Postpartum perineal pain: temporal evolution, anatomical distribution and functional impact during the first 90 days

Postpartum perineal pain is a common condition that may interfere with functional recovery. This study aimed to characterize its temporal evolution, anatomical distribution and functional impact during the first 90 days after vaginal birth.

Prospective cohort study including 106 women following vaginal delivery. Participants were assessed using structured digital questionnaires at eight time points (1, 2, 7, 15, 21, 30, 60 and 90 days postpartum). Pain intensity was measured using a numerical rating scale (PNRS), and location was recorded using a standardized neuroanatomical perineal map. Pain triggers, treatments and functional limitations were also documented.

Perineal pain was highly prevalent in the immediate postpartum period and declined over time, but remained clinically relevant. At 15 days, 78% of women reported pain, decreasing to 50% at one month and 25% at two months. At 90 days, 13.3% still reported persistent pain, generally mild to moderate. Pain was most frequently localized in the lower vulvar and vulvoanal regions, with a modest right-sided predominance. Approximately one-third of women reported limitations in sitting, standing or walking. Women reporting persistent pain were less likely to have resumed sexual activity and more frequently reported continued analgesic use during follow-up.

Postpartum perineal pain is common, functionally relevant and may persist for months after vaginal birth. Recognition of its temporal evolution, anatomical distribution and functional impact may facilitate a more comprehensive clinical assessment during the postpartum period.