Prevalence and Characteristics of Postpartum Vulvovaginal Atrophy and Lack of Association With Postpartum Dyspareunia

J Low Genit Tract Dis. 2020 Oct;24(4):411-416. doi: 10.1097/LGT.0000000000000548.

Abstract

Objective: Breastfeeding-related hypoestrogenic state has been reported as a possible risk factor for postpartum dyspareunia. This study aimed to evaluate the prevalence and characteristics of postpartum vulvovaginal atrophy according to 3 different diagnostic methods and to estimate its association with postpartum dyspareunia and daily vulvovaginal symptoms.

Methods: This is a prospective cohort study of puerperal women attending a routine postpartum checkup. Participants completed a questionnaire and underwent a gynecological examination. Atrophy was diagnosed separately according to gynecologist impression, vaginal pH measurement (≥5.1), and cytologic vaginal maturation index. Patients were followed up with a telephone survey 2-3 months later, inquiring about symptoms possibly associated with atrophy.

Results: Of 117 participants, vaginal atrophy was diagnosed in 48% by gynecological examination, 62% by a pH level of 5.1 or greater, and 40.2% had cytological atrophy. Of the 35.9% of women who had resumed sexual intercourse (42/117), 69% reported dyspareunia. No significant association was found between dyspareunia and atrophy parameters. There was no difference in the rates of dyspareunia among women who were exclusively breastfeeding (21/27 = 78%), partially breastfeeding (4/7 = 57%), or not breastfeeding (4/8, 50%). Atrophy was more common in breastfeeding women according to the 3 criteria (gynecological examination: 57.6% vs 16.7%, p = .006; pH: 70% vs 22%, p < .001; vaginal maturation index: 51.1% vs 0%, p < .001). Of the 117 participants, 47% reported daily vulvovaginal symptoms. Those with daily symptoms reported more dyspareunia as compared with those without daily symptoms (85% vs 52%, p = .025).

Conclusions: A high prevalence of atrophy was observed in puerperal women in association with breastfeeding. There was no significant association between atrophy and dyspareunia or daily vulvovaginal symptoms.

MeSH terms

  • Adult
  • Atrophy / pathology
  • Breast Feeding / adverse effects*
  • Dyspareunia / complications
  • Dyspareunia / epidemiology*
  • Female
  • Humans
  • Israel / epidemiology
  • Postpartum Period
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Vagina / pathology
  • Vaginal Diseases / complications
  • Vaginal Diseases / epidemiology*
  • Vaginal Diseases / pathology
  • Vulva / pathology
  • Vulvar Diseases / complications
  • Vulvar Diseases / epidemiology*
  • Vulvar Diseases / pathology
  • Young Adult