Assessment of sexual and body esteem in postpartum women with or without perineal laceration: a cross-sectional study with cultural translation and validation of the Vaginal Changes Sexual and Body Esteem Scale

de Souza, Renata Stefânia Olah; Luz, Adriana Gomes; Zielinski, Ruth; Sarian, Luis Otavio Zanatta; Juliato, Cassia Raquel Teatin; Lara, Lucia Alves da Silva; Brito, Luiz Gustavo Oliveira

doi:10.61622/rbgo/2024rbgo35

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev Bras Ginecol Obstet 46 • 2024 • https://doi.org/10.61622/rbgo/2024rbgo35 copy

Assessment of sexual and body esteem in postpartum women with or without perineal laceration: a cross-sectional study with cultural translation and validation of the Vaginal Changes Sexual and Body Esteem Scale

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

We aimed to translate and determine cultural validity of the Vaginal Changes Sexual and Body Esteem Scale (VSBE) for Brazilian Portuguese language in postpartum women who underwent vaginal delivery with or without perineal laceration and cesarean section.

Methods:

A cross-sectional study conducted virtually, with online data collection through a survey with 234 postpartum women of 975 that were invited. Clinical, sociodemographic, and psychometric variables from the VSBE questionnaire were analyzed (content validity index, internal consistency, test-retest reliability, construct/structural and discriminant validity). Multivariate analysis was performed to explore associated factors with the presence of perineal laceration.

Results:

One-hundred fifty-eight women experienced vaginal delivery, of which 24.79% had an intact perineum, 33.33% had perineal laceration, and 9.4% underwent episiotomy; and 76 participants had cesarean sections. Women with perineal laceration were older, presented dyspareunia and previous surgeries than women without perineal laceration (p<0.05). For VSBE, a high internal consistency (Cronbach's α > 0.7) was observed, but it did not correlate with Body Attractiveness Questionnaire and Female Sexual Function Index; however, it correlated with the presence of women sutured for perineal laceration. Moreover, VSBE presented good structural validity with two loading factors after exploratory factor analysis. VSBE also demonstrated discriminant validity between the presence or absence of perineal laceration. The presence of urinary incontinence (UI) (OR=2.716[1.015-4.667];p=0.046) and a higher VSBE total score (OR=1.056[1.037-1.075];p<0.001) were the only factors associated with perineal laceration.

Conclusion:

Vaginal Changes Sexual and Body Esteem Scale demonstrated appropriate translation and good internal consistency, discriminant/construct validity and reliability. Vaginal Changes Sexual and Body Esteem Scale total score and presence of UI were associated with women that underwent perineal laceration.

Keywords
Postpartum; Vaginal delivery; Cesarean section; Self-concept; Sexuality

Variables		Without laceration (n=100)	With laceration (n=134)	p-value
Age (years)		30.94	32.32	0.019^α α Student t-test
Body mass index		24.46	25.53	0.113 ^α α Student t-test
Race/Ethnicity				0.763^β β Fisher test
	White	79	108
	Non-White	21	26
Education				0.158 ^β β Fisher test
	>15 years	92	129
	< 14 years	8	5
Sexual orientation				0.953^§ § Chi-square test
	Heterosexual	91	123
	Homosexual	7	9
	Bisexual	2	2
Satisfaction with childbirth				0.239^§ § Chi-square test
	Strongly dissatisfied	11	15
	Dissatisfied	13	15
	Indifferent	21	29
	Satisfied	22	16
	Completely satisfied	33	59
Smoker				0.246 ^β β Fisher test
	Yes	1	0
	No	99	134
Stable partnership				0.250 ^β β Fisher test
	Yes	95	131
	No	5	3
Urinary incontinence				0.066^β β Fisher test
	Yes	28	24
	No	72	110
Sexual activity				0.089^β β Fisher test
	Yes	90	110
	No	10	24
Dyspareunia				<0.001^β β Fisher test
	Yes	14	70
	No	75	75
Sexual frequency				0.380^§ § Chi-square test
	None	17	17
	Daily or Weekly	41	63
	Fortnightly (Every Two Weeks)	16	28
	Monthly	9	20
	Other/Rarely	6	17
Prior surgery				0.001^§ § Chi-square test
	None	43	97
	Cesarean	39	29
	Cesarean + Other	3	5
	Other	4	14

