Sexual function in women after delivery: Does episiotomy matter?


Objective: Despite the fact that a restrictive use of episiotomy has proven to be beneficial, it continues to be widely used in vaginal births. Our aim was to compare women with episiotomy, to women with an intact perineum, 3 months after delivery, regarding several sexual variables, namely: sexual desire, arousal, orgasm, pain, sexual satisfaction and sexual function. Methods: An exploratory, descriptive and quantitative study using a non-probabilistic, convenience sample of 147 Portuguese women, of which 54 belonged to a control group, was performed. The groups were not significantly different regarding socio-demographic aspects. Three instruments were used: the Female Sexual Function Index, a Socio-demographic and Clinical Questionnaire and the Female Sexual Function Questionnaire. Results: Most women mentioned a moderate level of sexual interest. Women with episiotomy present higher pain intensity, less sexual satisfaction, greater changes regarding the orgasm’s duration and intensity, lower levels of sexual arousal and total sexual function, than women with intact perineum. Discussion: We found no significant differences between women with episiotomy and women with an intact perineum in most variables. However, women with episiotomy presented higher levels of pain and a lower sexual satisfaction, being these significant differences.

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Leal, I. , Lourenço, S. , Oliveira, R. , Carvalheira, A. and Maroco, J. (2014) Sexual function in women after delivery: Does episiotomy matter?. Health, 6, 356-363. doi: 10.4236/health.2014.65052.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Kalis, V., Stepan, J.J., Horak, M., Roztocil, A., Kralickova, M. and Rokyta, Z. (2008) Definitions of mediolateral episiotomy in Europe. International Journal of Gynaecology and Obstetrics, 100, 188-189.
[2] Löwenstein, L., Drugan, A., Gonen, R., Itskovitz-Eldor, J., Bardicef, M. and Jakobi, P. (2005) Episiotomy: Beliefs, practice and the impact of educational intervention. European Journal of Obstetrics & Gynecology and Reproductive Biology, 123, 179-182.
[3] Mattar, R., Aquino, M.M.A. and Mesquita, M.R.D.S. (2007) A prática da episiotomia no Brasil. Revista Brasileira de Ginecologia e Obstetricia, 29, 1-2.
[4] Tomasso, G., Althabe, F., Cafferata, M.L., Aleman, A. and Sosa, C. (2006) The need to avoid the routine use of episiotomy. Current Women’s Health Reviews, 2, 99-102.
[5] American College of Obstetricians and Gynecologists (2006) ACOG Practise Bulletin no 71—Episiotomy: Clinical management guidelines for obstetrician-gynecologists. Obstetrics and Gynecology, 107, 957-962.
[6] Department of Reproductive Health and Research WHO. (2000) Integrated Management of Pregnancy and Childbirth: Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors. World Health Organization, Geneva.
[7] Carroli, G. and Mignini, L. (2009) Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews, 1.
[8] Hartmann, K., Viswanathan, M., Palmieri, R., Gartlehner, G., Thorp, J. and Lohr, K.N. (2005) Outcomes of routine episiotomy: A systematic review. JAMA: Journal of the American Medical Association, 293, 2141-2148.
[9] Rathfisch, G., Dikencik, B.K., Kizilkaya Beji, N., Comert, N., Tekirdag, A.I. and Kadioglu, A. (2010) Effects of perineal trauma on postpartum sexual function. Journal of Advanced Nursing, 66, 2640-2649.
[10] Carroli, G. and Belizan, J. (2007) Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews, 4.
