Vaginal tears
Reviewed by Dr. Jennifer Lincoln
During delivery, the vagina is often stressed and stretched to the limit. Some women have only superficial abrasions that do not require a repair—this is most commonly associated with spontaneous delivery (i.e. no medical intervention), when women are able to push in any position. Still, some type of tear is very common, even during the easiest vaginal deliveries. In fact, it’s estimated that as many as 80 percent of all women will experience vaginal tearing to some extent during childbirth1, and for most women, the extent is greater when it’s their first time giving birth.
80%
As many as 80 percent of all women who deliver vaginally experience a vaginal tear during childbirth.
The degree of tearing can range dramatically, but the most common place to tear is the perineum. You can also tear in the labia, vaginal side wall, or around the urethra, though these tears are usually more superficial and have fewer long-term consequences. And while they are administered in only 8 percent of births2 today, your doctor may perform an episiotomy, a surgical cut intended to facilitate birth.
Understanding degrees of vaginal tearing
Dr. Jennifer Lincoln
Obstetrician-gynecologist
Perineal tears are categorized as first-, second-, third-, and fourth-degree tears. Understanding the differences between these degrees can help prepare you for both delivery and the postpartum healing journey.
The least severe tear associated with childbirth occurs only within the perineal skin between the opening of your vagina and your rectum. Because the muscles of the perineum remain intact, healing involves skin and superficial tissues of the vagina.
Half of perineal tears are second-degree tears. They’re similar to a first-degree tear, but the perineal muscle is also affected. These tears usually extend up into the vagina, and repair involves reapproximating the deep and superficial perineal muscles, which play an important role in pelvic-floor support and defecation.
Third-degree tears are significantly deeper than second-degree tears. They extend along your perineum and into the muscles surrounding your anus. These types of tears are more common when your baby is on the larger side, facing sunny-side up during delivery, or you had an operative vaginal delivery (with a vacuum or forceps). You may also receive an extra dose of IV antibiotics to prevent infection.
The most severe tears associated with childbirth, fourth-degree tears, extend from the vaginal skin through the perineal muscle, anal sphincter, and rectal mucosa. (Yes, that means you've torn through your vagina to your rectum.) Because multiple layers of muscle are involved, you may need to go to the operating room for the repair, and you will receive an extra dose of IV antibiotics to prevent infection.
What to do about it
With some degree of vaginal tearing being so common, there are several tried-and-true remedies that can help alleviate some of the discomfort you may feel over the course of your recovery.
EXPLORE POSTPARTUM PERINEAL CARE
Lay back and rest
For the first 24 hours, it is important to lie down for approximately 20 to 40 minutes each hour to reduce swelling and assist healing.
If you have lower-back pain, lying on your side is often more comfortable.
Wrap ice or a cold pack in a thin piece of dampened cloth, and apply it to the sore area for 10 to 20 minutes at a time, repeating each hour as necessary.
You can also put an ice pack in the inside lining of a sanitary pad, or use a frozen pad or diaper as a cold compress.
This is especially important in the first 24 hours to help decrease swelling and ease pain.
Shower or bathe every day. If you have a first- or second-degree tear, consider taking sitz baths after your first couple postpartum days.
Taking sitz baths—soaking your pelvic floor for 10 to 20 minutes several times a day—can help reduce irritation and swelling.
Studies show that cold sitz baths relieve pain more effectively than warm ones. Start with lukewarm water, and gradually add ice cubes.
Check with your physician before adding medications or epsom salts. After each sitz bath, dry any tears or stitches by gently patting them with a towel or using a hair dryer on cool.
With an extra-sensitive perineum, you cannot wipe as you normally would when using the bathroom. Instead, use a squeeze (or peri) bottle.
Hospitals often send mothers home with a peri bottle to help keep the area clean without friction. You can use this squirt bottle to wash away urine, feces, or anything containing bacteria that could induce irritation or an infection.
When finished, gently pat the area dry with baby wipes, medicated pads, or clean toilet paper.
Once the wound is healed, you can wipe gently from front to back.
Soak a pad in aloe and/or witch hazel, freeze it, and place it either between a sanitary napkin and your perineum or directly on the area for cooling relief.
Change your padsicle at least every four hours to reduce the risk of infection.
The “pelvic elevator” can help strengthen your pelvic floor while reducing perineal pain and swelling. Try a set of three of these exercises each hour.
- Imagine your pelvic floor is an elevator in a three-story building
- Sit upright on a chair and breathe in, lengthening your spine
- Hold your breath, and feel your pelvic floor squeeze, closing the elevator door
- Exhale
- Breathe in, keeping the elevator doors closed and lifting your pelvic floor to level two
- Exhale
- Breathe in as you lift your pelvic floor to level three
- Breathe out as you release your pelvic floor to ground level
When sitting, use a pillow, padded ring, or inflatable “donut” cushion for 30 or fewer minutes.
Making slight adjustments to your sitting position is important during this time to avoid blood pooling.
If you’ve undergone perineal repair, try to sit with your legs together rather than crossed.
Drink plenty of water to avoid constipation. Straining with bowel movements will stretch the perineum and can cause pain.
You can also avoid constipation by eating fiber-rich foods such as fresh fruits and vegetables.
When to get help
Check in with your doctor if you experience:
- Severe pain that is persisting or worsening, particularly if associated with fever
- Oozing, rash, or discharge at the site of the tear
- Fever that’s worsening
- Flu-like symptoms or foul-smelling vaginal discharge
References
1 https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03447-0
2 https://www.leapfroggroup.org/news-events/new-report-maternity-care-us-shows-encouraging-progress-reducing-episiotomies-none
Additional resources
RELATED READING
Recovering from a vaginal delivery
Two-thirds of babies born in the United States are born through vaginal deliveries.
Postpartum conditions and complications
Even with the smoothest of births, it's normal to experience changes.
Episiotomy
An episiotomy is a surgical cut made to facilitate vaginal birth, though natural perineal tears are generally favored.
Postpartum pelvic health and recovery
Pelvic-floor disorders are some of the leading postpartum complications.