Abstract Background: Perineal trauma is an injury to the perineum during childbirth. Using cold gel pads as soon as possible during the first twenty-four hours after giving birth will help to promote endorphin production and speed up the healing. Aim: To investigate the effect of ice gel pad application on early postpartum perineal trauma outcomes. Design: A randomized controlled trial. Setting: The postpartum ward at El Fayoum General Hospital. Participants: sixty postpartum women with perineal trauma were chosen randomly and allocated into the study group (n = 30) or the control group (n = 30). Methods: Four tools were used: A) Structured interview; B) a visual analogue scale for pain severity; C) The visual analogue scale for difficulties with routine activities; D) Standardized REEDA scale. Results: At baseline assessment, there was no significant difference between the two groups on the level of perineal pain and REEDA scale parameters. There was a significant difference between the two groups in the degree of perineal pain after 6 hours and 24 hours (p = 0.000 and p = 0.000, respectively). Additionally, at 24 hours, there was a significant difference between both groups' scores for redness, edema, ecchymosis (p = 0.001). Conclusion: Early application of ice gel pad on postpartum perineal trauma had a significant effect on decreasing the perineal pain and improving the perineal wound condition during the first 24 hours postpartum Recommendations: Integrating the perineal ice gel pad application as a main part of perineal trauma care during the early postpartum period.