Instruments	Without laceration (n=100)	With laceration (n=134)	p-value^* * Student t test
VSBE Total Score	29.47	12.35	<0.005
FSFI Total Score	20.45	20.84	0.7556
FSFI Desire	2.66	2.83	0.2438
FSFI Excitation	3.35	3.25	0.6952
FSFI Lubrication	3.39	3.48	0.7242
FSFI Orgasm	3.41	3.48	0.8041
FSFI Satisfaction	3.91	3.91	0.9662
FSFI Pain	3.71	3.85	0.6252
BAQ Total Score	123.88	126.67	0.3153
BAQ Overall Fatness	11.49	12.20	0.1196
BAQ Self-disparagement	15.65	16.11	0.5005
BAQ Strength	17.63	17.82	0.3815
BAQ Salience of	23.13	23.29	0.7986
BAQ Attractiveness	16.95	16.51	0.3229
BAQ Lower body fat	39.03	40.71	0.3334

Item	n	Item-test correlation	Item-rest correlation	Covariance	Alpha
VSBE Total Score	234	0.2907	0.1718	5.7086	0.7459
VSBE 1	234	0.2637	0.2548	6.0178	0.7446
VSBE 2	234	0.2173	0.2054	6.0156	0.7445
VSBE 3	234	0.2510	0.2386	6.0060	0.7442
VSBE 4	234	0.2572	0.2446	6.0033	0.7441
VSBE 5	234	0.2684	0.2548	5.9956	0.7439
VSBE 6	234	0.3019	0.2891	5.9905	0.7437
VSBE 7	234	0.2672	0.2537	5.9969	0.7439
VSBE 8	234	0.2719	0.2584	5.9951	0.7439
VSBE 9	234	0.2672	0.2540	5.9976	0.7440
VSBE 10	234	0.2692	0.2555	5.9955	0.7439
Retest VSBE Total Score	73	0.2254	0.0569	5.8704	0.7460
FSFI Total Score	234	0.2153	0.1536	5.8875	0.7432
FSFI Desire	234	0.1512	0.1440	6.0397	0.7453
FSFI Excitement	234	0.2311	0.2194	6.0107	0.7444
FSFI Lubrication	234	0.1849	0.1716	6.0167	0.7746
FSFI Orgasm	234	0.1846	0.1711	6.0160	0.7446
FSFI Satisfaction	234	0.1609	0.1514	6.0322	0.7451
FSFI Pain	234	0.1962	0.1824	6.0122	0.7445
BAQ Total Score	234	0.2879	0.1492	5.6945	0.7492
BAQ Attractiveness	234	0.0109	-0.0115	6.0647	0.7464
BAQ Self-disparagement	234	0.1733	0.1391	5.9759	0.7440
BAQ Salience	234	0.2100	0.1775	5.9959	0.7433
BAQ Lower body fat	234	0.2039	0.1812	5.9853	0.7438
BAQ Strength	234	0.0860	0.0605	6.0337	0.7455
BAQ Overall Fatness	234	0.2299	0.1434	5.8381	0.7445

Instruments	Mean + Standard Deviation (SD)	Mean difference + SD	p-value^* * Paired t-test
VSBE total score	20.80+-18.29	-1.86+-17.94	0.378
Retest VSBE total score	18.94+-18.66	-1.86+-17.94
FSFI total score	18.77+-10.09	2.72+-9.81	0.020
Retest FSFI total score	21.49+-9.34	2.72+-9.81
BAQ total score	123.47+-21.46	2.35+-13.15	0.130
Retest total score	125.83+-23.87	2.35+-13.15

Variables	n	p-value	R Spearman
FSFI total score	234	0.532	0.04
BAQ total score	234	0.163	-0.09
VSBE total score (retest)	73	<0.001	0.55
FSFI total score (retest)	73	0.743	-0.03
BAQ total score (retest)	73	0.188	-0.15
Was sutured for perineal laceration	115	0.045	0.18
Underwent episiotomy	158	0.205	0.10
Women satisfied with labor	234	0.467	-0.04
Sexual Frequency	234	0.041	0.13

