An episiotomy is a surgical cut made during vaginal birth in the area between the vaginal opening and the anus (the perineum). Perineal tears, on the other hand, occur naturally in this area during birth. The episiotomy cut and tears that need stitches are repaired with dissolvable stitches after the birth and usually heal without problems. In some women, however, complaints may continue after healing.
Reasons for seeking care
Birth tears or episiotomy scars, changes at the vaginal opening and discomfort in the perineal area may be among the reasons for seeking care:
- Thickened, raised, itchy or tender scar tissue
- Pain during intercourse
- Widening, narrowing or asymmetry of the vaginal opening
- Discomfort related to the appearance of the scar
Assessment
The natural healing process, pelvic floor function and plans for future pregnancies are taken into account. Pain during intercourse is common in the first months after birth and may last for several months; for this reason, healing is allowed to complete before a decision on surgical repair is made. The examination assesses the scar tissue, the structure of the perineum and the condition of the vaginal opening.
Because pain during intercourse can also have other causes, such as vaginal dryness, infections or involuntary tightening of the muscles at the vaginal opening (vaginismus), these possibilities are also investigated. After severe tears that also involve the muscles around the anus, complaints such as leakage of gas or stool may occur; if present, these are assessed in detail and their treatment is planned separately.
Options
Depending on need, pelvic floor rehabilitation, scar tissue revision or surgical repair options are considered.
- Non-surgical approaches: pelvic floor muscle exercises and physical therapy (pelvic floor rehabilitation), lubricants if there is dryness and, where appropriate, medication are among the options.
- Perineoplasty (surgical repair): scar tissue is removed where necessary, the muscles and supporting tissue of the perineum are brought back together and the skin is stitched. Depending on its extent, the procedure may be performed under general, regional or local anesthesia.
There is no definitive guideline on when and with which technique perineoplasty should be performed; scientific data are limited.
Recovery
In the days after the procedure there may be pain, swelling and light bleeding. Intercourse and strenuous physical activity are postponed until the stitches have healed; this period is determined at the follow-up examination. For people planning a pregnancy, the timing of the procedure is discussed separately, bearing in mind that a later vaginal birth may affect the area again.
Possible risks
Possible risks include bleeding and a collection of blood (hematoma), infection, separation of the stitches, new scar tissue, altered sensation, excessive narrowing of the vaginal opening and continuing or new pain during intercourse. Rarely, injury to the bowel (rectum) may occur. It cannot be guaranteed that the complaints will resolve completely.