Perineal Healing Post-Delivery

The area between the vagina and anus is called the perineum. Due to the support it provides the pelvic floor muscles, it is known as the foundation of the pelvic cavity. During labor, the perineum, vagina, and pelvic floor muscles stretch to their limit to allow the baby to pass through the vaginal opening. Sometimes, particularly for first-time mothers, the skin, muscles, and tissues of the perineum and vagina tear during childbirth. 

Here, we outline the types of perineal tears that are common during childbirth, how they are repaired, and the best tips for perineal healing post-delivery. 

The Different Types of Perineal Tears

As many as 85% of women giving birth vaginally for the first time are known to experience some form of perineal tear. While some are mild and heal on their own within a matter of weeks, more severe tears can require sutures and a few months for healing. 

Perineal tears are categorized into four degrees to outline their size, severity, and side effects. 

  • A first-degree tear is considered a mild and small tear that is usually only skin deep and heals naturally within a few weeks without the need for sutures.
  • A second-degree tear is a bit deeper; it usually involves a tear in the perineal muscles and sometimes the vaginal muscles. Sutures are needed to repair it, but these types of tears are also known to heal within a few weeks.  
  • Third-degree tears spread to the sphincter muscles, which help the rectum to function. Sutures are required and healing can take up to three months. 
  • Fourth-degree tears also affect the sphincter muscle and extend into the rectal lining. Sutures are needed to repair the tear and healing can take three months or longer.  

What Causes Perineal Tears?

The female body is an amazing machine that can grow and give birth to a baby; however, labor and delivery can be taxing on the body. Incidents that contribute to perineal tearing include the following: 

  • When it is your first birth and the vagina, perineum, and pelvic floor muscles have never stretched this much before. 
  • When the birth of your baby happens fast, the skin and tissues have not had enough time to thin and stretch gradually. 
  • When the baby is facing up the severity of tearing can increase because the head and neck must pass under the pubic bone to come out of the vaginal opening.
  • If you’ve experienced a perineal tear during a previous birth, the weakened skin and tissue might tear again. When this occurs, however, the subsequent tear is normally less severe. 

What Is an Episiotomy?

An episiotomy is a small incision in the perineum that is administered under topical anesthetic during labor to help with an easier birth. Similar to severe perineal tears, sutures are required to close the wound. 

In the past, episiotomies were performed regularly if the OB/GYN felt that the vaginal or perineal skin had already stretched to its limit. The belief was that performing an episiotomy could prevent third and fourth-degree perineal tears as well as the complications that could occur afterward. 

Research has since shown that rather than prevent future complications, an episiotomy can instead contribute to them. Therefore, an episiotomy is only performed today if the baby or mother is in distress, the baby is too large to pass through the vaginal opening, or when forceps or a vacuum are needed to help the birthing process. 

Complications Caused by Perineal Tears or An Episiotomy

Following a perineal tear or episiotomy, new mothers can experience pain, inflammation, and discomfort for the first few days and weeks, depending on the severity of the tear. With the proper care, the sutures should dissolve, the wound should heal, and these initial symptoms should subside. 

If the wound is not adequately cared for, however, some complications can ensue. These include: 


During the initial healing period after the birth, there is a risk of the wound becoming infected. It is in a precarious part of the body after all and susceptible to bacteria from the anus, vagina, and unclean hands. 

It’s therefore important to notify your healthcare provider if you have a high temperature or feel unwell. Other signs of an infection include an unpleasant vaginal odor, increased swelling or throbbing around the wound, and an unusual vaginal discharge (different than what is usually expected after childbirth). 

Another reason to call your doctor is if the sutures are dissolving or coming apart before your perineal tear has healed. 

Incontinence, Dyspareunia & Prolapse

Other complications can be more long-term and generally arise from the formation of scar tissue around the wound, as well as weakened pelvic floor muscles. 

When scar tissue begins to form around a wound, it typically receives less oxygen than normal skin tissue, meaning the newly forming fibers are weaker with less range of movement. A lack of elasticity around a perineal or episiotomy scar can impact the pelvic floor, resulting in urinary or fecal incontinence, pelvic organ prolapse, and pain during sex (dyspareunia).  

How to Heal the Perineum After Childbirth?

Whether healing from a perineal tear or an episiotomy, understanding how to care for your wound and the developing scar will not only make your recovery more comfortable but also prevent long-term side effects.  

Initial Care 

It’s vitally important during the initial few weeks after childbirth to rest and sleep when your baby sleeps to provide your body with the time and energy to recover. If you have sutures, they will begin to dissolve within a few weeks or a month. In the meantime, allow yourself time to lie down and rest (when your baby is sleeping) a few times a day. 

  • While you rest, remove your underwear and allow the wound to air for better healing.   
  • Try not to sit for too long. When sitting try a donut cushion for relief. 
  • When feeding your baby, it can be more comfortable to lay on your side.
  • Avoid tight clothing and wear disposable or breathable cotton underwear for comfort.
  • Drink at least eight glasses of water per day to stay hydrated for better healing.

Pain Relief

Over-the-counter pain relief medications like ibuprofen are safe if you are breastfeeding and can help relieve the pain of perineal wounds. Ibuprofen is not recommended if your baby was born premature and aspirin is not advised because it is passed through breastmilk to the baby. 

