A prospective study of the trajectory and biopsychosocial determinants of postpartum genito-pelvic pain

During pregnancy and after childbirth, many women experience pains that can severely disrupt their lives. Pain in the genital or pelvic region ("genito-pelvic") is poorly understood, often misdiagnosed or ignored, and viewed as shameful by the women who experience it. Genito-pelvic pain is common, with estimates ranging from 8 to 62% in the six weeks to one year after childbirth. This pain negatively affects women's sexuality as well as their psychological well-being, quality of life, and intimate relationships. There is a critical lack of studies describing the symptoms and persistence of genito-pelvic pain after childbirth, as well as the potential biological, psychological, and social predictors that may help identify women who are at risk. The objectives of this study are to: 1) describe the prevalence, symptom profile, and course of development of genito-pelvic pain from mid-pregnancy to two years postpartum, and 2) determine the influence of biological, psychological, and social variables on women's genito-pelvic pain and associated sexual and psychological difficulties. We expect that breastfeeding and labour characteristics (e.g., tearing) will be associated with greater pain intensity and sexual and psychological problems in the first year after birth, but their impact will diminish by the second year when healing is complete and breastfeeding ends. We also expect that certain psychological and social variables assessed during pregnancy, such as a greater fear of pain and engaging in intercourse to avoid a partner's disappointment, among others, will be associated with more pain, and poorer psychosexual functioning after childbirth. Findings will improve our understanding of how chronic genito-pelvic pain develops after childbirth and why it persists for some women but not others. Results may improve the health and quality of life of affected women by aiding in identifying those who may benefit from earlier intervention to improve their coping.