At the risk of stating the obvious, a vaginal delivery requires your vagina to stretch (and stretch…) so it can accommodate the arrival of your baby into the world.
But during childbirth, the pressure from baby’s head as it pushes through the vaginal opening can still cause tears and lacerations in the perineum, the area between your vagina and your anus, and sometimes your cervix as well.
Here's more about perineal and vaginal tears during and after childbirth, including how long it takes a vaginal tear to heal, the types you may experience, what causes them, and how to treat them.
What is a vaginal tear?
The most common type of laceration is a vaginal or perineal tear — a rip in the skin and sometimes the tissue or muscle around your vagina and perineum. Tears can also occur on your labia, near your urethra or clitoris, deep inside your vagina, or on your cervix.
Vaginal tears are relatively common: More than half of all women will have at least a small tear after childbirth. And every woman who delivers vaginally — and sometimes even those who experience a lengthy labor before delivering via C-section — can expect some level of postpartum perineal pain.
How long does it take for vaginal tears to heal?
Whether you had a vaginal tear or an incision, a new wound like this one will take time to heal, usually seven to 10 days. Stitches used in the repair of various tears will dissolve on their own within six weeks.
The site of the tear, however, will likely hurt for several weeks — and more severe tears may take longer to heal — so take it easy in the meantime.
What types of vaginal tears can occur during childbirth?
There are a handful of different types (or "levels") of vaginal tears that can happen during labor and delivery, and their labels are based on the severity of tearing in the tissue. Here’s more about each one:[1]
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- First-degree tear. This superficial tear occurs on the perineal skin.
- Second-degree tear. This injury is the most common and is a slightly deeper tear that extends to the skin and muscle of the perineum and sometimes the vagina.
- Third-degree tear. This level of tear involves a second-degree rip that then extends into part or all of the muscle of the anal sphincter.
- Fourth-degree tear. This most severe, and thankfully rare, laceration extends from the vagina and perineum through the anal sphincter muscles and into the rectum.
What causes vaginal tears during childbirth?
Your body is a wondrous machine that’s actually designed for vaginal births, but some babies don’t always exit quite so easily.
During labor and delivery, the vaginal skin will thin out so it can stretch, allowing your baby’s head, body and limbs to slide out. Still, in some cases, the vagina or perineum can tear for one or more of these reasons:
- This is your first birth. Your body has never stretched to this extent before — and sometimes, a tear is the result.
- You had a fast birth. A very quick labor may not allow the skin enough time to thin and stretch.
- Your baby is bigger. If your newborn weighs more than 8 pounds, a tear is more likely.
- Your baby is face-up. Also called “sunny side up,” a baby in this position has to extend his head and neck under the pubic bone in order to exit, increasing the risk of a tear.
- Your doctors used forceps or a vacuum. These tools may also cause vaginal or perineal lacerations.
- You’ve had a prior laceration. If you have had a previous delivery that resulted in tearing, that tissue tends to be slightly weaker and can re-tear during a subsequent birth. The good news is that this tear usually tends to be less deep.
How are vaginal tears treated or repaired?
Stitches are required to treat tears that are longer than 2 centimeters (or about an inch) in size, which includes second-, third- and fourth-degree lacerations.
A first-degree tear, however, usually heals on its own.
You may be stitched up right in the delivery room, though more severe tears are sometimes repaired under anesthesia, possibly by a specialist, in an operating room.
In cases in which a third- or fourth-degree laceration occurs, immediate care should include adequate pain control, steps to avoid postpartum constipation, and evaluation for urinary retention.
Tips for caring for vaginal tears after childbirth
Your stitches will absorb over time, but you can help your tears heal more quickly by keeping the area clean postpartum. Here’s how to keep the area healthy and prevent an infection:
- Spritz it. Squirt your perineum with warm water in a plastic bottle during and after urinating, and try using a sitz bath.
- Dry with care. Use gentle patting — no rubbing — with gauze pads or paper wipes that come with your hospital-approved sanitary pads. Try to change the pads at least every four to six hours.
- Have a hands-off policy. Try not to touch the area at all. If you're constantly "testing" how the site's healing with your hands, it's going to take longer to get better.
- Air it out. Exposing the area to the air can help it heal more quickly and ease pain.
- Stay regular. The sooner you can get your bowels moving, the better all around (don’t fret if it takes a few days). It’s natural to be scared about splitting your stitches during your first postpartum bowel movement. But don’t worry — you won’t.
- Eat right. To help move your bowels along, drink plenty of water and chow down on roughage like whole grains, fresh fruits and veggies. When you’re ready, take short strolls.
- Go OTC. If your bowels aren’t cooperating, you might ask your practitioner about an over-the-counter stool softener or mild laxative to ease constipation.
- Do your Kegels. After delivery, continue doing your Kegels as soon as you can — even if you can't feel yourself doing them. These exercises can stimulate circulation and help you heal faster. They're great for muscle tone and may decrease your risk of incontinence.
How to reduce pain from vaginal tears
The pain is real when it comes to vaginal tears, but there are some ways to get relief:
- Ice. Chilled witch hazel pads, crushed ice in a plastic bag or wash cloth, or a maxi-pad lined with a plastic cold pack can fight swelling.
- Heat. Take a warm sitz bath for 20 minutes three times a day, or apply warm compresses.
- Numbing. Your practitioner may recommend an anesthetic to numb the area — usually in the form of an over-the-counter option such as a spray or ointment.
- No straining. Don’t plan on activities that could put more strain on your body. Sleep on your side, and try not to stand or sit for long periods of time, which can increase perineal pain.
- Cushioning. Donut-shaped pillows or rings that are marketed for hemorrhoid sufferers could give you some comfort while you sit. If you had hemorrhoids during pregnancy and are still recovering, you can kill two pains with one pillow!
Can you prevent vaginal tears?
There’s no guaranteed way to prevent vaginal tears during labor and delivery.[2]
Some research has shown that performing perineal massage during pregnancy, specifically in the month or so before your due date, may reduce the risk of having a third- or fourth-degree tear. Making your perineal area softer may help it stretch over your baby’s head during childbirth.
Applying warm compresses to the perineum and using perineal massage during labor may also help you avoid larger tears, as can controlled labor, which means pushing only when you feel the urge and allowing your skin enough time to stretch.
Lastly, there’s some evidence that delivering while on all fours, rather than squatting or lying on your back, can reduce the risk of vaginal tears.
And while episiotomies were once standard protocol in order to widen the vaginal opening, this cut doesn’t always prevent tearing and it can even put you at risk for more severe lacerations. In fact, routine episiotomies are no longer recommended by ACOG, though one may be needed due to a baby’s size, position or another reason.
If I had a vaginal tear during my last pregnancy, am I at risk of having one again?
Having a vaginal tear once doesn’t necessarily increase your odds of experiencing a tear again, especially if you had a first- or second-degree laceration.
But some research shows that if you had a third- or fourth-degree tear during your first delivery, the risk of having a severe tear increases in future deliveries.
When to call the doctor about a vaginal tear
If your perineum becomes very red, very painful or swollen, or if you detect an unpleasant odor, you may have developed an infection, so be sure to get in touch with your practitioner.
And always make a call if you develop a fever or the pain you experience doesn’t ease, even with medication.
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