Perineal pain and dyspareunia after uncomplicated primiparous delivery

In a prospective cohort study of 210 women who underwent uncomplicated primiparous childbirth the relative effects of episiotomy, first or second degree perineal tears and delivery without tears or episiotomy on perineal pain and dyspareunia have been investigated. After childbirth, women who underwent an episiotomy indicated a significantly higher level of perineal pain than women whose perineum was intact or torn. On physical examination significant differences in the occurrence of hematomas between the various groups of women could be detected, probably accounting for the differences in pain level observed. While perineal pain in the first postpartum week is most likely following episiotomy, dyspareunia at 6 months is most frequently found in women having perineal tears. In comparison to the situation before pregnancy, for the total experimental patient population dyspareunia decreased. This decline in dyspareunia is most obvious for women whose perineum remained intact, less obvious for women with an episiotomy and absent for women with a perineal tear