产后性问题与产后保健服务

目的 :了解产后各种不同类型性问题的发生率以及在产后保健服务中对性健康重视的状况。方法 :采用横断面研究方法 ,将分娩活婴的 4 6 0例初产妇产科住院记录和产后 6月门诊随访问卷调查所得资料进行分析。结果 :94 74 %初产妇于产后 6月内恢复性生活 ,但妇女性问题的发生率较产前明显增加。其中 ,产后 3月内 70 5 9%存在性问题 ,产后 3～ 6月内下降为 6 4 0 8% ,产后 6月时 ,降至 34 17% ,但未恢复到妊娠前 (7 17% )的水平。产后常见的女性性问题有 :性交疼痛、阴道干涩、性高潮障碍、阴道松弛等 ;其中 ,性交疼痛发生率占第 1位 ,产后 3月内为 6 1 76 % ,产后 6月为 13 2 1%。产后 4 2天接受产科随访时 ,仅 2 0 82 %的妇女从卫生保健人员得到有关的性健康知识。在有产后性问题的妇女中 ,与卫生保健人员讨论过该问题者仅为 8 0 2 %。结论 :产后性健康问题非常普遍 ,但产后保健服务中性健康未得到应有重视 ,缺乏专业人员提供咨询与治疗。提示对产后性问题的咨询与治疗的潜在需求极大 ,值得重视。     

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。     

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。     

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)     

Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women

OBJECTIVE: Our goal was to evaluate the relationship between obstetric perineal trauma and postpartum sexual functioning. STUDY DESIGN: Our study was carried out with a retrospective cohort design in 3 groups of primiparous women after vaginal birth: Group 1 (n = 211) had an intact perineum or first-degree perineal tear; group 2 (n = 336) had second-degree perineal trauma; group 3 (n = 68) had third- or fourth-degree perineal trauma. These sample sizes reflect a 70% response rate. Outcomes were time to resuming sexual intercourse, dyspareunia, sexual satisfaction, sexual sensation, and likelihood of achieving orgasm. RESULTS: At 6 months post partum about one quarter of all primiparous women reported lessened sexual sensation, worsened sexual satisfaction, and less ability to achieve orgasm, as compared with these parameters before they gave birth. At 3 and 6 months post partum 41% and 22%, respectively, reported dyspareunia. Relative to women with an intact perineum, women with second-degree perineal trauma were 80% more likely (95% confidence interval, 1.2--2.8) and those with third- or fourth-degree perineal trauma were 270% more likely (95% confidence interval, 1.7--7.7) to report dyspareunia at 3 months post partum. At 6 months post partum, the use of vacuum extraction or forceps was significantly associated with dyspareunia (odds ratio, 2.5; 95% confidence interval, 1.3--4.8), and women who breast-fed were > or = 4 times as likely to report dyspareunia as those who did not breast-feed (odds ratio, 4.4; 95% confidence interval, 2.7--7.0). Episiotomy conferred the same profile of sexual outcomes as did spontaneous perineal lacerations. CONCLUSIONS: Women whose infants were delivered over an intact perineum reported the best outcomes overall, whereas perineal trauma and the use of obstetric instrumentation were factors related to the frequency or severity of postpartum dyspareunia, indicating that it is important to minimize the extent of perineal damage incurred during childbirth.     

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.     

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.     

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.     

Subsequent obstetric performance related to primary mode of delivery

Objective To relate subsequent obstetric performance with primary mode of delivery.
Design Postal questionnaire survey of women who delivered their first child five years ago.
Setting Huddersfield Royal Infirmary.
Population Women who were delivered of their first baby in 1991: 250 by normal vaginal delivery; 250 by instrumental vaginal delivery; and 250 by caesarean section.
Main outcome measures Answers to fixed choice questions on fear of future childbirth, number of subsequent children and reasons for no further children.
Results The response rate was 64%. Overall, 222 (4606%) women were initially frightened about future childbirth. According to mode of delivery: 93 (57.1%) after instrumental vaginal; 79 (47.9%) after caesarean section; and 50 (33.8%) after normal vaginal delivery. Five years after the primary delivery, 99 women (20.8%) were still frightened about future childbirth: instrumental vaginal group 41 (25.2%); caesarean section group 43 (26.1%); and normal vaginal group 15 (10.1%). In the group of women who were delivered by caesarean section 13% more women had not had a second child after five years compared with the normal vaginal delivery group ((   P < 0.03  , relative risk 1.46 (1.07–1.99)). In the group of women who had a vaginal instrumental delivery 6% more had not had a second child after five years compared with normal vaginal delivery group. Of the women who had no further children, 30% who had caesarean section and 28% vaginal instrumental delivery had involuntary infertility.
Conclusions Caesarean section or vaginal instrumental delivery leaves many mothers frightened about future childbirth. Primary caesarean section and to some extent vaginal instrumental delivery is associated with an increased risk of voluntary and involuntary infertility.     

