Standardized Episiotomy Using a Blade-Based Device Reduces Long-Term Perineal Pain and Improves Sexual Function: A Randomized Controlled Trial.

introduction and hypothesisAlthough routine episiotomy is discouraged, mediolateral episiotomy remains necessary in selected clinical situations. Variability in incision technique may influence pelvic floor-related morbidity. We hypothesized that a standardized blade-based episiotomy technique would be associated with lower rates of persistent perineal pain and improved sexual function compared with conventional scissors.

methodsIn this randomized controlled trial, 60 nulliparous women undergoing vaginal delivery with a clinical indication for mediolateral episiotomy were randomized to episiotomy performed using a standardized blade-based device (BasIQ-4) or conventional Braun-Stadler scissors. Perineal pain was assessed using a visual analog scale at 2 and 48 h postpartum. The primary outcome was persistent perineal pain at 6 months postpartum, evaluated using a structured clinical interview. Sexual function at 6 months was assessed using the Female Sexual Function Index (FSFI).

resultsSixty nulliparous women were randomized and included in the intention-to-treat analysis (BasIQ-4, n = 30; scissors, n = 30). Baseline demographic and obstetric characteristics were largely similar between groups. Pain scores at 2 h postpartum were lower in the BasIQ-4 group, with no differences at 48 h. Persistent perineal pain at 6 months was significantly less frequent in the BasIQ-4 group (6.7% vs. 50.0%, p < 0.001). Total FSFI scores were significantly higher in the BasIQ-4group, primarily driven by differences in pain-related domains.

conclusionsWhen mediolateral episiotomy is clinically indicated, incision standardization using a blade-based technique is associated with reduced long-term perineal pain and improved pain-related aspects of postpartum sexual function.