Abstract

BackgroundObstetric anal sphincter injuries (OASIS) might cause anal incontinence (AI) and sexual dysfunction, and might be associated with urinary incontinence (UI). Episiotomy has been identified both as a risk and a protective factor of OASIS. Lately, episiotomies with specific characteristics have shown to be protective against the risk of OASIS. However, little is known about episiotomy characteristics and pelvic floor dysfunction. This study investigates AI, UI, and sexual problems in primiparous women with episiotomy, comparing women with and without OASIS. Associations between episiotomy characteristics and AI, UI, and sexual problems were assessed.MethodsThis is a matched case–control study investigating 74 women with one vaginal birth, all with an episiotomy. Among these, 37 women sustained OASIS and were compared to 37 women without OASIS. The two groups were matched for vacuum/forceps. AI, UI and sexual problem symptoms were obtained from St. Mark’s scoring-tool and self-administered questionnaires. The episiotomy characteristics were investigated and results assessed for the whole group.ResultsThe mean time from birth was 34.5 months (range1.3-78.2) for those with OASIS and 25.9 months (range 7.0-57.4) for those without OASIS, respectively. More women with OASIS reported AI: 14 (38%) vs. 3 (8%) p = 0.05 (OR 4.66, 95% CI 1.34-16.33) as well as more problem with sexual desire p = 0.02 (OR 7.62, 95% CI 1.30-44.64) compared to women without OASIS. We found no association between episiotomy with protective characteristics and dysfunctions.ConclusionWomen with OASIS had more AI and sexual problems than those without OASIS. Episiotomy characteristics varied greatly between the women. Episiotomy with protective characteristics was not associated with increased dysfunctions. OASIS should be avoided, and correct episiotomy used if indicated.

Highlights

  • Obstetric anal sphincter injuries (OASIS) might cause anal incontinence (AI) and sexual dysfunction, and might be associated with urinary incontinence (UI)

  • Midline episiotomy starts at the posterior fourchette followed by a straight downward cut, the mediolateral episiotomy starts at the posterior fourchette and continues with a cut 40-60° from the midline [14]

  • Episiotomy characteristics in relation to AI and sexual problems We found that all the episiotomy characteristics varied across the cohort

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Summary

Introduction

Obstetric anal sphincter injuries (OASIS) might cause anal incontinence (AI) and sexual dysfunction, and might be associated with urinary incontinence (UI). Obstetric anal sphincter injury is a serious complication of vaginal delivery that can cause significant morbidity, leading to anal incontinence (AI) in 30 - 50% of the women despite adequate repair [1,2,3,4]. These injuries can cause sexual dysfunctions [2], and might be associated with urinary incontinence (UI) [5]. Lateral episiotomy starts to the left or right of the midline, at either 4–5 or 7–8 o’clock and the cut is angled 40–60° from the midline [14]

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