(065) ASSOCIATION BETWEEN LEVATOR ANI MUSCLE AVULSION INJURY AND SEXUAL FUNCTION IN PAROUS WOMEN
Bibliographic record
Abstract
Abstract Introduction Childbirth is a major risk factor for levator ani muscle (LAM) trauma. In 21%-36% of women, stretching of the LAM leads to an avulsion injury, which is the detachment of the LAM from its insertion points on the pubic symphysis. LAM avulsion injury has been found to be significantly associated with important consequences such as higher rates and greater severity of stress urinary incontinence and pelvic organ prolapse. However, little is known about the impact of this obstetrical injury on sexual function. Objective This study aimed to examine the association between LAM avulsion injury and sexual function in parous women. Methods This multicenter prospective study involved 322 primiparous and multiparous women aged 18 to 45 years. Participants underwent a 3D/4D transperineal assessment, ≥ 3-month after delivery with a physiotherapist experienced in assessing LAM injury. The avulsion diagnosis was confirmed by two offline reviewers blinded to the patient’s clinical data following a validated protocol. A third reviewer was involved in case of discrepancy. Sexual function was measured with the Female Sexual Function Index (FSFI) questionnaire. Multiple linear regressions were computed to examine the association between avulsion injury and sexual function while controlling for potentially confounding variables (maternal age, time since last childbirth, stage of perineal tears 0-4, use of hormonal contraception, breastfeeding, urinary incontinence assessed with the International Consultation Incontinence Questionnaire – Urinary Incontinence (ICIQ-IU-SF), and pelvic organ prolapse evaluated with the Pelvic Organ Prolapse Symptom Score (POPSS). Results Of the 322 women who completed the study, 194 had an intact LAM, 77 had a unilateral avulsion, and 51 had a bilateral avulsion. Participants had a median parity of 2 (IQR 2-3) as well as a median of 4.4 (IQR 1.7-9.4) years since last childbirth. Avulsion was significantly associated with lower sexual function (β = -0.143, p = 0.011) as measured by the FSFI total score. Further analyses of the FSFI domains revealed that avulsion was also significantly associated with lower arousal (β = -0.160, p = 0.004), decreased lubrication (β = -0.128, p = 0.023) and lower orgasm (β = -0.146, p = 0.010). Conclusions The findings of this study support the role of LAM avulsion in sexual dysfunction. LAM avulsion was associated with poorer sexual function overall and more specifically, lower arousal, lubrication, and orgasm. Given the impact of LAM avulsion on sexual function, women diagnosed with this obstetrical injury should be screened for sexual dysfunction and offered appropriate treatment and counselling. Further research is needed to explore effective interventions and support for sexual dysfunctions in women sustaining this injury. Disclosure No.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".