Natural childbirth is, has been and will probably continue to be, the subject of much research, but it also poses a significant problem in the context of the controversy surrounding the impact of natural childbirth on sensory stimuli and, therefore, on sexual satisfaction. Recalling a study by Schultz, in which 60 women were examined for vaginal reactivity to electrical stimuli, a significantly low level of reactivity was found. This allowed specialists, therefore, to conclude that a decrease in satisfaction with sexual life, is caused by its relaxation in the external part.

The scale of the phenomenon

A decrease in satisfaction with sexual life affects between 40% and 80% of women who have had a natural birth at least once. These patients report feeling a decrease in vaginal sensitivity, which is caused both by widening of the vaginal entrance and a decrease in membrane and muscle tone. Can it be unequivocally stated that natural childbirth is the cause of this? Experts do not unequivocally answer this question. While there is some correlation and association between natural childbirth and a decrease in the quality of sexual life, it is not confirmed that delivery by caesarean section will not cause this type of complication. Furthermore, when the subjective feeling of vaginal laxity was contrasted with colpomyometric parameters - such as the distance of the cervix from the vaginal entrance before and after repositioning and the distance of the upper surface of the rectus abdominis muscles from the vaginal entrance - it was found that this feeling was associated with a decrease in pelvic muscle tone and reduced resting vaginal pressure.

ZRP

From a scientific point of view, the correct term to describe this type of phenomenon is Vaginal Relaxation Syndrome (ZRP). However, in the specialist literature, we will not encounter such a disease entity, nor the classic diagnostic criteria, mainly because it is a condition whose definition depends largely on subjective feelings of satisfaction with sexual life.

So what is the diagnosis based on? First and foremost, it is based on an interview, which should be supplemented with validated questionnaires to assess the quality of sexual life. However, the differential diagnosis, which consists of eliminating possible lesions, defects or disorders of the pelvis and urinary tract, is of great importance.

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A similar situation applies to the classification of PE, which has not been confirmed in the literature; only attempts to classify the phenomenon have been encountered. ZRP can thus be divided into those caused by an anterior defect, a lateral defect or a posterior defect, with mixed defects being the most common and isolated posterior defects the least common.

ZRP a taboo subject?

According to data from specialists, women between 45 and 55 years of age are twice as likely to report a decline in the quality of their sexual life. Undoubtedly, ZRP remains a classic example of a functional post-partum defect; nevertheless, the changes occurring during the menopause can contribute to and exacerbate the problem of reduced quality of life caused by natural childbirth. Despite the magnitude of the phenomenon, only 20% of women report such observations and complaints during a visit to the gynaecologist and, on the other hand, the vast majority of specialists, do not find the time during a routine visit to carry out a sexual quality of life interview. From another perspective, the problem of vaginal looseness caused by natural childbirth is recognised and begins to be taken into account when problems with incontinence occur.