1) Identify the prevalence of pain during sexual intercourse after childbirth and its implication on women's quality of life.
 (2) identify pelvic floor dysfunctions reported by women up to 12 months after childbirth.

A descriptive cross-sectional study was conducted by administering a questionnaire on an online platform between May and July 2022. 
All women who had given birth in the last 12 months were included, and those who did not resume sexual intercourse were excluded. The questionnaire comprised questions about: parity, childbirth, breastfeeding, pain in sexual intercourses, whether women related this pain with childbirth and if this pain affected their quality of life. We also asked about the presence of other pelvic floor dysfunctions (urinary and fecal incontinence).

A sample of 141 women was collected, with 3 excluded for not having resumed sexual relations at the time of questionnaire completion. Thus, data analysis was performed on 138 women with a mean age of 31.67 ± 5.13, of whom 13 had had 3 births, 29 had 2 births, and 96 were primiparous. 61.7% of women in this study reported experiencing pain during sexual intercourse after the last delivery (25 women experienced pain “always” and 62 women "sometimes"), with 52.9% of them reporting that this pain moderately or significantly affects their quality of life and 68% attributing this pain to childbirth. 58,1% of women who had a cesarean delivery and 63.9%, 66.7%, and 63.3% of women who had vaginal delivery with vacuum extraction, forceps, and without instruments (respectively) reported dyspareunia. It is noteworthy that 25.5% of the women reported urinary incontinence after the last delivery and 10,15% reported involuntary loss of stools and/or gas.

Literature tells us that 85% of women who have had a vaginal delivery experience some type of perineal trauma. In our sample, more than 60% of the surveyed women reported feeling some type of pain/discomfort during sexual intercourse. Postpartum sexual changes can manifest as delayed return to sexual activity, decreased desire and lubrication, dyspareunia, among others. This situation has a significant impact on a woman's quality of life. In this sample, more than 50% of the women reported that the pain they feel affects their quality of life. We know that untreated pain can become a chronic problem, as several studies have shown that physiotherapy intervention through manual therapy techniques is effective in resolving this issue; this intervention should be considered as first-line for these women.
In our sample, post-partum urinary incontinence (UI) was the second most frequent pelvic floor dysfunction, with one-fourth of women reported urinary leakage.
These results are similar to those of a systematic review (1), which showed an overall mean prevalence rate of UI up to one year post-partum of 31%. It is important to identify these women because over half of those with UI post-partum think that it will improve by itself in time and only 25% of women with post-partum UI actually seek help However, 73% of women with UI 3 months post-partum still report UI at 6 years post-partum (2). Although symptoms of fecal incontinence were the least common in our sample, 14 women reported experiencing involuntary loss of stools and/or gas, prevalence data similar to those found in other studies (3).

The results suggest that the presence of pain during sexual intercourse is quite frequent and has impact on women's quality of life. The majority of women attribute this complaint to their childbirth. The high presence of pelvic floor dysfunctions in the postpartum period should be a topic of discussion among healthcare professionals in order to guide these women towards the best resolution of their complaints.

Moossdorff-Steinhauser HFA, Berghmans BCM, Spaanderman MEA, et al. Prevalence, incidence and bothersomeness of urinary incontinence between 6 weeks and 1 year post-partum: a systematic review and meta-analysis. Int Urogynecol J 2021; 32: 1675–1693.
MacArthur C, Wilson D, Herbison P, Lancashire RJ, Hagen S, Toozs-Hobson P, Dean N, Glazener C. Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12-year longitudinal cohort study. Bjog. 2016;123(6):1022–1029. doi: 10.1111/1471-0528.13395.
Guise JM, Morris C, Osterweil P, Li H, Rosenberg D, Greenlick M. Incidence of fecal incontinence after childbirth. Obstet Gynecol. 2007 Feb;109(2 Pt 1):281-8. doi: 10.1097/01.AOG.0000254164.67182.78. PMID: 17267825.