Abstract
Background: Episiotomy-related morbidity remains a substantial challenge in postpartum recovery, often affecting maternal quality of life. Given the crucial role of local microbiota and wound environment in perineal healing, intravaginal lactic acid gel emerges as a promising adjunctive therapy. Objective: To evaluate the effectiveness and safety of intravaginal lactic acid gel (Canesbalance(®), Bayer) in enhancing scar healing and reducing pain following mediolateral episiotomy. Methods: In this single-center randomized controlled trial, 100 postpartum women with mediolateral episiotomy were allocated to either a treatment group receiving intravaginal lactic acid gel (Canesbalance(®), Bayer) or a standard care group. Scar healing was assessed at 7 and 40 days postpartum using POSAS, VAS, and NRS scores; hematological parameters were also monitored. Results: The lactic acid gel group demonstrated significantly greater reductions in scar severity and pain scores over time (p < 0.05), with no adverse hematological effects. Effect sizes (Cohen's d) were moderate to high for scar healing (d = 0.76) and pain reduction (VAS: d = 0.83; NRS: d = 0.79), indicating clinical relevance beyond statistical significance. Conclusions: Intravaginal application of lactic acid gel may offer a safe and effective strategy to enhance perineal wound healing and pain relief after episiotomy. Further large-scale studies are warranted to validate these promising findings and explore underlying mechanisms.