An episiotomy is a surgical procedure that can be performed during a vaginal birth. It involves making an incision (a cut) in the perineum (the region between the opening of the vagina and the anus) and its objective is to widen the opening of the vagina, making it easier for the baby to come out. Episiotomy is not a routine procedure performed in any vaginal birth. It should only be performed in selected cases, that is, when it is absolutely necessary. Therefore, the decision to do it or not can only be made during childbirth, considering the conditions at the time. There are two types of episiotomy incisions, the median and the mediolateral. Mediolateral episiotomy, in which the incision line forms an angle in relation to the midline , is the most frequently performed in Europe, including Portugal. It has a lower risk of laceration of the anal sphincter and rectum compared to median episiotomy. It is also associated with a 50% reduction in the risk of rectum and anal sphincter injuries compared with the option of not performing an episiotomy (6% versus 13%). After birth, the episiotomy is sutured with stitches that will be eliminated naturally. Indications for an episiotomy Episiotomy may be indicated in situations of: Fetal distress, demonstrated by a pathological cardiotocography (CTG), with the aim of shortening time to birth; Narrowed vaginal canal and need for instrumental delivery, in which mediolateral episiotomy reduces the risk of anal sphincter and/or rectal in instrumental deliveries from 13% to 6%; Some situations of shoulder dystocia; Perineal rigidity in women who have previously undergone vulvar interventions; Signs of imminent severe perineal tear (grade 3 and 4) or when it is already beginning. Complications associated with an episiotomy The most common early complications of episiotomy are its extension to the anal sphincter and rectum (which is more frequent in median episiotomy), greater blood loss, infection and pain. Bruising may also occur, but this is a rare complication. The most frequent late complications are dyspareunia (pain during sexual intercourse), increased risk of laceration in a future birth and fear of having to perform a new episiotomy. All of these complications can occur with a spontaneous perineal tear, especially in the case of severe ones. This content was prepared by the Gynecology-Obstetrics team at Hospital da Luz. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
