title: Anal incontinence, urinary incontinence and sexual problems in primiparous women - a comparison between women with episiotomy only and women with episiotomy and obstetric anal sphincter injury.
abstract: BACKGROUND
  Obstetric anal sphincter injuries (OASIS) might cause anal incontinence (AI) and sexual dysfunction, and might be associated with urinary incontinence (UI). Episiotomy has been identified both as a risk and a protective factor of OASIS. Lately, episiotomies with specific characteristics have shown to be protective against the risk of OASIS. However, little is known about episiotomy characteristics and pelvic floor dysfunction. This study investigates AI, UI, and sexual problems in primiparous women with episiotomy, comparing women with and without OASIS. Associations between episiotomy characteristics and AI, UI, and sexual problems were assessed.
  
  
  METHODS
  This is a matched case-control study investigating 74 women with one vaginal birth, all with an episiotomy. Among these, 37 women sustained OASIS and were compared to 37 women without OASIS. The two groups were matched for vacuum/forceps. AI, UI and sexual problem symptoms were obtained from St. Mark's scoring-tool and self-administered questionnaires. The episiotomy characteristics were investigated and results assessed for the whole group.
  
  
  RESULTS
  The mean time from birth was 34.5 months (range1.3-78.2) for those with OASIS and 25.9 months (range 7.0-57.4) for those without OASIS, respectively. More women with OASIS reported AI: 14 (38%) vs. 3 (8%) p = 0.05 (OR 4.66, 95% CI 1.34-16.33) as well as more problem with sexual desire p = 0.02 (OR 7.62, 95% CI 1.30-44.64) compared to women without OASIS. We found no association between episiotomy with protective characteristics and dysfunctions.
  
  
  CONCLUSIONS
  Women with OASIS had more AI and sexual problems than those without OASIS. Episiotomy characteristics varied greatly between the women. Episiotomy with protective characteristics was not associated with increased dysfunctions. OASIS should be avoided, and correct episiotomy used if indicated.
authors.affiliation: The National Advisory Unit on Continence and Pelvic Floor Health, University Hospital of North Norway, Tromsø, Norway. mona.stedenfeldt@unn.no.|Department of Clinical Medicine, Women's Health and Perinatology Research Group, Faculty of Health Science, University of Tromsø, Tromsø, Norway. mona.stedenfeldt@unn.no.
authors.forename: Mona
authors.initials: M
authors.lastname: Stedenfeldt
authors.affiliation: The National Advisory Unit on Continence and Pelvic Floor Health, University Hospital of North Norway, Tromsø, Norway. tj.pirhonen@gmail.com.
authors.forename: Jouko
authors.initials: J
authors.lastname: Pirhonen
authors.affiliation: Research Group Maternal, Reproductive and Children's Health, Faculty of Health, Oslo and Akershus University College of Applied Sciences, Oslo, Norway. ellen.blix@hioa.no.
authors.forename: Ellen
authors.initials: E
authors.lastname: Blix
authors.affiliation: Department of Community Medicine, Faculty of Health Science, University of Tromsø, Tromsø, Norway. tom.wilsgaard@uit.no.
authors.forename: Tom
authors.initials: T
authors.lastname: Wilsgaard
authors.affiliation: Department of Clinical Medicine, Women's Health and Perinatology Research Group, Faculty of Health Science, University of Tromsø, Tromsø, Norway. barthold.vonen@nordlandssykehuset.no.
authors.forename: Barthold
authors.initials: B
authors.lastname: Vonen
authors.affiliation: Department of Clinical Medicine, Women's Health and Perinatology Research Group, Faculty of Health Science, University of Tromsø, Tromsø, Norway. pal.oian@unn.no.|Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway. pal.oian@unn.no.
authors.forename: Pål
authors.initials: P
authors.lastname: Øian
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D016022:Case-Control Studies; D004841:Episiotomy / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000150:complications*; D007989:Libido; D010298:Parity; D011247:Pregnancy; D012720:Severity of Illness Index; D015599:Trauma Severity Indices; D014549:Urinary Incontinence / Q000209:etiology*; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*; D055815:Young Adult