Perineal damage associated with vaginal birth occurs in up to 85% of women and generates short- and long-term complications, especially when they are severe (OASIS - obstetric anal sphincter injuries) which, despite fewer incidents, cause greater anatomical impact, functional, psychological and financial, extremely unwanted as they promote negative effects on the quality of life of these women. The incidence of urinary incontinence (UI) after OASIS varies in the world literature at around 13 – 46% after the third month of postpartum, with authors also stating that there is no difference in the incidence of UI in women with and without OASIS1. The signs and symptoms commonly observed in patients after OASIS are pelvic pain, lower urinary tract symptoms, anal incontinence (AI), dyspareunia, muscle disorders, infections, surgical wound dehiscence and rectus-vaginal fistula2. 
The influence of OASIS on the long-term prevalence of such symptoms has been reasonably studied, however, existing results are conflicting. Furthermore, factors associated with the development of such symptoms remain unclear in the literature3. 
After analyzing studies involving women who had OASIS, the following question emerged: what is the prevalence of urinary and intestinal symptoms, pelvic pain and sexual dysfunction in patients treated in our population? And what is the impact of such symptoms on the quality of life of these women? To evaluate in the long term the possible symptoms of pelvic floor dysfunction (PFD), through the application of validated questionnaires, comparing them with women without severe perineal injuries.

A prospective cohort study was carried out with women who had recently given birth vaginally with (G2) and without (G1) OASIS lesions, between July 2022 and January 2024. 
Sociodemographic, pregnancy and birth data, recorded in medical records, and the scores of the quality of life questionnaires: Pelvic Floor Distress Inventory – Short Form – 20 (PFDI – 20), Pelvic Floor Impact Questionnaire (PFIQ – 7), Female Sexual Function Index (FSFI), and general quality of life (Short form – SF 36), were analyzed at the time of hospitalization (T0) and 3 months (T1) after birth, comparing the groups. 
The database was structured in an Excel® spreadsheet and was evaluated for normality distribution using the Kolmogorov Smirnov test. Afterwards, the Mann-Whitney test, Pearson's Chi-Square test, Fisher's exact test, and the Friedman/Dunn test were applied. Conclusions were based on p-values using the traditional 5% cutoff range. The descriptive analysis of the database variables was placed in tables and graphs.

The incidence of OASIS in the studied period was 1.17%. Ninety-one women participated (G1 n=69 vs G2 n=22). Primiparity (p=0.03), epidural analgesia (p=0.041), use of a vacuum extractor (p=0.046), and greater newborn (NB) weight (p=0.002) were associated with a greater risk of OASIS. Thirty-four patients reported UI at T0, 82.4% were from G1 and 17.6% from G2. Stress UI was more prevalent in G1 and urgency UI in G2. Only 1 (1.44%) woman in G1 presented AI. At T1, the incidence of UI was 60% in G2 and 40% in G1 (p=0.047), 2 women in each group presented AI. 
In the SF-36, an improvement in quality of life was observed in both groups over time, with no difference between the groups, except functional capacity (FC) (p=0.546 and p=0.197). The limitation of the emotional aspect was the only domain that was worse in G1 at T0 (p=0.033). 
In the FSFI, all scores worsened between T0 and T1 (p<0.001), however there was no difference in desire (p=0.330) in G2. At T0, G2 scores were worse than G1, except for satisfaction (p=0.059). G2's sexuality worsened over time. 
In the PFDI-20, an improvement in the score was observed between T0 and T1 (p<0.001), with the exception of intestinal symptoms that worsened in G2 (p=0.430). At T2, intestinal and bladder symptoms and the total score were worse in G2 (p=0.014, 0.005, 0.006). 
In PFIQ-7, only the impact of intestinal symptoms in G1 did not decrease over time (p=0.501) , and no G2 domain had an impact between T0 and T1, despite the improvement in the score that only did not occur in the intestinal domain. Bladder symptoms and total score were worse in G2 than in T1.

The impact of OASIS lesions occurs not only on the pelvic floor, but also on women's quality of life, due to urinary and intestinal symptoms. UI was present in 17.6% of women with such injuries, and intestinal symptoms in 59% after 3 months of birth.

The present study showed the risk factors associated with OASIS, as well as the main symptoms generated, in addition to the association of such symptoms with worsening quality of life.

ANDREWS, V. et al. Anal and urinary incontinence 4 years after a vaginal delivery. International Urogynecology Journal and Pelvic Floor Dysfunction, v. 24, n. 1, p. 55–60, 2013
KARP, D. R. et al. Health Care – Seeking Characteristics of Women With Pelvic Floor Disorders After Obstetric Anal Sphincter Injury. v. 00, n. 00, p. 1–5, 2018.
MARSH, F. et al. Obstetric anal sphincter injury in the UK and its effect on bowel, bladder and sexual function. European Journal of Obstetrics and Gynecology and Reproductive Biology, v. 154, n. 2, p. 223–227, 2011.