What Is a Vaginal Tear?

A vaginal tear, also known as a perineal laceration, is a common injury that happens during childbirth. The perineum is the space between the vaginal opening and anus, and the tear in the soft tissue typically occurs around this area. There are four grades of tears, varying in levels of severity, with a fourth-degree tear being the worst.

Vaginal tears typically happen when the baby’s head is too large for the vaginal opening. During a vaginal delivery, the skin of the vagina thins out and stretches to make room for the baby’s head, but sometimes it does not stretch enough, which allows for the skin to tear. Treatment depends on the severity of the tear. There are many at-home treatments that help to minimize pain or discomfort.

Episiotomy vs Tear

The difference between an episiotomy and a tear is that an episiotomy is a cut that the doctor makes in the perineum and vaginal wall to create more space for your baby to be born. The cut makes the opening of the vagina a bit wider. It is only done with your consent. Typically, episiotomies are only performed if your baby needs to be born quickly, is being born with the help of instruments (forceps or vacuum), or there is a risk of tearing the anus.

Types and Degrees of Vaginal Tears

1st Degree Tear

This is the least severe tear. The injury is small and only involves the first layer of skin around the vagina and perineum. Typically, this grade does not require stitches.

2nd Degree Tear

This is the most common grade of tearing. The tear is slightly bigger and extends through the first layer of skin into the underlying muscles of the vagina and perineum. This tear requires stitches.

3rd Degree Tear

This grade of tearing extends from your vagina to your anus. The injury involves tearing of the skin and muscles of the perineal area and does damage to your anal sphincter muscles. The anal sphincter muscles are involved in bowel movement functioning. Stitches are required for a third-degree tear.

4th Degree Tear

This is the most severe and least common type of vaginal tear. This tear extends from your vagina, through the perinium and the anal sphincter muscles, and into your rectum. You may need to be taken to an operating room for stitches.

What Causes Vaginal Tearing?

Vaginal tearing occurs when the baby’s head stretches the vagina and perineum beyond its ability to stretch. During a vaginal delivery, the vagina prepares by thinning and stretching, but sometimes it does not stretch enough. Vaginal tearing is a normal and common occurrence during vaginal births.

Who Is at Higher Risk of Tearing?

There are certain risk factors that may increase your risk of experiencing a vaginal tear during childbirth. Risk factors include:

• It is your first delivery
• The baby was face up instead of face down for delivery
• Delivering a larger baby (more than 8 pounds)
• Forceps or a vacuum were used during delivery
• Prolonged second stage of labor
• Use of an epidural
• Being of Asian descent

How to Prevent Tearing During Childbirth

Vaginal tears are mostly unavoidable. However, there are some preventative measures that may decrease your risk of tearing. Prevention techniques include:

• Perineal massage. A perineal massage helps the perineum to stretch more easily. It is usually recommended to try this technique after about 34 weeks and during labor.
• Keeping the perineum warm. Your doctor may provide a warm cloth to put on your perineum.
• Delivery position. Sitting upright or lying on your side during delivery may decrease the risk of tearing.

Treatment for Perineal Tears

Treatment for vaginal tears depends on the severity of the tear. Some tears require stitches, while first-degree tears may not and are able to heal with at-home treatments. Second, third, and fourth-degree tears all require stitches to heal. Stitches will dissolve on their own within 6 weeks. Most tears are treated while in the delivery room, unless it is a fourth-degree tear, which sometimes requires being transferred to an operating room.

It is normal to feel discomfort for a few weeks following delivery while your tear heals. There are a few recommendations that can help ease the discomfort, including:

• Using a peri-bottle (squirt bottle). You can use this to wash yourself clean after using the bathroom. It is recommended to use lukewarm water.
• Pat dry. Gently pat yourself dry with toilet paper instead of wiping.
• Apply ice packs. You can apply ice packs or wear special sanitary pads that have cold packs inside. These types of pads are usually available at the hospital or local drugstore.
• Avoid constipation. Make sure to stay hydrated, drinking plenty of fluids with electrolytes, or using a stool softener.
• Sitz bath. Fill the bath with a few inches of warm water and sit in it for a few minutes.
• Donut pillow. Use a donut pillow if you have a third or fourth-degree tear, as it will help to relieve pressure from your bottom.
• Avoid certain exercises or movements. Avoid exercises or movements that aggravate or cause pain and discomfort in the perineal area. Walking down steps or doing squats are two exercises you may want to consider avoiding if it all possible.
• Pain medication. Your doctor may recommend over-the-counter pain medication as your tear heals.
• Numbing spray. Your doctor may recommend a pain-relieving numbing spray.

Perineal Tears FAQs

How Long Does It Take for Vaginal Tears to Heal?

Vaginal tears typically take about 2 weeks to heal, while larger tears may take longer. The stitches will dissolve on their own and you should not require any further treatment. It is important to monitor any signs of infection as your injury heals. Signs may include:

• Fever
• Foul smelling discharge
• Pain that does not subside with medication

Additionally, some women may experience pain with sex, even after the tear has healed. If you feel pain or discomfort with sex, speak with your healthcare provider.

What Are the Complications of Tearing During Childbirth?

Usually, with first or second-degree tears, there are no complications and tears will heal within two weeks. There is a greater risk for complications with larger tears. Complications may include:

• Infection
• Bleeding
• Ongoing pain and soreness
• Fecal incontinence (leaking poop)
• Painful intercourse