Psychological distress and pelvic floor dysfunction in postpartum women: Associations with anxiety, perceived stress, and sexual health

doi:10.5498/wjp.119636

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Oct 19, 2026; 16(10): 119636
Published online Oct 19, 2026. doi: 10.5498/wjp.119636

Table 1 Comparison of general characteristics of postpartum women between the two groups, n (%)/mean ± SD/median (interquartile range)

Variable	PFD group (n = 98)	Non-PFD group (n = 42)	Statistical value	P value
Age (years)	31.2 ± 4.1	29.6 ± 4.3	t = 2.18	0.031^a
BMI (kg/m²)	23.9 ± 3.1	23.1 ± 3.0	t = 1.44	0.153
Postpartum months	4.0 (3.0-7.0)	3.0 (2.0-6.0)	Z = 1.86	0.063
Primiparous women	63 (64.3)	31 (73.8)	χ² = 1.25	0.264
Vaginal delivery	71 (72.4)	25 (59.5)	χ² = 2.40	0.121
Lateral episiotomy/laceration ≥ degree II	38 (38.8)	9 (21.4)	χ² = 4.10	0.043^a
Breastfeeding	64 (65.3)	32 (76.2)	χ² = 1.67	0.196
PSQI > 7 (i.e., poor sleep quality)	46 (46.9)	10 (23.8)	χ² = 6.76	0.009^b
Total SSRS score (points)	40.6 ± 6.7	44.1 ± 6.2	t = -2.92	0.004^b
Secret history	22 (22.4)	5 (11.9)	χ² = 2.17	0.141

^aP < 0.05 vs the non-pelvic floor dysfunction group.

^bP < 0.01 vs the non-pelvic floor dysfunction group.

BMI: Body mass index; PFD: Pelvic floor dysfunction; PSQI: Pittsburgh Sleep Quality Index; SSRS: Social Support Rating Scale.

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Table 2 Symptoms and effects of pelvic floor dysfunction in the two groups, n (%)/mean ± SD/median (interquartile range)

Indicators	PFD group (n = 98)	Non-PFD group (n = 42)	Statistical value	P value
PFDI-20 total score (points)	108.4 ± 32.7	38.6 ± 12.4	t = 13.52	< 0.001^b
PFIQ-7 total score (points)	57 (36-84)	14 (7-26)	Z = 8.21	< 0.001^b
Stress urinary incontinence	52 (53.1)	9 (21.4)	χ² = 12.40	< 0.001^b
Urgency urinary incontinence	19 (19.4)	3 (7.1)	χ² = 3.44	0.064
Mixed urinary incontinence	14 (14.3)	2 (4.8)	χ² = 2.65	0.104
Symptoms of pelvic organ prolapse	29 (29.6)	2 (4.8)	χ² = 10.70	0.001^b
Defecation disorder/anal incontinence symptoms	21 (21.4)	3 (7.1)	χ² = 4.55	0.033^a
Chronic pelvic floor/pain-related discomfort	27 (27.6)	5 (11.9)	χ² = 4.26	0.039^a
POP-Q stage ≥ II	24 (24.5)	1 (2.4)	χ² = 10.55	0.001^b

^aP < 0.05 vs the non-pelvic floor dysfunction group.

^bP < 0.01 vs the non-pelvic floor dysfunction group.

PFD: Pelvic floor dysfunction; PFDI-20: Pelvic Floor Distress Inventory-20; PFIQ-7: Pelvic Floor Impact Questionnaire-7; POP-Q: Pelvic Organ Prolapse Quantification.

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Table 3 Anxiety, perceived stress, and sexual health status in the two groups, n (%)/mean ± SD

Indicators	PFD group (n = 98)	Non-PFD group (n = 42)	Statistical value	P value
HADS-A (points)	7.6 ± 3.8	5.2 ± 3.1	t = 3.76	< 0.001^b
Anxiety (HADS-A ≥ 8)	41 (41.8)	9 (21.4)	χ² = 5.37	0.020^a
PSS-10 (points)	19.8 ± 6.1	15.7 ± 5.4	t = 3.73	< 0.001^b
High perceived stress (PSS-10 ≥ 20)	45 (45.9)	9 (21.4)	χ² = 7.33	0.007^b
Total FSFI score (points)	23.7 ± 5.4	27.8 ± 4.6	t = -4.38	< 0.001^b
Sexual dysfunction (FSFI < 26.55)	62 (63.3)	14 (33.3)	χ² = 10.88	0.001^b
FSFI-desire (points)	3.1 ± 1.0	3.6 ± 0.9	t = -2.90	0.004^b
FSFI-arousal (points)	3.6 ± 1.1	4.1 ± 1.0	t = -2.55	0.012^a
FSFI-lubrication (points)	3.9 ± 1.1	4.5 ± 1.0	t = -3.02	0.003^b
FSFI-orgasm (points)	3.8 ± 1.2	4.4 ± 1.1	t = -2.73	0.007^b
FSFI-satisfaction (points)	4.0 ± 1.3	4.7 ± 1.2	t = -3.04	0.003^b
FSFI-pain (points)	5.3 ± 1.2	5.9 ± 1.0	t = -2.88	0.005^b

^aP < 0.05 vs the non-pelvic floor dysfunction group.

