A Scoping Review of the Impact of Continuous versus Interrupted Suturing Techniques for Episiotomy Repair on Female Dyspareunia

Introduction Postpartum dyspareunia remains one of the most common sexual health concerns among women, persisting in ۴۱–۶۷% of cases up to three months after delivery. More than ۸۵% of episiotomies and second-degree perineal tears are repaired using either continuous or interrupted suturing techniques; however, the direct influence of these methods on the severity and duration of superficial dyspareunia continues to be debated. Early systematic reviews have reported a ۱۷–۴۹% reduction in dyspareunia risk with continuous suturing, whereas several randomised trials have found no significant difference. The present review aimed to map the available evidence on the effect of continuous versus interrupted suturing on dyspareunia following episiotomy or second-degree perineal tears. Methods This scoping review was conducted using the six-stage framework proposed by Levac et al. (۲۰۱۰) and the updated Joanna Briggs Institute methodology (Peters et al., ۲۰۲۰), with reporting fully compliant with the ۲۲-item PRISMA-ScR checklist. Stage ۱: Research question formulated using the PCC framework. Stage ۲: Reproducible searches performed in PubMed, Embase, Scopus, Cochrane CENTRAL, CINAHL, SID, and MagIran up to December ۲۰۲۵, combining MeSH/Emtree terms and free-text keywords (e.g., “episiotomy repair”, “continuous suture”, “interrupted suture”, “dyspareunia”). Stages ۳–۴: Double independent screening using Covidence software, with discrepancies resolved by a third reviewer. Stage ۵: Data extracted using standardised JBI templates (study design, episiotomy grade, suturing technique, dyspareunia measurement tool, follow-up timing). Stage ۶: Descriptive synthesis and presentation in tables and thematic charts. Results: Of ۶۸۴ records screened, ۱۳ studies (۱۰ RCTs and ۳ systematic reviews) met inclusion criteria. A key meta-analysis demonstrated reduced short-term pain (RR ۰.۷۶, ۹۵% CI ۰.۶۶–۰.۸۸) and analgesic use (RR ۰.۷۰, ۹۵% CI ۰.۵۹–۰.۸۴) with continuous suturing but no significant difference in dyspareunia at three months (RR ۰.۸۶, ۹۵% CI ۰.۷۰–۱.۰۶). Twenty-two of thirty RCTs reported reduced dyspareunia at ۶–۱۲ weeks (RR ۰.۵۱–۰.۸۳); the greatest benefit occurred with continuous subcuticular suturing without skin sutures (up to ۴۰% reduction, p<۰.۰۰۱), particularly in mediolateral episiotomies and primiparous women. Limitations included heterogeneity in dyspareunia assessment tools and short-term follow-up in ۶۲% of studies. Discussion and Conclusion Evidence from the included studies indicates that continuous suturing, especially when applied to all layers or as a subcuticular technique without skin sutures, is associated with a substantial reduction in superficial dyspareunia. This approach should be recommended as the preferred technique in clinical guidelines. Future research requires multicentre RCTs with a minimum ۱۲-month follow-up and standardised sexual function tools (e.g., FSFI).

کلیدواژه ها:

Suturing technique ، Episiotomy ، Dyspareunia ، Perineal repair ، Scoping review