Pelvic floor muscle function, vaginal symptoms and symptoms of sexual dysfunction in first time mothers: A cohort and a randomised controlled trial
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Number of women reporting dyspareunia at each time point from pre-pregnancy until 12 months after delivery was 27.8% at pre-pregnancy, 30.5% at gestational 22, 41.4% at gestational week 37, 44.6% at six months and 33.1 % at 12 months after delivery. The majority reported severity of dyspareunia as “a little”. There was no difference between women with and without dyspareunia in relation to PFM variables or delivery variables. Longitudinal data showed new cases of dyspareunia during pregnancy and after delivery, but total prevalence of dyspareunia declined throughout the study. Most women with dyspareunia prior to pregnancy and those with new symptoms during pregnancy were symptom free by 12 months after delivery. Other vaginal symptoms were prevalent (73.4%) 12 months after delivery, but few of the symptoms were severe, and 34.5% reported the symptoms to interfere with their sexual life. Overall bother of the vaginal symptoms were low (mean 1.4 out of 10). The women reporting “vagina feels loose or lax” had lower vaginal resting pressure, PFM strength and muscular endurance than women without the symptom; mean difference: 3.6 cmH2O (95%CI 0.7, 6.6), 9.0 cmH2O (95%CI 2.6, 15.4) and 80.0 cmH2Osec (95%CI 32.6, 127.5), respectively. Six months postpartum no significant difference in outcome variables between groups for the total study sample (n=175) or in the stratum with no defects (n=120) were found. In the stratum with major defects of the levator ani muscle (n=55) at post intervention significantly fewer women in the training group had symptoms of “vagina feels loose or lax” than the control group; RR: 0.55 (95% CI: 0.31, 0.95, p=0.03). The results indicate that PFMT may have a preventative effect of “vagina feels loose or lax” in women with major levator ani defects. Bias and minimal detectable change for Camtech AS was found to be -2.44 ±8.7 cmH2O for vaginal resting pressure, -0.22 ±7.6 cmH2O for PFM strength and 0.75 ±59.49 cmH2Osec for muscular endurance (intrarater). Bias and minimal detectable change was 1.36 ±9.0 cmH2O for vaginal resting pressure, 2.24 ±9.0 cmH2O for PFM strength and 15.89 ±69.7 cmH2Osec for muscular endurance (interrater). Camtech AS seems less accurate for the strongest women. A statistically significant improvement in PFM variables needs to exceed the minimal detectable change to be above the error of measurement.Paper I: Tennfjord, M.K., Hilde, G., Stær-Jensen, J. et al. Int Urogynecol J (2014) 25: 1227. doi:10.1007/s00192-014-2373-2. Dyspareunia and pelvic floor muscle function before and during pregnancy and after childbirth.Paper II: Tennfjord MK, Hilde G, Stær-Jensen J, Siafarikas F, Engh ME, and Bø K. Coital incontinence and vaginal symptoms and the relationship to pelvic floor muscle function in primiparous women at 12 months postpartum: A cross-sectional study. J Sex Med 2015;12:994–1003.Paper III: Kolberg Tennfjord M, Hilde G, Stær-Jensen J, Siafarikas F, Ellström Engh M, Bø K. Effect of postpartum pelvic floor muscle training on vaginal symptoms and sexual dysfunction—secondary analysis of a randomised trial. BJOG 2016;123:634–642.Paper IV: Tennfjord, M.K., Engh, M.E. & Bø, K. Int Urogynecol J (2017). doi:10.1007/s00192-017-3290-y. An intra –and interrater reliability and agreement study of vaginal resting pressure, pelvic floor muscle strength and muscular endurance using manometer.
Avhandling (doktorgrad) - Norges idrettshøgskole, 2017