Long-term impacts of vaginal birth with mediolateral episiotomy on sexual and pelvic dysfunction and perineal pain

Objective: To investigate whether spontaneous vaginal birth with mediolateral episiotomy has any long-term impact on urinary and/or fecal incontinence, sexual dysfunction and perineal pain in primiparous women.

Methods: This matched case-control study included 150 women between 25 and 35 years old who had a singleton childbirth at least five years previously. Patients were grouped as; women who had a spontaneous vaginal delivery with mediolateral episiotomy (Group 1), an elective cesarean delivery (Group 2), and who had no delivery (Group 3). Controls were matched for age and delivery time. Urinary/fecal incontinence were questioned and Female Sexual Function Index (FSFI) questionnaire was completed. Total FSFI and domain scores were compared. Statistical evaluation was performed using One-way ANOVA test or χ² test. Statistical significance was defined as p?Results: No women had urinary/fecal incontinence nor sexual dysfunction. Mean total FSFI points in Group 1 were significantly lower than in Groups 2 and 3 (p?=?0.001). There were significant differences in sexual desire between groups 1 and 3 (p?=?0.005), in arousal and in orgasm between both groups 1 and 2 (p?=?0.001 and p?=?0.038, respectively) and groups 1 and 3 (p?=?0.001 and p?=?0.001, respectively). There was no significant difference between groups 2 and 3 in any parameters or total points.

Conclusions: Vaginal delivery with mediolateral episiotomy is not associated with urinary and/or fecal incontinence and sexual dysfunction but associated with a decreased sexual functioning as well as sexual desire, arousal and orgasm within postpartum five years.     

Development,validity and reliability of a new pressure air biofeedback device (PAB) for measuring isometric extension strength of the lumbar spine

This study describes the development of a new portable muscle testing device, using air pressure as a biofeedback and strength testing tool. For this purpose, a pressure air biofeedback device (PAB^®) was developed to measure and record the isometric extension strength of the lumbar multifidus muscle in asymptomatic and low back pain (LBP) persons. A total of 42 subjects (age 47.58 years, ±18.58) participated in this study. The validity of PAB^® was assessed by comparing a selected measure, air pressure force in millibar (mb), to a standard criterion; calibrated weights in kilograms (kg) during day-to-day tests. Furthermore, clinical trial-to-trial and day-to-day tests of maximum voluntary isometric contraction (MVIC) of L5 lumbar multifidus were done to compare air pressure force (mb) to electromyography (EMG) in microvolt (μV) and to measure the reliability of PAB^®. A highly significant relationship were found between air pressure output (mb) and calibrated weights (kg). In addition, Pearson correlation calculations showed a significant relationship between PAB^® force (mb) and EMG activity (μV) for all subjects (n?=?42) examined, as well as for the asymptomatic group (n?=?24). No relationship was detected for the LBP group (n?=?18). In terms of lumbar extension strength, we found that asymptomatic subjects were significantly stronger than LBP subjects. The results of the PAB^® test differentiated between LBP and asymptomatic subject’s lumbar isometric extension strength without any risk to the subjects and also indicate that the lumbar isometric extension test with the new PAB^® device is reliable and valid.     

Management of acute pain

Acute pain is an important fear for most patients and influences their recovery and overall experience. Poorly treated, it could lead to undesirable effects and patient dissatisfaction. Hence, it is important to understand, assess and treat acute pain effectively. Pain is regarded as the fifth vital sign and should be addressed as important as other vital parameters. Management of pain involves team work, including acute pain services, especially in dealing with complex problems. Management of pain ideally starts at the pre-assessment visit or from first presentation to the clinician. It is important to anticipate and treat acute pain effectively, which may prevent the development of chronic pain syndromes. Patients should be given information about analgesic options, the risk:benefit ratio of the treatment options at the earliest opportunity and ideally have an individualized management plan.