The Low-Down on Tearing ‘Down There’

Try to relax, perineal lacerations, aka “tears,” are a common occurrence during vaginal birth. Yes, it’s common; in fact, it happens in more than two out of three vaginal deliveries.

These lacerations are classified into four categories:

• First-degree: skin on the labia, perineum or vaginal membrane is torn

• Second-degree: like a first-degree tear, but including perineal muscles

• Third-degree: skin, muscle and anal sphincter are torn

• Fourth-degree: skin, muscle, anal sphincter and rectal membranes are torn

The quick facts:

Why do tears happen? 

Quite simply, in humans and some other primates, the head of the full-term baby is so much bigger than the vulvar opening that birth rarely happens without some trauma.

How is a tear treated? 

Depending on your specific tear, you may need sutures.

Can anything be done to prevent tearing? 

The evidence says no. Although many people may suggest therapies like prenatal perineal massage, counter-pressure during pushing, waterbirth, or others, no evidence shows that these therapies stop tears from happening.

On a personal note, I gave birth vaginally three times and tore twice. I’m the statistic! With my first baby, I had a second-degree tear that needed three stitches. My midwife used dissolvable sutures so nothing needed to be removed later. I tore again with my third baby in two places but didn’t require any repairs.

What’s life like after a tear? Will sex be uncomfortable? Will everything go back to like it was before or am I changed forever?

The thought of activities like intercourse or urinating or the first bowel movement after a tear can be scary stuff. But in reality, our worries are greater than the actual issue. If you’re anxious, ask your care provider for a stool softener. Since you should abstain from sexual intercourse for at least six weeks after birth, you most likely will be healed by then. However, you may want to use lubrication to make yourself more comfortable.  Urinating can sting or burn at the tear,so rinsing with a peri bottle for a few days (versus wiping with toilet paper) can be both soothing and cleaning. Your care provider will give you more specific treatment guidelines.

Most importantly, you will heal. You will heal and you most likely will never notice it again. Really! Your tear will heal, your life will be normal again relatively quickly. You’ll be amazed.