Breastfeeding and Genitourinary Symptoms: A Prospective Cohort Study.

IMPORTANCE: Understanding genitourinary effects of breastfeeding allows for proactive treatments and quality-of-life improvements. OBJECTIVE: The objective of this study was to estimate the effect of breastfeeding on genitourinary symptoms. STUDY DESIGN: This prospective cohort study of breastfeeding (BF) versus non-breastfeeding (NB) primiparous women characterized genitourinary symptoms after singleton delivery at ≥34 weeks of gestation. Validated measures included the Urinary Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), Most Bothersome Symptom questionnaire (MBS), and Pelvic Organ Prolapse Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Questionnaires were completed at baseline, 6 weeks, 3 months, and 6 months postpartum. The primary outcome was the UDI-6 score at 3 months. Multivariable linear and logistic regression models were evaluated for group differences. RESULTS: UDI-6 scores at 3 months were not different between groups (5.6±11.8 BF, 7±12 NB, P=0.43). Differences in IIQ-7 scores were not statistically significant (4.9±7.4 BF, 13.5±25.2 NB, P=0.07). Multivariable analysis for those not sexually active revealed better partner-related scores in the BF group (β, -0.85; 95% CI, -1.58, -0.12, P=0.024). Among those sexually active, the BF group had worse condition impact scores (β, 0.29; 95% CI, 0.11, 0.47, P=0.002). The three-month MBS revealed nearly a threefold likelihood of experiencing vaginal dryness in BF (adjusted odds ratio, 2.82; 95% CI, 1.19, 6.66, P=0.018). At 6 months, vaginal dryness was no longer different, but breastfeeding continued to affect sexual function. CONCLUSIONS: At 3-months postpartum, there were no differences in lower urinary tract symptom severity between BF versus NB women. The BF group had increased bothersome vaginal symptoms and a mixed effect on sexual function. Awareness of these findings should lead to proactive assessment of symptoms and timely treatments.