Standardized Episiotomy Using a Blade-Based Device Reduces Long-Term Perineal Pain and Improves Sexual Function: A Randomized Controlled Trial

Int Urogynecol J. 2026 Jun 17. doi: 10.1007/s00192-026-06763-9. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Although routine episiotomy is discouraged, mediolateral episiotomy remains necessary in selected clinical situations. Variability in incision technique may influence pelvic floor-related morbidity. We hypothesized that a standardized blade-based episiotomy technique would be associated with lower rates of persistent perineal pain and improved sexual function compared with conventional scissors.

METHODS: In this randomized controlled trial, 60 nulliparous women undergoing vaginal delivery with a clinical indication for mediolateral episiotomy were randomized to episiotomy performed using a standardized blade-based device (BasIQ-4) or conventional Braun-Stadler scissors. Perineal pain was assessed using a visual analog scale at 2 and 48 h postpartum. The primary outcome was persistent perineal pain at 6 months postpartum, evaluated using a structured clinical interview. Sexual function at 6 months was assessed using the Female Sexual Function Index (FSFI).

RESULTS: Sixty nulliparous women were randomized and included in the intention-to-treat analysis (BasIQ-4, n = 30; scissors, n = 30). Baseline demographic and obstetric characteristics were largely similar between groups. Pain scores at 2 h postpartum were lower in the BasIQ-4 group, with no differences at 48 h. Persistent perineal pain at 6 months was significantly less frequent in the BasIQ-4 group (6.7% vs. 50.0%, p < 0.001). Total FSFI scores were significantly higher in the BasIQ-4group, primarily driven by differences in pain-related domains.

CONCLUSIONS: When mediolateral episiotomy is clinically indicated, incision standardization using a blade-based technique is associated with reduced long-term perineal pain and improved pain-related aspects of postpartum sexual function.

PMID:42307742 | DOI:10.1007/s00192-026-06763-9