Intact perineum and women's postpartum health: scoping review
DOI:
https://doi.org/10.37914/riis.v9.431Keywords:
parturition, perineum, women’s healthAbstract
Background: perineal integrity is a recognized indicator of obstetric care quality and a determinant of women's postpartum health, with documented impact across multiple domains including perineal pain, urinary and fecal continence, sexual function, pelvic floor muscle function, and mental health. Available evidence remains scattered and lacks integrative mapping. Objective: to map the available evidence on health outcomes associated with perineal integrity in the postpartum period. Methods: a scoping review was conducted across CINAHL, Scopus, MEDLINE, Eric, MedicLatina, and the Cochrane Library, supplemented by grey literature search in RCAAP. Thirty-two studies published between 1994 and 2024 were included. Results: included studies map five outcome domains: perineal pain (n=15), sexual function (n=13), urinary and anal incontinence (n=8), pelvic floor muscle function (n=7), and mental health (n=1). Studies stratifying findings by perineal condition consistently document an apparent tendency toward lower frequency and intensity of adverse outcomes in women with intact perineum, without allowing causal inference. Conclusion: mapped evidence supports the clinical relevance of perineal preservation, while acknowledging that methodological heterogeneity limits transferability of findings and warrants interpretive caution.
References
American College of Obstetricians and Gynecologists. (2018). ACOG Committee Opinion No. 736: Optimizing postpartum care. Obstetrics & Gynecology, 131(5), e140-e150. https://doi.org/10.1097/AOG.0000000000002633
Andrews, V., Thakar, R., Sultan, A. H., & Jones, P. W. (2008). Evaluation of postpartum perineal pain and dyspareunia: a prospective study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 137(2), 152–156. https://doi.org/10.1016/j.ejogrb.2007.06.005
Barrett, G., Pendry, E., Peacock, J., Victor, C., Thakar, R., & Manyonda, I. (2000). Women's sexual health after childbirth. BJOG: An International Journal of Obstetrics & Gynaecology, 107(2), 186–195. https://doi.org/10.1111/j.1471-0528.2000.tb11689.x
Bols, E. M., Hendriks, E. J., Berghmans, B. C., Baeten, C. G., Nijhuis, J. G., & de Bie, R. A. (2010). A systematic review of etiological factors for postpartum fecal incontinence. Acta Obstetricia et Gynecologica Scandinavica, 89(3), 302–314. https://doi.org/10.3109/00016340903576004
Buhling, K. J., Schmidt, S., Robinson, J. N., Klapp, C., Siebert, G., & Dudenhausen, J. W. (2006). Rate of dyspareunia after delivery in primiparae according to mode of delivery. European Journal of Obstetrics & Gynecology and Reproductive Biology, 124(1), 42–46. https://doi.org/10.1016/j.ejogrb.2005.04.008
Campbell, F., Tricco, A. C., Munn, Z., Pollock, D., Saran, A., Sutton, A., White, H., & Khalil, H. (2023). Mapping reviews, scoping reviews, and evidence and gap maps (EGMs): the same but different — the "Big Picture" review family. Systematic Reviews, 12(1), 45. https://doi.org/10.1186/s13643-023-02178-5
Dannecker, C., Hillemanns, P., Strauss, A., Hasbargen, U., Hepp, H., & Anthuber, C. (2004). Episiotomy and perineal tears presumed to be imminent: randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica, 83(4), 364–368. https://doi.org/10.1111/j.0001-6349.2004.00366.x
De Souza, A., Dwyer, P. L., Charity, M., Thomas, E., Ferreira, C. H., & Schierlitz, L. (2015). The effects of mode of delivery on postpartum sexual function: a prospective study. BJOG: An International Journal of Obstetrics & Gynaecology, 122(10), 1410–1418. https://doi.org/10.1111/1471-0528.13331
Fleming, N., Newton, E. R., & Roberts, J. (2003). Changes in postpartum perineal muscle function in women with and without episiotomies. Journal of Midwifery & Women’s Health, 48(1), 53–59. https://doi.org/10.1016/s1526-9523(02)00368-9
Franz, H. B., Schneider, D., Benda, N., Erz, W., Neuer, A., & Gonser, M. (1999). Uncomplicated obstetric injury as a risk factor for anal incontinence? Objective assessment of manometric measurements. Zeitschrift für Geburtshilfe und Neonatologie, 203(1), 24–28. https://pubmed.ncbi.nlm.nih.gov/10427669/
