Postpartum: Will episiotomy pain

I had an episiotomy when I gave birth five weeks ago. The area is still hurting. How long does it normally take for an episiotomy to heal and will it hurt to make love?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

An episiotomy, the incision which enlarges the birth canal, will typically "heal" within about 10 to 14 days. There are many variables involved in healing, however. The stitches, which are absorbable, are dissolved within about 10 days but it can take substantially longer for pain to resolve.

By five weeks postpartum, the suture should be absorbed and your perineum should be healed sufficiently to have intercourse with minimal discomfort. If you are breastfeeding, vaginal dryness can make intercourse uncomfortable, so the addition of a lubricant may be necessary (eg. Astroglide, Slippery Stuff, KY jelly).

A woman's comfort level much depends upon her ability to heal, her tissue type and the extent of the incision. Other variables include the type of episiotomy and if there were associated lacerations. If the mother had a long difficult labor or if delivery was assisted by forceps or a vacuum extraction, there may be underlying muscle and pelvic floor damage and bruising.

In general, "medio-lateral" episiotomies (those directed off to the right or left side) involve more muscles and are deeper and therefore take longer to heal and form more scar tissue. Midline episiotomies -- those directed straight down to, but not involving the rectum -- are less extensive and take less time to heal, so they are not quite as painful in the postpartum period.

Postpartum care is another variable. If ice is placed on the perineum in regular cycles immediately after the birth, less swelling occurs and there is less postpartum pain. Kegel exercises, up to 100 per day, will also help to improve blood flow to the area and assist healing.

Mothers who have extensions to the episiotomy, for example into the rectum or rectal sphincter, or upwards into the sensitive periurethral and labial areas, may have more discomfort, especially with urination. In addition, mothers who have experienced postpartum complications such as hemorrhage take longer to heal.

An episiotomy must also be skillfully repaired in order to minimize pain and assist healing.

Sometimes the care provider sutures women up too tightly which makes intercourse very painful for the first few times. Dilating the opening with your fingers may be necessary. Use a bit of olive oil and over a few days attempt to place two fingers into the vagina. It may take some time and patience but these tissues can be stretched out again.

Rarely, there is occlusion of the vagina due to the knitting together of tissues which were not meant to be joined. This happens when there is raw tissue which may not have needed to be sutured. If you feel that the opening to the vagina is very small, a visit to your care provider should be make to ascertain if this is the problem. You may use a mirror to try to identify the problem as well.

I have had women who tell me that they still feel the effects of a large episiotomy up to a year postpartum. While this is very unusual, it is a concern that must be addressed by more care providers.

My best advice is to return to the provider who assisted at the birth and ask for an exam which might help highlight the reasons for your pain and discomfort. You might want to bring your partner along so he is aware of the situation and will be understanding of your discomfort.

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