[11] Chang, S.-R., Chen, K.-H., Lin, H.-H., Chao, Y.-M.Y. and Lai, Y.-H. (2011) Comparison of the effects of episiotomy and no episiotomy on pain, urinary incontinence, and sexual function 3 months postpartum: A prospective follow-up study. International Journal of Nursing Studies, 48, 409-418.
[12] Botros, S.M., Abramov, Y., Miller, J.-J.R., Sand, P.K., Gandhi, S., Nickolov, A., et al. (2006) Effect of parity on sexual function: An identical twin study. Obstetrics & Gynecology, 107, 765-770.
[13] Lourenço, M.D.C. (2002) Conjugalidade e parentalidade: Continuar a díade na presença de um terceiro. Psychologica, 31, 25-42.
[14] Colman, A. and Colman, L. (1994) Gravidez: A experiência psicológica. Lisboa Ediçães Colibri.
[15] Katz, A. (2010) Sexual changes during and after pregnancy. American Journal of Nursing, 110, 50-52.
[16] Ryding, E.-L. (1984) Sexuality during and after pregnancy. Acta Obstetrica et Gynecologica Scandinava, 63, 679-682.
[17] Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., et al. (2000) The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26, 191-208.
[18] Hentschel, H., Alberton, D.L., Capp, E., Goldim, J.R. and Passos, E.P. (2007) Validação do Female Sexual Function Index (FSFI) para uso em Língua Portuguesa. Revista do Hospital de Clínicas de Porto Alegre, 27, 10-14.
[19] Lourenço, S., Leal, I. and Carvalheira, A. (2010) Estudo da resposta sexual feminina no período peri-gravídico em mulheres sujeitas a episiotomia episiorrafia. In: Leal, I., Pais-Ribeiro, J., Marques, M. and Pimenta, F., Eds., 8o Congresso Nacional de Psicologia da Saúde, ISPA, Lisboa, 849-858.
[20] Barret, G., Pendry, E., Peacock, J., Victor, C., Thacker, R. and Manyonda, I. (2000) Women’s sexual health after childbirth. British Journal of Obstetrics and Gynaecology, 107, 186-195.
[21] Paterson, L.Q.P., Davis, S.N.P., Khalifé, S., Amsel, R. and Binik, Y.M. (2009) Persistent genital and pelvic pain after childbirth. The Journal of Sexual Medicine, 6, 215-221.
[22] Baksu, B., Davas, I., Agar, E., Akyol, A. and Varolan, A. (2007) The effect of mode of delivery on postpartum sexual function in primiparous women. International Urogynecology Journal, 18, 401-406.
[23] Connolly, A., Thorp, J. and Pahel, L. (2005) Effects of pregnancy and childbirth on postpartum sexual function: A longitudinal prospective study. International Urogynecology Journal, 16, 263-267.
[24] Von Sydow, K. (1999) Sexuality during pregnancy and after childbirth: A metacontent analysis of 59 studies. Journal of Psychosomatic Research, 47, 27-49.
[25] Masters, W. and Jonhson, V. (1966) Human sexual response. Churchill, London.
[26] Buhling, K., Schmidt, S., Robinson, J., Klapp, C., Siebert, G. and Dudenhausen, J. (2006) Rate of dyspareunia after delivery in primiparae according do mode of delivery. European Journal of Obstetrics & Gynecology and Reproductive Biology, 124, 42-46.
[27] Signorello, L., Harlow, B., Chekos, A. and Repke, J. (2001) Postpartum sexual functioning and its relationship to períneal trauma: A retrospective cohort study of primiparous women. American Journal of Obstetrics and Gynecology, 184, 881-888.
[28] Andrews, V., Thakar, R., Sultan, A.H. and Jones, P.W. (2007) Evaluation of postpartum períneal pain and dyspareunia—A prospective study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 137, 152-156.
[29] Sleep, J., Grant, A., Garcia, J., Elbourne, D., Spencer, J., Chalmers, I. (1984) West Berkshire perineal management trial. British Medical Journal, 289, 587-590.
[30] Klein, M., Gauthier, R., Robbins, J., Kaczorowski, J., Jorgensen, S., Franco, E., et al. (1994) Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. American Journal of Obstetrics & Gynecology, 171, 591-598.

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