Dyspareunia and Sexual Dysfunction after Vaginal Delivery in Thai Primiparous Women with Episiotomy

IntroductionEpisiotomy remains commonly practiced in Thailand. There are limited data on its impacts on sexuality among Asian women during the first postdelivery year.AimsThe aim was to study dyspareunia and sexual function at 3–12 months after vaginal delivery in Thai primiparous women with episiotomy.MethodsA total of 190 participants were approached on Day 2 postpartum. Of these, 93 sexually active women were evaluated for dyspareunia and sexual function at 3 months by using 10-cm visual analog scale and the validated Thai version of Female Sexual Function Index (TFSFI). TFSFI < 26.5 was defined as having potential sexual dysfunction. At 6 and 12 months, sexual function was evaluated by telephone interview.Main Outcome MeasuresThe prevalence of dyspareunia at 3 months and the changes of TFSFI scores during the first postdelivery year were the main outcome measures.ResultsThe average age of the participants, over 90% of whom were high school finishers, was 24. Their partners were around 3 years older, and the median partnership duration was 3 years. At 3 months, 30.1% of participants reported dyspareunia. There was no association between dyspareunia and the following characteristics: pre-pregnancy dyspareunia, newborn's head circumference and birthweight and breast-feeding (P > 0.05 for all). Sexual dysfunction was demonstrated in 66.7% at 3 months, 31.0% at 6 months, and 14.9% at 12 months. From 3 to 12 months, the median TFSFI scores in all domains increased significantly. There was no difference of the scores in all domains at 3 and 12 months between women with and without dyspareunia at 3 months. However, at 6 months, those without dyspareunia had better scores in pain, orgasm, satisfaction, and total scores (P < 0.05 for all).ConclusionDyspareunia at 3 months is common in Thai primiparous women with episiotomy. Those with dyspareunia have a slower resumption of normal sexual function. Chayachinda C, Titapant V, and Ungkanungdecha A. Dyspareunia and sexual dysfunction after vaginal delivery in Thai primiparous women with episiotomy. J Sex Med 2015;12:1275–1282.     

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.     

Expectation and experiences of childbirth in primiparae with caesarean section

Objective  The aim of this study was to examine the expectations and experiences in women undergoing a caesarean section on maternal request and compare these with women undergoing caesarean section with breech presentation as the indication and women who intended to have vaginal delivery acting as a control group. A second aim was to study whether assisted delivery and emergency caesarean section in the control group affected the birth experience.
Design  A prospective group-comparison cohort study.
Setting  Danderyd Hospital, Stockholm, Sweden.
Sample  First-time mothers ( n = 496) were recruited to the study in week 37–39 of gestation and follow up was carried out 3 months after delivery. Comparisons were made between 'caesarean section on maternal request', 'caesarean section due to breech presentation' and 'controls planning a vaginal delivery'.
Methods  The instrument used was the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ).
Main outcome measures  Expectations prior to delivery and experiences at 3 months after birth.
Results  Mothers requesting a caesarean section had more negative expectations of a vaginal delivery ( P < 0.001) and 43.4% in this group showed a clinically significant fear of delivery. Mothers in the two groups expecting a vaginal delivery, but having an emergency caesarean section or an assisted vaginal delivery had more negative experiences of childbirth ( P < 0.001).
Conclusions  Women requesting caesarean section did not always suffer from clinically significant fear of childbirth. The finding that women subjected to complicated deliveries had a negative birth experience emphasises the importance of postnatal support.     

