ArticleInternational urogynecology journal2026
Impact of Episiotomy on Postpartum Pain, Pelvic Floor Function, and Sexual Health: A Propensity Score-Matched Cohort Study and Prediction Model Development.
Article in International urogynecology journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introduction and hypothesisTo evaluate the association between episiotomy and postpartum pain, perineal healing, pelvic floor function, and sexual function, and to develop a prediction model for identifying women at high risk of moderate-to-severe perineal pain following vaginal delivery.
methodsThis retrospective cohort study included 638 women who underwent vaginal delivery between January 2023 and December 2024. Propensity score matching (PSM; 1:1, caliper 0.02) balanced baseline characteristics between episiotomy (n = 268) and non-episiotomy groups (n = 268). Visual Analog Scale (VAS) pain scores were assessed at six time points up to 3 months postpartum. Pelvic floor dysfunction, perineal healing, and Female Sexual Function Index (FSFI) were evaluated at 3 months. A logistic regression prediction model was developed and internally validated.
resultsAfter PSM, 516 patients completed 3-month follow-up (96.3% retention). The episiotomy group demonstrated significantly higher VAS pain scores at all time points (P < 0.001), with effect sizes decreasing from 1.2 at 24 h to 0.2 at 6 weeks. At 3 months, the episiotomy group showed poorer perineal healing (P < 0.001), higher stress urinary incontinence (32.8% vs 22.2%, P = 0.028, OR 1.58), and lower FSFI scores (24.2 vs 27.6, P < 0.001), with sexual dysfunction prevalence of 75.7% vs 55.0%. A prediction model for moderate-to-severe perineal pain (VAS ≥ 4) demonstrated good discrimination (training AUC 0.819, validation AUC 0.804) and calibration (Hosmer-Lemeshow P = 0.445). Key predictors included primiparity (OR 2.32), instrumental delivery (OR 2.1), and prolonged second stage (OR 1.9). Risk stratification identified three groups with observed pain incidence of 28.9%, 55.8%, and 72.0%, respectively.
conclusionsEpisiotomy is associated with increased postpartum pain, impaired perineal healing, higher stress urinary incontinence risk, and reduced sexual function at 3 months. The prediction model shows promise for early postpartum risk stratification. External validation is needed before clinical implementation.
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