Factors related to women's sexuality are considered a problem by many couples during pregnancy, leading to a significant decrease in the number of sexual intercourses during pregnancy. This decrease in sexual function during pregnancy can be due to a number of factors: religion and sociocultural factors, fear of harming the fetus, discomfort with certain positions, weight of the abdomen, decrease in sexual satisfaction, sexual desire and orgasm, in addition to the emergence of dysfunctions. sexual disorders, such as dyspareunia[1].
Dyspareunia is common in pregnancy and can be associated with other factors such as urinary incontinence and constipation. The intensity and frequency of symptoms increase during pregnancy. Unlike other sexual dysfunctions that tend to decrease after delivery, dyspareunia tends to remain or increase until the third month postpartum[1]. The International Classification of Functioning (ICF) is part of the Classifications developed by the World Health Organization (WHO) and identifies what a person can or cannot do in their daily life, analyzing the functions of the systems and structures of the body, as well as the limitations of activities and social participation in the environment of the person analyzed through functionality [2].
In this sense, it is relevant to study functionality, as it is a concept that integrates a woman-centered approach to examine how a health condition affects her life, but few studies have been carried out from this perspective. Therefore, the aim of the present study is to analyze the functionality of women who had dyspareunia during pregnancy compared to those who did not.

This cross-sectional study was approved by the Ethics in Research Committee under registration number CAAE 43945515.5.0000.5568. All participants signed the Free and Informed Consent Term (ICF) to participate in the research. Participants were randomly selected by a sequence of numbers. Women classified as low-risk pregnancies were included, in the second gestational trimester, who were over 18 years of age who underwent prenatal care. The exclusion criteria established were: women who underwent a change in the classification of pregnancy to high risk.
The evaluation form containing sociodemographic aspects and lifestyle habits was created exclusively for this research. The pain complaint was assessed by the woman's self-report. Having the option of answering “yes” or “no” for the presence or absence of pain during the sexual act. To assess functionality, the WHODAS 2.0 questionnaire validated for Portuguese was used. The WHODAS 2.0 has its structure based on the ICF concept and has 36 questions that generate scores for the six domains: cognition, mobility, self-care, interpersonal relationships, life activities and participation in society. The score ranges from 0 to 100, where the higher the score, the worse the functionality of that pregnant woman[2] .
The processing of the collected data was performed using the Statistical Package for the Social Science (SPSS) software, version 20.0 for Windows. The characterization of the sample was performed using measures of central tendency, with their respective values of dispersion, relative and absolute frequencies (for categorical variables). To verify the normality of the data, the Kolmogorov-Smirnov test was performed. Numerical variables are presented as medians and percentiles. Categorical variables were presented as absolute and relative frequencies. The variables resulting from the WHODAS 2.0 were numerical and ranged from 0 to 100, using the Mann-Whitney test. The significance level adopted was 5%, that is, for all tests it was considered significant when p< 0.05.

Out of a total of 53 pregnant women accessed for eligibility. The prevalence of dyspareunia was 11.3%. Regarding socio-demographic characteristics and life habits, the majority (71.7%) of the women declared themselves to be non-white. There was a predominance of women who were married (formally or informally), (79,2%), had 11 or more years of schooling (48.1%), did not have paid work (81.1%), had 11 or more years of schooling (48.1%), did not have paid work (81.1%), did not use alcohol (96.2%) did not smoke  (98.1%) (Table 1).
When comparing the scores obtained in the WHODAS 2.0, there was a greater disability in those women who had dyspareunia, when compared to those who did not report this condition. Women who had dyspareunia had higher scores in the WHODAS domains: cognition (P = 0.015), mobility (P = 0.003), self-care (P = 0.049), domestic activity (P = 0.023), participation (0.016) and in the total score (P = 0.014) (Table 2).

The frequency of 11.3% of dyspareunia was verified in the studied sample, which is lower than what is found in other national studies. Regarding functionality, there was an increase in disability in the total WHODAS scores Also in the cognition domain, which assesses understanding and communication than those who did not have this condition, although this score was relatively low, demonstrating a low impact on functionality in both groups. Concerning the assessment of mobility domains that assess activities such as standing, moving around the house, leaving the house and walking long distances, self-care that assesses hygiene, dressing and eating and being alone. Life activities that assess leisure, work and school household responsibilities. Participation, which assesses participation in community activities and in society, it was verified in the present study that women who had a report of dyspareunia obtained higher scores in all these domains. Corroborating studies that report that gestational adaptations, whether physical, emotional or cognitive, can negatively contribute to the health and functionality of women in the short and long term, and can be intensified if there is any gestational aggravation or discomfort, as well as factors of stress and anxiety, factors that are present in women with dyspareunia [1,2,3]
This study had the limitation of not applying a specific questionnaire for sexual dysfunction, which would result in a better understanding of this symptom. Further studies with longer follow-up and using more adequate instruments are needed to better verify the sexual function and functionality of women during pregnancy and postpartum.

The results of this study showed a low prevalence of dyspareunia in the sample studied, however, they suggest that women with dyspareunia during pregnancy, have a greater disability in almost all WHODAS domains, with the exception of interpersonal relationships and school or work activities.

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Silveira C, Angela M, Carvalho R, Soares R, Camargo D, Laura M, Maria D, Carlos E, Paula J, Hanson L, Guilherme J, Andreucci B. Artigo original Adaptação transcultural da Escala de Avaliação de Incapacidades da Organização Mundial de Saúde ( WHODAS 2.0 ) para o Português. Rev Assoc Med Bras. 2013; 59(3):234–40
Jomeen J. The importance of assessing psychological status during pregnancy, childbirth and the postnatal period as a multidimensional construct: A literature review. Clin Eff Nurs. 2004; 8(3–4):143–55.

Continence 2S2 (2022) 100447
DOI: 10.1016/j.cont.2022.100447