Pelvic Floor Integrity and Female Sexual Function in the Postpartum Period

Barrett G, Pendry E, Peacock J, Victor C, Thakar R, Manyonda I. Women’s sexual health after childbirth. BJOG Int J Obstet Gynaecol. 2000 Feb;107(2):186–95.

Dietz HP. Pelvic floor trauma following vaginal delivery. Curr Opin Obstet Gynecol. 2006 Oct;18(5):528–37.

Leeman LM, Rogers RG. Sex after childbirth: postpartum sexual function. Obstet Gynecol. 2012 Mar;119(3):647–55.

Jawed-Wessel S, Sevick E. The Impact of Pregnancy and Childbirth on Sexual Behaviors: A Systematic Review. J Sex Res. 2017 June 13;54(4–5):411–23.

Manresa M, Pereda A, Goberna-Tricas J, Webb SS, Terre-Rull C, Bataller E. Postpartum perineal pain and dyspareunia related to each superficial perineal muscle injury: a cohort study. Int Urogynecology J. 2020 Nov;31(11):2367–75.

Baruch Y, Manodoro S, Barba M, Cola A, Re I, Frigerio M. Prevalence and Severity of Pelvic Floor Disorders during Pregnancy: Does the Trimester Make a Difference? Healthcare. 2023 Apr 11;11(8):1096.

Karsten MDA, Wekker V, Bakker A, Groen H, Olff M, Hoek A, et al. Sexual function and pelvic floor activity in women: the role of traumatic events and PTSD symptoms. Eur J Psychotraumatology. 11(1):1764246.

BİLGİ K, BİLGE Ç. Postpartum Dönemin Görünmeyen Yüzü: Cinsel İşlev Bozukluğu. Karya J Health Sci. 2021 Dec 31;2.

Serati M, Salvatore S, Siesto G, Cattoni E, Zanirato M, Khullar V, et al. Female sexual function during pregnancy and after childbirth. J Sex Med. 2010 Aug;7(8):2782–90.

Bharucha AE. Pelvic floor: anatomy and function. Neurogastroenterol Motil. 2006 July;18(7):507–19.

Stoker J. Anorectal and pelvic floor anatomy. Best Pract Res Clin Gastroenterol. 2009;23(4):463–75.

Raizada V, Mittal RK. PELVIC FLOOR ANATOMY AND APPLIED PHYSIOLOGY. Gastroenterol Clin North Am. 2008 Sept;37(3):493–vii.

Lawson JO. Pelvic anatomy. I. Pelvic floor muscles. Ann R Coll Surg Engl. 1974 May;54(5):244–52.

Roos AM, Speksnijder L, Steensma AB. Postpartum sexual function; the importance of the levator ani muscle. Int Urogynecology J. 2020;31(11):2261–7.

Alkatout I, Wedel T, Pape J, Possover M, Dhanawat J. Review: Pelvic nerves – from anatomy and physiology to clinical applications. Transl Neurosci. 2021 Oct 8;12(1):362–78.

Snooks SJ, Setchell M, Swash M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet Lond Engl. 1984 Sept 8;2(8402):546–50.

Barber MD. Contemporary views on female pelvic anatomy. Cleve Clin J Med. 2005 Dec 1;72(Suppl_4):S3–S3.

Andrews V, Thakar R, Sultan AH, Jones PW. Evaluation of postpartum perineal pain and dyspareunia--a prospective study. Eur J Obstet Gynecol Reprod Biol. 2008 Apr;137(2):152–6.

Westerik-Verschuuren L, Lutke Holzik-Mensink M, Wieffer-Platvoet M, van der Velde M. Sexual Aspects of the Female Pelvic Floor. In: Geuens S, Polona Mivšek A, Gianotten WoetL, editors. Midwifery and Sexuality [Internet]. Cham: Springer International Publishing; 2023 [cited 2025 Dec 3]. p. 113–23. Available from: https://doi.org/10.1007/978-3-031-18432-1_10

Lien KC, Mooney B, DeLancey JOL, Ashton-Miller JA. Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol. 2004 Jan;103(1):31–40.

Kearney R, Miller JM, Ashton-Miller JA, DeLancey JOL. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006 Jan;107(1):144–9.

Abdool Z, Thakar R, Sultan AH. Postpartum female sexual function. Eur J Obstet Gynecol Reprod Biol. 2009 Aug;145(2):133–7.

Elenskaia K, Thakar R, Sultan AH, Scheer I, Beggs A. The effect of pregnancy and childbirth on pelvic floor muscle function. Int Urogynecology J. 2011 Nov;22(11):1421–7.

MacLennan AH, Nicolson R, Green RC, Bath M. Serum relaxin and pelvic pain of pregnancy. Lancet Lond Engl. 1986 Aug 2;2(8501):243–5.

Elenskaia K, Thakar R, Sultan AH, Scheer I, Beggs A. The effect of pregnancy and childbirth on pelvic floor muscle function. Int Urogynecol J Pelvic Floor Dysfunct. 2011 Nov;22(11):1421–7.

