Experiencing a vaginal tear during childbirth is relatively common but it can make the first few weeks after birth a little more difficult as you navigate the healing process on top of caring for your new baby.
The good news is that there are a number of steps you can take to speed up the recovery of perineal tears and help ease the pain you're in.
Here's everything you need to know about vaginal tears and how to treat them.
What is a vaginal tear?
A vaginal tear or perineal tear is a laceration or rip in the skin (and sometimes the tissue or muscle too) around the vagina and perineum.
This is the region between the vagina and the anus.
While vaginal tears can occur during sexual activity, they are most commonly associated with childbirth [1].
The figures around perineal tears show that around 26% of women experience a tear during a vaginal delivery that needs to be stitched [2]. A further 23% experience minor vaginal tearing or grazing.
2% of women experience the most severe form of tear during a vaginal delivery, which involves the vagina, perineum and anus.
What causes a vaginal tear?
The body is an incredible machine that is designed for vaginal delivery but not all babies exit the womb easily.
The vaginal skin will thin out during labour, allowing it to stretch to help your baby's head, body and limbs slide out with ease [3].
Unfortunately, sometimes a number of things can cause a vaginal tear including:
- The first birth: It's common to experience tearing during your first birth as your body hasn't stretched this way before.
- A quick birth: If you've experienced very quick labour, your vaginal skin may not have time to thin and stretch properly, which could create a tear.
- A big baby: Tearing is more likely if your baby weighs over 8 pounds (just over 3 kilos).
- A face-up baby: If the baby's head is in the wrong position, it will have to extend its head and neck under the pubic bone in order to exit the vagina. This can greatly increase the risk of a tear.
- Use of forceps or a vacuum: An assisted vaginal delivery that uses tools like forceps or a vacuum can increase the risk of vaginal tears [4].
- Previous episiotomy: If you've had a vaginal incision during a previous birth, especially a midline episiotomy, it can lead to fourth-degree perineal tears.
Symptoms of a vaginal tear
Wondering whether your vagina has torn during a vaginal birth?
Some of the symptoms of a vaginal tear include:
- Itching or burning sensations
- Stinging pain when urinating
- Discomfort when having sex or inserting a tampon
- Bleeding
Unfortunately, if your experience is a severe tear, you likely won't need to question whether it's happened or not.
Severe tears are usually indicated with symptoms like blood-soaked sanitary pads and large blood clots.
What are the different types of tears?
When it comes to the severity of vaginal tears, there are 4 distinct types.
- A first-degree tear is the least severe of all perineal tears and involves a small tear in the vaginal tissues.
- A second-degree tear is the most common type of vaginal tear. This vaginal tearing often includes a slightly deeper tear that extends to the skin and muscle of the perineum and sometimes the vagina.
- A third-degree tear indicates a tear that reaches the muscles from the vagina to the anus.
- A fourth-degree perineal tear is the most severe, and thankfully, the rarest type, too. This tear extends from the vagina to the anal sphincter muscles and into the rectum too.
Third and fourth-degree perineal tears are extremely painful and can impact your body in a number of ways [5].
According to studies, third and fourth-degree perineal tears affect four out of every 100 women who have a vaginal birth.
These kinds of tears can cause anal incontinence, as well as pain and discomfort with intercourse.
The good news is that 60-80% of women who have a third or fourth-degree tear have no symptoms 12 months after the event.
Can an episiotomy prevent you from tearing?
An episiotomy is a small surgical incision that's performed during the second stage of labour, allowing the vaginal opening to quickly become enlarged for the baby to pass through [1].
While these procedures used to be common, they're not recommended now unless absolutely necessary.
Research shows that this procedure can actually contribute to more severe vaginal tears that might otherwise occur naturally.
There's also a slight risk of infection, blood loss and incontinence.
Is there anything else you can do to prevent tearing?
Unfortunately, there's no guaranteed way to prevent a tear during labour and delivery.
But, there are a few things you can do in the lead-up to birth to help prevent perineal trauma.
Both pelvic floor exercises like Kegels and perineal massage have been shown to make a difference in reducing vaginal tearing.
A study from 2017 found that combining Kegel exercises with perineal massage increased the chance of having no tearing from 6% to 17%, while also reducing the risk of perineal tears that included the anus [6].
