Re: Association between Sexual Dysfunction and Avulsion of the Levator Ani Muscle after Instrumental Vaginal Delivery

Abstract Introduction and hypothesis Pelvic floor muscle function plays an important role in female sexual functioning. Smaller genital hiatal dimensions have been associated with sexual dysfunction, mainly dyspareunia. On the other hand, trauma of the levator ani muscle sustained during childbirth is associated with increased genital hiatus, which potentially can affect sexual functioning by causing vaginal laxity. This study aims to determine the association between levator hiatal dimensions and female sexual dysfunction after first vaginal delivery. Methods This is a secondary analysis of a prospective observational study. Two hundred four women who had a first, spontaneous vaginal delivery at term between 2012 and 2015 were recruited at a minimum of 6 months postpartum. Thirteen pregnant women were excluded. We analyzed the association of total PISQ-12 score, as well as individual sexual complaints (desire, arousal, orgasm and dyspareunia), with levator hiatal dimensions at rest, with maximum Valsalva and during pelvic floor muscle contraction as measured by 4D transperineal ultrasound. Statistical analysis was performed using linear regression analysis and Mann-Whitney U test. Results One hundred ninety-one women were evaluated at a median of 11 months postpartum. There was no significant association between total PISQ-12 score and levator hiatal dimensions. Looking at individual sexual complaints, women with dyspareunia had significantly smaller levator hiatal area and anterior-posterior diameter on maximum Valsalva. By using multivariate logistic regression analysis however we found dyspareunia was not independently associated with levator hiatal dimensions. Conclusions After first vaginal delivery sexual dysfunction is not associated with levator hiatal dimensions as measured by 4D transperineal ultrasound.

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Animal models for pelvic organ prolapse: systematic review

International Urogynecology Journal ◽

10.1007/s00192-020-04638-1 ◽

2021 ◽

Author(s):

Marina Gabriela M. C. Mori da Cunha ◽

Katerina Mackova ◽

Lucie Hajkova Hympanova ◽

Maria Augusta T. Bortolini ◽

Jan Deprest

Keyword(s):

Pelvic Organ Prolapse ◽

Animal Models ◽

Vaginal Delivery ◽

Structural Changes ◽

Meta Analysis ◽

Levator Ani ◽

Complete Recovery ◽

Pelvic Organ ◽

Squirrel Monkeys ◽

Levator Ani Muscle

Abstract Introduction and hypothesis We aimed to summarize the knowledge on the pathogenesis of pelvic organ prolapse (POP) generated in animal models. Methods We searched MEDLINE, Embase, Cochrane and the Web of Science to establish what animal models are used in the study of suggested risk factors for the development of POP, including pregnancy, labor, delivery, parity, aging and menopause. Lack of methodologic uniformity precluded meta-analysis; hence, results are presented as a narrative review. Results A total of 7426 studies were identified, of which 51 were included in the analysis. Pregnancy has a measurable and consistent effect across species. In rats, simulated vaginal delivery induces structural changes in the pelvic floor, without complete recovery of the vaginal muscular layer and its microvasculature, though it does not induce POP. In sheep, first vaginal delivery has a measurable effect on vaginal compliance; measured effects of additional deliveries are inconsistent. Squirrel monkeys can develop POP. Denervation of their levator ani muscle facilitates this process in animals that delivered vaginally. The models used do not develop spontaneous menopause, so it is induced by ovariectomy. Effects of menopause depend on the age at ovariectomy and the interval to measurement. In several species menopause is associated with an increase in collagen content in the longer term. In rodents there were no measurable effects of age apart of elastin changes. We found no usable data for other species. Conclusion In several species there are measurable effects of pregnancy, delivery and iatrogenic menopause. Squirrel monkeys can develop spontaneous prolapse.

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Computational model of levator ani muscle stretch during vaginal delivery

Journal of Biomechanics ◽

10.1016/s0021-9290(06)84382-4 ◽

2006 ◽

Vol 39 ◽

pp. S348 ◽

Cited By ~ 4

Author(s):

L. Hoyte ◽

P. Krysl ◽

G. Chukkapalli ◽

A. Majumdar ◽

D.J. Choi ◽

...

Keyword(s):

Computational Model ◽

Vaginal Delivery ◽

Levator Ani ◽

Levator Ani Muscle ◽

Muscle Stretch

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Prediction Index of Levator Ani Muscle Avulsion After Vaginal Delivery: An Evidence-Based Appraisal

Advanced Science Letters ◽

10.1166/asl.2018.12689 ◽

2018 ◽

Vol 24 (8) ◽

pp. 6214-6217

Author(s):

Budi Iman Santoso ◽

Adly Nanda Al-Fattah ◽

Raymond Surya ◽

Surrahman Hakim

Keyword(s):

Pelvic Floor ◽

Vaginal Delivery ◽

Pelvic Floor Dysfunction ◽

Levator Ani ◽

Influential Factors ◽

Cochrane Library ◽

Levator Ani Muscle ◽

Second Stage Of Labor ◽

Second Stage ◽

Levator Ani Muscle Avulsion

Pelvic floor dysfunction (PFD) due to vaginal delivery is related to tear of levator ani muscle (LAM) that potentially lead to the impairment of quality of life among women. A number of attempts to predict LAM injury after vaginal delivery had been conducted. This study aims to appraise the accuracy of several prediction index determining LAM injury after vaginal delivery. We conducted a search in Cochrane Library®, Pubmed®, and Medline® with the keywords of “pelvic floor dysfunction” AND “vaginal delivery” AND “prediction.” Critical appraisal determining the validity, importance, and applicability (VIA) was conducted by 2 independent authors. After 6 weeks to 3 months’ duration of follow up, the incidence of LAM avulsion was varied from 15.4% to 35.6% from three studies. Multivariate analysis showed that forceps delivery, OASIS, and active second stage (OR 3.8; 3.1; 1.61; respectively) as the most influential factors for LAM incidence. Maternal age and time spent in active pushing were also contributed to LAM incidence. OASIS and second stage of labor could be used as the most influential components of prediction index for LAM incidence. Prediction indexes for LAM incidence are developed. OASIS and second stage of labor are acknowledged as two most influential variables among three appraised studies.

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