Female sexual health after obstetric anal sphincter injury: a scoping review

INTRODUCTION: Sexuality is integral to most women's quality of life. However, pregnancy and childbirth often lead to biological, psychological, and relational challenges that can impact sexual health and wellbeing. Research has documented declines in sexual activity, functioning, and satisfaction during the postpartum period, particularly among women who sustained severe perineal injuries during delivery. However, these issues remain scientifically and clinically underrecognized.

OBJECTIVES: Approximately 90% of primiparous women experience perineal tearing during vaginal delivery, with 5% sustaining an obstetric anal sphincter injury (OASI). This scoping review aims to synthesize existing evidence on the relationship between OASI and postpartum sexual health, focusing on three key dimensions: (1) sexual activity, (2) sexual functioning, and (3) sexual satisfaction. Understanding the impact of OASI on female sexual health is essential for providing tailored postpartum care and support.

METHODS: A comprehensive literature search was conducted in PubMed, Embase, Scopus, CINAHL, Cochrane, and "gray literature" sources to identify relevant peer-reviewed studies. The selection process involved three stages: screening of titles and abstracts, full-text evaluation, and final inclusion based on predefined criteria. Original quantitative studies presenting statistical evidence on the impact of OASI on postpartum sexual health were eligible for inclusion.

RESULTS: Based on 33 articles, the scoping review revealed that women with OASI experienced delayed resumption of sexual intercourse compared to those with no or minor perineal tears. In addition, most studies reported that OASI increased the risk of dyspareunia, potentially persisting for years after childbirth. Several studies also observed a temporary or long-term decrease in desire, lubrication, orgasm ability, and overall sexual satisfaction. OASI was further associated with a heightened risk of long-lasting complications such as anal incontinence, which could contribute to or exacerbate sexual problems.

CONCLUSION: Women who sustain OASI during childbirth face an increased risk of postpartum sexual health issues. To mitigate these challenges, healthcare providers should encourage open discussions about sexual health and, when necessary, provide referrals to physiotherapy, couples therapy, or specialized sexological support.