New research examines platelet-rich plasma for healing after episiotomy and perineal tears—and points toward an important area of women’s sexual-health research.
Childbirth changes the female body. Some of those changes resolve within weeks.
Others can persist for months or years.
Women who have experienced an episiotomy or a significant
perineal tear during vaginal delivery may be left with tenderness,
painful scar tissue, tightness, altered sensation, pain during intercourse, or other
changes that affect sexual function and quality of life.
For many years, treatment options for these problems have been limited.
Now researchers are investigating a different question:
Could platelet-rich plasma (PRP) help damaged perineal tissue heal?
A scientific paper published in August 2026 provides one of the most useful examinations
of that question to date:
Platelet-Rich Plasma in Episiotomy Repair: A Critical Appraisal of a Sparse and Partly Non-Indexed Evidence Base and Rationale for a Randomized Controlled Trial
,
by Brezeanu and colleagues, published in Life.
The answer is intriguing—but it is important to understand both what the research
shows and what it does not yet prove.
What Happens During an Episiotomy or Perineal Tear?
An episiotomy is a surgical incision made in the perineum—the tissue
between the vaginal opening and anus—to enlarge the vaginal opening during childbirth.
A perineal tear, by contrast, occurs spontaneously during delivery.
They are related injuries, but they are not the same thing. Tears can range from
relatively superficial injuries involving skin to severe third- or fourth-degree injuries
involving the anal sphincter or rectal lining.
Most women heal normally. But some experience wound infection, separation of the wound,
persistent tenderness or pain, and longer-term sexual problems.
The 2026 review discusses contemporary data showing infection rates of approximately
5–10% following episiotomy in large cohorts. Longer-term complications
can include chronic perineal pain, painful intercourse (dyspareunia)
and impairment of sexual quality of life.
Those longer-term consequences are particularly important.
The goal after childbirth should not merely be closing a wound. Ideally, we want restoration
of healthy, comfortable and functional tissue.
Why Would PRP Potentially Help?
Platelet-rich plasma is prepared from a patient’s own blood.
The blood is processed to concentrate platelets, which release numerous signaling molecules
involved in tissue repair, including platelet-derived growth factor, transforming growth
factor-beta and vascular endothelial growth factor.
These signals participate in processes including
angiogenesis—the formation of new blood vessels—modulation of inflammation,
and organized tissue repair.
This is one of the biological principles underlying the O-Shot®,
which uses autologous PRP in female genital tissues.
But biological plausibility alone does not demonstrate that a treatment works.
So the more important question is:
What happens when PRP is actually studied in women with childbirth-related perineal injuries?
A Randomized Trial of PRP After Episiotomy
The Brezeanu review performed an unusually broad literature search and identified a
randomized clinical trial specifically examining PRP after episiotomy.
In that study, 200 first-time mothers undergoing episiotomy were randomized
to PRP treatment or standard treatment. PRP was placed in the episiotomy wound before
skin closure, and 176 women were ultimately analyzed.
The investigators reported:
- better early wound-healing scores,
- better scar scores,
- less pain beginning at one week, and
- no cases of wound gaping in the PRP group compared with seven cases in the control group.
Those results are encouraging.
They are not, however, definitive.
The trial was not prospectively registered, did not report a sample-size calculation,
apparently did not blind outcome assessors, lost some participants to follow-up,
and contained inconsistencies in portions of its reported data.
a promising preliminary signal. It does not, by itself, establish PRP as proven treatment
for episiotomy injury.
What About More Serious Childbirth Tears?
The literature also contains smaller studies and case reports involving more severe
childbirth-related perineal injuries.
A 2026 non-randomized study evaluated PRP following repair of
third- and fourth-degree perineal lacerations and reported favorable
wound-healing and continence outcomes.
Published case reports have also described PRP treatment in women with an episiotomy
wound that separated after delivery and in a woman with chronic pain following a deep
episiotomy and second-degree laceration.
Case reports and small non-randomized studies cannot establish effectiveness, but they
add to the rationale for conducting better-controlled studies.
Two New Clinical Trials Are Testing the Question More Rigorously
Perhaps the most important development is that investigators are now testing PRP
prospectively in randomized clinical trials specifically involving childbirth-related
perineal injury.
1. PRP-EpiHeal
PRP-EpiHeal is a randomized controlled trial designed to compare
autologous PRP with standard care following episiotomy.
Its primary endpoint is wound healing at six weeks using the REEDA scale, which evaluates
redness, edema, bruising, discharge and approximation of the wound edges. Secondary
outcomes include pain, wound dehiscence, infection, need for additional suturing and
maternal satisfaction.
View PRP-EpiHeal on ClinicalTrials.gov — NCT07669285
2. The RELIEVE Study
A second study, called RELIEVE, broadens the question beyond episiotomy alone.
RELIEVE is designed as a triple-blind, randomized, placebo-controlled trial
evaluating whether a local injection of a woman’s own PRP during repair of a
perineal tear and/or episiotomy reduces postpartum perineal pain compared
with saline placebo.
