BACKGROUND: To evaluate the current anal sphincter function, the frequency of urinary incontinence and of dyspareunia in patients with earlier anal sphincter rupture following vaginal delivery. DESIGN: Retrospective case-control study between 1994 and 1999 at the Central Hospital of Helsingborg, Sweden. PARTICIPANTS: Two hundred and eighteen women with a history of obstetric anal sphincter rupture and 436 matched controls. METHODS: Postal questionnaire regarding anal incontinence, urinary incontinence, dyspareunia and lifestyle alterations. Obstetric data were collected from hospital records. RESULTS: Of the 654 women included, 534 (82%) responded at a median follow up of 4 ears. Anal incontinence was significantly more common among patients with sphincter rupture. Sixty-one (33%) reported incontinence of flatus and 39 (21%) incontinence of liquid stools compared with 53 (15%) and 26 (7%) in the control group. Dyspareunia was reported by 26 (14%) patients and 20 (6%) controls. The symptoms of dyspareunia seemed to decrease with time. There was no significant difference in urinary incontinence between the two groups. A third of the women in the case group claimed that their problems with anal incontinence affected their daily lives, but only a few had asked for medical assistance. CONCLUSIONS: Anal sphincter rupture is strongly associated with anal incontinence and dyspareunia several years postpartum. The complaints affect the daily lives of these women to a great extent.