What is perineal tearing?
Did you experience perineal tearing with the birth of your child? According to The American College of Obstetricians and Gynecologists (ACOG) 53-79% of women with vaginal deliveries will experience some degree of perineal tearing or laceration. (The term "perineal" refers to the area between the vaginal opening and the anus). This number increases in deliveries that utilize forceps or a vacuum to assist the delivery.
Perineal Tearing and Scar Tissue
Luckily, episiotomies are rarely used these days, except for in emergency situations. This is primarily because tissues that naturally tear can come together heal more easily than two edges of tissue that have been abruptly cut. Regardless of how your perineal tearing occured, scar tissue will form as the perineum heals, and this scar tissue can cause problems. The scar tissue develops as the damaged tissue tries to quickly heal and unfortunately the tissue that forms doesn’t have the same properties as healthy, normal skin. Because of this, perineal scar tissue can lead to pelvic pain, pelvic floor dysfunction, low back pain, and pain with intercourse.
Will scar tissue improve on its own?
While you can perform perineal massage (gentle stretching at the vaginal opening) on yourself, most often the scar tissue extends much deeper than just the superficial level of the skin at the opening. Even with minor tears the scar tissue can extend into the deeper pelvic floor muscles affecting your pelvic floor strength, control, and coordination. So if you have attempted some perineal massage and noticed it was very uncomfortable or painful, you are likely to benefit from the helping hands of the pelvic floor physical therapist to further treat the scar tissue and help you fully recover.
What if I do nothing?
Perhaps one of the most interesting facts about scar tissue is that it can continue to build or form for up to a year after an injury or incision is made. The beautiful thing about scar tissue therapy is it can break up scar tissue even 20+ years after it has formed, resulting in decreased pain and improved function of the tissue that is scarred. However, you will benefit most by seeking scar tissue therapy sooner rather than later. If you are experiencing pain beyond the first 12 weeks postpartum, it is likely that you will continue to experience long-term issues due to the scar tissue from your perineal tearing if you don’t seek out treatment. A pelvic floor physical therapist is specially trained to treat scar tissue caused by perineal tearing. Gentle, manual therapy has been shown to be very effective alleviating issues caused by the damaged tissue.
Perineal Tearing in Subsequent Deliveries
Scar tissue that is not addressed can affect future deliveries and the chance of experiencing perineal tearing again. Scar tissue is not as strong and stretchy as at normal, healthy tissue. So if scar tissue still persists after your first delivery, it is possible that you could end up with perineal tearing in the same area as your previous scar tissue. As the tissue heals, you would end up with even more damaged tissues (and likely more pain) in the same area.
Is it normal to experience pain during sex after baby?
NO! In a recent study1, it was found that 16-20% of women who had perineal tearing or trauma with a vaginal delivery still had pain with intercourse at 18 months postpartum. Pain with intercourse is a common issue that occurs due to the scar tissue that forms from perineal tearing after a vaginal delivery. There are other issues like dryness and hormonal changes that can cause discomfort with intercourse. But if you are experiencing sharp, stabbing, ripping, intense pain at the vaginal opening it is likely related to scar tissue and likely will not change with hormone shifts. You do not have to endure the pain caused by scar tissue--physical therapy can help!
If you want to learn more about perineal tearing, scar tissue, and painful sex after baby, check out our video “Let’s Talk About Sex (after), Baby” and be sure to download the companion worksheet as an added resource!
1. McDonald, EA, Gartland, D, Small, R, Brown, SJ. Dyspareunia and childbirth: a prospective cohort study. BJOG 2015; 122: 672– 679.