The effects of mediolateral episiotomy on pelvic floor function after vaginal delivery

Obstet Gynecol. 2004 Apr;103(4):669-73. doi: 10.1097/01.AOG.0000119223.04441.c9.


Objective: To evaluate the effect of mediolateral episiotomy on puerperal pelvic floor strength and dysfunction (urinary and anal incontinence, genital prolapse).

Methods: 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).

Results: 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.

Conclusion: 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.

Level of evidence: II-2

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Dyspareunia / etiology
  • Episiotomy / adverse effects*
  • Fecal Incontinence / etiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Pain Measurement
  • Pain, Postoperative / etiology
  • Pelvic Floor / physiopathology*
  • Puerperal Disorders / etiology*
  • Urinary Incontinence / etiology*
  • Uterine Prolapse / etiology*