title: The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women.
abstract: To determine the effect of perineal lacerations on pelvic floor outcomes, including urinary and anal incontinence, sexual function, and perineal pain in a nulliparous cohort with low incidence of episiotomy.
  
  
  
  Nulliparous women were prospectively recruited from a midwifery practice. Pelvic floor symptoms were assessed with validated questionnaires, physical examination, and objective measures in pregnancy and 6 months postpartum. Two trauma groups were compared, those with an intact perineum or only 1st degree lacerations and those with second-, third-, or fourth-degree lacerations.
  
  
  
  Four hundred and forty-eight women had vaginal deliveries. One hundred and fifty-one sustained second-degree or deeper perineal trauma and 297 had an intact perineum or minor trauma. Three hundred and thirty-six (74.8%) presented for 6-month follow-up. Perineal trauma was not associated with urinary or fecal incontinence, decreased sexual activity, perineal pain, or pelvic organ prolapse. Women with trauma had similar rates of sexual activity; however, they had slightly lower sexual function scores (27.3 vs 29.1). Objective measures of pelvic floor strength, rectal tone, urinary incontinence, and perineal anatomy were equivalent. The subgroup of women with deeper (> 2 centimeter) perineal trauma demonstrated increased likelihood of perineal pain (15.5% vs 6.2%) and weaker pelvic floor muscle strength (61.0% vs 44.3%) compared with women with more superficial trauma.
  
  
  
  Women having second-degree lacerations are not at increased risk for pelvic floor dysfunction other than increased pain, and slightly lower sexual function scores at 6 months postpartum.
authors: Departments of Family and Community Medicine, and Obstetrics and Gynecology at the University of New Mexico School of Medicine, Albuquerque, NM, USA.
authors: Lawrence
authors: L
authors: Leeman
authors: Department of Obstetrics and Gynecology at the University of New Mexico School of Medicine, Albuquerque, NM, USA.
authors: Rebecca
authors: R
authors: Rogers
authors: University of New Mexico, Albuquerque, NM, USA.
authors: Noelle
authors: N
authors: Borders
authors: University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
authors: Dusty
authors: D
authors: Teaf
authors: Clinical and Translational Research Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
authors: Clifford
authors: C
authors: Qualls
mesh_terms: D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects; D004841:Episiotomy / Q000009:adverse effects; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D022125:Lacerations / Q000150:complications*; D008880:Midwifery; D010298:Parity; D017773:Pelvic Floor / Q000503:physiopathology*; D010502:Perineum / Q000293:injuries*; D049590:Postpartum Period / Q000502:physiology*; D011247:Pregnancy; D011446:Prospective Studies; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology*
keywords: childbirth; genital tract trauma; incontinence; pelvic organ prolapse; perineal pain; sexual dysfunction