Episiotomy and perineal trauma during childbirth in primiparous women: associations with anxiety, quality of life, vaginal and sexual symptoms in the first year postpartum

Maria Patricia Roman^1,2Razvan Ciortea^1,2*Stergios K Doumouchtsis^3,4,5Andrei Mihai Măluțan^1,2Carmen Elena Bucuri^1,6Oana Mihaela Oltean¹Cristina Mihaela Ormindean^1,2Viorela Elena Suciu¹Ionel-Daniel Nati^1,2Denisa Rus²Dan Mihu^1,2

• ¹University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
• ²County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Cluj, Romania
• ³Epsom and St Helier University Hospitals NHS Trust, Carshalton, United Kingdom
• ⁴St George's, University of London, London, England, United Kingdom
• ⁵National and Kapodistrian University of Athens, Athens, Greece
• ⁶Military Emergency Hospital Doctor Constantin Papilian, Cluj-Napoca, Romania

Introduction: Childbirth-related pelvic floor trauma is prevalent among primiparous women and can lead to significant physical and psychological consequences. While the impact of pelvic floor trauma on physical outcomes has been studied, the relationship between anxiety caused by such trauma and long-term patient-reported outcomes (PROs) such as vaginal symptoms, sexual function, and quality of life (QoL) remains underexplored. This study aims to fill this gap by investigating the association between anxiety induced by pelvic floor trauma during childbirth and these key PROs.Methods: This prospective longitudinal cohort study analysed data from 175 nulliparous women who delivered at term a singleton fetus in cephalic presentation and sustained some form of perineal trauma. Anxiety levels were assessed at two time points: during labour and at 12 months postpartum, using a single-item 10-point Likert scale. The other PROs were measured using the International Consultation on Incontinence Questionnaire-Vaginal Symptoms tool (ICIQ-VS).Results: Findings revealed that higher anxiety scores at birth were associated with elevated anxiety levels at 12 months postpartum and correlated significantly with increased vaginal symptoms, sexual symptoms, and QoL. Notably, while anxiety was linked to negative physical outcomes, higher anxiety scores were also associated with improved perceived QoL, suggesting the potential role of coping mechanisms in response to childbirth trauma as well as the need for future studies using more specialized anxiety tools.Conclusions: The study underscores the intricate relationship between psychological distress and physical health outcomes in postpartum women. Addressing both anxiety and physical symptoms through personalized care strategies may enhance recovery and overall well-being. Future research should explore effective interventions to mitigate anxiety, evaluate resilience and improve PROs in this population.