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Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis


Introduction and hypothesis

Perineal pain and dyspareunia are experienced by women undergoing a vaginal birth that can have short and longer term physical and psychological morbidities. This review aimed to determine the incidence of perineal pain and dyspareunia following spontaneous vaginal birth (SVB) with intact perineum, first and second-degree perineal trauma or episiotomy.


Searches of MEDLINE, EMBASE, CINAHL, AMED and MIDIRS (inception – December 2017) were undertaken with selection criteria of any study evaluating the effect of intact perineum, first- or second-degree perineal trauma on perineal pain or dyspareunia in women with SVB.


Eighteen studies (8 RCTs and 10 NRSs) were included. Fourteen and 12 studies were undertaken to assess perineal pain and dyspareunia after SVB, respectively. Meta-analysis of 16 studies (3133 women) demonstrated that women at 2 days postpartum experienced nearly the same incidence of perineal pain whether perineal trauma existed or not. At 4–10 days postpartum there was a significant reduction in the incidence of perineal pain for both presence and absence of any perineal trauma. Episiotomy was associated with the highest rate of perineal pain. The incidence of dyspareunia was high at resumption of sexual intercourse following SVB with an intact perineum. At 12 months, women still experienced dyspareunia whether perineal trauma existed or not.


Women experience perineal pain and dyspareunia regardless of the presence or absence of perineal trauma after SVB; nonetheless, the reported incidence is higher if perineal trauma occurred.

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Correspondence to Margarita Manresa.

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IUGA 43rd Annual Meeting, Vienna, Austria. 27–30 June 2018.

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Table S1

Quality assessment criteria for NRSs using Joana Briggs Institute Prevalence Critical Appraisal Tool (DOCX 13 kb)

Figure S1

Quality assessment of the studies included in the Perineal Pain and Dyspareunia Systematic Review (DOCX 107 kb)

Appendix 1

: PRISMA 2009 Check list (DOC 66 kb)

Appendix 2

: MEDLINE search strategies (DOCX 13 kb)

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Manresa, M., Pereda, A., Bataller, E. et al. Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis. Int Urogynecol J 30, 853–868 (2019).

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  • Perineal trauma
  • Perineal pain
  • Dyspareunia
  • Spontaneous vaginal birth
  • Systematic review