Boeldt D, Bird I. Vascular Adaptation in Pregnancy and Endothelial Dysfunction in Preeclampsia. J Endocrinol. 2017 Jan;232(1):R27–44.

Zarzecka J, Pycek M, Pietrzykowska-Szczubelek K, Barcz E, Pomian A. Influence of pregnancy and mode of delivery on pelvic floor function: a review of literature. Ginekol Pol. 2024;95(10):830–4.

Betsch M, Wehrle R, Dor L, Rapp W, Jungbluth P, Hakimi M, et al. Spinal posture and pelvic position during pregnancy: a prospective rasterstereographic pilot study. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2015 June;24(6):1282–8.

Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S, Norwegian EPINCONT Study. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003 Mar 6;348(10):900–7.

National Guideline Alliance (UK). Risk factors for pelvic floor dysfunction: Pelvic floor dysfunction: prevention and non-surgical management: Evidence review B [Internet]. London: National Institute for Health and Care Excellence (NICE); 2021 [cited 2025 Dec 3]. (NICE Evidence Reviews Collection). Available from: http://www.ncbi.nlm.nih.gov/books/NBK579611/

Kearney R, Miller JM, Ashton-Miller JA, DeLancey JOL. Obstetrical factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006 Jan;107(1):144–9.

Dietz HP, Shek C. Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J Pelvic Floor Dysfunct. 2008 May;19(5):633–6.

Sideris M, McCaughey T, Hanrahan JG, Arroyo-Manzano D, Zamora J, Jha S, et al. Risk of obstetric anal sphincter injuries (OASIS) and anal incontinence: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020 Sept;252:303–12.

Mary DrVP, Kumar DrGA, Padmanaban S. Obstetric anal sphincter injuries (Oasis): A prospective observational longitudinal study. Int J Clin Obstet Gynaecol. 2019 Sept 1;3(5):22–6.

Okeahialam NA, Sultan AH, Thakar R. The prevention of perineal trauma during vaginal birth. Am J Obstet Gynecol. 2024 Mar;230(3S):S991–1004.

Signorello LB, Harlow BL, Chekos AK, Repke JT. Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. Am J Obstet Gynecol. 2001 Apr;184(5):881–8; discussion 888-890.

Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD000081.

Handa VL, Blomquist JL, McDermott KC, Friedman S, Muñoz A. Pelvic Floor Disorders After Childbirth: Effect of Episiotomy, Perineal Laceration, and Operative Birth. Obstet Gynecol. 2012 Feb;119(2 Pt 1):233–9.

Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Womens Health Lond Engl. 2013 May;9(3):10.2217/whe.13.17.

Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM. Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol. 2006 June;107(6):1253–60.

Memon H, Handa VL. Pelvic floor disorders following vaginal or cesarean delivery. Curr Opin Obstet Gynecol. 2012 Oct;24(5):349–54.

Fonti Y, Giordano R, Cacciatore A, Romano M, La Rosa B. Post partum pelvic floor changes. J Prenat Med. 2009;3(4):57–9.

Dietz HP, Wilson PD. Childbirth and pelvic floor trauma. Best Pract Res Clin Obstet Gynaecol. 2005 Dec;19(6):913–24.

Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand. 2010 Dec;89(12):1511–22.

McDonald EA, Gartland D, Small R, Brown SJ. Dyspareunia and childbirth: a prospective cohort study. BJOG Int J Obstet Gynaecol. 2015 Apr;122(5):672–9.

Gutzeit O, Levy G, Lowenstein L. Postpartum Female Sexual Function: Risk Factors for Postpartum Sexual Dysfunction. Sex Med. 2019 Dec 16;8(1):8–13.

Szöllősi K, Komka K, Szabó L. Risk factors for sexual dysfunction during the first year postpartum: A prospective study. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2022 May;157(2):303–12.

Rathfisch G, Dikencik BK, Kizilkaya Beji N, Comert N, Tekirdag AI, Kadioglu A. Effects of perineal trauma on postpartum sexual function. J Adv Nurs. 2010 Dec;66(12):2640–9.

Khajehei M, Doherty M, Tilley PJM, Sauer K. Prevalence and risk factors of sexual dysfunction in postpartum Australian women. J Sex Med. 2015 June;12(6):1415–26.

Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997 Apr;89(4):501–6.

Diez-Itza I. Urinary incontinence during pregnancy and in the postpartum period. Nat Rev Urol. 2025 Oct 6;

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.

Lavand’homme P. Postpartum chronic pain. Minerva Anestesiol. 2019 Mar;85(3):320–4.

Von Bargen E, Haviland MJ, Chang OH, McKinney J, Hacker MR, Elkadry E. Evaluation of Postpartum Pelvic Floor Physical Therapy on Obstetrical Anal Sphincter Injury: A Randomized Controlled Trial. Female Pelvic Med Reconstr Surg. 2021 May 1;27(5):315–21.

Chevalier F, Fernandez-Lao C, Cuesta-Vargas AI. Normal reference values of strength in pelvic floor muscle of women: a descriptive and inferential study. BMC Womens Health. 2014 Nov 25;14:143.

Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1–20.

Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322–30.

