title: Assessment of postpartum perineal pain after vaginal delivery: prevalence, severity and determinants. A prospective observational study.
abstract: OBJECTIVE
  Perineal pain is present, after birth, in almost all (95-100%) women who have experienced perineal trauma. It has been shown that women with spontaneous vaginal delivery and minimal or absent perineal trauma will have better recoveries: less pain, more tonic perineal muscles, improved sexual function and lower rates of depression. The purpose of the present study was to prospectively assess the prevalence of perineal pain in a population of women with vaginal birth at term and physiological single newborn.
  
  
  METHODS
  Pain assessment was performed using two subjective scales: the Verbal Numeric Scale (VNS) of 11 points and the Verbal Rating Score (VRS) of 4 points. Data collection period ran from the first postnatal day until 6 months after delivery, with two intermediate measurements at 1 and 7 weeks after birth.
  
  
  RESULTS
  The study enrolled 451 women: 239 primiparous and 212 multiparous, with a response rate of 92% at 6 months. The prevalence of pain was found 88.2% in the first day postpartum, 62.3% one week after birth, 8.0% at seven weeks and 0.7% at six months. With regard to the resumption of sexual activity at 6 months postpartum, a dyspareunia rate of 27% was observed in the Episiotomy group (OR 5.72, P<0.001).
  
  
  CONCLUSIONS
  The study found that an increase in the extent of trauma is associated with the highest scores in the self-assessment of perceived pain, with long term persistent symptoms. Furthermore, the presence of an episiotomy is a conditioning factor for the sexual function after childbirth (OR 0.43, P<0.001).
authors.affiliation: Department of Surgery and Interdisciplinary Medicine University of Milano Bicocca, Monza, Italy - giuseppina.persico@unimib.it.
authors.forename: G
authors.initials: G
authors.lastname: Persico
authors.forename: P
authors.initials: P
authors.lastname: Vergani
authors.forename: C
authors.initials: C
authors.lastname: Cestaro
authors.forename: M
authors.initials: M
authors.lastname: Grandolfo
authors.forename: A
authors.initials: A
authors.lastname: Nespoli
mesh_terms: D004841:Episiotomy; D005260:Female; D006801:Humans; D010502:Perineum; D049590:Postpartum Period; D015995:Prevalence; D011446:Prospective Studies