Preventing perineal trauma during childbirth: a systematic review.

Eason et al, in an extensive and carefully documented review of perineal trauma during childbirth (Obstet Gynecol 2000;95:464–71), fail to define “perineal trauma,” the topic of the paper. I assume it is defined as a visible tear in the skin of the perineum or a visual tear of the sphincter. In over 30 years in this profession, I have yet to see a paper documenting the late (or delayed) results of the treatment (or lack of it) of the perineum at delivery, in terms of persistent significant symptoms or dysfunction of the perineum. I submit that the end point of visual trauma is invalid in the assessment of future symptoms or function related to the perineal technique used at delivery. “Trauma” is often occurring under that intact, stretched skin. In many medical situations, it is obvious that some present pain (ie ample episiotomy) is necessary to prevent future undesirable results. Old National Geographic pictures of African tribesmen with huge lips demonstrate that it is possible to stretch many parts of our bodies to great extents. This can surely be done with the female perineum; however, it is not necessarily desirable.