This trial is particularly interesting because it directly includes spontaneous childbirth
tears as well as episiotomies.
View the RELIEVE Trial on ClinicalTrials.gov — NCT07727213
View the RELIEVE study in the Swiss Human Research registry
Supporting Evidence From Cesarean Wound Healing
PRP has also been investigated in another obstetric wound: the cesarean-section incision.
This evidence cannot simply be assumed to apply to the perineum. Cesarean and perineal
wounds differ in anatomy, bacterial exposure and mechanical stresses.
Nevertheless, favorable findings from cesarean wound and scar research add biological
support to the hypothesis that platelet-derived signaling may influence obstetric wound healing.
One completed clinical study evaluated intraoperative PRP for postoperative scarring
following cesarean delivery:
View the Cesarean PRP Study on ClinicalTrials.gov — NCT06978010
What Does This Mean for Women Who Had Their Babies Years Ago?
Here we must make another important distinction.
Most of the strongest research described above concerns
PRP applied around the time of childbirth and primary wound repair.
That is different from treating a woman months or years later who has an established
episiotomy scar, tenderness, dyspareunia or altered sexual sensation.
The latter question has not yet been answered by large randomized clinical trials.
The authors of the 2026 review specifically identify longer-term outcomes as an important
subject for future research, including:
- scar quality,
- chronic perineal pain, and
- sexual function.
Those may ultimately prove to be among the outcomes that matter most to women.
Where Does the O-Shot® Fit?
The O-Shot® uses a woman’s own platelet-rich plasma in vulvar and
vaginal tissues. It’s the only standardized protocol that’s been around for over a decade and is provided by over 1,000 physicians throughout the U.S. and over 50 countries.
For a woman with persistent symptoms following childbirth—such as scar tenderness,
painful intercourse, altered sensation or other changes in sexual function—it may therefore
be reasonable to discuss PRP as one possible treatment approach after an appropriate
medical examination by one of our O-Shot® providers.
And…the side effects could be better sex and stronger family relations!
What the research does NOT yet prove:
The studies described here do not prove that the O-Shot® repairs an old episiotomy scar
or reverses chronic childbirth-related sexual dysfunction.
What the research does show is that PRP is now being investigated specifically for
childbirth-related perineal healing, that early clinical results provide encouraging
signals, and that researchers consider the question important enough to justify more
rigorous randomized trials.
That represents genuine scientific progress.
The Larger Question
For generations, medicine understandably concentrated on getting mother and baby
safely through childbirth.
But survival is not the only outcome that matters.
What happens to a woman’s comfort, sensation and sexual function after delivery matters too.
An episiotomy or obstetric tear may occur during a few minutes of childbirth, but its effects
can sometimes persist for years.
Regenerative medicine raises the possibility that instead of simply accepting those
consequences, we may eventually be able to improve the way injured tissues heal—or perhaps
help previously injured tissues remodel.
PRP may ultimately prove useful for that purpose, or future rigorous trials may demonstrate
that its effects are more limited than preliminary research suggests.
The scientific answer is not yet settled.
But after decades in which postpartum perineal injury received relatively little regenerative
research, and after 15 years of our O-Shot® providers seeing excellent results, investigators are finally asking the question.
And for women still experiencing the consequences of childbirth years later,
that is a question worth answering.
Considering the O-Shot® After Childbirth?
If you have persistent pain, scar tenderness, discomfort during intercourse,
altered sensation or other sexual changes following childbirth, an experienced
O-Shot® provider can evaluate your symptoms and discuss whether PRP treatment
may be appropriate.
Research & Clinical Trials
- Brezeanu D, Brezeanu A-M, Surdu T-V, Surdu M, Tica V.
Platelet-Rich Plasma in Episiotomy Repair: A Critical Appraisal of a Sparse
and Partly Non-Indexed Evidence Base and Rationale for a Randomized Controlled Trial.
Life. 2026;16:1339.
Read the full article
- PRP-EpiHeal: Platelet-Rich Plasma Versus Standard Care for Episiotomy Wound Healing.
ClinicalTrials.gov Identifier: NCT07669285.
ClinicalTrials.gov record
- RELIEVE: Platelet-Rich Plasma to Reduce Postpartum Pain After Perineal Tears or Episiotomy.
ClinicalTrials.gov Identifier: NCT07727213.
ClinicalTrials.gov record
- Efficacy of Platelet-Rich Plasma in Improving Postoperative Scarring After Cesarean Delivery.
ClinicalTrials.gov Identifier: NCT06978010.
ClinicalTrials.gov record
=>More O-Shot® Research<=
Medical information notice:
This article is provided for educational purposes and does not establish that PRP or the
O-Shot® is effective for any particular patient’s episiotomy scar, perineal injury,
postpartum pain, or sexual dysfunction. The O-Shot® has not been established by large
randomized controlled trials as a treatment for chronic episiotomy scars or chronic
postpartum perineal injury. Individual results vary. Persistent postpartum pain or
sexual dysfunction should be medically evaluated because multiple conditions can cause
these symptoms.
