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To determine whether women withprevious third/fourth degree perineal tears develop worsening anal sphincter function following a subsequent vaginal delivery. Endoanal Ultrasound (EAUS) and Anorectal Physiology (ARP) are offered as part of counselling the mode of subsequent delivery in women withprevious perineal tears [1,2].Between November 2001 and November 2009, 303 women with third/fourth degree perineal tears underwent EAUS/ARP investigation. Forty-three opted for a subsequent vaginal delivery and were offered a repeat EAUS/ARP. Fifteen women attended for investigation.Eleven out of 15 (73%) demonstrated deterioration in the repeat EAUS/ARP results in comparison to the initial investigation. Eight developed a new external anal sphincter defect, three developed a new internal anal sphincter defect plus low ARPpressures, and four developed abnormally low ARPpressures. Only three became symptomatic, one experiencing faecal urgency and two developing flatal incontinence.The results show that vaginal delivery after aprevious third/fourth degree perineal tear is associated with deterioration in anal function demonstrated by EAUS/ARP studies. This could be due to thepresence of anal sphincter damage from the initial trauma rather than a new tear, with original 3b/3c tears more likely to cause EAUS/ARP deterioration.