^bP < 0.01 vs the non-pelvic floor dysfunction group.

PFD: Pelvic floor dysfunction; HADS-A: Hospital Anxiety and Depression Scale-Anxiety subscale; PSS-10: 10-item Perceived Stress Scale; FSFI: Female Sexual Function Index.

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Table 4 Correlations among pelvic floor function, psychological status, and sexual function

Variable pair	r value	P value
PFDI-20 total score vs HADS-A	0.46	< 0.001^b
PFDI-20 total score vs PSS-10	0.52	< 0.001^b
PFDI-20 total score vs FSFI total score	-0.49	< 0.001^b
PFIQ-7 total score vs HADS-A	0.41	< 0.001^b
PFIQ-7 total score vs PSS-10	0.44	< 0.001^b
PFIQ-7 total score vs FSFI total score	-0.42	< 0.001^b
HADS-A vs PSS-10	0.58	< 0.001^b
PSS-10 vs FSFI total score	-0.35	< 0.001^b

^bP < 0.01 vs the non-pelvic floor dysfunction group.

PFDI-20: Pelvic Floor Distress Inventory-20; PFIQ-7: Pelvic Floor Impact Questionnaire-7; HADS-A: Hospital Anxiety and Depression Scale-Anxiety subscale; PSS-10: 10-item Perceived Stress Scale; FSFI: Female Sexual Function Index.

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Table 5 Multivariable logistic regression analysis of anxiety, high perceived stress, and sexual dysfunction in postpartum women

Outcome	Independent variable	OR (95%CI)	P value
Anxiety (HADS-A ≥ 8)	PFDI-20 (per 10-point increase)	1.29 (1.10-1.52)	0.002^b
	PSQI > 7	2.46 (1.12-5.38)	0.025^a
	SSRS (per 5-point increase)	0.72 (0.56-0.92)	0.009^b
	Lateral episiotomy/≥ degree II laceration	1.98 (0.93-4.22)	0.078
High perceived stress (PSS-10 ≥ 20)	PFDI-20 (per 10-point increase)	1.35 (1.15-1.59)	< 0.001^b
	PSQI > 7	2.13 (1.02-4.46)	0.045^a
	SSRS (per 5-point increase)	0.69 (0.54-0.88)	0.003^b
	Postpartum months (per 1-month increase)	0.91 (0.83-0.99)	0.031^a
Sexual dysfunction (FSFI < 26.55)	PFDI-20 (per 10-point increase)	1.31 (1.12-1.54)	0.001^b
	Breastfeeding	1.87 (0.92-3.79)	0.083
	PSQI > 7	2.67 (1.26-5.64)	0.010^b
	SSRS (per 5-point increase)	0.74 (0.58-0.95)	0.018^a

^aP < 0.05 vs the non-pelvic floor dysfunction group.

^bP < 0.01 vs the non-pelvic floor dysfunction group.

OR: Odds ratio; HADS-A: Hospital Anxiety and Depression Scale-Anxiety subscale; PFDI-20: Pelvic Floor Distress Inventory-20; PSQI: Pittsburgh Sleep Quality Index; SSRS: Social Support Rating Scale; PSS-10: 10-item Perceived Stress Scale; FSFI: Female Sexual Function Index.

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Table 6 Comparison of psychological and sexual health outcomes across severity levels of pelvic floor symptoms, n (%)/mean ± SD

Layer	PFDI-20 (points)	HADS-A (points)	PSS-10 (points)	FSFI (points)	Anxiety	High stress perception	Sexual dysfunction
Non-PFD (n = 42)	38.6 ± 12.4	5.2 ± 3.1	15.7 ± 5.4	27.8 ± 4.6	9 (21.4)	9 (21.4)	14 (33.3)
Mild (n = 34)	74.1 ± 8.2	6.3 ± 3.3	16.9 ± 5.3	25.4 ± 4.8	10 (29.4)	10 (29.4)	18 (52.9)
Moderate (n = 33)	103.6 ± 8.5	7.6 ± 3.6	19.9 ± 5.7	23.6 ± 5.3	14 (42.4)	15 (45.5)	21 (63.6)
Severe (n = 31)	143.8 ± 20.9	9.0 ± 4.1	23.1 ± 6.0	21.7 ± 5.6	17 (54.8)	20 (64.5)	23 (74.2)

PFD: Pelvic floor dysfunction; PFDI-20: Pelvic Floor Distress Inventory-20; HADS-A: Hospital Anxiety and Depression Scale-Anxiety subscale; PSS-10: 10-item Perceived Stress Scale; FSFI: Female Sexual Function Index.

Full Size Table

Citation: Zhao CY, Peng XC, Liu ZH, Yin J, Zhao L. Psychological distress and pelvic floor dysfunction in postpartum women: Associations with anxiety, perceived stress, and sexual health. World J Psychiatry 2026; 16(10): 119636
URL: https://www.wjgnet.com/2220-3206/full/v16/i10/119636.htm
DOI: https://dx.doi.org/10.5498/wjp.119636

Zhao CY, Peng XC, Liu ZH, Yin J, Zhao L. Psychological distress and pelvic floor dysfunction in postpartum women: Associations with anxiety, perceived stress, and sexual health. World J Psychiatry 2026; 16(10): 119636 [DOI: 10.5498/wjp.119636]

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