To evaluate the effect of mediolateral episiotomy on puerperal pelvic floor strength and dysfunction (urinary and anal incontinence, genital prolapse).
Five hundred nineteen primiparous women were enrolled 3 months after vaginal delivery. Puerperae were divided in 2 groups: group A (254 women) comprised the women who received mediolateral episiotomy and group B (265 women) the women with intact perineum and first- and second-degree spontaneous perineal lacerations. Each woman was questioned about urogynecological symptoms and examined by digital test, vaginal perineometry, and uroflowmetric stop test score. Data were subjected to Student t test and Fisher exact test to assess, respectively, the difference between the mean values and the proportions within the subpopulations. Using a simple logistic regression model to test an estimate of relative risk, we expressed the odds ratios of the variables considered with respect to the control population (group B).
No significant difference was found with regard to the incidence of urinary and anal incontinence and genital prolapse, whereas dyspareunia and perineal pain were significantly higher in the episiotomy group (7.9% versus 3.4%, P = .026; 6.7% versus 2.3%, P = .014, respectively). Episiotomy was associated with significantly lower values, both in digital test (2.2 versus 2.6; P < .001) and in vaginal manometry (12.2 versus 13.8 cm water; P < .001), but not in uroflowmetric stop test.
Mediolateral episiotomy does not protect against urinary and anal incontinence and genital prolapse and is associated with a lower pelvic floor muscle strength compared with spontaneous perineal lacerations and with more dyspareunia and perineal pain.
Mediolateral episiotomy is associated with a worse pelvic floor function than spontaneous perineal lacerations 3 months after vaginal delivery and does not protect against incontinence and prolapse.
From the Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico, Burlo Garofolo, University of Trieste, Italy.
Address reprint requests to: Dr. Andrea Sartore, Department of Obstetrics and Gynecology, I.R.C.C.S. “Burlo Garofolo,” University of Trieste, Italy, Via dell'Istria 65/1–34137 Trieste, Italy; e-mail: firstname.lastname@example.org.
Received October 2, 2003. Received in revised form January 7, 2004. Accepted January 15, 2004.