Eligibility criteria
We included all randomized clinical trials, controlled clinical trials, cohort, cross-sectional and case-control studies, comparing potential obstetric risk factors for developing sexual dysfunction up to one year after delivery. Duplicate records, reviews, case reports, incomplete reports, book chapters, conference abstracts, letters to the editor and comments were excluded. We used language restrictions due to the lack of resources for translation(14); only studies written in English were retrieved in the full text format. The PICO format was used to identify studies and data to be extracted(15).
PATIENT/POPULATION: All childbearing women without age and ethnicity restrictions.
INTERVENTION/EXPOSURE: Childbirth irrespective of the mode of delivery
COMPARATOR(S)/CONTROL(S) were the following categories:
OUTCOMES: Primary outcomes were sexual dysfunction anddyspareunia consistent with the ICS/IUGA Terminology(1) and assessed with validated and standardized tools. Secondary outcomes werevaginal dryness(1) and body image dissatisfaction(19-21) . When Female Sexual Function Index (FSFI) scores were available, the total score was retrieved or calculated by addition of the separate subscores. An FSFI total score of ≤26.55 was used as a cut off for differentiating women with and without sexual dysfunction(22).