by Meghan Rossi

This blog is a summary of our published article: Rossi, M. A., Mooney, K. M., Binik, Y. M., & Rosen, N. O. (2019). A Descriptive and Longitudinal Analysis of Pain During Intercourse in Pregnancy. The Journal of Sexual Medicine. doi.org/10.1016/j.jsxm.2019.09.011

When women experience pain during intercourse, both they and their partners report lower sexual, relational, and psychological health and well-being [1] . During pregnancy, pain during intercourse can occur in response to biological (e.g., vaginal connective tissues) and psychological (e.g., depression) changes [2, 3]. Although such changes can be normal or common during pregnancy, this pain can be distressing [4] and is associated with postpartum pain [5] and depression [6]. Despite these consequences, there is limited information about the prevalence and characteristics of this pain in pregnancy.

The goal of our study was to determine the prevalence and characteristics of pain during intercourse in pregnancy. With more information of the prevalence and characteristics of pain during intercourse in pregnancy, we can better communicate to health care providers the impact of this pain and improve treatment options that enhance women’s sexual well-being during pregnancy.

What did we do?

501 women were recruited from the IWK Health Centre in Halifax, Nova Scotia. They completed two online surveys at 20 and 34 weeks in their pregnancy. Women were asked to report the average intensity of their pain during intercourse. Women who reported clinically significant pain (i.e. pain greater than or equal to 4/10) then completed questions about the onset of their pain (i.e., before or during pregnancy), the degree of improvement since the pain first began (e.g., ranging from a lot better to a lot worse), interference with other sexual activities (e.g., oral sex), descriptive aspects of their pain (e.g., burning, tender), and pain management strategies.

Women were then separated into three groups based on the presence of their clinically significant pain across the two time-points to see if there were differences among these women:

(1) Resolved pain – pain that was no longer clinically significant at 34 weeks

(2) Persistent pain – pain that remained at clinical significance at both time-points

(3) New onset – pain that became clinically significant at 34 weeks

What did we find…and what does it mean?

Overall, 21% of our sample reported clinically significant pain during intercourse. We also found that across all pain groups, women reported similar characteristics, including:

(1) The majority of women reported that this pain began during pregnancy

Pain during intercourse that begins in pregnancy increases the risk of that pain continuing into the postpartum period [5, 7]. Identifying this pain in pregnancy could identify women for early intervention to reduce the persistence of this pain.

 

(2) The pain was most often described as: tender, throbbing, aching, and sharp

(3) The pain occurs during other sexual activities, such as manual stimulation from their partner.

(4) Not accessing treatment for their clinically significant pain

These descriptions of pain are similar to descriptions of pain during intercourse that occurs in non-pregnant women [8]. This suggests that treatments for pain during intercourse that is not related to pregnancy may also be helpful for women with this pain during pregnancy [9].

 

This finding shows that women experience interference to many other aspects of their sexual well-being, highlighting the importance of adapting treatment recommendations to address all affected areas.

Given the biological changes that occur to women’s bodies during pregnancy, women and health care providers may perceive pain during intercourse in pregnancy to be expected or temporary and not requiring treatment. However, this pain can be distressing for women and may persist into the postpartum period. This finding suggests that health care providers should ask women about this pain and provide treatment resources.

Why are these findings important?

Our findings suggest that one in five women experience clinically significant pain during pregnancy.

With the millions of pregnancies that occur worldwide [10], pain during intercourse may impact a massive number of pregnant women. Understanding the characteristics of this pain, such as the onset and how it’s described by women, can lead to increased recognition, prevention, and treatment of this pain to improve the lives of women.

References

  1. Bergeron, S., et al., Female sexual pain disorders: A review of the literature on etiology and treatment. Curr Sex Health Rep, 2015. 7(3): p. 159-169.
  2. Bartellas, E., et al., Sexuality and sexual activity in pregnancy. BJOG, 2000. 107(8): p. 964-8.
  3. DeJudicibus, M.A. and M.P. McCabe, Psychological factors and the sexuality of pregnant and postpartum women. J Sex Res, 2002. 39(2): p. 94-103.
  4. Vannier, S.A. and N.O. Rosen, Sexual distress and sexual problems during pregnancy: Associations with sexual and relationship satisfaction. J Sex Med, 2017. 14(3): p. 387-395.
  5. Glowacka, M., et al., Prevalence and predictors of genito-pelvic pain in pregnancy and postpartum: The prospective impact of fear avoidance. J Sex Med, 2014. 11(12): p. 3021-34.
  6. Kwok, S.C.M., D; Sia, S.T; Razak, A.S; Sng, B.L, Childbirth pain and postpartum depression. Trends Anaesth Crit Care, 2015. 5(4): p. 95-100.
  7. Tennfjord, M.K., et al., Dyspareunia and pelvic floor muscle function before and during pregnancy and after childbirth. Int Urogynecol J, 2014. 25(9): p. 1227-35.
  8. Bergeron, S., et al., Vulvar vestibulitis syndrome: Reliability of diagnosis and evaluation of current diagnostic criteria. Obstet Gynecol, 2001. 98(1): p. 45-51.
  9. Goldstein, A.T., et al., Vulvodynia: Assessment and treatment. J Sex Med, 2016. 13(4): p. 572-90.
  10. Sedgh, G., S. Singh, and R. Hussain, Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann, 2014. 45(3): p. 301-14.

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