Screening for Pelvic Floor Disorders and Sexual Dysfunction in Postpartum Women

Objectives: Despite the prevalence of pelvic floor disorders (PFDs) and sexual dysfunction (SD) in postpartum women, these disorders may be overlooked at postpartum visits. This study aims to assess screening for PFDs and SD at postpartum visits within the first year of giving birth and to determine the proportion of women with PFDs and SD referred to urogynecology or pelvic floor physical therapy (PFPT).

Methods: This is a retrospective review of postpartum women seen in a university clinic who delivered at the associated hospital. Women who had postpartum visits from June 1, 2020 to April 15, 2022 were included. Women who were pregnant within one year of delivery, had postpartum care with a urogynecologist, had previous urogynecology visits, or had a history of PFDs were excluded. Charts were reviewed from obstetric delivery to one year postpartum. Demographic and clinical characteristics were compared between women with and without postpartum screening for PFDs or SD. Independent-samples t-test for continuous variables and χ2 test for categorical variables were used to assess statistically significant differences. Log-binomial regression was used to estimate risk ratios (RR) and 95% confidence intervals (CI) representing the association between patient characteristics and PFD/SD screening.

Results: 382 women were reviewed, and 334 met inclusion criteria. The mean age was 32.2 ± 4.9 years and mean BMI was 29.4 ± 6.8. 220 (65.9%) women were screened for PFDs/SD. Compared to women that were not screened, women who were screened were older (32.6 vs 31.3, p=0.02). Women with a cesarean delivery (73% vs. 58% vaginal, p=0.004), first postpartum visit less than six weeks after delivery (76% vs. 43% 6-12 weeks, p< 0.001), and three or more postpartum visits (80% vs. 65% two visits, 50% one visit, p< 0.001) were more likely to be screened [Table 1]. In an adjusted model, only timing of the first postpartum visit remained significant. Women whose first postpartum visit was 6-12 weeks after delivery were 36% less likely to be screened for PFDs/SDs compared to women with their first visit at less than six weeks (RR=0.64; 95% CI: 0.50, 0.81) [Table 2]. Urinary incontinence and fecal incontinence were the most common PFDs discussed. Of the 41 women who had PFDs and/or SD, 31 (75.6%) were referred to PFPT and/or urogynecology.

Conclusions: There is a gap in screening postpartum women for PFDs and SD. In our sample, one third of postpartum women were not screened. Having a cesarean section, 3 or more visits, and a first visit less than 6 weeks postpartum increased the likelihood of screening. Women with positive screening were likely to be referred to advanced care.