Management of Perineal Injury After Vaginal Childbirth: Surgery or Pelvic Floor Exercises?

Inadequately healed perineal tears after vaginal delivery may cause dyspareunia, genital discomfort, and a sensation of an open or wide vagina. Investigators in Sweden randomized 70 women at a median 10 months' postpartum (age, 35; parity, 2; body-mass index, 22.5 kg/m²; perineal body thickness <2 cm) with symptomatic perineal tears to surgical repair (perineorrhaphy with distal posterior colporrhaphy) or pelvic floor physical therapy (PT). Participants assigned to PT saw a physical therapist for consultation and up to 3 follow-up visits; they were taught how to contract their pelvic floor muscles and instructed to build up to 10 maximal 5-second contractions 3 times daily. The primary outcome, the Patient Global Impression of Improvement, …