Rate of dyspareunia after delivery in primiparae according to mode of delivery

OBJECTIVES: The purpose of this study was to evaluate the influence of mode of delivery on sexual function. DESIGN: One thousand six hundred and thirteen questionnaires containing 16 questions about sexual behavior and dyspareunia before, during and after pregnancy were sent out to primiparous, ethnically homogeneous (fluent in German) patients who delivered in a large tertiary referral center between 6 months and 2(1/2) year before. The returned questionnaires were merged to clinical data from our obstetric database in an anonymous fashion. The patients were subdivided into four groups (A) "spontaneous without injuries (except minor labial laceration)", (B) "c-section", (C)"episiotomy or perineal laceration", and (D) "operative vaginal delivery". RESULTS: The response rate of primiparae was 41% (655/1613). Forty-seven percent of women resumed sexual intercourse (SI) within 8 weeks after delivery. Altogether 31% of the women did not experience any pain during the first SI post-partum whereas 49% of all patients noted significant pain (medium, considerable or severe), depending on the mode of delivery (p = 0.007). Persistence of dyspareunia longer than 6 months was 3.5% (4/115; group A), 3.4% (2/58; group B), 11% (34/316; group C), and 14% (20/114; group D). CONCLUSIONS: Recently, female sexuality may not have been prominent in any discussion concerning possible advantages and disadvantages of different modes of childbirth. Our results should be taken into consideration when counseling patients antenatally regarding mode of delivery.     

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 dyspareunia and sexual functioning: a prospective cohort study

Objectives: Sexual functioning is an important concern for women in the postpartum period. The aim of this research was to investigate the prevalence and determinants of dyspareunia and sexual dysfunction before and after childbirth.

Methods: Between November 2013 and April 2014, 109 women in their third trimester of pregnancy were enrolled in a prospective cohort study at Ghent University Hospital. Dyspareunia, sexual functioning and quality of life (QOL) were evaluated at enrolment and again 6 weeks and 6 months postpartum. Sexual functioning and QOL were assessed using validated self-report questionnaires: the Female Sexual Function Index and the Short Form-36 health survey. Dyspareunia was evaluated by a specific self-developed questionnaire.

Results: One hundred and nine women were enrolled; respectively, 71 (65.1%), 66 (60.6%) and 64 (58.7%) women returned the questionnaires prepartum, and 6 weeks and 6 months postpartum. Sexual functioning at 6 weeks was predictive of sexual functioning at 6 months postpartum (r_s?=?0.345, p?=?.015). The prevalence of dyspareunia in the third trimester of pregnancy, and 6 weeks and 6 months postpartum was, respectively, 32.8%, 51.0% and 40.7%. The severity of pain decreased significantly between 6 weeks and 6 months postpartum (p?=?.003). In the first 6 weeks postpartum, the degree of dyspareunia was significantly associated with breastfeeding (p?=?.045) and primiparity (p?=?.020). At 6 months, only the association with primiparity remained significant (p?=?.022).

Conclusions: The impaired postpartum sexual functioning, the high prevalence of dyspareunia postpartum and their impact on QOL indicate the need for further investigation and extensive counselling of pregnant women, especially primiparous women, about sexuality after childbirth.     

Faecal incontinence after childbirth

Objective To measure the prevalence and severity of postpartum faecal incontinence, especially new incontinence, and to identify obstetric risk factors.
Design A cohort study with information on symptoms collected in home-based interviews and obstetric data from hospital casenotes.
Setting Deliveries from a maternity hospital in Birmingham.
Participants Nine hundred and six women interviewed a mean of 10 months after delivery.
Main outcome measures New faecal incontinence starting after the birth, including frank incontinence, soiling and urgency.
Results Thirty-six women (4%) developed new faecal incontinence after the index birth, 22 of whom had unresolved symptoms. Twenty-seven had symptoms several times a week, yet only five consulted a doctor. Among vaginal deliveries, forceps and vacuum extraction were the only independent risk factors: 12 (33%) of those with new incontinence had an instrumental delivery compared with 114 (14%) of the 847 women who had never had faecal incontinence. Six of those with incontinence had an emergency caesarean section but none became incontinent after elective sections.
Conclusions Faecal incontinence as an immediate consequence of childbirth is more common than previously realised, and medical attention is rarely sought. Forceps and vacuum extraction deliveries are risk factors, with no protection demonstrated from emergency caesarean section. Identification and treatment is a priority.     

