Effects of Episiotomy: Beyond Physical


A recent study by the University of Michigan has found that women who have an episiotomy during childbirth experience feelings of poor body image and a less satisfying sex life than women who have not had the procedure.


The episiotomy procedure is a surgical incision to cut the muscles and other tissue of the perineum, the area located between the vagina and the anus, to open the area and allow for an easier birth.

The procedure was standard for many years, as many physicians believed a surgical cut would leave patients with less scarring and a more aesthetically pleasing final look.

Other theories regarding the procedure were that it would help to prevent stress on the bladder that would lead to incontinence after delivery.

However, in the last twenty years, researchers found that the procedure did not yield any real health benefits over allowing women to tear naturally during childbirth. Studies of the procedures showed that the episiotomy procedure puts women at risk for serious tears reaching as far the anal sphincter. These types of lacerations can lead to complications in healing, like infection, as well as problems urinating and defecating. As a result, the American Congress of Obstetricians and Gynecologists advise that the episiotomy procedure should not be done regularly.

Around 12 percent of women still receive episiotomies in the United States, but the practice is done at the discretion of the patient and the provider. It is a common procedure for first-time mothers.

The Michigan study is one of the first to examine how women feel about the procedure’s impact on the look of their vagina and any emotional esteem issues tied to the procedure.

Sixty-nine women participated in the study. Eight-four percent of the participants reported physical changes to their vaginal and rectal areas after giving birth.

Many women experience changes to their vagina brought on by childbirth. Changes include vaginal laxity, or a feeling of looseness, misshapen or elongated labia and a change in the appearance of their vagina. These changes can negatively impact how a woman feels about her body and may make her uncomfortable

The study found that the women who had the episiotomy procedure frequently had negative feelings about the looks of their genitals and lacked self-esteem in intimate relationships. Researchers also found that episiotomy patients had these feelings at a higher rate than study participants that did not have an episiotomy, but still had physical changes to their genitals brought on by childbirth.

The factor that increased episiotomy patients’ negative feelings was scarring that occurred as a result of the surgery and the stitches required after the procedures.

"Changes that remain after the procedure may make some women feel self-conscious," Dr. Mona Alqulali, M.D., F.A.C.O.G., said.

Alqulali in a Clinton, Iowa, OB-GYN. She counsels many women about the changes in their bodies that occur both during and after childbirth.

"The body undergoes considerable changes because of pregnancy and childbirth, and many women are left with a different body afterward," Alqulali said.

Feelings of self-consciousness regarding the appearance of their vagina often prompt women to seek cosmetic vaginal surgery procedures, like labiaplasty. The labiaplasty procedure surgically reduces the size of the labia. Some women also choose to have dermal fillers injected into their labia to improve the shape of the tissue.

Leaders of the study hope that their findings encourage more communication between women and they OB-GYN health providers.

"Women should discuss their preferences regarding episiotomy with their doctor," Alqulai said.

Alqulali also encourages women with feelings of self-consciousness regarding their the appearance of their genitals to discuss their options for genital cosmetic surgery with their physicians.

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