Influence of perineal tears and body image disturbance on postpartum sexual quality of life: a cross-sectional study.

BACKGROUND

Whether perineal injury severity independently determines postpartum sexual quality of life (SQoL) is unclear. This study evaluated perineal tears and body image as determinants of SQoL and sexual resumption timing.

METHODS

A total of 173 women (2-24 months postpartum, vaginal delivery) completed an online questionnaire including the SQoL-F and Body Image Scale (BIS). Women with perineal tear/episiotomy (PT/E; n = 118) were compared with those with an intact perineum (n = 51) using multivariate regression.

RESULTS

SQoL-F scores were similar between groups (71.1 ± 23.3 vs 76.9 ± 24.0; p = 0.10), though PT/E delayed sexual resumption (p = 0.04). On multivariate analysis, SQoL-F was independently associated with dyspareunia (β = -10.96; p < 0.001), body image disturbance (β = -0.93; p < 0.001), and pre-pregnancy sexual satisfaction (β = +4.99; p = 0.001), but not tear type. Delayed resumption was independently associated with OASI (OR = 7.02; p = 0.02), first/second-degree tears (OR = 2.20; p = 0.04), and lower pre-pregnancy relationship satisfaction (OR = 0.50; p = 0.048).

CONCLUSIONS

Postpartum SQoL is primarily determined by dyspareunia and body image disturbance rather than perineal tear severity. OASI carries a substantial risk of delayed sexual resumption, warranting dedicated postpartum counseling.