Perineum: what it is, perineal tears and healing after birth

The perineum is the area of skin and muscle between your vagina and your anus. KKH says it thins out and stretches as your baby is born, and it can tear or be cut in an episiotomy. The NHS says up to 9 in 10 first-time mothers who have a vaginal birth get a tear, graze or episiotomy, and the RCOG says most tears are minor and heal quickly.

Perineal tears: first to fourth degree

After the birth, your doctor or midwife examines your vagina, perineum and back passage to see whether you have torn and how deeply. The RCOG grades tears like this:

• First degree: small tears of the skin only, which usually heal quickly without treatment.
• Second degree: tears through the muscle of the perineum and the skin.
• Third and fourth degree: deeper tears into the muscle that controls the anus, the anal sphincter. The RCOG says 3.5 in 100 women have one, and they are repaired in the operating theatre.

An episiotomy is a deliberate cut instead of a tear. KKH's obstetricians say it is usually made sideways, because a natural tear can run in many directions and be harder to repair.

How long a perineal tear takes to heal

KKH says a perineal tear usually heals in two to three weeks, depending on its size and the stitches used, and that the stitches dissolve on their own. The NHS says stitches should heal within a month of the birth. For an episiotomy, KKH's obstetrics team says the pain lasts about 2 to 3 days and healing is complete by 6 weeks.

Soreness should ease week by week. If your stitches get more painful instead, the NHS treats that as a possible sign of infection.

Caring for your perineum at home

KKH's Delivery Suite gives new mothers this routine:

• Wash with water after every toilet visit, then dab dry gently.
• Change your pad every two to three hours.
• Use cooling gel pads, rest on your side every few hours, and avoid sitting for long.
• Take the painkillers you were prescribed.
• Try a sitz bath: two teaspoons of salt in cool or lukewarm water, sitting in it for about 20 minutes, three times a day.

The NHS adds that it can feel better to hold a clean pad of tissue over the stitches when you poo, and that you are very unlikely to break them. If anyone tells you to skip washing during confinement, Families for Life notes that avoiding baths can lead to wound or episiotomy infection.

Signs your perineum needs a doctor

KKH asks you to see a doctor for pus-like or foul-smelling discharge, bleeding from the wound, fever or chills, or perineal pain that is severe or getting worse. The NHS adds red, swollen skin around the cut or tear.

Some problems show up later. The NHS lists pain in the perineum, painful sex, and trouble holding in wind, pee or poo as things to tell your doctor at your 6-week postnatal review, and says pelvic floor exercises can help with leaks. Our guide to episiotomy and perineal tears in Singapore walks through healing week by week.

Frequently asked questions

What is the perineum?

The area between the vaginal opening and the anus. KKH describes it as the skin between the vagina and the anus, and the RCOG's grading shows it includes muscle as well as skin.

How common is a perineal tear?

Very common in a first vaginal birth. The NHS and the RCOG both say up to 9 in 10 first-time mothers have a tear, graze or episiotomy. Deep third or fourth degree tears happen to about 3.5 in 100 women, the RCOG says.

Do perineal stitches need to be removed?

Usually not. KKH says the stitches dissolve on their own. The NHS notes that once in a while they have to be taken out.

When can I have sex after a perineal tear?

Wait until the tear has fully healed, KKH advises, and get the go-ahead from your doctor at the postnatal review, often around six weeks after the birth.

Related terms

• Episiotomy: A small cut in the perineum during birth to widen the vaginal opening, closed afterwards with dissolvable stitches.
• Pelvic Floor: The hammock of muscles holding up your womb, bladder and bowel, which pregnancy and birth can weaken.
• Lochia: The bleeding and discharge after birth, red at first and paler over three to eight weeks.
• 6-Week Postnatal Review: Your own check-up with a doctor four to six weeks after birth, covering healing, mood, feeding and contraception.
• Confinement (Zuo Yue Zi): The traditional rest period after birth, 30 to 44 days depending on community, with food rules and extra help at home.

See every term in the glossary