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J Obstet Gynaecol Can. 2005 Apr;27(4):332-9.

A comparison of urinary and sexual outcomes in women experiencing vaginal and Caesarean births.

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  • 1Department of Family Practice, University of British Columbia, Vancouver BC.



To evaluate the urinary and sexual consequences of vaginal delivery compared with Caesarean section.


We performed a cohort analysis of data from a randomized controlled trial of episiotomy conducted in 3 Montreal hospitals in 1990-1991. Of the 999 trial participants for whom follow-up data were available, 135 delivered by Caesarean section (CS), and 864 had a vaginal birth (VB). After stratifying for parity, we compared rates of urinary incontinence (UI) and sexual functioning at 3 months postpartum in women who had a VB with the rates in women who had a CS.


Primiparous women reported unspecified UI at 3 months postpartum more often (17.9%) in the VB group than in the CS group (6.4%). This difference remained significant whether or not there was a prior history of UI. Multiparous women showed no difference in rates of UI (VB 17.1% vs. CS 16.0%), whether there was a prior history of UI or not. Stress incontinence was greater among primiparous women in the VB group (VB 34.5% vs. CS 12.8%) regardless of prior UI history, but the proportion of women whose UI was severe enough to wear a pad was similar in primiparous women (VB 16.0%, CS 15.4%) and multiparous women (VB 23.8%, CS 25.0%). Women's sexual dissatisfaction was greater among primiparous women who had a vaginal birth (VB 70.1%, CS 54.5%), but in multiparous women, the rates of sexual dissatisfaction were similar (VB 64.2%, CS 71.4%). The frequency of dyspareunia for each mode of delivery was similar in primiparous women (VB 30.7%, CS 31.6%). Overall, both primiparous and multiparous women who had intact perineums after VB had less dyspareunia than those undergoing CS (VB 26.2, CS 40.7%). However, the proportion of women experiencing dyspareunia was greatest among those who had an episiotomy with or without forceps.

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