Postpartum sexual health is a topic of increasing interest, though often under-discussed in clinical practice. Despite a recent increase of literature data regarding this topic, the impact of pelvic floor injuries following vaginal delivery on sexual function remains unclear. Pelvic floor ultrasound assessment has proven to be able to identify most pelvic floor defects, including levator ani injury associated with parity. Specifically, modifications in the levatorl hiatus area after delivery have been identified as a risk factor for sexual distress. The primary objective of our study is to evaluate the prevalence of sexual dysfunction in women after spontaneous delivery. Our secondary goal is to investigate potential correlations between sexual dysfunction and pelvic floor defects, through the help of pelvic floor ultrasound assessment.

We conducted a retrospective analysis of prospectively collected data from 115 primiparous women who delivered at term. Participants were recruited regardless of whether they received an episiotomy, experienced perineal laceration, or had an intact perineum. During the third trimester examination, all patients completed the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-revised (FSDS-r) questionnaires to evaluate prior sexual dysfunctions. Twelve months after delivery, all participants completed the same questionnaires, underwent a complete urogynecological examination, and had a 3D transvaginal ultrasound to measure the levator hiatus area and assess Levator Ani Muscle (LAM) defects. Statistical analysis was performed to identify any correlation between LAM lesions and sexual distress, with a multivariate analysis conducted to identify specific risk factors for this condition.

One year after delivery, sexual function demonstrated a worsening trend, as indicated by poor scores on the FSFI and FSDS-r questionnaires after spontaneous delivery (p < 0.001 and p = 0.004, respectively). Our data suggests that pelvic floor injuries may contribute to the development of sexual distress, with FSDS-r results showing more severe distress in patients with greater levator hiatal areas observed on ultrasound scans (p = 0.003). Additionally, we conducted a multivariate analysis, that showed how episiotomy seems associated to worse scores compared to women with spontaneous lacerations (RR=1.250, CI: 0.274-5.708, p>0.05; versus RR=0.457, CI: 0.105-0.1980, p>0.05, respectively).

Pelvic floor defects associated with vaginal delivery such as LAM injury and hiatal enlargement may lead to sexual distress. Identifying patients with those lesions might allow urogynecologists to set a prevention plan (i.e. pelvic floor rehabilitation) after a spontaneous delivery.

Pelvic floor ultrasound seems to be a good tool to detect LAM lesions. Further studies will allow us to establish the right relationship between LAM injuries and sexual function after delivery.