{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T02:23:19Z","timestamp":1776306199199,"version":"3.50.1"},"reference-count":36,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T00:00:00Z","timestamp":1692316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Perineal tears are common after childbirth and, if not surgically repaired, they may result in a deficient perineum that can cause symptoms of pelvic floor dysfunction. Perineal reconstruction aims to restore the perineal body and increase the support of the pelvic floor. The objective of the present study was to estimate symptom reduction after perineal reconstruction in patients with deficient perineum after vaginal delivery and to compare outcomes between participants with or without concomitant levator ani muscle deficiency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Participants presenting at the Karolinska Pelvic Floor Center with symptoms of deficient perineum at least 1\u2009year after vaginal birth were invited to the study. Inclusion criteria were a visible perineal scar and confirmed anatomic defect. Levator ani defects were assessed using the Levator Ani Deficiency score. A perineal reconstruction was performed in a standardized way. Subjective symptoms were evaluated using the validated \u201cKarolinska Symptoms After Perineal Tear Inventory\u201d at baseline and 1\u2010year follow\u2010up. A score difference in the symptom of an acquired sensation of a wide vagina was the primary outcome. Results were stratified by the presence or absence of a levator ani deficiency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A perineal reconstruction was performed in 131 patients and 128 patients completed the Karolinska Symptoms After Perineal Tear Inventory at baseline and 119 at follow\u2010up. Median age was 36.1 (interquartile range [IQR] 7.9), median body mass index 22.3 (IQR 5.1) and a median of two vaginal deliveries. Fifty\u2010four women (41.2%) had a levator ani deficiency. The mean score reduction for the item \u201cDo you feel that your vagina is too wide\/loose?\u201d was \u22121.56 (SD 0.96; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) from a mean score of 2.75 (maximum 3) at baseline. The mean total score reduction was \u22129.1 points (SD 5.3; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) from a mean score of 18.4 (maximum 33) points at baseline. There were no significant differences between groups when stratifying by levator ani deficiency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results show that perineal reconstructive surgery significantly decreases symptoms of deficient perineum after vaginal delivery. A concomitant levator ani defect does not affect the symptom reduction of an acquired sensation of a wide vagina or the total score reduction after surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14666","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T21:07:53Z","timestamp":1692652073000},"page":"1338-1346","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["One\u2010year follow\u2010up after standardized perineal reconstruction in women with deficient perineum after vaginal delivery"],"prefix":"10.1111","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2529-9390","authenticated-orcid":false,"given":"Emilia","family":"Rotstein","sequence":"first","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Gynecology and Reproductive Medicine Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vilhelmina","family":"Ullemar","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Gynecology and Reproductive Medicine Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hedvig","family":"Engberg","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Reproductive Medicine Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelica","family":"Lind\u00e9n\u00a0Hirschberg","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Reproductive Medicine Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gunilla","family":"Ajne","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Pregnancy Care and Delivery Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gunilla","family":"Tegerstedt","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Gynecology and Reproductive Medicine Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,8,18]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.31128\/AFP-09-17-4333"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-13-59"},{"key":"e_1_2_11_4_1","unstructured":"GrimesWR StrattonM.Pelvic floor dysfunction. 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