Postnatal

Perineal Care

The perineum after vaginal delivery

If you have had a tear or episiotomy, the perineum after vaginal delivery can feel quite painful. If you have not had a tear/episiotomy, your perineum may still be swollen or tender, but will likely feel fine in a few days.

Healing varies from woman to woman.

Recovery from a perineal tear or episiotomy

In general, the deeper the cut or tear, the longer the recovery time. First degree tears heal quickly and cause little discomfort. Second degree tears often heal in two or three weeks. Third or fourth degree tears take longer to heal. In the first few days after birth, there may be some trouble with urinating or having a bowel motion. It is important not to fight the urge to move your bowels or you could become constipated as a result. Ice packs to the perineal area and pain relief will help with discomfort and reduce swelling. Antibiotics and a stool softener will sometimes be prescribed to help. The pain will lessen over time, but your discomfort may last for three months or more. Women with tears into the sphincter or all the way through to the rectum are at increased risk for incontinence of gas or faeces later. Talk to us if you have concerns.

Helping healing:

  • Ice packs to reduce swelling and discomfort
  • Pain relief regularly will make life more bearable
  • Keeping clean and dry with a bidet, and regularly changing pads
  • Pat yourself dry from front to back to avoid introducing germs from the rectum into the vaginal area
  • Avoid sitting for long periods of time while your bottom is still very sore
  • Warm soaks in the tub or in a sitz bath for 20 minutes three times a day
  • Expose the wound to air as much as possible
  • Kegel exercises to help restore muscle tone, stimulate circulation, and speed healing. Try doing a Kegel while changing positions or getting up from a bed or chair. This helps to support the wound so you'll feel less of a pulling sensation on your stitches when you move.
  • Drink plenty of fluids.
  • Avoid constipation
  • Take it easy. Save your energy for taking care of your baby and yourself so your body has time to heal.
  • Talk to us if you have worries. Call if you have any fever, which can be a sign of infection
Sex after an episiotomy or perineal tear

Your perineum should be completely healed around four to six weeks after delivery. Sex should be avoided until healing. If you had a third- or fourth-degree tear, it is important to wait till you have been examined before having sex.

Initially, you may feel some tenderness and tightness. Foreplay and relaxation is important. You may find different positions more comfortable for instance on top to control the degree of penetration or lying on your side.

A good water-soluble lubricant will help make sex more comfortable. This is especially so if you're breastfeeding, as lactation lowers oestrogen levels, which reduce the amount of lubrication in your vagina. If sex is still too uncomfortable, wait a while longer and get creative with your mate in the meantime. Talk to us if the pain continues long after you've given birth.

Our goal at Birthright is to provide you the best gynaecological care in a friendly and relaxed atmosphere, where you can talk to us about your needs.