Painful Episiotomy/Vaginal Tear

The good news is that the rate of episiotomy with all vaginal deliveries decreased from 60.9% in 1979 to 24.5% in 2004.  Anal sphincter laceration spontaneous with vaginal delivery declined from 5% in 1979 to 3.5% in 2004 as stated in Frankman EA, Wang L, Bunker CH, et al. Episiotomy in the United States: has anything changed? Am J Obstet Gynecol 2009;200:xx-xx. 

Whether you are recovering from episiotomy or natural tear post delivery, healing should occur by six weeks postpartum, with ability to return to intercourse with little or no discomfort.  Your vaginal tear will be graded on a scale of first degree to fourth degree, depending on the depth of the tear and the structures involved. 

If your perineal scar is still painful, inhibiting intercourse, by six weeks, early intervention with physical therapy treatment is prudent, to reduce thickening and pain of restricted scar with use of manual therapy techniques and modalities, to work on compromised pelvic floor muscles, and to provide you with tools to return to intercourse as quickly as possible.

by International Consultation on Incontinence and the RCOG:

First degree: Injury to perineal skin only.

Second degree: Injury to perineum involving  perineal muscles, but not involving the anal sphincter.

Third degree: Injury to perineum involving the anal sphincter complex (EAS and IAS :
3a: Less than 50% of EAS thickness torn.
3b: More than 50% of EAS thickness torn.
3c: Both EAS and IAS torn.

Fourth degree
: Injury to perineum involving the anal sphincter complex and anal epithelium

 

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