Question Title: Surgical Repair of Perineal Tearing

I now suspect that the surgical repair was done "too tightly," and would like to know
if this can or should be corrected. My husband and I would like to have
another baby, and I would like to know if I am now more likely to tear
again in the same place, more likely to tear in a worse place, or perhaps
more likely to receive a "necessary" episiotomy? Also,
it is causing uncomfortable sexual relations, which in turn is causing
mild depression. I would greatly appreciate any information you have on
repairs that are "too tight."

Dear Angela:

Follow spontaneous vaginal delivery, tears that are first degree (only through the mucosa) and are not bleeding are allowed by heal "on their own". Tears that extend into the supporting tissues are repaired to restore the normal anatomy, to control bleeding, the limit the risk of infection and shorten the healing interval.
At two months following delivery, the healing process is in the "remodelling phase" that takes 6-12 months for full completion. The introitus has a large ability to stretch: however, when it has not been stretched for an interval of time, it contracts and needs to be restretched. Thus, most women, following delivery, find the vaginal entrance, as they resume relations, "tight". Some women benefit from rubbing lanolin or cocoa butter into the scar; some benefit from mechanically stretching the entrance with fingers, often after a warm bath which tends to be relaxing. The need for mechanical dilators or any "relaxation surgery" is very infrequent.
Breast feeding compounds "tightness" and discomfort because it limits the return of estrogen production and this hormone is contributes to the vitality of the pelvic floor tissues.
Scar is without sensation in 9/10 ladies. A minority of scars heal and are a source of continuing discomfort.
The need for future episiotomy and the likelihood for future tear will be determined by obstetrical factors: the size and position of the baby, the stretchability of the tissues under the influence of hormones, the rapidity of delivery.

Keywords: perineum, postpartum

This information is provided for education purposes and is not a medical consultation. If you have specific questions, please contact your physician.