Vaginal tears & episiotomy

What is a vaginal tear?

Vaginal tears, or splits or fissures refer to any injury of the vaginal tissue, which can include the vagina or the vulva. Tears can be superficial, and include small cuts or grazes that can affect the clitoris, labia or inside the vagina. These usually heal by themselves. Other tears may be more serious and may require medical attention.

Even small tears can cause pain and discomfort.

What causes a vaginal tear?

Vaginal tears or lacerations can be caused by several things:

Sexual activity — This is one of the most common cause of vaginal tears. Factors that increase the risk of a tear include:

• intercourse with tearing of the hymen
• rough or vigorous thrusting into the vagina may tear the entrance
• vaginal dryness may lead to minor splitting or abrasion
• some skin conditions such as lichen sclerosus or lichen planus, psoriasis or eczema
• drier, thinner and less elastic vaginal tissue (common after menopause and childbirth)
• scarring or tissue damage as a result of surgery, pelvic radiation or abnormalities

Hair removal — You can sustain vaginal tears by using a razor to remove pubic hair. Waxing can also result in cuts or tears.

Childbirth — Vaginal delivery can cause cuts and tears inside the vagina and other parts of the vulva including the labia. The perineum (area of skin between the vagina and anus) is also prone to tearing. More than 85% of women will experience some form of tear during a vaginal delivery with incidence decreasing with subsequent births.

Tears caused by childbirth are classified by degrees:

• First degree — Small tears or grazes only affecting the skin which may affect the vagina, labia and clitoris

• Second degree — Tears that affect the perineal muscle and the skin, which usually require stitches

• Third or fourth degree — Also known as obstetric anal sphincter injury (OASIS), these are deep tears which extend into the anal sphincter (muscle that controls the anus). They occur in around 6% of first-time births and less than 2% of women who have given birth previously. Surgery is required to repair these injuries.

A procedure called an episiotomy may be performed during childbirth in order to prevent a tear.

What is an episiotomy?

An episiotomy is an incision (cut) made in the perineum to widen the vaginal opening during childbirth. They used to be a routine part of childbirth, but now episiotomies are only performed in some circumstances. These may include when:

• a baby needs to be delivered quickly due to foetal distress
• forceps or suction are required to assist in delivery
• the baby’s shoulders are stuck behind the pelvic bone

Episiotomies are performed under local anaesthetic, and involve a small diagonal cut from the back of the vagina down towards one side. After the birth, the cut is stitched together using dissolvable stitches.

It’s normal to feel pain and discomfort for two to three weeks after an episiotomy. During this time, you can take over-the-counter (OTC) painkillers to help relieve the pain. Applying ice wrapped in a cloth for 10-20 minutes at a time can also help.

Your health practitioner will also be able to provide advice on managing day-to-day activities such as going to the toilet, sitting and walking.

Signs and symptoms of a vaginal tear

Symptoms of vaginal cuts and tears include pain and stinging. You may also notice:

• itching or burning sensations
• stinging pain when urinating
• discomfort when having sex or inserting a tampon
• bleeding

Most of the time, vaginal cuts or tears heal by themselves, but in some cases, you may need to seek medical treatment. It’s important to examine the area using a mirror when you first notice symptoms so you can monitor whether they are improving or not.

Treating and managing vaginal tears

Home treatment

The majority of superficial tears will heal by themselves and treatment aims to reduce the associated discomfort. This may include:

• OTC painkillers
• soaking in a warm bath with salt or bicarb of soda. Avoid detergents, soaps and scented products that may sting and aggravate the tear
• keep the area clean by gently washing the area once or twice a day
• wipe from front to back after going to the toilet
• pat the area dry instead of rubbing
• avoid using tampons or having sex until it has healed
• avoid touching the area as much as possible while it heals
• wear cotton underwear and avoid tight clothing

Medical treatment

More severe vaginal tears may require medical attention, particularly if there is heavy bleeding, the cut is deep or there are numerous cuts. You should also visit your doctor if:

• minor tears don’t heal on their own
• symptoms get worse
• you experience numbness or tingling
• you have fever or chills
• there is smelly or discoloured discharge
• your vaginal tear is associated with a skin condition

Risks and complications

Cuts and tears in your vagina and vulva can become infected if not properly looked after. They can also get worse and develop into larger or deeper tears. If your symptoms don’t resolve, make sure you visit your doctor.

What you can do

If you have sensitive skin which tears, you can reduce the risk by:

• using adequate lubrication during sexual activity
• trying different sexual positions
• taking care when inserting anything into the vagina, including tampons and sex toys
• taking extra care when removing hair from your pubic region

If you experience any kind of problem with your vulva or vagina make an appointment to see your doctor.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at April 2021.