title: Obstetric vulvar lacerations and postpartum dyspareunia.
abstract: OBJECTIVE
  To report the type and prevalence of obstetric lacerations in a primigravid patient population after term spontaneous vaginal delivery without episiotomy. We examined the characteristics of lacerations in patients with postpartum dyspareunia or vulvodynia.
  
  
  METHODS
  This was a retrospective cohort of primiparous patients who spontaneously delivered in the residents' service at a large urban hospital under the supervision of Ob/Gyn faculty. Data was extracted from medical records using discharge diagnosis codes. Postpartum medical records and diagnostic codes of all patients with lacerations and postpartum dyspareunia were reviewed. The study was IRB approved.
  
  
  RESULTS
  A cohort of 1617 primiparous patients with spontaneous vaginal delivery met the inclusion criteria. No tears were recorded in 836 patients (51.7%), first-degree tears in 413 cases (25.5%), second-degree tears in 271 cases (16.8%), third-degree tears in 58 cases (3.6%), fourth-degree in 21 cases (1.3%), and 18 cases (1.1%) were not further classified. Only 51 patients (3.2%) with first- and second-degree lacerations had postpartum complications, and merely 6 (0.4%) had vulvar pain and 6 (0.4%) had dyspareunia. However, 4 of those patients (33.3%) required vulvoplasty for complete dyspareunia remission.
  
  
  CONCLUSIONS
  Almost half of patients with spontaneous vaginal delivery without episiotomy experienced some type of vaginal laceration. A first degree was documented in >25% of cases; however, <10% of those subsequently had complaints of vulvar pain or dyspareunia.
authors.affiliation: Texas Tech University Health Sciences Center, Odessa, Texas, USA. gary.ventolini@ttuhsc.edu
authors.forename: Gary
authors.initials: G
authors.lastname: Ventolini
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Yaklic
authors.forename: Michael L
authors.initials: ML
authors.lastname: Galloway
authors.forename: Moss
authors.initials: M
authors.lastname: Hampton
authors.forename: James E
authors.initials: JE
authors.lastname: Maher
mesh_terms: D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000706:statistics & numerical data; D004414:Dyspareunia / Q000209:etiology*; D005260:Female; D005431:Florida / Q000453:epidemiology; D020073:Gravidity; D006801:Humans; D022125:Lacerations / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies; D014844:Vulva / Q000293:injuries*; D056650:Vulvodynia / Q000209:etiology