Other methods of pain relief that are helpful for perineal healing include:

  • Placing a cold compress or ice pack wrapped in a towel against the perineum for 10-20 minutes a few times per day
  • Taking a warm sitz bath helps to ease the pain and keep the wound clean

Perineal Care During Toilet Visits 

It can admittedly be uncomfortable to use the toilet after a perineal tear or episiotomy during childbirth, but the following tips will help you through without infecting the wound or disrupting the sutures. 

  • Gently pour some warm water over the vagina and perineal wound when you pee to prevent stinging, pain, or discomfort. 
  • Instead of wiping clean after a pee, use a spray bottle to spritz some water on the vagina. 
  • To dry the vagina after a pee, gently pat it clean or use a hairdryer.
  • Holding a clean sanitary pad against the perineal wound while having a bowel movement will protect it from the pressure of pushing.  
  • Eat a healthy diet with plenty of fiber to avoid constipation. 
  • Always wipe from front to back to keep the sutures clean and prevent infection.

Pelvic Floor Recovery 

Due to the over-stretching of the perineum, vagina, and pelvic floor muscles during labor, they will require some re-toning afterward to prevent long-term urinary incontinence, pelvic organ prolapse, and painful sex. 

To re-strengthen and improve blood circulation to the perineum and pelvic floor muscles after childbirth, it’s helpful to start practicing Kegel exercises as soon as you feel ready. Kegel exercises involve contracting, holding, and releasing the pelvic floor muscles in repeated sets a few times per day. 

It is helpful to contract and relax the pelvic floor muscles to improve circulation to the muscles themselves and surrounding tissues. These contractions are called kegels. It is helpful to begin practicing regular Kegel exercises in the weeks after childbirth, it also helps to progress to using Kegel Weights once your OB/GYN approves it, generally 12 weeks and beyond past delivery to allow for full healing. Recent research has shown that the majority of women are not targeting the pelvic floor muscles correctly during Kegel exercises, and the weights help train the brain to control these pelvic floor muscles.  

Available in sets that range from 0.9oz-4.400z, Intimate Rose Kegel Weights are made from medical-grade silicone that is safe for the body. Once inserted with the help of some water-based lubricant, the vaginal and pelvic floor muscles naturally wrap around the weights to hold them in place. This allows busy new mothers to retrain their pelvic floor for 10-20 minutes while getting on with other mom chores and responsibilities.  

Treating the Scar of a Perineal Tear or Episiotomy

Within 4-5 weeks after birth, the perineal tear will begin to form a scar. Elasticity will still be lacking in the newly formed skin as well as in its connections to the muscles and tissues around it. If your OB/GYN doesn’t show you how to perform a perineal massage, ask them to. 

Regular perineal massage for 5-10 minutes per day at this stage will improve blood circulation to the area and reduce the risk of tight and painful scar tissue forming. It will also help to reduce the emergence of raised bumps along the scar and help new mothers feel more confident about the prospect of resuming intercourse. 

Approximately 8 weeks after childbirth, the perineal wound will feel less painful during massage, meaning the skin tissues and muscles are strengthening. At this point, a pelvic massage wand can be used for deep tissue and muscle massage to further reduce tight scar tissue and any raised bumps along the line of the scar. 

Returning to Sex After Perineal Tears or an Episiotomy

The most important thing to remember about returning to sex after childbirth is, there is no rush. In addition to feeling sore, you may also feel too tired. Taking your time will also give your pelvic floor muscles and vagina the time they need to recover. 

When you do resume sex after childbirth be sure to use lubricant to avoid vaginal dryness and a condom if you’re not planning on getting pregnant again.  

What If Sex Is Painful After Childbirth?

Some women encounter pain during sex after childbirth or develop a fear of penetration due to the pelvic trauma they experienced during delivery. Although unsettling, painful sex or fear of vaginal penetration does not have to last forever and it’s helpful to speak with your OB/GYN about using pelvic health tools called Vaginal Dilators. 

Vaginal dilators are widely recommended for at-home use to gently and slowly rejuvenate the vaginal and pelvic floor muscles after childbirth and other pelvic injuries.  

When purchasing a set of vaginal dilators, make sure they are made from body-safe, medical-grade silicone for vaginal health and comfort. It’s also recommended to buy a set of gradually increasing sizes so you can start with the smallest dilator (the size of a pinkie finger) and progress at your own pace to the largest (the size of an erect penis). 


Perineal tears during childbirth are common but can differ for every woman. Some are mild and heal quickly, while others can be severe, require sutures, take longer to heal, and result in long-term complications. Caring for the perineal wound after delivery is the key to preventing complications like incontinence, prolapse, and painful sex. 

Whether you’ve experienced a perineal tear or an episiotomy, follow our guide to perineal healing above to avoid infection, prevent complications, and return to enjoyable sex after childbirth. 


Mayo Clinic – What to Expect After a Vaginal Birth -

Teach Me Anatomy – The Perineum -

National Childbirth Trust – Perineal Tears: Recovery and Care -

Johns Hopkins Medicine – Episiotomy -

Birth Injury Health Center - Episiotomy Complications and Side Effects -

Cleveland Clinic – Skin -

Cleveland Clinic – Healing After an Episiotomy -

Obstetrics & Gynecology Online Library - Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities -

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