A Catastrophic Outcome of Ineffectual Episiotomy Causing Acquired Vaginal Atresia: A Case Report

Episiotomy is an aid done to prevent perineal tears, which may involve the anal sphincter and rectum. However, if not given judiciously, this can result in an increase in morbidity in patients. We present a case report of two young females who presented to our outpatient department with a complaint of vaginismus after their previous vaginal deliveries. The first patient had partial vaginal atresia and the second patient had complete vaginal atresia after an episiotomy repair. The complication arose due to mismanaged episiotomy repair that had a severe impact on their physical, sexual, and psychological well-being. They both underwent vaginal stricture release and adhesiolysis showed satisfactory outcomes during their follow-up. Though not recommended, prophylactic episiotomy continues to be widely performed. The approach adopted during the operative delivery stays unclear, as episiotomy execution is likely to be impacted by the physician's working environment, as well as maternal and fetal circumstances. Trained execution at rural or urban and private or public facilities is the need of the hour. Counseling regarding prophylactic or emergency episiotomy and its consequences during labor should be considered as a part of their antenatal care.