Saga S, Vinsnes AG, Norton C, Haugan G. Symptoms of anal incontinence and quality of life: a psychometric study of the Norwegian version of the ICIQ-B amongst hospital outpatients. Arch Public Health. 2022 Dec 9;80:251.

Davidson N. REEDA: evaluating postpartum healing. J Nurse Midwifery. 1974;19(2):6–8.

Declercq E, Cunningham DK, Johnson C, Sakala C. Mothers’ reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey. Birth Berkeley Calif. 2008 Mar;35(1):16–24.

Man R, Le Vance J, Popa Y, Wilson D, Tohill S, Maltby J, et al. Healing-assessment tools for perineal and cesarean section wounds in postpartum women: A scoping review. Acta Obstet Gynecol Scand. 2025 Nov 11;

Cox JL, Chapman G, Murray D, Jones P. Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women. J Affect Disord. 1996 July 29;39(3):185–9.

Grekin R, O’Hara MW. Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. Clin Psychol Rev. 2014 July;34(5):389–401.

von Sydow K. Sexuality during pregnancy and after childbirth: a metacontent analysis of 59 studies. J Psychosom Res. 1999 July;47(1):27–49.

Dobaria DG, Tafti D, Cohen HL. Pelvic Ultrasound. İn: StatPearls [Internet] [İnternet]. StatPearls Publishing; 2025 [cited 2025 Dec 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470360/

Seynaeve R, Billiet I, Vossaert P, Verleyen P, Steegmans A. MR imaging of the pelvic floor. JBR-BTR Organe Soc R Belge Radiol SRBR Orgaan Van K Belg Ver Voor Radiol KBVR. 2006;89(4):182–9.

Tirumanisetty P, Prichard D, Chakraborty S, Zinsmeister AR, Bharucha AE. NORMAL VALUES FOR ASSESSMENT OF ANAL SPHINCTER MORPHOLOGY, ANORECTAL MOTION, AND PELVIC ORGAN PROLAPSE WITH MRI IN HEALTHY WOMEN. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2018 July;30(7):e13314.

Robert R, Prat-Pradal D, Labat JJ, Bensignor M, Raoul S, Rebai R, et al. Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat SRA. 1998;20(2):93–8.

Meekins AR, Siddiqui NY. Diagnosis and Management of Postpartum Pelvic Floor Disorders. Obstet Gynecol Clin North Am. 2020 Sept;47(3):477–86.

Golmakani N, Zare Z, Khadem N, Shareh H, Shakeri MT. The effect of pelvic floor muscle exercises program on sexual self-efficacy in primiparous women after delivery. Iran J Nurs Midwifery Res. 2015;20(3):347–53.

Yuan F, Hu Y, Yang C. Effect of health education combined with biofeedback electrical stimulation on early pelvic floor function and psychology: A retrospective study. Medicine (Baltimore). 2024 Aug 23;103(34):e39321.

Zhong F, Miao W, Yu Z, Hong L, Deng N. Clinical effect of electrical stimulation biofeedback therapy combined with pelvic floor functional exercise on postpartum pelvic organ prolapse. Am J Transl Res. 2021;13(6):6629–37.

Kotarinos R. Myofascial pelvic pain. Curr Pain Headache Rep. 2012 Oct;16(5):433–8.

Pacik PT. Understanding and treating vaginismus: a multimodal approach. Int Urogynecology J. 2014 Dec;25(12):1613–20.

Smith PE, McLaughlin EM, Pandya LK, Hade EM, Lynch CD, Hudson CO. A pilot randomized controlled trial of vaginal estrogen on postpartum atrophy, perineal pain, and sexual function. Int Urogynecology J. 2022 Dec;33(12):3383–90.

Pinheiro E, Bogen DL, Hoxha D, Wisner KL. Transdermal Estradiol Treatment during Breastfeeding: Maternal and Infant Serum Concentrations. Arch Womens Ment Health. 2016 Apr;19(2):409–13.

Huang WC, Su CY, Wang YL. The efficacy of fractional CO2 laser treatment on postpartum vulvovaginal atrophy: A prospective observational study. Taiwan J Obstet Gynecol. 2025 May;64(3):463–8.

Filippini M, Farinelli M, Lopez S, Ettore C, Gulino FA, Capriglione S. Postpartum perineal pain: may the vaginal treatment with CO2 laser play a key-role in this challenging issue? J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2021 Apr;34(8):1190–7.

Bretelle F, Fabre C, Golka M, Pauly V, Roth B, Bechadergue V, et al. Capacitive-resistive radiofrequency therapy to treat postpartum perineal pain: A randomized study. PloS One. 2020;15(4):e0231869.

Fiani B, Sekhon M, Doan T, Bowers B, Covarrubias C, Barthelmass M, et al. Sacroiliac Joint and Pelvic Dysfunction Due to Symphysiolysis in Postpartum Women. Cureus. 13(10):e18619.

Jibrel F, Cox CK, Fairchild PS, Fenner DE, Suresh S, Swenson CW. Indications for surgical intervention in a postpartum pelvic floor specialty clinic. Int Urogynecology J. 2020 Nov;31(11):2233–6.