The Effectiveness of Photobiomodulation Therapy on Perineal Pain and Wound Healing After Episiotomy—A Systematic Review and Meta-Analysis

Objective: the aim of this systematic review and meta-analysis was to evaluate the effectiveness of photobiomodulation therapy (PBM) on perineal pain and wound healing following episiotomy. Methods: Electronic databases were searched for randomized controlled trials (RCTs) and non-RCTs investigating PBM after episiotomy. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for non-RCTs. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analyses were performed using random-effects models. Results: Eight studies were included in the systematic review, and six studies were included in the meta-analysis. According to RoB 2, one trial was judged at low risk of bias, two trials raised some concerns, and three trials were at high risk of bias. ROBINS-I showed the serious risk of bias of two non-RCTs. GRADE for both pain and wound-healing outcomes was rated as very low. Meta-analysis of pain showed no significant difference between PBM and control groups (SMD = 0.04; 95% CI -0.60 to 0.68; p = 0.89), with considerable heterogeneity (I2 = 91%). For wound-healing outcomes, meta-analysis showed no significant difference (MD = 0.94; 95% CI -0.69 to 2.56; p = 0.26), with substantial heterogeneity (I2 = 94%). Conclusions: PBM therapy did not demonstrate a significant benefit for reducing perineal pain or improving wound healing after episiotomy compared with control interventions. Interpretation of these findings should be made cautiously due to small study numbers, substantial heterogeneity, and the inability to perform sensitivity or subgroup analyses, highlighting the need for high-quality RCT with standardized PBM protocols before clinical recommendations can be made.