Does Episiotomy Play a Role in the Development of Pelvic Organ Prolapse?

Background: Pelvic organ prolapse (POP) is a prevalent gynecological disorder affecting approximately one-third of women worldwide, characterized by the descent of pelvic organs and associated with symptoms such as pelvic pressure, incontinence, and sexual dysfunction, all of which significantly impair quality of life. This study investigated the relationship between episiotomy and the development of POP in women with a history of vaginal delivery. Methods: A retrospective cross-sectional study was conducted on a cohort of 1030 women admitted to two tertiary university hospitals between 2021 and 2024. Demographic, obstetric, and clinical data were collected, and POP was diagnosed using the Pelvic Organ Prolapse Quantification (POP-Q) system. Results: The median age of the participants was 44 (18–70) years, and POP was diagnosed in 321 (31.2%) patients. Women with POP had significantly higher age (p < 0.001), body mass index (BMI) (p < 0.001), waist-to-hip ratio (WHR) (p < 0.001), gravidity (p < 0.001), parity (p < 0.001), menopausal status (p < 0.001), macrosomic delivery (p < 0.001), and episiotomy rates (p < 0.001) compared with those without POP. However, smoking history (p < 0.001) and induced delivery (p < 0.001) were significantly higher in those without POP. Median episiotomy was significantly associated with posterior POP (p < 0.001), while mediolateral episiotomy was significantly associated with apical POP (p < 0.001). Age (odds ratio [OR] = 1.094, 95% confidence interval [CI]: 1.060–1.128, p < 0.001), BMI (OR = 1.464, 95% CI: 1.346–1.593, p < 0.001), parity (OR = 16.907, 95% CI: 10.508–27.203, p < 0.001), macrosomic delivery (OR = 8.221, 95% CI: 3.104–21.773, p < 0.001), and episiotomy (OR = 11.533, 95% CI: 5.660–23.501, p < 0.001) were strongly associated with increased risk of POP. However, smoking (OR = 0.073, 95% CI: 0.025–0.217, p < 0.001) was strongly associated with a decreased risk of POP. Conclusions: Episiotomy was independently associated with increased odds of POP, underscoring the importance of its selective use in obstetric practice.