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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Vaginal or perineal tears

Vaginal_TearsIt is common to tear during a vaginal birth. Vaginal tears are rips in the skin and muscles above or near the vaginal opening. Tears most frequently occur in the perineum, the region between the anus and the opening to the vagina. There are four degrees of vaginal tears that are classified on the basis of their severity - this includes both the size of the tears and the muscles affected.

First and second-degree tears involve superficial lacerations in the skin and underlying fatty tissue. Although painful, these tears are generally easy to repair. Third and fourth degree tears are larger, deeper lacerations, involving muscle tissue and therefore involve more complex surgical interventions. 50-60% of women who tear require stitching and 2% will suffer tearing that reaches the anus.

Repairs are carried out under general or local anaesthetic and are usually done as soon as possible after birth. Post-operative care is necessary to prevent infection or damage to the newly repaired tear. If an early diagnosis is made and appropriate treatment is provided, there is a good chance of a full recovery. 60-80% of patients have no symptoms after 12 months.


Vaginal tears may be caused by any of the following factors:
  1. Your baby’s head is too large to fit through the vaginal opening
  2. Your baby is in a breech position and is coming down the birth canal with their feet or buttocks first
  3. Labour has progressed too quickly, without there being sufficient time for the perineum to stretch
  4. You are unable to control your pushing
  5. Minor lacerations can occur during sexual intercourse
  6. Inadequate lubrication and vaginal dryness can lead to trauma that produces cuts or abrasions. Minimal vaginal fluid secretion may be due to insufficient foreplay or may be related to menopause, which causes the thinning of the vaginal walls and vaginal dryness

  1. Superficial vaginal tears may produce mild bleeding
  2. Pain and burning during urination
  3. General pain and discomfort
  4. Severe vaginal tears may produce heavy bleeding
  5. If you have lost a considerable amount of blood, you may feel weak, faint and dizzy
  6. Lower abdominal pain


Your doctor will be with you during labour and will notice if you tear and he/she may suggest doing an episiotomy in order to prevent tearing. This is a surgical procedure in which the vaginal opening is made larger so that your baby does not tear your vagina or the surrounding muscles during birth


First-degree tears are the least painful of all vaginal tears and tend to heal naturally, often without any stitching. These tears only affect the skin around the vagina and tend to be less than one half inch in length.

Second-degree tears are deeper into the vaginal tissue and affect the perineal muscles. Stitching is required to close the wound. This type of tear is also associated with a good prognosis and tends to heal well over a few weeks.

Third degree tearing not only involves the vaginal tissue and perineal muscles, but the tearing of the anal sphincter too. Stitching is essential and the surgical repair of the muscles may be required. Third degree tears take six weeks or more to heal.

Fourth degree vaginal tearing is the most severe and involves the vaginal tissue, perineal muscles, anal sphincter muscles and the rectum. Surgical repair is necessary for healing to begin. Women who experience post-operative fecal incontinence may require additional surgery. During the healing process, rectal tearing requires a strict cleansing regime to avoid infection. Wounds associated with fourth degree tearing, take 6-8 weeks to heal.

In rare cases, there may be abnormal healing and additional surgery may be needed to repair significant tears.

How to take care of yourself after a tear or episiotomy:
  1. Your doctor may prescribe non-steroidal anti-inflammatory (e.g. ibuprofen) drugs or other medication (e.g. acetaminophen) to ease the pain you are experiencing.
  2. Warm baths, also known as sitz baths may relieve some of the pain and discomfort associated with tearing. This involves sitting in a warm bath that only covers your hips and buttocks.
  3. Applying ice wrapped in a cloth or chilled witch hazel pads to the inflamed area may help alleviate the pain.
  4. Keeping the area clean at all times, is essential
  5. Antibiotics may be necessary to prevent or control infection
  6. If you have had a serious tear, the pain will diminish over time but expect to experience some discomfort for three months or more. Here are some tips to make your recovery more manageable:
  7. Urinating or having a bowel movement may be painful during this time. Your medical practitioner may order a stool softener that can be taken during your first few weeks at home.
  8. Do not avoid the urge to move your bowels because you may become constipated.
  9. Only resume sexual relations after your medical advisor has given you the go ahead.
  10. Avoid putting anything in your rectum, including suppositories or an enema.
  11. Women with tears in their anal sphincter or all the way through their rectums are more likely to have the incontinence of gas or feces than women with more superficial tears. 

Risk factors:
  1. More serious tears (third or fourth degree tears) can happen to anyone but are more likely if:
  2. This is your first vaginal delivery
  3. You've previously given birth vaginally and had a third or fourth degree laceration.
  4. You have an assisted delivery, particularly if forceps are used
  5. You have an episiotomy or you had one in a previous delivery
  6. You give birth to a big baby
  7. Your baby is born in the posterior position (face-up)
  8. You push for a long time
  9. You have a small frame, especially in the pelvic area
  10. The distance between your vaginal opening and anus is shorter than average

  1. Tearing is not necessarily preventable, especially if you have a large baby, your child is in a difficult position or you have particularly “fragile” tissue 
  2. Massaging your perineum during the third trimester may help stretch the skin in this area, making it less likely that you will tear or need an episiotomy. From approximately 34 weeks, you or your partner can massage the perineum with fingers and a lubricating jelly, such as K-Y Jelly. Complete this action on a daily basis, to soften and stretch the skin and help it to stretch more easily during labour.
  3. Practice kegel exercises, in which you contract and hold the muscles of the pelvic floor. These are the same muscles you use to control the flow of urine. By contracting, holding and slowly releasing these muscles, you are helping to strengthen them
  4. Having a slow, controlled delivery that allows plenty of time for your perineum to stretch and accommodate your baby, is associated with a lower tear risk (E.g. resisting the urge to push when your baby’s head is crowning).
  5. One study, reported a link between the use of warm compresses on the perineum during the latter part of the second stage of labour and a lower risk of serious tears
  6. If you are a very small woman, carrying a very large baby, your doctor will be aware of and be able to advise you of this risk before you give birth.
  7. To prevent future tearing or tearing associated with intercourse: use a water-based lubricant during intercourse to prevent vaginal dryness. Oil-based lubricants can cause skin irritations or allergic reactions and may cause damage to condoms, increasing your risk of pregnancy or infection. Adequate foreplay produces natural lubrication, which can help prevent tearing. Experiment with different sexual positions, to avoid traumatic tears.

Contact your doctor immediately if:
  1. You are experiencing heavy bleeding, dizziness, faintness, fever or lower abdominal pain.
  2. You are suffering from fecal incontinence. This will probably result in a referral to a gynaecologist or colorectal surgeon
  3. You are experiencing vaginal discharge with a bad odour. This may be indicative of a vaginal infection that requires antibiotic treatment.

  1. BabyCentre L.L.C. Perineal tears. BabyCentre. Accessed January 18, 2013.
  2. BabyMed.Com. Vaginal tearing. Accessed January 19, 2013.
  3. ClinicTime.Net. Vaginal Tearing: Treatment & Prevention. Clinic Time.  Updated January 18, 2013. Accessed January 19, 2012.
  4. Lifescript. Vaginal Tears. Reviewed November 2009. Accessed January 18, 2013.
  5. Lucey J R. Vaginal Laceration. NYU Langone Medical Centre. Reviewed September 2012. Accessed January 19, 2012.