Immediate perineal cryotherapy during labor: effects on early postpartum pain, edema, and pelvic floor recovery in primiparous women.

objectiveTo evaluate the effects of immediate perineal cryotherapy during labor on early postpartum outcomes, with a special focus on pain relief, reduction of perineal edema, and promotion of pelvic floor recovery, among primiparous women.

methodsIn this retrospective cohort study, 260 medical records of primiparous women who delivered vaginally at Quanzhou First Hospital between January 2022 and June 2025 were analyzed. According to the predefined inclusion and exclusion criteria, 135 women underwent instant perineal cryotherapy constituted the observation group, and the other 125 women that were not given cryotherapy were the controls. Baseline data of mothers and their newborns as well as postpartum outcomes were evaluated at set intervals. The primary outcome was pain intensity at the perineum assessed using visual analog scale (VAS) at 2 hours, 6 hours and 24 hours after delivery. The secondary outcome measures included perineal edema, pelvic floor functionality, wound healing, sleep quality, systemic inflammation, coagulation indices, and sexual function.

resultsCryotherapy was associated with lower perineal pain intensity at all time points (all P < 0.001), with fewer women reporting severe pain or requiring analgesics in the cryotherapy group. Functional pain during sitting, standing, and urination was significantly alleviated, and a greater proportion of participants achieved ≥ 30% pain reduction at 6 and 24 hours postpartum (both P < 0.001). Edema scores, perineal circumference, skin temperature, and subcutaneous thickness decreased more rapidly in the cryotherapy group (all P < 0.001), indicating effective attenuation of tissue swelling. Pelvic floor assessments demonstrated lower resting tone, higher maximal voluntary contraction, greater endurance, and stronger vaginal squeeze pressure in the cryotherapy group (all P < 0.001). Wound healing improved significantly across all REEDA score dimensions. Sleep quality in the cryotherapy group was improved notably, with significantly better PSQI scores, shorter latency, longer duration, and reduced disturbances (all P < 0.001). Furthermore, systemic proinflammation factors (CRP, IL-6, TNF-α) and coagulation parameters (fibrinogen, D-dimer) were also reduced markedly in the cryotherapy group without evidence of deteriorating hemostasis at one week postpartum. Sexual function outcomes, including FSFI total and domain scores, were markedly improved (all P < 0.001).

conclusionPerineal cryotherapy administered immediately during childbirth significantly reduces the pain, edema, and systemic inflammation and improves the recovery of the pelvic floor and wound healing, sleep patterns, and sexual activity in women whose first birth was by cesarean section, highlighting its value as versatile, relatively safe, and non-pharmacological option to optimize early postpartum recovery.