Body fat composition and weight changes during pregnancy and 6–8 months post-partum in primiparous and multiparous women

Objective:  To compare changes in maternal weight and body fat composition from early to late pregnancy and 6–8 months postnatally between primiparous and multiparous patients
Methods:  Maternal weight and body fat percentage were assessed in a cohort of low-risk uncomplicated women in a general antenatal clinic at 14–20 weeks gestation, after 36 weeks, and around six to eight months after delivery using a Tanita TBF 105 Fat Analyser. Maternal epidemiological and anthropometric data, as well as pregnancy characteristics and perinatal outcome, were derived from standard antenatal records after delivery. The cohort was stratified into primiparous and multiparous women for comparison.
Results:  In a cohort of 104 women, 55 (52.8%) were primiparous and 49 (47.1%) were multiparous. A relatively good overall correlation between body fat percentage gain and weight gain was observed (correlation coefficient 0.33) from early to late pregnancy. Primiparous women had higher weight gain (12 kg) and higher body fat gain (7.7%) during the pregnancy compared to multiparous women (10.8 kg and 6%, respectively), and they also retained more of the fat accumulated during pregnancy (1.92% vs – 0.44%, P  < 0.001) when assessed over six months after their delivery.
Conclusion:  The findings could represent more exaggerated physiological responses to the pregnant state in the primiparous woman as compared to multiparous women.     

The effect of hysterectomy or levonorgestrel-releasing intrauterine system on sexual functioning among women with menorrhagia: a 5-year randomised controlled trial

Objective  To compare among women with menorrhagia the effect of hysterectomy or levonorgestrel-releasing intrauterine system (LNG-IUS) on sexual functioning .
Design  A randomised controlled trial.
Setting  Five university hospitals in Finland.
Sample  A total of 236 women, aged 35–49 years.
Methods  Of the women, 117 were treated by hysterectomy and 119 by LNG-IUS.
Main outcome measures  Sexual functioning was evaluated by modified McCoy sexual scale at baseline and at 6 months, 12 months, and 5 years after initiation of treatment (hysterectomy or application of LNG-IUS).
Results  Among women treated by hysterectomy, sexual satisfaction increased and sexual problems decreased. Among LNG-IUS users, satisfaction with partner decreased. In addition to treatment modality ( P = 0.02), estrogen therapy ( P = 0.01), smoking ( P = 0.001), night sweats ( P = 0.03), vaginal dryness ( P = 0.04), hot flushes ( P = 0.01), and having someone to ask for advice ( P = 0.03) and to share worries ( P = 0.01) explained changes in sexual functioning.
Conclusions  Among women with menorrhagia, hysterectomy improves sexual functioning, whereas LNG-IUS does not have such a positive effect.     

Obstetric outcomes of elderly primiparous singleton pregnancies conceived by <Emphasis Type="Italic">in vitro</Emphasis> fertilization compared with those conceived spontaneously

Aim:  To examine the obstetric outcomes of elderly primiparous singleton pregnancies conceived by in vitro fertilization (IVF) compared with those conceived spontaneously.
Methods:  Data were collected from primiparous women aged 35 years and older with a singleton pregnancy conceived by IVF ( n  = 89) or spontaneously ( n  = 849). Data included antenatal data, gestational age at delivery, obstetric complications, such as pregnancy-induced hypertension, gestational diabetes, placental previa and placental abruption, mode of delivery, birth weight, fetal demise and the Apgar score at 1 min.
Results:  The elective Cesarean rate in pregnancies following IVF was significantly higher than that in the control group ( P =  0.014). However, there were no significant differences in obstetric outcomes between the two groups.
Conclusions:  The current results did not support the IVF-related risks of elderly primiparous singleton pregnancies. (Reprod Med Biol 2007; 6: 219–222)     

Mothers' satisfaction with planned vaginal and planned cesarean birth

We sought to describe maternal satisfaction with childbirth among women planning either cesarean or vaginal birth. We enrolled primiparous women planning cesarean birth and a comparison group planning vaginal birth. After delivery, the maternal subjective experience was assessed with a visual analogue satisfaction scale and the Salmon questionnaire, with scale scores for these aspects of the maternal experience of birth: fulfillment, distress, and difficulty. The sample included 160 women planning vaginal birth and 44 women planning cesarean. Eight weeks postpartum, women planning cesarean reported higher satisfaction ratings ( P = 0.023), higher scores for fulfillment ( P = 0.017), lower scores for distress ( P = 0.010), and lower scores for difficulty ( P < 0.001). The least favorable scores were associated with unplanned cesarean ( N = 48). Women planning cesarean reported a more favorable birth experience than women planning vaginal birth, due in part to low satisfaction associated with unplanned cesarean. Maternal satisfaction with childbirth may be improved by efforts to reduce unplanned cesarean, but also by support for maternal-choice cesarean.