Page 138 - Petelin, Ana, Nejc Šarabon, Boštjan Žvanut, eds. 2017. Zdravje delovno aktivne populacije ▪︎ Health of the Working-Age Population. Proceedings. Koper: Založba Univerze na Primorskem/University of Primorska Press
P. 138
avje delovno aktivne populacije | health of the working-age population 136 Episiotomy is a surgical incision into the perineum in order to assist the
birth of a baby (Dahlen, 2015). The correct performance of the cut is of
crucial meaning for the future sexual life of the labouring woman.
Episiotomy
The recommended use is restrictive (only in the case of indications such as foe-
tal distress and the urgent need to finish the labour quickly) (Jiang et al., 2017).
In case of the need for episiotomy, the correct timing to perform the procedure
is when 3-4 cm of presenting part of the baby is visible in between the contrac-
tions. Local anaesthetic should be applied before the procedure (Dahlen, 2015).
National Institute for Clinical Excellence - NICE (2017) suggests mediolateral
type of episiotomy that must be executed in one clear cut. The recommended
length of the incision is 2 and not more than 4 cm. The cut should start at the
midpoint of the fourchette, directed mediolateral at a 45-60° angle, toward the
ischial tuberosity (Kalis et al., 2017).
If the start of episiotomy is too lateral, Bartholin’s glands can be damaged
and if performed too soon, episiotomy can cause more bleeding (Holmes and
Baker, 2006) and the musculus levator ani (Dahlen, 2015) that pays a major role
in the woman’s sexual excitation can be damaged. Episiotomy also weakens
perineal muscles (Walsh, 2007) and can predispose woman to perineal trauma,
therefore routines use is not advised (Jiang et al., 2017).
Dyspareunia
Dyspareunia is genital-pelvic pain, evoked by the penetration during the sex-
ual intercourse and is classified as a sexual dysfunction by American Psychiat-
ric Association – APA (2013). It can be expressed as a local pain at the vaginal
introitus or a diffuse pain in the pelvis. The nature and intensity of pain var-
ies. Dyspareunia can be primary or secondary and is closely connected to vag-
inismus and/or vulvodynia (Edwards and Bowen, 2010; World Health Organ-
ization - WHO, 2010).
The incidence of dyspareunia is increasing (APA, 2013), especially among
young women. Systematic review by Latthe et al. (2006) showed that studies re-
port very different rates of dyspareunia. Numbers in the reviewed studies var-
ied from 8 to 21.8 %. Slovenian online study among women under the age of 30
(N = 408) revealed prevalence of 15.4 % (Kovačič, 2014).
The causes for dyspareunia can be physical or psychological (WHO,
2010). In the case of vulvo-vaginal pain are physical causes more common, es-
pecially common cause is perineal trauma (Edwards and Bowen, 2010). This
can be closely connected with episiotomy. A very important determinant of
postpartum sexual function is perineal pain and resultant dyspareunia (Škod-
ič Zakšek, 2015).
Slovenian online study among 368 women who gave birth in the last 24
months and had episiotomy during it showed that women often postpone first
birth of a baby (Dahlen, 2015). The correct performance of the cut is of
crucial meaning for the future sexual life of the labouring woman.
Episiotomy
The recommended use is restrictive (only in the case of indications such as foe-
tal distress and the urgent need to finish the labour quickly) (Jiang et al., 2017).
In case of the need for episiotomy, the correct timing to perform the procedure
is when 3-4 cm of presenting part of the baby is visible in between the contrac-
tions. Local anaesthetic should be applied before the procedure (Dahlen, 2015).
National Institute for Clinical Excellence - NICE (2017) suggests mediolateral
type of episiotomy that must be executed in one clear cut. The recommended
length of the incision is 2 and not more than 4 cm. The cut should start at the
midpoint of the fourchette, directed mediolateral at a 45-60° angle, toward the
ischial tuberosity (Kalis et al., 2017).
If the start of episiotomy is too lateral, Bartholin’s glands can be damaged
and if performed too soon, episiotomy can cause more bleeding (Holmes and
Baker, 2006) and the musculus levator ani (Dahlen, 2015) that pays a major role
in the woman’s sexual excitation can be damaged. Episiotomy also weakens
perineal muscles (Walsh, 2007) and can predispose woman to perineal trauma,
therefore routines use is not advised (Jiang et al., 2017).
Dyspareunia
Dyspareunia is genital-pelvic pain, evoked by the penetration during the sex-
ual intercourse and is classified as a sexual dysfunction by American Psychiat-
ric Association – APA (2013). It can be expressed as a local pain at the vaginal
introitus or a diffuse pain in the pelvis. The nature and intensity of pain var-
ies. Dyspareunia can be primary or secondary and is closely connected to vag-
inismus and/or vulvodynia (Edwards and Bowen, 2010; World Health Organ-
ization - WHO, 2010).
The incidence of dyspareunia is increasing (APA, 2013), especially among
young women. Systematic review by Latthe et al. (2006) showed that studies re-
port very different rates of dyspareunia. Numbers in the reviewed studies var-
ied from 8 to 21.8 %. Slovenian online study among women under the age of 30
(N = 408) revealed prevalence of 15.4 % (Kovačič, 2014).
The causes for dyspareunia can be physical or psychological (WHO,
2010). In the case of vulvo-vaginal pain are physical causes more common, es-
pecially common cause is perineal trauma (Edwards and Bowen, 2010). This
can be closely connected with episiotomy. A very important determinant of
postpartum sexual function is perineal pain and resultant dyspareunia (Škod-
ič Zakšek, 2015).
Slovenian online study among 368 women who gave birth in the last 24
months and had episiotomy during it showed that women often postpone first