The aim of the game is to make your perineal area softer and more stretchy in order to allow the baby's head to pass through easier.
You might also like to try applying warm compresses to the perineum during labour.
Controlled labour is also another brilliant way to try and prevent tears.
This refers to only pushing when you feel the urge, which allows your skin enough time to stretch for the baby's birth.
There's also new evidence emerging that shows delivering on all fours can reduce your risk of tearing.
How are vaginal tears treated or repaired?
If your vaginal tear is small, it will heal on its own within a few weeks [7].
For women with third or fourth-degree tears (and sometimes even second-degree tears), it's important to seek medical attention.
If your tear is bigger and you need stitches, this procedure will be performed not long after you give birth.
The good news is that unless you're bleeding profusely and need urgent significant medical attention (which is rare), you'll be able to enjoy skin-to-skin contact with your baby as soon as you give birth.
If you've only had a small tear, you're likely to be given a local anaesthetic to numb the area so you don't feel the stitches.
For larger tears, you'll probably be given a regional anaesthetic designed to completely numb the area of trauma [7].
In this case, you'll be taken to an operating theatre.
The good news is that once your stitches are in, you'll likely heal within 2-3 weeks.
The stitches might irritate you when you go to the toilet or feel itchy, but this is completely normal.
For third and fourth-degree tears, it might take a little longer to heal.
In this case, you might be prescribed antibiotics to prevent infection.
How to help heal a vaginal tear
Once you're all stitched up and ready to go home, the at-home care begins.
You'll want to keep the area as clean as possible by showering or bathing every day — just make sure you don't directly soap the wound.
You'll also want to wash the wound area every time you use the toilet and make sure it's completely dry by patting it with a clean towel.
It's important to also change your maternity pads regularly to reduce the risk of infection.
One of the most important aspects of helping a perineal tear heal is minimising any pain involved [7].
The following things can help here:
- Take paracetamol or ibuprofen, which can help with stinging and swelling.
- Place an ice pack on the perineal area for about 10 minutes at a time. Wrap it in a face washer or cloth to avoid burning yourself with ice.
- Take warm baths (if cleared by your doctor!).
- Sit on a rubber ring (for no longer than half an hour).
- Change your position regularly so you don't put unnecessary pressure on the area.
- Use a Peri Bottle to wash your perineum area during and after going to the toilet. This can help with stinging sensations.
- Eat a healthy balanced diet and stay hydrated. This can help you avoid painful constipation.
Kin's Postpartum Recovery Bundle was designed to support new parents in their healing journey after birth.
This 6-step kit includes tools that are super helpful in your recovery, including The Peri Bottle, The Mesh Panties, The Soothing Padsicles and The Healing Foam.
The Peri Bottle delicately cleans your vagina without painful pressure and it helps reduce stinging when going to the toilet.
The Mesh Panties are soft, stretchy and breathable and hold you in with the right amount of support.
The Soothing Padsicles combine instant cold therapy and an absorbent pad in one.
The coolness provides relief to your sore and sensitive bits while also catching any postpartum bleeding you're experiencing.
The Nourishing Cream is a luxurious belly butter blend that prevents and reduces the appearance of stretch marks whilst relieving breast discomfort and itchiness.
The Postnatal Vitamin is designed to address symptoms of postpartum depletion including hair loss, fatigue, and brain fog.
Rounding out the kit is the Healing Foam — a soothing foam that fights bacteria and reduces swelling while helping ease pain and itching.
The inclusion of witch hazel, which is a natural healer, helps with perineal trauma recovery.
Risks and complications of a vaginal tear
There are a few risks associated with vaginal tears and it's helpful to be aware of this.
Dealing with a first or second-degree tear?
You're likely in the clear when it comes to incontinence.
If you have a third or fourth-degree tear, you might pass poo or pee without meaning to — but this doesn't happen to every woman.
Regardless of whether you tear, up to one-third of women experience urinary incontinence after giving birth.
You might find the following helpful:
- Pelvic floor exercises [7]
- Avoiding high-impact exercises
- Avoiding heavy lifting
- Treating constipation
- Cutting down on caffeine
- Avoiding alcohol
- Drinking 6-8 glasses of water a day.
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