Postpartum and Lactation-Related Genitourinary Symptoms: A Systematic Review

Abstract

Objective: To consolidate the best available evidence on the prevalence of genitourinary syndrome of lactation and its associated symptoms, including vaginal dryness, vaginal atrophy, urinary symptoms, dyspareunia, and sexual dysfunction, among postpartum lactating individuals.

Methods: The systematic review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A comprehensive search of PubMed, Google Scholar, Scopus, ScienceDirect, and Cochrane Library databases was conducted through April 30, 2024. A search in ClinicalTrials.gov did not yield any studies. Search terms included combinations of "postpartum lactation" or "breastfeeding" and "genitourinary symptoms." Eligibility was limited to studies on postpartum individuals assigned female at birth without congenital vulvar abnormalities that were written in English. Studies on participants taking exogenous hormone therapy or with diagnosed hormonal disorders were excluded. Screening involved two independent reviewers, with conflicts resolved by a third reviewer. Data were analyzed with R software. Study quality was assessed with the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the JBI Critical Appraisal Checklist.

Results: Of 1,550 studies initially screened, 65 met inclusion criteria. Among postpartum lactating individuals, the prevalence of vaginal atrophy and dryness was 63.9% (95% CI, 55.3-71.6%) and 53.6% (95% CI, 33.6-72.5%), respectively. Meta-analyses for dyspareunia at 3, 6, and 12 months postpartum revealed pooled prevalence estimates to be 60.0% (95% CI, 45.1-73.3%), 39.7% (95% CI, 28.9-51.5%), and 28.5% (95% CI, 26.3-30.9%) and pooled odds ratios to be 2.33 (95% CI, 1.92-2.83), 2.24 (95% CI, 1.62-3.10), and 1.45 (95% CI, 1.36-1.56) compared with women of reproductive age who were not postpartum, respectively. The pooled prevalence for sexual dysfunction was 73.5% (95% CI, 59.1-84.2%) and mean FSFI (Female Sexual Function Index) score was 21.5±1.83 (threshold for sexual dysfunction less than 26.55).

Conclusion: This systematic review highlights the significant effect of lactation-induced hormone deficiency on genitourinary health, with the majority reporting vaginal atrophy and dryness and a high proportion also experiencing sexual dysfunction.

Systematic review registration: PROSPERO, CRD42024519600.