.25; 95% CI for difference −2.2% to 7.9%  ), 43.1% of cases were having problems with sexual relations compared with 18.7% of controls (   P < 0.001; 95% CI for difference 8.9% to 21.9%  ). There was evidence of poorer general health in cases. Some 31.5% of cases attended outpatients in the first six months and 9.4% required emergency admission to hospital compared with 17.0% (   P < 0.001; 95% CI for difference 9.1% to 19.9%  ) and 3.7% (   P < 0.001; 95% CI for difference 2.4% to 9.0%  ), respectively, in controls.
Conclusion Both control pregnancy and childbirth and severe obstetric morbidity are associated with significant postnatal morbidity. A severe obstetric morbid event significantly influences women's sexual health and wellbeing and increases health services utilisation. Prevention and appropriate management of severe obstetric morbid events may reduce these outcomes.     

Maternal health after childbirth: results of an Australian population based survey

Objective To describe the prevalence of maternal physical and emotional health problems six to seven months after birth.
Design Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth.
Participants All women who gave birth in a two-week period in Victoria, Australia in September 1993 except those who had a stillbirth or known neonatal death.
Results The response rate was 62.5% (   n = 1336  ). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of nonEnglish speaking background were under-represented. One or more health problems in the first six postnatal months were reported by 94% of the women; a quarter had not talked to a health professional about their own health since the birth. Of women reporting health problems, 49% would have liked more help or advice. The most common health problems were tiredness (69%), backache (435%), sexual problems (26.%), haemorrhoids (24.%) and perineal pain (21%); 16.% of women scored as depressed. Compared with spontaneous vaginal births, women having forceps or ventouse extraction had increased odds for perineal pain (OR 4.9 [95% CI 3.–6.]), sexual problems (OR 2.6 [95% CI 1.–3.]), and urinary incontinence (OR 1.81 [95% CI 1.–2.1). These differences remained significant after adjusting for infant birthweight, length of labour and degree of perineal trauma.
Conclusion Physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them.