顺产、会阴侧切与剖宫产对初产妇产后性功能的影响

Effect of natural labor,episiotomy and cesarean section on postpartum sexual function of primipara

目的:结合临床经验,探讨顺产、会阴侧切与剖宫产3种分娩方式对初产妇产后性功能的影响。方法:选取2013年9月至2015年6月在我院妇产科分娩的初产妇312例作为研究对象,按照分娩方式不同分为会阴侧切组(95例)、顺产组(109例)、剖宫产组(108例),分别在产后3个月、6个月、9个月对产妇进行性功能状况问卷调查,选用国际认可度较高的女性性功能指数(FSFI)调查问卷考察性功能水平,分别对三组性功能障碍发生率、性功能评分、性生活恢复的比例进行统计分析,并加以比较。结果:三组产妇在产后3个月性功能障碍发生率最高,6个月、9个月明显降低,差异有统计学意义(P<0.05);会阴侧切组产后3个月、6个月、9个月性功能障碍发生率均高于顺产组和剖宫产组,差异有统计学意义(P<0.05);三组产妇产后3个月、6个月顺产组、剖宫产组分别与会阴侧切组比较,顺产组、剖宫产组性功能状况评分明显优于会阴侧切组,差异有统计学意义(P<0.05);三组产妇产后9个月性功能状况评分差异无统计学意义(P>0.05);会阴侧切组、剖宫产组、顺产组产后3个月性生活恢复比例分别为61.05%、66.67%、72.48%;产后6个月性生活恢复比例分别为85.26%、89.81%、90.83%;产后9个月性生活恢复比例分别为95.79%、96.29%、98.17%。剖宫产组、顺产组产后3个月和6个月性生活恢复情况明显优于会阴侧切组,差异有统计学意义(P<0.05);三组产妇产后9个月性生活恢复情况比较,差异无统计学意义(P>0.05)。结论:顺产分娩方式可使产妇产后性生活恢复较快,性生活恢复比例较高,其次为剖宫产产妇,而会阴侧切产妇产后对性生活影响程度较大,恢复较慢,因此建议产妇选择顺产分娩方式。

Objectives： To discuss the effect of natural labor,episiotomy and cesarean section on postpartum sexual function of primipara combined with clinical experience. Methods： 312 primipara in our hospital from September 2013 to June 2015 were selected as the research object. According to the delivery way,they were divided into episiotomy group（95 cases）,natural labor group（109 cases） and cesarean section group（108 cases）. Respectively,at 3 months,6 months and 9 months after delivery,sexual maternal status questionnaire was done among the primipara by choosing international high recognition of the female sexual function index（ FSFI） questionnaire,to investigate sexual function level,the incidence of sexual dysfunction,sexual function score and proportion of sex life restore of three groups. Results： The incidence rates of sexual dysfunction in the three groups at 3 months after delivery were the highest. These were decreased obviously at 6 months and 9 months after delivery,and the differences were statistically significant（ P 0. 05）. The incidence of sexual dysfunction in episiotomy group at 3 months,6 months and 9 months after delivery were higher than these of natural birth group and cesarean section group,with statistically significant differences（ P 0. 05）. Compared with episiotomy group,sexual function scores of natural birth group and cesarean delivery group at 3 months and 6 months after delivery were obviously better than that of episiotomy group,with statistically significant differences（ P 0. 05）. At 9 months after delivery,sexual function scores of three groups had no statistically significant differences（ P 0. 05）. The postpartum sexual life recovery ratios of episiotomy group,cesarean section group and natural labor group at 3 months after delivery were 61. 05%,66. 67% and 61. 05% respectively. Postpartum sexual life recovery ratios of episiotomy group,cesarean sectiongroup and natural labor group 6 months after delivery were 85. 26%,89. 81% and 85. 26% respectively; postpartum sexual life recovery ratios of episiotomy group,cesarean section group and natural labor group at 9 months after delivery were 95. 79%,96. 29% and 98. 17% respectively. Postpartum sexual life recovery ratios of cesarean section group and natural birth group at 3 months and 6 months after delivery were obviously better than that of episiotomy group,with statistically significant differences（ P 0. 05）. Postpartum sexual life recovery ratios of three groups9 months after delivery had no statistically significant difference（ P 0. 05）. Conclusion： Natural birth childbirth can make the maternal postpartum sexual recovery faster,with higher recovery ratio,followed by cesarean delivery.The impact of episiotomy on postpartum sexual life is larger,with slower restore speed. It is recommended that women choose natural labor.