Sexual Function After Obstetric Anal Sphincter Injuries (OASIs): A Systematic Review and Meta-Analysis

BACKGROUND: Obstetric anal sphincter injuries (OASIs) may lead to life changing sequelae. OBJECTIVE: The aim was to determine whether sustaining an OASI independently influences postpartum sexual function. SEARCH STRATEGY: . RESULTS: Twenty-two studies met inclusion criteria; no meta-analysis pooled more than six studies, yielding low-certainty evidence. Exploratory pooled estimates suggested women with an OASI were 30% less likely to be sexually active at 3 months postpartum [RR 0.69 (95% CI 0.49-0.95), p = 0.03] and more likely to suffer from dyspareunia at 3 months [RR 1.58 (95% CI 1.14-2.17), p = 0.005] and > 12 months postpartum [RR 1.69 (95% CI 1.31-2.17), p < 0.001] when compared to the control group. FSFI outcomes were sparsely reported and largely derived from single studies; limited data suggested lower domain scores at 2 and 12 months among women with OASI. CONCLUSION: Available evidence is observational, heterogeneous and frequently lacks baseline sexual function assessment, substantially limiting causal inference. Quantitative findings should therefore be interpreted as exploratory. High-quality, baseline-controlled prospective studies using standardised outcome measures are needed. In the interim, proactive enquiry during the postnatal follow-up of OASI patients represents a low-risk, patient-centred approach to addressing under-reported sexual health concerns.