Perineal Scarring After Childbirth

Perineal scarring occurs as a result of tears or planned tissue incision (episiotomy) during the delivery.

Natalia Silina

What is Perineal Scarring?

Most women recover completely after childbirth and have no permanent problems in the long term. However, a small proportion may experience a complication such as postpartum perineal scarring.

Scarring occurs after spontaneous tears or intentional incisions of the perineum – episiotomy – during the passage of the baby’s head through the birth canal. When tears occur spontaneously, they may occur anywhere in the perineum, labia, and even affect the anal sphincter.

Four types of tears depending on the severity:

  • First degree: a small injury that affects the first layer of tissue around the vagina and perineum;
  • Second degree: the most common type is a slightly larger tear that involves the muscle tissue of the vagina and perineum.
  • Third degree: extends from the vagina to the anus. There is damage to the skin and muscle tissue of the perineal area, as well as damage to the anal sphincter muscles. These muscles control your bowel movements.
  • Fourth degree: It is quite rare and spreads from the vagina through the perineum and anal sphincter muscles to the rectum.
perineal scarring
Types of tears

Causes of Perineal Scarring

Almost 9 out of 10 women have tears of varying degrees during their first childbirth.

The tissues around the vagina may be too tense, poorly stretched, or the baby’s head is too large. Plus, in maternity hospitals, women are still often forced to give birth lying on a chair. This is one of the risk factors for tearing during labor.

Additionally, there are certain indications for doctors to decide performing an episiotomy.


Once upon a time, almost every woman underwent an episiotomy, due to believe that it was easier to prevent more severe tears and give birth. However, modern researches have shown that this procedure should be performed only for medical reasons. In particular, it is not recommended during natural childbirth without complications.

Under local anesthesia, an incision is made from the back of the vagina outward. Indications for this procedure are:

The need to speed up labor. This can be due to the deterioration of the baby’s condition, like hypoxia. Another reason is that the baby is going with its butt or legs forward. Or the woman has health problems, and a lasting labor can seriously harm her health. Other reasons include that the woman is already tired of laboring, or there is a threat of a third-degree tear of the anal sphincter.

Difficulties with childbirth. Doctors need to use forceps or a vacuum, so the vagina needs to be dilated.

After the procedure, self-absorbable stitches are applied, so you do not need to go to the hospital for removing them.

Symptoms of Perineum Scarring

Most scars heal within a couple of months after childbirth. Even if small scars remain, they do not affect the quality of life at all. However, in some cases, scars cause the following unpleasant symptoms:

  • Chronic pain in the perineum;
  • Difficulty in defecating;
  • Burning sensation during and after urination;
  • Painful sex.

If you feel this way, don’t just wait! See a doctor and get help. Modern medicine can solve this problem.

How to Treat and Prevent Perineum Scarring

You can prepare the tissues of the vagina and perineum and avoid tearing during labor.


Perineal massage. Women who received perineal massage during the third trimester of pregnancy were 21% less likely to have tears in labor than those who did not. In addition, women who received perineal massage during labor were significantly less likely to need an episiotomy.

Exercises to strengthen the pelvic floor muscles. In particular, Kegel exercises. This allows you to better control these muscles. When you push the baby out gently and slowly, the vaginal and perineal tissues have time to expand enough to avoid tearing. Combining it with a perineal massage increases the effectiveness.

Attention to health during pregnancy. Responding to threatening symptoms in time will protect you from unforeseen problems during labor that can lead to tears or the need for an episiotomy.

Warming the perineum. A warm compress – gauze, pillow or tampon – applied to this area relaxes the tissues.

Childbirth in an upright position. You can stand, leaning on a table or chair, or squatting. Gravity will help you here, and it’s also easier to control the pelvic floor muscles.

Diet in the last trimester. A healthy diet high in fiber, vitamin C, and “light” protein, especially fish, will help keep the baby’s weight normal and increase tissue elasticity.

Proper breathing. You can learn how to do this during pregnancy at prenatal wellness care classes. It’s also important to listen to your doctor during labor, as they can see when the tissue is stretched too much and suggest that you stop pushing and breathe to ensure the baby’s progress is gentle and gradual.

As you can see, you can and should prepare for childbirth in advance, and this can really help to deal with such a problem as perineal scarring.


The earlier you start treating scars, the more effective any therapy is. In particular, perineal massage can be started as early as 6 weeks after delivery. A healthy diet in the postpartum period helps to avoid constipation, which can slow down the healing process and, as a result, cause scarring. And, of course, if possible, try to get more rest, sleep, and maintain proper intimate hygiene.

If all of these methods don’t help, consult your gynecologist to recommend more effective methods. It may include:

  • Revision episiotomy. The doctor will remove excess tissue (granulation tissue) and nodes that may have occurred as a result of the previous episiotomy.
  • Hyaluronic acid injections. You get the filler into the tissues, smoothing and moisturizing them. Our body has hyaluronic acid, so it is usually well perceived and contributes to the natural recovery of perineal tissue.
  • Laser resurfacing. Micro-damage with a laser beam removes scar tissue and activates regenerative processes around application.

The latest technique that allows not only to get rid of scar deformation, but also to significantly improve the condition of the vagina and perineum:

Plasma Therapy

One of the most modern methods of scar treatment is platelet-rich plasma (PRP) therapy. Thanks to latest technology, plasma containing an increased number of platelets is separated from your venous blood. Then it is injected into the problem area – restoring vaginal and perineal tissues and stimulating the production of the body’s own natural collagen, due to the incredible effect of platelet growth factors.

My Lior Medical Center uses the Swiss Regen Lab system. It is the centrifuge and tubes of this system that make it possible to obtain a whole and intact platelet. This unique technology, confirmed by clinical studies, is able not only to treat scar deformity of the perineum, but also urinary incontinence, as well as to rejuvenate the skin, treat inflammation, alopecia, orthopedic and other gynecological problems.

My course Preparing for Pregnancy will help you get ready for pregnancy in the best possible way. And I tell you more about preparing for childbirth and the first year of your baby’s life in the course Pregnancy and the Postpartum Period – A Complete Guide.

I’m eager to file all of these courses in English, just send me a request to dr.silinaeducation@gmail.com.

You can always find your doctor at the Lior Medical Center.

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