The effect of Aloe vera on reducing episiotomy pain and improving wound healing: A systematic review and meta-analysis

Document Type : Review Article


1 PhD student of Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Associate professor, Department of Midwifery, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 PhD student of Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan , Iran.

4 Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran.


Introduction: Episiotomy is one of the causes that can affect mothers' postpartum quality of life. Aloe Vera plant has been suggested as one of the ways to heal wounds and reduce pain. Regarding to these properties, several clinical trial studies have been conducted to determine the effect of aloe vera on episiotomy pain relief and wound healing, and different findings have been reported. This study was performed with aim to determine the effect of Aloe Vera on episiotomy pain relief and wound healing.
Methods: In this systematic review study, the databases of Scopus, PubMed (MEDLINE), Embase, Proquest, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Library and Web of Science were searched using the keywords of "pain", "Wound", "Healing", "Episiotomy", " Perineum" and "Aleo Vera" by OR and AND without time, language and geographical limitation until 23 April 2021. The quality of the articles was evaluated using the Cochran Group tool and data were analyzed by Stata software (version 14). Cochran test and I2 index were used to assess the heterogeneity of the articles.
Results: Finally, 9 articles with sample size of 611 people were included in this systematic review study. Preliminary studies showed the effectiveness of Aloe Vera in wound healing and pain relief. Four studies with sample size of 258 patients had the potential to perform the meta-analysis for pain outcome. Results of the meta-analysis showed that Aloe vera can reduce pain intensity compared to the control group (P<0.05).
Conclusion: Aloe Vera seems to be effective in repairing episiotomy wounds and reducing pain; however, high quality studies with sufficient sample size are recommended for definitive results.


