Trimesters of Change: Pelvic Floor and Sexual Health in Community Hospital Pregnancy Care

Introduction: Pelvic floor disorders can negatively impact an individual’s quality of life with disruptive signs and symptoms, such as urinary incontinence, fecal incontinence, pelvic organ prolapse, and pelvic pain. Approximately 25% of women in the United States have at least one pelvic floor disorder, which contributes to high healthcare expenditure. Pregnancy has been associated with physical changes to the pelvic floor and may contribute to the development of pelvic floor disorders. The purpose of this study was to evaluate the perception of pelvic floor and sexual function during pregnancy using validated questionnaires with a focus on how these domains relate to one another and differ across trimesters. Methods: This study was a cross-sectional survey that was approved by the Institutional Review Board of an academic tertiary care center in the southern United States and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Pregnant individuals between the ages of 18 and 45 years who presented to a community hospital for a prenatal visit were asked to complete a survey composed of demographic questions and validated questionnaires targeting pelvic floor and sexual function – the Pelvic Floor Distress Inventory-20 (PFDI-20), the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and the Female Sexual Function Index-6 (FSFI-6). Individuals who were unable to provide informed consent, incarcerated at the time of the visit, or non-English speaking were excluded. The surveys were distributed from February 25, 2025 until March 21, 2025 to achieve a target sample size of 200, which was determined a priori to provide adequate statistical power. The data were entered into the secure web application called Research Electronic Data Capture (REDCap) with no missing data noted. Statistical analysis was performed using R software version 4.3.1 and included descriptive statistics, analysis of variance (ANOVA), Pearson correlation, and multiple linear regression. A p-value of less than 0.05 was used to define statistical significance. Results: Two hundred eligible individuals completed the survey and were included in the analysis. Most participants were between 20 and 29 years old, obese [Body mass index (BMI) >30 kg/m2], in the third trimester, multigravida (pregnant previously), multiparous (delivered previously), high school graduates, unemployed, Black, unmarried, in the lowest household income category ( 0.05), whereas sexual function differed significantly across trimesters as measured by the FSFI-6 [F(2, 197) = 4.25, p = 0.016]. Furthermore, sexual function scores were significantly lower in the third trimester compared to the second (mean difference = -2.22; 95% CI: -4.38 to -0.06; p = 0.042). Sexual function scores were also lower in the third trimester compared to the first but not significantly (mean difference = -2.98; 95% CI: -6.02 to 0.06; p = 0.056), and there was no significant difference in sexual function scores between the first and second trimesters (mean difference = -0.76; 95% CI: -3.87 to 2.34; p = 0.830). Pearson correlation analysis demonstrated no statistically significant association between pelvic floor function and sexual function. However, the correlation between pelvic floor quality of life as measured by the PFIQ-7 and sexual function as measured by the FSFI-6 was slightly stronger (r = -0.13, p = 0.06) than the correlation between pelvic floor distress as measured by the PFDI-20 and sexual function as measured by the FSFI-6 (r = -0.08, p = 0.24). Multiple linear regression models were used to determine if there were any associations between demographic and clinical information and pelvic floor and sexual function. Overall, the models were not statistically significant for pelvic floor quality of life [F(23, 175) = 0.95, p = 0.53] and pelvic floor distress [F(23, 175) = 1.23, p = 0.23], but the model was statistically significant for sexual function [F(23, 175) = 2.36, p = 0.0009]. Being in the third trimester had a statistically significant association with lower FSFI-6 scores (β = -3.72, 95% CI: -6.16 to -1.11, p = 0.00397), whereas identifying as White had a statistically significant association with higher FSFI-6 scores (β = 2.21, 95% CI: 0.19 to 4.20, p = 0.030). Conclusion: This study offers valuable insight on an underserved population by focusing on individuals who receive prenatal care at a resource-limited facility. Sexual function scores were lower in later pregnancy, whereas pelvic floor function scores did not change significantly across pregnancy. Notably, identifying as White was associated with higher sexual function scores than other race/ethnicity categories. Future research should involve a longitudinal approach for a detailed understanding of pelvic floor and sexual function throughout the perinatal period and the development of prevention and management strategies.