To evaluate the effects of episiotomy and Kegel exercises on symptoms and signs indicating postpartum pelvic relaxation, we prospectively studied 100 primigravidas consecutively enrolled from a homogeneous patient population. A control group was defined as the first 20 women requiring cesarean section prior to labor for accepted indications. The remaining four groups of 20 women each were treated as follows: no episiotomy or Kegel, episiotomy but no Kegel, episiotomy plus postpartum Kegel, and episiotomy plus antepartum Kegel. Research outcomes included the incidence and severity of pelvic relaxation determined by physicians blinded to group assignment and complaints of stress urinary incontinence. Fisher's exact tests were used for comparisons. Episiotomy alone was associated with decreased incidence of cystocele and rectocele, but there was no effect on degree of defects that occurred. Episiotomy plus antepartum Kegel produced no significant difference compared with cesarean controls for any defect of pelvic relaxation and, furthermore, was the only vaginal delivery group producing no third-degree defects. This study supports the use of episiotomy in most primigravidas and further suggests that teaching of Kegel exercises be included in antepartum patient instruction.