Women who have had an episiotomy reported having a poorer body image and less satisfying sex life than women who experienced natural tears during childbirth, according to a study completed at the University of Michigan and published in the International Journal of Women’s Health in April 2017.
An episiotomy, also called a perineotomy, is a surgical incision made in the muscular area between the vagina and anus shortly before birth to quickly enlarge the opening of the vagina so the baby can more easily pass through.
In the U.S., episiotomies are performed in 62.5 percent of births, which is more than double the rate in Europe, according to a study completed in 2014. The World Health Organization (WHO) recommends that the practice of routine episiotomy be abandoned and that this procedure be limited to about 10 percent of births.
There are risks associated with episiotomies, according to the American Pregnancy Association, including
- extended healing time
- painful scarring that may interfere with sex
- future problems with incontinence
The April 2017 study highlighted another possible complication of episiotomy: The potential negative effects on a woman’s sexual/body esteem and sex life.
Researchers conducted follow-up examinations and surveys with 69 women who were at risk of genital tears during childbirth. Fifteen of these women had had an episiotomy; the rest experienced natural tears ranging from mild to severe. The researchers completed the follow-up eight months after the birth. They used the Vaginal Changes Sexual and Body Esteem (VBSE) to measure the women’s satisfaction with their genitals and their sex life.
Most of the women in the study indicated a positive sexual/body esteem, although 38 percent indicated some interference in sexual enjoyment due to genital changes after childbirth. The women in the study who reported low levels of sexual satisfaction were much more likely to have had an episiotomy. Women who experienced severe natural tears also tended to have lower VBSE scores, but the study authors wrote that this did not reach statistical significance.
The women who had had episiotomies reported that the pain often interfered with sexual relations, even three months after birth. This pain might have negatively affected their ability to relax and enjoy sex for many months following birth.
The incision made during an episiotomy tends to be much deeper than what is experienced during a natural tear, according to the U.S. National Library of Medicine.
Episiotomies also require stitches, while natural tears may or may not require stitches, depending on the severity. These factors lead to increased pain, discomfort, and healing time with episiotomy.
Despite WHO’s recommendation to stop routine episiotomies, there are times when an episiotomy is necessary, according to the U.S. National Library of Medicine. These situations include:
- The baby is in distress during labor and the pushing phase needs to be shortened to decrease problems for baby.
- The baby’s head or shoulders are too big for the vaginal opening.
- The baby is in a breech position and there is a problem during delivery.
- Instruments are needed to help deliver the baby.
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