The effect of pelvic floor complaints after childbirth on sexual embarrassment

Background: In pelvic physiotherapy practice many women are treated for pelvic floor complaints after childbirth. The most common complaints women report are urinary incontinence, fecal incontinence, flatus, prolapse, dyspareunia and pain in the pelvic floor area whilst sitting. Many of these women also seem embarrassed in relation to sex. It is unclear if this embarrassment is related to particular pelvic floor complaints and this study seeks to investigate this.

Methods: A total of 153 parous women between the age of 18 and 45 participated in this study, each having experienced a vaginal birth within the last two years. Pelvic floor complaints were considered to exist if they scored positive on urinary incontinence, fecal incontinence, flatus, prolapse, dyspareunia and/or pain in the pelvic floor area whilst sitting. The Sexual Self-Consciousness Scale was used to measure sexual embarrassment (6 items). Univariate analysis of variance was used to answer the research question. Age was added as covariate.

Results: In the research sample 81 women reported pelvic floor complaints and 72 women did not. Only pain in the pelvic floor area whilst sitting had a significant effect on sexual embarrassment, (F(1,127) = 4.33, p = .04). No significant effect of any other pelvic floor complaint was found on sexual embarrassment. Also no significant interactions were found.

Discussion: It is surprising that only pain in the pelvic floor area whilst sitting had an effect on sexual embarrassment. A possible explanation for this result could be found in differences in pelvic floor muscle dysfunction in relation to the specific complaints. In the scenario of pain in the pelvic floor area, the pelvic floor muscles are often found to be overactive and there seems to be a constant bother of this pain during activities that involve actively sustained lumbar flexion, which can occur during sex. The other complaints could be due to inadequate or poor tonic support or strength of the pelvic floor muscles.

Implications for clinical practice: In view of the above findings, it seems appropriate to inform women before or during their pregnancy about pelvic floor muscle function, prevalence and causes of common pelvic floor complaints after childbirth and their consequences on sex. These women could be taught and trained how to use their pelvic floor muscles and above all how to relax them in the presence of pain and so reduce the likelihood of developing sexual embarrassment.