Variables	Adjusted Odds Ratio	95% CI LL-UL^* * LL – lower limit; UL - upper limit	p-value^ Adjusted for all variables in this table
Age < 35 years	0.502	0.222-1.137	0.099
Skin color (non-white)	1.209	0.563-2.598	0.625
Body mass index	0.951	0.878-1.030	0.220
Stable partner (yes)	0.738	0.146-3.726	0.713
Years of education	0.335	0.079-1.409	0.136
Urinary incontinence (yes)	2.176	1.015-4.667	0.046
Dyspareunia (yes)	1.832	0.952-3.523	0.070
Satisfaction with labor (yes)	1.011	0.803-1.271	0.926
VSBE total score	1.056	1.037-1.075	<0.001
BAQ total score	1.001	0.982-1.020	0.913
FSFI total score	0.987	0.952-1.024	0.497

	Concordo plenamente	Concordo	Indiferente	Discordo	Discordo completamente	Não tive alterações na área íntima
1. Sinto que as alterações em minha área íntima podem interferir no meu prazer sexual	1	2	3	4	5	N/A
2. Se eu estivesse procurando um(a) parceiro(a) sexual, acho que poderia ser mais difícil encontra-lo(a) devido às mudanças em minha área íntima	1	2	3	4	5	N/A
3. Gostaria de esconder as alterações da minha área íntima o máximo possível	1	2	3	4	5	N/A
4. Me sinto sexualmente frustrada devido às mudanças em minha área íntima	1	2	3	4	5	N/A
5. Sinto que as mudanças em minha área íntima provavelmente vão me impedir de satisfazer um(a) parceiro(a) sexual	1	2	3	4	5	N/A
6. Sinto que minha expressão sexual poderia ser limitada pelas mudanças em minha área íntima	1	2	3	4	5	N/A
7. Sinto que um(a) parceiro(a) sexual poderia não estar tão sexualmente interessado(a) em mim por causa das mudanças em minha área íntima	1	2	3	4	5	N/A
8. Eu invejo pessoas com área íntima inalterada pós parto	1	2	3	4	5	N/A
9. Se eu pudesse, eu mudaria minha área íntima por uma área íntima sem alterações	1	2	3	4	5	N/A
10. Acredito que posso sofrer rejeição de um(a) parceiro(a) sexual por causa das alterações em minha área íntima	1	2	3	4	5	N/A

Item	Professional 1	Professional 2	Professional 3	CVI
1	4	4	4	1
2	4	4	4	1
3	4	4	4	1
4	4	4	4	1
5	4	4	4	1
6	3	4	3	0.83
7	4	4	4	1
8	4	4	4	1
9	4	4	4	1
10	4	4	4	1
Mean CVI				0.98

VSBE questionnaire	Factor 1	Factor 2	Uniqueness
1. I feel that changes in my intimate area can interfere with my sexual pleasure	0.6341	0.1643	0.4106
2. If I were looking for a sexual partner it may be harder to find one because I have these kinds of changes to my intimate area	0.7822	0.1166	0.2341
3. I would like to hide changes in my intimate área as much as possible	0.6896	0.2395	0.2128
4. I feel sexually frustrated due to changes in my intimate area	0.7419	0.2511	0.0999
5. I feel that changes in my intimate area are likely to prevent me from satisfying a sexual partner	0.7204	0.2797	0.0926
6. I feel that my sexual expression could be limited by changes in my intimate area	0.6876	0.3054	0.1107
7. I feel that a sexual partner might not be as sexually interested in me because of changes in my intimate area	0.5907	0.4027	0.1227
8. I envy people with an unaltered intimate rea after childbirth	0.1281	0.8003	0.1853
9. If I could, I would change my intimate area to an unaltered intimate area	0.1860	0.7762	0.1406
10. I believe that I may experience rejection from a sexual partner because of changes in my intimate area	0.3508	0.6499	0.1035

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[1] Corresponding author Luiz Gustavo Oliveira Brito E-mail: lgobrito@unicamp.br