Long-term impacts of vaginal birth with mediolateral episiotomy on sexual and pelvic dysfunction and perineal pain

J Matern Fetal Neonatal Med. 2017 Feb;30(4):457-460. doi: 10.1080/14767058.2016.1174998. Epub 2016 Apr 25.


Objective: To investigate whether spontaneous vaginal birth with mediolateral episiotomy has any long-term impact on urinary and/or fecal incontinence, sexual dysfunction and perineal pain in primiparous women.

Methods: This matched case-control study included 150 women between 25 and 35 years old who had a singleton childbirth at least five years previously. Patients were grouped as; women who had a spontaneous vaginal delivery with mediolateral episiotomy (Group 1), an elective cesarean delivery (Group 2), and who had no delivery (Group 3). Controls were matched for age and delivery time. Urinary/fecal incontinence were questioned and Female Sexual Function Index (FSFI) questionnaire was completed. Total FSFI and domain scores were compared. Statistical evaluation was performed using One-way ANOVA test or χ2 test. Statistical significance was defined as p < 0.05.

Results: No women had urinary/fecal incontinence nor sexual dysfunction. Mean total FSFI points in Group 1 were significantly lower than in Groups 2 and 3 (p = 0.001). There were significant differences in sexual desire between groups 1 and 3 (p = 0.005), in arousal and in orgasm between both groups 1 and 2 (p = 0.001 and p = 0.038, respectively) and groups 1 and 3 (p = 0.001 and p = 0.001, respectively). There was no significant difference between groups 2 and 3 in any parameters or total points.

Conclusions: Vaginal delivery with mediolateral episiotomy is not associated with urinary and/or fecal incontinence and sexual dysfunction but associated with a decreased sexual functioning as well as sexual desire, arousal and orgasm within postpartum five years.

Keywords: Female sexual function index; mediolateral episitotomy; perineal pain; sexual function; vaginal delivery.

MeSH terms

  • Adult
  • Analysis of Variance
  • Case-Control Studies
  • Delivery, Obstetric / methods*
  • Episiotomy / methods*
  • Fecal Incontinence / etiology
  • Female
  • Humans
  • Libido
  • Pain / etiology
  • Perineum / physiopathology
  • Pregnancy
  • Sexual Behavior*
  • Sexual Dysfunction, Physiological / etiology
  • Surveys and Questionnaires
  • Urinary Incontinence / etiology