Persistent genito-pelvic pain 2 months after vaginal birth: a nationwide population-based analysis from the 2021 French National Perinatal Survey

Background: Persistent pain can significantly impact maternal health outcomes. However, there is a lack of representative data after vaginal birth. We used population-based data to estimate the prevalence and risk factors of persistent genito-pelvic pain 2 months after vaginal birth. Methods: We analyzed data from the 2021 National Perinatal Survey, a French nationwide, cross-sectional, population-based survey. The study population included women who delivered vaginally. The main outcome was persistent genito-pelvic pain at 2 months postpartum after vaginal birth. Prevalence with 95% confidence intervals (CIs) was estimated overall and by degree of perineal tear. Risk factors were identified on univariable and multivariable logistic regression. All analyses were weighted to account for 2-month attrition. Results: Among 5,802 vaginal births, the prevalence of persistent genito-pelvic pain at 2 months postpartum was 12.8% (95%CI 11.8-13.8), ranging from 5.9% (4.3-7.9%) for women with no tear to 38.9% (27.1-52.2) for those with obstetric anal sphincter injury (OASI). On multivariable analyses, persistent pain was significantly associated with all degrees of perineal tear versus no tear (1 st /2 nd -degree tears, adjusted odds ratio 2.08 [1.51-2.87]; episiotomy 3.37 [2.27-4.99] and OASI 5.92 [3.03-11.55]). Other risk factors included being born in Africa (1.51 [1.06-2.16]), primiparity (1.50 [1.20-1.87]), poor maternal psychological status during pregnancy (2.05 [1.48-2.83]) and operative birth (1.43 [1.14-1.79]). Negative childbirth experience (2.03 [1.50-2.77]), and dissatisfaction with pain management during the maternity stay (somewhat satisfied: 1.59 [1.28-1.98]; and little/not at all satisfied: 3.11 [2.27-4.26]) were also associated with persistent pain. Conclusions: At 2 months postpartum, persistent genito-pelvic pain affected one in eight women after vaginal birth and increased with perineal injury severity. Further studies are warranted to explore the potential preventive effects of limiting perineal tears and instrumental births on persistent pain, optimizing maternal satisfaction with postpartum pain management, and improving childbirth experience.