PERINEAL TEARS: STILL STIGMATIZING WOMEN IN THE 21ST CENTURY
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Keywords
Perineal tears, fistula, maternal, morbidity, postpartum
Abstract
Background: Perineal tears are the most common injuries sustained during vaginal delivery. These are caused either spontaneously or by iatrogenic. Several factors precipitate the cause of perineal tears such as maternal age, parity, and gestational age. Perineal tears are treated based on their severity to the mucosal injury and ruptured anal sphincters and pose much morbidity to the patients. The aim of this study was to explore the morbidity associated with perineal tears.
Materials and methods: A mixed-method study was conducted from February 2021 to September 2021 at the Maternal and child health care center, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Quantitative data of 2621 patients over 5 years comprising the demographic data. Data was collected from the archival records of the patients with vaginal delivery. Data of patients with a perineal tear was sorted out of the total patients as 108 patients reported a perineal tear. Qualitative data was collected via semi-structured interviews from the current five patients already admitted with a perineal tear. The collected data was translated transcribed and analyzed with the help of SPSS 25 and ATLAS. Ti.
Results: Out of 2621 patients with genitourinary tract fistulae,108 patients were with the perineal tears, making an overall incidence of perineal tears in our study to be 4.1%.84 participants (78%) were with 3rd-degree perineal tear while the rest 24 participants (22%) were of 4th degree perineal tears. Interviews of 13 patients regarding morbidity associated with perineal tears led to formations of 32 codes, and 6 categories leading to 2 main themes. Among quality of life, categories included physical morbidity, psychological distress and sexual dysfunction. Second theme was about barriers to treatment for perineal tears and included lack of self-awareness, lack of family support and lack of medical facility nearby.
Conclusion: Perineal tears stigmatize women in physical and psychosocial grounds even in the 21st century. More efforts are needed by the government to promote awareness programs and facilitate such patients for optimum treatment for the much preventable disease.
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Shumaila Naeem
Assistant Professor of Obs and Gynae, Department of MCH, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
Sabeen Aslam
Associate Surgeon, Obs and Gynae Department, Federal Government Polyclinic Hospital, Islamabad
Dr. Syed Azra
Medical Officer, MCH, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
Hadia Hina
Assistant Professor of Obs and Gynae, Department of MCH, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
Khansa Qadeer
Medical Officer, MCH, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
Shubana Tabasum
Medical Officer, MCH, Pakistan Institute of Medical Sciences, Islamabad, Pakistan