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Childbirth-Related Perineal Trauma: Clinical Significance and Prevention


Connolly, AnnaMarie & Thorp, John M., Jr. (1999). Childbirth-Related Perineal Trauma: Clinical Significance and Prevention. Clinical Obstetrics & Gynecology, 42(4), 820-835.


The etiology of pelvic floor dysfunction is not known. Speculation about it focuses on known risk factors associated with dysfunction such as estrogen deficiency, chronically increased intra-abdominal pressure as from lifting or coughing, chronic straining with bowel movements, neurologic injury, and underlying predisposition as from poor nutrition or connective tissue abnormalities such as Ehlers–Danlos syndrome. 1 Childbirth is consistently associated with stress urinary incontinence (SUI), genital organ prolapse, and anal incontinence and thus is assumed to be a major causal factor. Making sense of the literature about childbirth and dysfunction is daunting given the variety of study designs and outcome variables measured. Time is a major barrier to exploring this relationship as the event in question, childbirth, may proceed the outcome, pelvic floor dysfunction, by many years. The studies available include questionnaire data 2,3; observational, case-control studies 4; cross-sectional descriptive studies 5; and prospective, cohort studies. 6,7 Most, by their small numbers, limit the ability to control for important cofactors. An overview of this topic involves reviewing data supporting that childbirth damages the pelvic floor and reviewing what may be possible to prevent or minimize damage and its sequelae, including perineal management at the time of delivery.


Reference Type

Journal Article

Year Published


Journal Title

Clinical Obstetrics & Gynecology


Connolly, AnnaMarie
Thorp, John M., Jr.