Severe perineal tears can predict bothersome pelvic floor disorders later in life. More than 85% of females who undergo a vaginal birth will suffer from some degree of perineal tear. With an increasing global birth rate and rising interventions in birth, the incidence of perineal trauma following vaginal birth is increasing on an international scale, impacted also by more accurate classification and definitions of obstetric anal sphincter injuries (OASIS) and increased pre-existing co-morbidities amongst affected women. We aimed to compare women with severe perineal trauma during childbirth with women who experienced minimal trauma, for pelvic floor distress, sexual function, and fecal incontinence in the long term at least one year after repair.

In a retrospective study,  delivery data was collected at a tertiary care women’s center. We recruited women with third- or fourth-degree tears (obstetric anal sphincter injuries, OASIS) and age-matched controls with no tears, first-degree tears, or second-degree in the one-year after postpartum period. Participants completed validated questionnaires at least one year after repair.

A total of 75 women completed the questionnaire (36 OASIS, 33 controls, and six sphincteroplasty). Both groups had similar demographics except for age (P=0.026). The episiotomy rate in the OASIS group was significantly higher than in the control group (52.8% vs. 12.1%; P<0.001). In addition, care providers related to the delivery in women with OASIS were different compared to the control group (P<0.001). Analgesia was used in 33.3% of the control group vs. 8.3%of OASIS (P=0.01). Augmentation with oxytocin alone or beside misoprostol was used in most of the women in the control group (63.6%, and 15.2%) compared to the OASIS group (P<0.001). Different validated questionnaires were completed for women, and the results showed that there are no differences in the total scores of Pelvic Floor Distress Inventory (PFDI - 20), and its subdomains (Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6); Colorectal-Anal Distress Inventory-8 (CRADI-8); Urinary Distress Inventory-6 (UDI-6)), Female Sexual Function Index (FSFI) and its domains, including desire, arousal, lubrication, orgasm, satisfaction, and pain as well as International Consultation on Incontinence Questionnaire Anal Incontinence Symptoms and Quality of Life Module (ICIQ-B) (P>0.05).

In conclusion, this study found significant differences in episiotomy rates, care provider relationships, analgesia use, and augmentation methods between women with obstetric anal sphincter injuries (OASIS) and controls. However, there were no differences in pelvic floor dysfunction, sexual function, or quality of life scores between the two groups. These findings suggest that while there are differences in certain obstetric outcomes, the long-term impact on pelvic floor function and quality of life may not be significantly different between women with OASIS and controls. Further research is needed to explore these findings and their implications for clinical practice.

In conclusion, this study found significant differences in episiotomy rates, care provider relationships, analgesia use, and augmentation methods between women with obstetric anal sphincter injuries (OASIS) and controls. However, there were no differences in pelvic floor dysfunction, sexual function, or quality of life scores between the two groups. These findings suggest that while there are differences in certain obstetric outcomes, the long-term impact on pelvic floor function and quality of life may not be significantly different between women with OASIS and controls. Further research is needed to explore these findings and their implications for clinical practice.