Dyspareunia after delivery with episiotomy

Uvod: Poporodno obdobje je čas neizmerne sreče, obenem pa lahko čas težkih preizkušenj. Gre za obdobje, ki je prepleteno z veliko telesnih, hormonskih in čustvenih sprememb ob sočasnem sprejemanju nove socialne vloge. Kako bo potekalo to obdobje, je odvisno od številnih dejavnikov. Eno od težav po porodu, s katero se lahko soočajo ženske, je tudi dispareunija. Dispareunija lahko povzroči psihosocialne težave pri ženskah ali pa tudi težave v partnerskem odnosu. Namen diplomskega dela je proučiti, kako epiziotomija vpliva na poporodno spolno življenje, kakšne so razlike v pojavnosti dispareunije med vrstami epiziotomije ter kolikšna je pojavnost dispareunije v primerjavi z opravljeno epiziotomijo ob porodu in morebitnimi obporodnimi poškodbami presredka. Ob tem nas bo zanimalo tudi, ali dolžina epiziotomijskega reza vpliva na pojav dispareunije. Metode dela: V diplomskem delu smo uporabili deskriptivno in kavzalno-neeksperimentalno metodo empiričnega raziskovanja s pregledom znanstvene in strokovne literature. Pri iskanju smo uporabili časovni okvir 20 let. Literatura je bila iskana v angleškem in slovenskem jeziku, s ključnimi besedami in besednimi zvezami: poporodno obdobje, spolnost po porodu, epiziotomija, dispareunija oziroma dyspareunia, sexual problems, painful intercourse, postpartum, medial episiotomy, mediolateral episiotomy. Literaturo smo poiskali s pomočjo naslednjih brskalnikov: COBISS, DiKUL, Medline, CINAHL, Cochrane in spletnega vira Google Učenjak. Rezultati: 69 % žensk je po porodu občutilo dispareunijo, od tega je imelo 75 % žensk epiziotomijo. Pri 79 % žensk so izvedli mediolateralno epiziotomijo, pri ostalih pa mediano. Največ žensk je imelo mediolateralno epiziotomijo, dolgo do dva cm. Takih je bilo 45 %. 35 % žensk je s spolnimi odnosi začelo med osmim tednom in tremi meseci, najmanj je bilo tistih, ki so s spolnimi odnosi začele pred šestim tednom (14 %). Redne spolne odnose pa je največ žensk začelo po treh mesecih od poroda, in sicer 56 %. V prvih šestih mesecih po porodu je močno bolečino pri spolnih odnosih občutilo 19 % žensk z epiziotomijo in 8 % brez nje. Po dvanajstih mesecih od poroda pa je hudo bolečino občutil le 1 % žensk z epiziotomijo in niti ena ženska brez nje. Zaradi bolečine je moralo spolni odnos prekiniti 56 % žensk. Razprava in sklep: Ugotovili smo, da na pojavnost, jakost bolečine in trajanje dispareunije močno vpliva epiziotomija. Pomembno je, da se epiziotomija ne izvaja rutinsko ter da se izvajalci obporodne nege zavedajo posledic, ki jih pusti v življenju ženske. Prav tako je pomembno, da se ženske pouči o preventivnih ukrepih za preprečevanje epiziotomije in s tem tudi dispareunije.Introduction: The postpartum period is the time of immense happiness. At the same time, however, it can be a difficult time. It is a period that is intertwined with many bodily, hormonal, and emotional changes, while simultaneously adopting a new social role. How this period will go depends on a number of factors. After the birth, women often experience painful sexual intercourse, dyspareunia. Purpose: The purpose of the bachelor’s thesis is to examine, how episiotomy influences sexual life after childbirth, what are the differences in the incidence of dyspareunia among many types of episiotomy, and how common is for dyspareunia to appear in comparison with the performed episiotomy at birth and also possible transient injuries to the intercourse. Methods: For my bachelor’s thesis, I used the descriptive and casual non-experimental method of empirical research, with a review of the scientific and technical literature. When looking for literature, I used the time frame, so that nothing will be older than 20 years. I was searching in English and Slovene with next keywords and word associations: postpartum, sexuality after delivery, episiotomy, dyspareunia, dyspareunia sexual problems, painful intercourse, postpartum, medial episiotomy, and dyspareunia after episiotomy. The literature was searched using the following browsers: COBISS, DiKUL, Medline, CINAHL, scholar web source Google Učenjak and Cochrane. Results: 69% of women felt dyspareunia after childbirth. 75% of these women also had an episiotomy. In 79% of women, mediolateral episiotomy was performed, while the median was performed on other 21% of women. Most women (45% of them) had a mediolateral episiotomy, up to two centimeters long. 35% of women started sexual intercourse between 8 weeks and 3 months after the childbirth and the smallest amount of women had sexual intercourse before the 6th week (only 14%). The majority of women started with regular sexual intercourse 3 months after the childbirth (56% of women). 19% of women with episiotomy and 8% of women without episiotomy experienced severe pain in the first 6 months after the birth. 12 months after the childbirth, only 1% of women with episiotomy felt severe pain, while women without it didn’t feel any pain. 56% of women had to stop sexual intercourse because of pain. Discussion and conclusion: We found out that episiotomy strongly affects the incidence, pain, and duration of dyspareunia. It is important that episiotomy is not performed routinely and that the healthcare workers are aware of the consequences that episiotomy leaves on women and their everyday life. It is also important that women learn about preventive measures to prevent episiotomy and Dyspareunia