Perineal tears are very common after childbirth, and most heal well with time and appropriate care. For some women, though, symptoms continue long after the birth, and help remains available whenever those problems arise. A gynaecologist can assess the perineum and discuss whether a repair might improve comfort and function. Mr Nicholas Morris, Consultant Gynaecologist, offers assessment and reconstructive perineal surgery for women affected by ongoing perineal changes.
What is a perineal tear?
The perineum is the anatomical area of tissue between the vaginal opening and the anus. Many women can experience some degree of tearing during a vaginal birth, as the baby’s head crowns and stretches the vagina and perineum. Tears are graded by how deep they are, with first-degree tears involving only the skin and second-degree tears involving the perineal muscles beneath. More significant tears, known as third and fourth-degree tears, extend into or through the muscle around the anus, and these are also called obstetric anal sphincter injuries (OASI).
How common are more serious tears?
Most tears after childbirth are first or second-degree and they can heal without long-term problems. Third and fourth-degree tears are less common, and according to RCOG they occur in about 3 in 100 women having a vaginal birth. They are more likely with a first vaginal birth, affecting around 6 in 100 women, compared with about 2 in 100 for women who have given birth vaginally before. Being aware of these figures can help put individual risk in perspective. It is vital that these tears are treated appropriately and repaired promptly, and you should be offered advice about your options for any future birth, including whether a planned caesarean birth might be right for you.
How long does a perineal tear take to heal?
Most perineal tears and stitches heal over the first few weeks after birth, though the timescale varies from woman to woman. For a third or fourth-degree tear, RCOG advises avoiding strenuous activity or heavy lifting for around four to six weeks, then increasing activity gradually. A follow-up appointment is usually offered a few weeks after the birth to check healing and assess the pelvic floor. Pain that is worsening rather than easing should always be reviewed, as it can indicate a problem with healing.
What if problems continue after the birth?
Some women find that symptoms persist well beyond the expected healing period, and these deserve proper assessment. Ongoing discomfort or a feeling of weakness can follow perineal trauma, and pain during sex is another symptom worth raising, however long ago the birth took place. A gynaecologist can examine the area to establish what is contributing to the symptoms, and discuss whether a further repair might help. Where a secondary perineal repair is appropriate, it aims to restore support and comfort rather than to change appearance. One reason a further repair may be needed is that the stitches from the original repair can come apart, leaving the tissue beneath exposed, which can cause pain and bleeding.
The emotional side of birth injury
Birth injury can affect how a woman feels as much as how she heals physically, and that emotional impact deserves care too. Feeling upset or low after a difficult birth is understandable, and support is available. Talking to your GP or a specialist can be a helpful first step, and your health visitor can also point you towards further support. Organisations such as the Birth Trauma Association and MASIC offer information and support for women affected by severe tears.
Frequently asked questions
Can a perineal tear be repaired years after birth?
Yes. Where symptoms persist, even when the birth was some years ago, a gynaecologist can assess the perineum and check whether any tissue is still exposed and causing pain or sensitivity. They can then discuss whether a secondary repair might help.
Is pain during sex after childbirth normal?
Some tenderness in the early weeks after a tear is common, though pain that continues is worth raising. It can often be helped once the cause has been assessed.
Will I tear again if I have another baby?
Having had a third or fourth-degree tear does raise the chance of another in a future vaginal birth. Your maternity team can discuss ways to reduce that risk and the birth options available to you.
How soon can I see Mr Morris?
Mr Morris offers assessment for perineal and other gynaecological concerns, usually within 24 to 48 hours, in person or online.
Speak to Mr Morris
To discuss perineal symptoms after childbirth, whenever the birth took place, call 020 8371 1510 or email secretary@rapidaccessgynaecology.co.uk to arrange an assessment with Mr Morris.