IMR Press / CEOG / Volume 48 / Issue 6 / DOI: 10.31083/j.ceog4806204
Open Access Systematic Review
Comparison of dyspareunia using female sexual index score in 3-month, 6-month, and 12-month postpartum after vaginal delivery and cesarean section: meta-analysis
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1 Urogynecology Reconstructive Division, Department of Obstetrics and Gynekology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Hospital, 60286 Surabaya, Indonesia
*Correspondence: (Eighty Mardiyan Kurniawati)
Clin. Exp. Obstet. Gynecol. 2021, 48(6), 1284–1291;
Submitted: 18 April 2021 | Revised: 7 May 2021 | Accepted: 31 May 2021 | Published: 15 December 2021
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

Background: The cesarean delivery rate has been increasing all over the world over the last few years. There is a change in mindset due to the change in women’s role, let alone the perception stating that cesarean delivery can decrease the risk of having pelvic floor dysfunction and maintain the sexual functions. Therefore, women think that cesarean delivery is a good choice for delivery, even it has no indications. This study aimed at analyzing and providing quantitative data by comparing the dyspareunia based on FSFI scores between cesarean section and vaginal delivery. Method: The systematic data search was done in the Medical Database (PUBMED, Google Scholar, Cochrane) and the archives of RSUD Dr. Soetomo. The inclusion criteria consisted of (1) observational study with the following keywords “cesarean section”, “cesarean delivery”, “vaginal birth”, “vaginal delivery”, “dyspareunia”, “FSFI”, (2) all included papers could be accessed completely, and the data that had been obtained could be analyzed accurately. Result: Twelve observational studies toward 2144 patients had been analyzed. The dyspareunia score after 3-month of delivery between cesarean section and vaginal delivery had a Mean Difference (MD) of 0.18 and 95% CI of –0.19 to 0.54 (p-value of 0.35). The dyspareunia score after 6-month of delivery between cesarean section and vaginal delivery had a Mean Difference (MD) of 0.43 and 95% CI of –0.28 to 1.14 (p-value of 0.23). Meanwhile, the dyspareunia score after 12-month of delivery between cesarean section and vaginal delivery had a Mean Difference (MD) of 0.12 and 95% CI of –0.23 to 0.48 (p-value of 0.50). From those three forest plots, all diamonds were tangent to the vertical line (no effect) and had a p > 0.05, so it could be inferred that no significant statistical difference was found between the experimental group (cesarean section) and the control group (vaginal delivery). Those three studies were heterogeneous since I2 was more than 50%. Conclusion: This meta-analysis concludes that there is a tendency for 3-month, 6-month, and 12-month of post delivery dypareunia rate to be lower in cesarean section than vaginal delivery, but it’s not staistically significant.

Cesarean section
Cesarean delivery
Vaginal birth
Vaginal delivery
Fig. 1.
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