Relationship between episiotomy and dyspareunia. A narrative review of the most recent literature

Vaginal and perineal tears during normal labor may require suturing, but can leave painful scars. Episiotomy, a surgical transection of the perineum during the second stage of labor, is performed to prevent large, uncontrollable perineal ruptures and to facilitate delivery. However, it is associated with long-term complications such as chronic pain, sexual dysfunction, urinary incontinence, and dyspareunia. The incidence of dyspareunia after episiotomy varies depending on the procedure and time postpartum. The purpose of this work is to study the most up-to-date data relating the occurrence of dyspareunia to the previous episiotomy. Several studies link episiotomy to dyspareunia. Jiang et al. (2017) found no significant difference in dyspareunia rates between routine and selective episiotomy (12.9% vs. 14.8%). Manresa et al. (2019) reported that up to 12 months postpartum, women with episiotomy experienced increased perineal pain and dyspareunia, with more pronounced symptoms if perineal trauma or episiotomy occurred. A 2020 study by Manresa et al. showed that transecting the transverse perineal muscle during episiotomy resulted in prolonged symptoms. Novo et al. (2020) found a 23.4% dyspareunia rate at 12 months, with episiotomy as a contributing factor (PR 1.2). Other studies also found higher dyspareunia rates post-episiotomy, though some (Gun et al., 2016; Fodstad et al., 2016) did not find a clear link. Most recent studies suggest a direct correlation between episiotomy and dyspareunia, with rates ranging from 13% to 60% in the first year postpartum. A key risk factor is the cross section of the transverse perineal muscles during the episiotomy.