Vaginal Tears: Common Causes and Effective Treatment

What are vaginal tears?

Vaginal tears, also called vaginal lacerations, are wounds in the vaginal tissue. They can occur throughout the vagina. Tears in the vagina, labia, and perineum are all possible. The perineum is the tissue between anus and vaginal opening. There are different types of perineal tears that range in severity from first- to fourth-degree. 

First-degree tears only affect the skin, while second-degree tears reach into the muscle. Third-degree tears go deeper, extending all the way into the anal sphincter. The anal sphincter is the muscle that helps you hold in and release stool. Third-degree tears are subdivided into three categories depending on whether only the external or both the external and internal anal sphincter is torn. In a fourth-degree tear, the rectal mucosa is torn as well.

What causes vaginal tears?

Vaginal tears can occur during birth, and when they do, they’re called obstetric tears. Tears can happen at other times, too. Penetrative sex is the most common cause of non-obstetric vaginal tearing. Virginity, atrophic vagina, congenital abnormalities, scarring or stenosis from surgery, insertion of foreign bodies, and sexual assault all increase the likelihood of tearing during intercourse. 

Obstetric tears occur during labor when the presentation of the baby stretches the tissues of the vagina and perineum. If the tissues are overstretched, they tear. This is more likely to happen during a first vaginal delivery. It’s also more likely if the baby weighs more than 9 pounds. Forcep- or vacuum-assisted delivery and long second stage of labor also increase the risk of tearing. Complications of labor such as shoulder dystocia (when the baby’s shoulders get stuck) can result in third- or fourth-degree tears. 

How common are vaginal tears during birth?

During birth, vaginal tears are very common. Most deliveries cause some degree of tearing, though severe tears are quite rare. 

According to the American College of Obstetricians and Gynecologists (ACOG), 53–79 percent of vaginal deliveries will cause some degree of perineal trauma. Fortunately, most of these tears do not lead to adverse functional outcomes. Third- or fourth-degree tears only occur in about 3 percent of first vaginal deliveries and 0.8 percent of subsequent deliveries.

What are the complications of vaginal tears?

The main complications of tears are pain, bleeding and infection. Third- or fourth-degree tears, although less frequent, are commonly associated with increased risk of fecal and urinary incontinence, pain, and sexual dysfunction associated with these symptoms that can persist long after giving birth. Infections aren’t common with proper treatment, but they can still occur. Smelly stitches or a fever may be signs that a tear is infected. 

Severe tears that affect the anal sphincters may interfere with bowel control. Studies have shown that this happens with 7.6–61 percent of these severe tears. Some symptoms of poor bowel control include leaking stool or not being able to hold in gas.

Treatment for vaginal tears

Perineum tear treatment isn’t always necessary. Because the vaginal area has a good blood supply, the tissues in this area heal well, and minor tears may require no treatment. For more severe tears, you may need stitches or surgical repair of the tear.

First-degree tears, which only involve the skin, don’t usually need treatment. With these types of tears, you may only need treatment if the wound gets infected. 

More severe tears may require treatment. Second-degree tears, which involve both the skin and the muscles underneath, often need to be stitched up. Third- and fourth-degree tears will require surgical treatment, which will repair the muscles between the vagina and anus.

After a vaginal tear, some home remedies may help you remain comfortable or heal more quickly. Applying an ice pack to the sore area can help control sweating. Kegel exercises can help boost circulation in the area, which may speed healing. Warm soaks or sitz baths can also help relieve discomfort. Proper hygiene is essential for tears that are healing. For more pain relief, your doctor may recommend using over-the-counter pain medications. If infection occurs, your doctor will most probably prescribe topical or oral antibiotics.  

Ways to prevent vaginal tears

There are several things that may help prevent a vaginal tear during birth from occurring.

To prevent vaginal tearing, medical professionals have many strategies they may use during delivery. Massaging the perineum can relax the muscles and help prevent tearing. This method may be used before or during the second stage of labor. A medical professional may hold a warm compress against the perineum during pushing. This may help prevent more severe tears. 

Penetrative sexual intercourse is the most common cause of non-obstetric vaginal tearing. Adequate foreplay can reduce the risk of these tears. In the event that there’s not enough natural vaginal lubrication to make sex comfortable, using an appropriate lube can make sex more enjoyable and help prevent tearing.

When to seek medical advice

If you experience a vaginal tear during birth, make sure to attend any scheduled follow-up appointments. If you experience a non-obstetric vaginal tear, you may only need a doctor if it causes bleeding or pain. You should also see a doctor if you think the tear is infected. 

The postpartum appointment, which occurs four to six weeks after delivery, is very important. At this appointment, your doctor will check to make sure you’re healing well. Let your doctor know if you’re experiencing perineal pain, bowel control problems, or other health issues due to your tear. If you’re bleeding, worried about infection, or have other concerns, see your doctor.

Conclusion

A vaginal tear is a common complication of childbirth, but these injuries can happen at other times, too. Fortunately, they’re not usually serious, and many treatments are available. Talk to your doctor to learn more about preventing and treating vaginal tearing.