Postpartum dyspareunia (PD) is a recognized phenomenon: it is estimated that 50-60% of women
have dyspareunia 6 to 7 weeks following delivery, and 33% and 17% will still report pain
during intercourse three and six months after delivery, respectively.
Studies that evaluated the prevalence and the causes for PD referred primarily to obstetric
trauma, such as vaginal tears, episiotomy, the mode of repair and damage to the pelvic floor
muscles as probable causes for PD. These studies did not refer to estrogen deficiency and the
possible effect of breastfeeding on vaginal atrophy and its contribution to PD. Comparison
between vaginal deliveries and cesarean sections revealed that there is no difference in the
prevalence of PD between the two groups, and according to these findings it can be assumed
that the mechanical trauma to the vagina and pelvic floor during delivery is not the main
cause for the development of PD.
Vaginal atrophy due to estrogen deficiency is a common cause for postmenopausal dyspareunia.
With estrogen deficiency, profound changes occur in the vagina: vaginal mucosa becomes thin
and pale or hyperemic and loose her flexibility. Blood flow decreases, normal vaginal
discharge is reduced, and maturation of epithelial cells do not take place in the absence of
estrogen. Women with estrogen deficiency may complain of dryness, pruritus, irritation,
burning, dysuria, pain and dyspareunia. These changes are reversible by estrogen, given
systemically or topically, and cause resolution of clinical findings, as well as
disappearance of symptoms in several weeks.
Similar to postmenopausal patients, breastfeeding women immediately after delivery,
experience decline of estrogen levels, and this decline may persist as long as lactation is
continued. Therefore, many women after delivery may experience vaginal atrophy due to
transitional lack of estrogen. It is possible that this atrophy is the cause for the high
rate of PD.
Our clinical experience shows that many women present with postpartum dyspareunia with
vaginal atrophy, and that vaginal atrophy is responsible for part or most of their
complaints. Although most gynecologists recognize atrophy easily in menopausal women, vaginal
atrophy is not recognized correctly in most puerperal patients and therefore do not receive
attention and proper treatment.
The aim of the study is to characterize the phenomenon of postpartum vaginal atrophy in terms
of prevalence, risk factors and duration, and the association between vaginal atrophy and
We also intend to evaluate the effect of vaginal treatment with estriol cream 0.1% (Ovestin
cream) on postpartum dyspareunia.
The study will expand our knowledge regarding postpartum dyspareunia and will enable
formulating recommendations for evaluation and treatment of PD.