2.4. Surgical method

Subjects were given the questionnaire package to complete before the surgery, and they were told that they could resume coital sexual activities 6 to 10 weeks postoperatively, as determined by their surgeon. Besides, all subjects have completed the instruments and all data were entered into a research database. After delivery of the placenta, operation was performed in accordance with the degree of vaginal relaxation. The 1/3 to 1/2 arc incision in posterior vaginal wall was designed at 0.3 cm position outside hymenal caruncles. Then, the mixture of 0.5% lidocaine and 1/20 million units adrenaline was injected into vaginal submucosa for local anesthesia. Vertical incision was conducted on vaginal mucous membrane until submucosa, followed by 4 to 5 cm blunt and sharp dissection along submucosa. After bipolar coagulation hemostasis, basal muscularis was separately sutured using 2-0 absorbable sutures from inside to outside. The inserting depth of needle was checked to avoid damaging anal canal. To the outermost layer, submucosa and muscularis were stitched by purse string suture with 1 cm interval. Suture was done from inside vagina to vaginal orifice, and the sutured vaginal mucosa showed vertical and horizontal folds. The medial mucosa edge of vaginal incision was relatively stitched using 5-0 absorbable sutures which were then left inside vagina, and the lateral side of mucosa edge was relatively stitched left and right after proper pruning. Newly formed vaginal orifice was supposed to barely accommodate 3 fingers (girth about 10 cm). The lacerated muscularis of perineal body was discontinuously stitched using 2-0 absorbable sutures via ladder type. To strengthen the height of perineal body, the damaged and removed anadesma and muscles were pull back in sequence from inside to outside the vagina. The lacerated skin of perineal body was interruptedly stitched with 5-0 absorbable sutures (Fig. ​(Fig.1).1). No injury occurred in anal canal or rectum through anal digital examination.

Second degree laceration of perineal body after vaginal delivery.