Gommesen, D., Nøhr, E., Qvist, N., & Rasch, V. (2019). Obstetric perineal tears, sexual function, and dyspareunia among primiparous women 12 months postpartum: a prospective cohort study. BMJ Open, 9(12), e032368. https://doi.org/10.1136/bmjopen-2019-032368
Huber, M., Malers, E., & Tunón, K. (2021). Pelvic floor dysfunction one year after first childbirth in relation to perineal tear severity. Scientific Reports, 11(1), 12560. https://doi.org/10.1038/s41598-021-91799-8
Imarengiaye, C. O., & Andet, A. B. (2008). Postpartum perineal pain among Nigerian women. West African Journal of Medicine, 27(3), 148–151. https://pubmed.ncbi.nlm.nih.gov/19256318/
Khalaf, A., Al Amri, N., & Al Qadire, M. (2023). Childbirth-related episiotomy and tear in relation to risk of postpartum depression: a retrospective cohort study on Omani mothers. Journal of Reproductive and Infant Psychology, Advance online publication, 1–14. https://doi.org/10.1080/02646838.2023.2300082
Klein, M. C., Gauthier, R. J., Robbins, J. M., Kaczorowski, J., Jorgensen, S. H., Franco, E. D., Johnson, B., Waghorn, K., Gelfand, M. M., Guralnick, M. S., Luskey, G. W., & Joshi, A. K. (1994). Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. American Journal of Obstetrics & Gynecology, 171(3), 591–598. https://doi.org/10.1016/0002-9378(94)90070-1
Klein, M. C., Kaczorowski, J., Firoz, T., Hubinette, M., Jorgensen, S., & Gauthier, R. (2005). A comparison of urinary and sexual outcomes in women experiencing vaginal and caesarean births. Journal of Obstetrics and Gynaecology Canada, 27(4), 332–339. https://doi.org/10.1016/s1701-2163(16)30459-5
Leeman, L. M., Rogers, R. G., Greulich, B., & Albers, L. L. (2007). Do unsutured second-degree perineal lacerations affect postpartum functional outcomes? Journal of the American Board of Family Medicine, 20(5), 451–457. https://doi.org/10.3122/jabfm.2007.05.060222
Leeman, L., Rogers, R., Borders, N., Teaf, D., & Qualls, C. (2016). The effect of perineal lacerations on pelvic floor function and anatomy at 6 months postpartum in a prospective cohort of nulliparous women. Birth, 43(4), 293–302. https://doi.org/10.1111/birt.12258
Macarthur, A. J., & Macarthur, C. (2004). Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study. American Journal of Obstetrics and Gynecology, 191(4), 1199–1204. https://doi.org/10.1016/j.ajog.2004.02.064
Manresa, M., Pereda, A., Bataller, E., Terre-Rull, C., Ismail, K. M., & Webb, S. S. (2019). Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis. International Urogynecology Journal, 30(6), 853–868. https://doi.org/10.1007/s00192-019-03894-0
Manresa, M., Pereda, A., Goberna-Tricas, J., Webb, S. S., Terre-Rull, C., & Bataller, E. (2020). Postpartum perineal pain and dyspareunia related to each superficial perineal muscle injury: a cohort study. International Urogynecology Journal, 31(11), 2367–2375. https://doi.org/10.1007/s00192-020-04317-1
McDonald, E. A., & Brown, S. J. (2013). Does method of birth make a difference to when women resume sex after childbirth? BJOG: An International Journal of Obstetrics & Gynaecology, 120(7), 823–830. https://doi.org/10.1111/1471-0528.12166
McDonald, E. A., Gartland, D., Small, R., & Brown, S. J. (2015). Dyspareunia and childbirth: a prospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 122(5), 672–679. https://doi.org/10.1111/1471-0528.13263
Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18(1), article 143. https://doi.org/10.1186/s12874-018-0611-x
Nussbaumer-Streit, B., Klerings, I., Dobrescu, A. I., Persad, E., Stevens, A., Garritty, C., Kamel, C., Affengruber, L., King, V. J., & Gartlehner, G. (2020). Excluding non-English publications from evidence-syntheses did not change conclusions: a meta epidemiological study. Journal of Clinical Epidemiology, 118, 42-54. https://doi.org/10.1016/j.jclinepi.2019.10.011
Ordem dos Enfermeiros. (2021). Padrões de qualidade dos cuidados especializados em enfermagem de saúde materna e obstétrica. https://www.ordemenfermeiros.pt/media/23179/ponto-3_padr%C3%B5es-qualidade-dos-cuidados-eesmo.pdf
Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan — a web and mobile app for systematic reviews. Systematic Reviews, 5(1), 210. https://doi.org/10.1186/s13643-016-0384-4
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372(71). https://doi.org/10.1136/bmj.n71
Persico, G., Vergani, P., Cestaro, C., Grandolfo, M., & Nespoli, A. (2013). Assessment of postpartum perineal pain after vaginal delivery: prevalence, severity and determinants. A prospective observational study. Minerva Ginecologica, 65(6), 669–678. https://pubmed.ncbi.nlm.nih.gov/24346253/
Peters, M. D. J., Godfrey, C., McInerney, P., Munn, Z., Tricco, A. C., & Khalil, H. (2020). Chapter 11: Scoping reviews (2020 version). In E. Aromataris & Z. Munn (Eds.), JBI Reviewer manual. JBI. https://doi.org/10.46658/JBIMES-20-12
Peters, M. D. J., Marnie, C., Colquhoun, H., Garritty, C. M., Hempel, S., Horsley, T., Langlois, E. V., Lillie, E., O’Brien, K. K., Tunçalp, Ö., Wilson, M. G., Zarin, W., & Tricco, A. C. (2021). Scoping reviews: reinforcing and advancing the methodology and application. Systematic Reviews, 10(1), article 263. https://doi.org/10.1186/s13643-021-01821-3
Pollock, D., Davies, E. L., Peters, M. D. J., Tricco, A. C., Alexander, L., McInerney, P., Godfrey, C. M., Khalil, H., & Munn, Z. (2021). Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. Journal of Advanced Nursing, 77(4), 2102-2113. https://doi.org/10.1111/jan.14743
Rikard-Bell, J., Iyer, J., & Rane, A. (2014). Perineal outcome and the risk of pelvic floor dysfunction: a cohort study of primiparous women. Australian and New Zealand Journal of Obstetrics and Gynaecology, 54(4), 371–376. https://doi.org/10.1111/ajo.12222
Rodrigues, S., Silva, P., Borges, A. C., de Sousa, N. Q., Silva, J. N., & Escuriet, R. (2024). Effect of perineal massage and warm compresses technique in postpartum pelvic floor dysfunction: a secondary analysis from a randomised controlled trial. Reproductive Sciences, 31(4), 1006–1016. https://doi.org/10.1007/s43032-023-01424-4
Rogers, R. G., Borders, N., Leeman, L. M., & Albers, L. L. (2009). Does spontaneous genital tract trauma impact postpartum sexual function?. Journal of Midwifery & Women’s Health, 54(2), 98–103. https://doi.org/10.1016/j.jmwh.2008.09.001
Senol, D. K., & Aslan, E. (2018). Perineal pain severity in postpartum period evaluated six hours and three months after delivery. International Journal of Caring Sciences, 11(3), 1691–1696. https://internationaljournalofcaringsciences.org/docs/40_aslan_original_11_3.pdf
Shahraki, A. D., Aram, S., Pourkabirian, S., Khodaee, S., & Choupannejad, S. (2011). A comparison between early maternal and neonatal complications of restrictive episiotomy and routine episiotomy in primiparous vaginal delivery. Journal of Research in Medical Sciences, 16(12), 1583–1589. https://pubmed.ncbi.nlm.nih.gov/22973367/
Signorello, L. B., Harlow, B. L., Chekos, A. K., & Repke, J. T. (2001). Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. American Journal of Obstetrics & Gynecology, 184(5), 881–888. https://doi.org/10.1067/mob.2001.113855
Williams, A., Herron-Marx, S., & Knibb, R. (2007), The prevalence of enduring postnatal perineal morbidity and its relationship to type of birth and birth risk factors. Journal of Clinical Nursing, 16(3), 549-561. https://doi.org/10.1111/j.1365-2702.2006.01593.x
World Health Organization. (2018). WHO recommendations: intrapartum care for a positive childbirth experience. https://www.who.int/publications/i/item/9789241550215
World Health Organization. (2022). WHO recommendations on maternal and newborn care for a positive postnatal experience. https://www.who.int/publications/i/item/9789240045989
Yamada, A., Takahashi, Y., Hirose, M., Usami, Y., Maruya, S., & Tamakoshi, K. (2024). Factors associated with perineal pain on the first postnatal day after vaginal delivery: a cross-sectional study of primiparous women. Nagoya Journal of Medical Science, 86(1), 52–63. https://doi.org/10.18999/nagjms.86.1.52
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