  1. Berkowitz LR, Foust-Wright CE, Lickwood C, Eckler K. Approach to episiotomy. UpToDate Last updated: Sep 2016; 26.
  2. Graham ID, Carroli G, Davies C, Medves JM. Episiotomy rates around the world: an update. Birth 2005; 32(3):219-23.
  3. Sagi-Dain L, Sagi S. Indications for episiotomy performance–a cross-sectional survey and review of the literature. Journal of Obstetrics and Gynaecology 2016; 36(3):361-5.
  4. Ghulmiyyah L, Sinno S, Mirza F, Finianos E, Nassar AH. Episiotomy: history, present and future–a review. The Journal of Maternal-Fetal & Neonatal Medicine 2020: 1-6.
  5. Maan AA, Nazir A, Khan MK, Ahmad T, Zia R, Murid M, et al. The therapeutic properties and applications of Aloe vera: A review. Journal of Herbal Medicine 2018; 12:1-10.
  6. Zhang J, Onakpoya IJ, Posadzki P, Eddouks M. The safety of herbal medicine: from prejudice to evidence. Evidence-Based Complementary and Alternative Medicine 2015.
  7. Shelton RM. Aloe vera. Its chemical and therapeutic properties. Int J Dermatol 1991; 30(10):679-83.
  8. Liang J, Cui L, Li J, Guan S, Zhang K, Li J. Aloe vera: a medicinal plant used in skin wound healing. Tissue Engineering Part B: Reviews 2020.
  9. Yagi A, Hasegawa M, Ataka S. Possible Efficacy of Aloe Vera Gel to Wound Healing and Pain Relief: Case Reports of Kampo Medicine With Aloe Vera Juice. Journal of Gastroenterology and Hepatology Research 2020; 9(5):3298-302.
  10. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj 2011; 343.
  11. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj 2003; 327(7414):557-60.
  12. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. Introduction to meta-analysis. John Wiley & Sons; 2021.
  13. Eghdampour F, Jahdie F, Kheyrkhah M, Taghizadeh M, Naghizadeh S, Hagani H. The impact of Aloe vera and calendula on perineal healing after episiotomy in primiparous women: a randomized clinical trial. Journal of caring sciences 2013; 2(4):279-86.
  14. Jahdie F, Egdampour F, Naghizadeh S, Kheyrkhah M, Tagizade M. Effect of Aloe vera and Calendula persica ointment on pain intensity of episiotomy in primiparous women. The Horizon of Medical Sciences 2013; 19(1):23-8.
  15. Sabzaligol M, Safari N, Baghcjeghi N, Latifi M, Bekhradi R, Taghizadeh M, et al. The effect of Aloevera gel on prineal pain & wound healing after episiotomy. Complementary Medicine Journal 2014; 4(2):766-75.
  16. Nazari S, Ezati Arasteh F, Nazari S, Shobeiri F, Shayan A, Parsa P. Effect of Aloe Vera gel on perineal pain and wound healing after episiotomy among primiparous women: A randomized clinical trial. Iran J Obstet Gynecol Infertil 2019; 21(11):44-51.
  17. Essa R, Mohamed N, Kandeel H. Effect of aloe vera gel versus normal saline on pain relief and healing process of episiotomy. JHMN 2020; 70:66-81.
  18. Jayashree S. A study to assess the effectiveness of fresh aloe vera gel application on pain relief and healing of episiotomy wound among postnatal mothers admitted at institute of obstetrics and gynaecology and government hospital for women and children, chennai (Doctoral dissertation, College of Nursing, Madras Medical College, Chennai).
  19. Dewi PS, Hani U, Anwar M. The effectiveness of aloe vera gel in reducing the pain of perineal wound. MEDISAINS 2020; 18(3):99-102.
  20. Menezes PM. Effectiveness of aloe vera gel vs lavender oil on episiotomy wound among postnatal mothers in a selected hospital, Mangalore. Int J Nurs Midwifery Res 2017; 4(03):48-54.
  21. Pooja M, Priyadarshini M. An Experimental Study To Evaluate The Effectiveness Of Aloevera Gel Application On Episiotomy Wound Healing Among Mothers In Early Puerperal Period Of Selected Maternity Hospitals, Jaipur, Rajasthan. International Journal for Research Trends and Innovation 2018; 3(5):289-94.
  22. Heaman M. Mothers' Reports of Postpartum Pain Associated With Vaginal and Cesarean Deliveries: Results of a National Survey. MCN: The American Journal of Maternal/Child Nursing 2008; 33(5):326.
  23. Karaçam Z, Eroğlu K. Effects of episiotomy on bonding and mothers’ health. Journal of advanced nursing 2003; 43(4):384-94.
  24. Taleb S, Ozgoli G, Mojab F, Nsiri M, Ahvazi M. Effect of Verbascum Thapsus cream on intensity of episiotomy pain in primiparous women. Iran J Obstet Gynecol Infertil 2016; 19(7):9-17.
  25. Shahrahmani H, Kariman N, Jannesari S, Ghalandari S, Asadi N. A systematic review on the type of treatment methods to reduce pain and improve wound healing in Iran. Iran J Obstet Gynecol Infertil 2016; 19(9):17-31.
  26. Ghosh R, Alajbegovic A, Gomes AV. NSAIDs and cardiovascular diseases: role of reactive oxygen species. Oxidative medicine and cellular longevity 2015; 2015.
  27. Schjerning Olsen AM, Fosbøl EL, Pallisgaard J, Lindhardsen J, Lock Hansen M, Køber L, et al. NSAIDs are associated with increased risk of atrial fibrillation in patients with prior myocardial infarction: a nationwide study. European Heart Journal-Cardiovascular Pharmacotherapy 2015; 1(2):107-14.
  28. Sadoyu S, Rungruang C, Wattanavijitkul T, Sawangjit R, Thakkinstian A, Chaiyakunapruk N. Aloe vera and health outcomes: An umbrella review of systematic reviews and meta‐ Phytotherapy Research 2021; 35(2):555-76.
  29. Rathor N, Mehta AK, Sharma AK, Mediratta PK, Sharma KK. Acute effect of Aloe vera gel extract on experimental models of pain. Inflammation 2012; 35(6):1900-3.
  30. Park MY, Kwon HJ, Sung MK. Evaluation of aloin and aloe-emodin as anti-inflammatory agents in aloe by using murine macrophages. Bioscience, Biotechnology, and Biochemistry 2009; 73(4):828-32.
  31. Kumar R, Singh AK, Gupta A, Bishayee A, Pandey AK. Therapeutic potential of Aloe vera—A miracle gift of nature. Phytomedicine 2019; 60:152996.
  32. Eshun K, He Q. Aloe vera: a valuable ingredient for the food, pharmaceutical and cosmetic industries—a review. Critical reviews in food science and nutrition 2004; 44(2):91-6.
  33. Moores J. Vitamin C: a wound healing perspective. British journal of community nursing 2013; 18(Sup12):S6-11.
  34. Kashanian M, Lakeh MM, Ghasemi A, Noori S. Evaluation of the effect of vitamin E on pelvic pain reduction in women suffering from primary dysmenorrhea. The Journal of reproductive medicine 2013; 58(1-2):34-8.
  35. Hajhashemi V, Ghannadi A, Heidari AH. Anti-inflammatory and wound healing activities of Aloe littoralis in rats. Research in pharmaceutical sciences 2012; 7(2):73.
  36. Arunkumar S, Muthuselvam M. Analysis of phytochemical constituents and antimicrobial activities of Aloe vera L. against clinical pathogens. World Journal of Agricultural Sciences 2009; 5(5):572-6.
  37. Hekmatpou D, Mehrabi F, Rahzani K, Aminiyan A. The effect of Aloe vera clinical trials on prevention and healing of skin wound: a systematic review. Iranian journal of medical sciences 2019; 44(1):1-9.