Musculoskeletal Pelvic Pain and Sexual Function in the First Year After Childbirth Sandi Tenfelde, Dina Tell, Cynthia Brincat, and Colleen M. Fitzgerald ABSTRACT Objective: To characterize sexual function in women with and without musculoskeletal pelvic pain during the first year after childbirth. Design: Cross-sectional descriptive study. Setting: Outpatient women’s health clinic in a Midwestern U.S. academic medical center. Participants: Women who gave birth to singleton infants within the past year. Methods: Women were recruited from various outpatient settings. We obtained baseline demographic variables and used selected components from the Wilson and Cleary Health-Related Quality of Life model. Participants completed questionnaires related to sexual health, pain symptoms, and general quality of life. They were asked to indicate their pain on a pain diagram and to quantify it with the use of a numeric rating scale (NRS). Examiners used validated examination techniques to assess pelvic floor muscle tenderness, strength, and pelvic girdle pain. Participants who reported pelvic pain and had at least one positive physical examination finding were classified in the pain group. Results: Forty-five participants completed the study, and 20 participants were in the pain group. Most participants with pain had pelvic girdle pain (n ¼ 15) and pelvic floor myofascial pain (n ¼ 20). Participants with pain reported less sexual satisfaction (t[43] ¼ 2.84, p ¼ .007) and reduced quality of life (t[36] ¼ 5.25, p < .001) compared with participants without pain. Conclusion: Participants who experienced musculoskeletal pelvic pain in the first year after childbirth were signifi- cantly more likely to report problems with sexual function compared with their counterparts without pain. JOGNN, 48, 59–68; 2019. https://doi.org/10.1016/j.jogn.2018.10.004 Accepted October 2018 P regnancy is a transformative time in a woman’s life and for her body, which undergoes substantial musculoskeletal changes. Although many of these changes are anticipated and resolve with childbirth, some women continue to have pain after giving birth. Residual musculoskeletal pelvic pain may result from the changes during pregnancy, labor, and/or birth, and this pain is often overlooked by providers and patients alike. Researchers found that pregnant women with pelvic girdle pain often have concomitant pelvic floor myofascial pain (Fitzgerald & Mallinson, 2012), and pelvic floor muscle dysfunction can persist after childbirth (Handa, Blomquist, McDermott, Friedman, & Munoz, 2012). Persistent pelvic pain after child- birth has been shown to significantly affect quality of life (Mackenzie, Murray, & Lusher, 2018; Woolhouse, Gartland, Perlen, Donath, & Brown, 2014). Pelvic pain that begins after childbirth can become chronic over time and can lead to significant functional limitations and altered sex- ual function and can adversely affect future de- cisions about having more children (Bergstro ¨m, Persson, Nerga ˚rd, & Mogren, 2017; Lawson & Sacks, 2018). Little research is available on the relationship between musculoskeletal pelvic pain and sexual function in the first year after childbirth. Sexually active women who gave birth within the past year reported some form of sexual dysfunction (Leeman & Rogers, 2012), and most dysfunction resolved within 6 months postpartum (Yeniel & Petri, 2013). Most current research on sexual health in the first year after childbirth is focused on dyspareunia related to perineal trauma (Brubaker et al., 2008; Signorello, Harlow, Chekos, & Repke, The authors report no con- flict of interest or relevant financial relationships. Correspondence Sandi Tenfelde, PhD, RN, APN, Loyola University, Marcella Niehoff School of Nursing, 2160 South First Ave., 105-2840, Maywood, IL 60153. stenfelde@luc.edu Keywords childbirth musculoskeletal pelvic pain postpartum sexual health Sandi Tenfelde, PhD, RN, APN, is an associate professor in the Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL. Dina Tell, PhD, is an assistant professor in the Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL. Cynthia Brincat, MD, PhD, is an associate professor in the Strich School of Medicine, Loyola University Chicago, Maywood, IL. (Continued) ª 2019 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved. http://jognn.org 59 R ESEARCH