The perineum is the area between your vagina and anus. During a vaginal delivery, it’s common for this area to stretch and even tear to allow your baby’s head to pass through the vaginal opening. Your healthcare provider may also make a cut in your perineum, called an episiotomy, to allow for more room for your baby’s head to pass through the vaginal opening. Women who give birth vaginally often experience a few weeks of swelling and pain in the perineum. For those who have a perineal tear or an episiotomy, it can be even more uncomfortable and take longer to recover. Episiotomies and some types of tears require stitches. The stitches generally will dissolve on their own in a few weeks.
Degrees of severity and healing times
- 1st-degree tear: The least severe tears involve just skin and tissue in the perineum, and they may not even need stitches. If stitches are required, they can typically be done in the delivery room. Healing usually takes several weeks.
- 2nd-degree tear: These tears involve both skin and muscle, and they may go deeper into the vagina. Stitches are likely required and can typically be done in the delivery room. Healing time is usually 3-4 weeks.
- 3rd-degree tear: These tears extend into the muscle known as your anal sphincter. Stitches are needed and may have to be done in an operating room. Healing time is usually 4-6 weeks, with antibiotics sometimes prescribed to prevent an infection.
- 4th-degree tear: These tears extend into your anal sphincter as well as the mucous membrane lining your rectum. Often, they have to be repaired in an operating room with stitches or more complex procedures. Healing time is usually 4-6 weeks or more, with antibiotics sometimes prescribed to prevent an infection.
What you can do to ease the pain
Some of the most common recommendations include:
- Applying chilled witch-hazel pads to the perineal area
- Using an ice pack or cold gel pack for 10-20 minutes at a time
- Taking a nonprescription pain reliever like ibuprofen or acetaminophen
- Sitting on a pillow or padded ring to reduce discomfort while seated
- Trying a side-lying breastfeeding position to avoid putting pressure on the perineal area
- Soaking in a sitz bath once your provider has given the green-light for postpartum baths
- Taking a stool softener or laxative to prevent constipation, if recommended by your provider
- Using a numbing spray or cream to lessen the pain, if recommended by your provider
- Abstaining from sex until your provider confirms that you’re completely healed
- Avoiding the use of tampons and menstrual cups until you’re completely healed
- Filling a squeeze bottle with warm water to rinse your perineum while urinating
- Patting yourself dry after urinating or showering to avoid irritating the wound
- Letting others do the heavy lifting until you’re completely healed
When to seek care immediately
Should your perineal pain get worse (instead of improving) or become disabling, it could indicate that you’ve developed an infection at the site of your perineal tear or episiotomy. Other signs of infection may include increased swelling, redness, pus/discharge, and fever. Contact your healthcare provider right away if you have any of these symptoms.
Reviewed by the Ovia Health Clinical Team
Sources:
- “Postpartum Pain Management” American College of Obstetrics and Gynecology ACOG. August 2022. https://www.acog.org/womens-health/faqs/postpartum-pain-management
- “What is postpartum perineal pain?” WebMD. WebMD. April 08, 2022. https://www.webmd.com/baby/what-is-postpartum-perineal-pain
- “Labor and delivery, postpartum care” Mayo Clinic. Mayo Clinic. October 26, 2023. https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/vaginal-tears/art-20546855
