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Perineal Tear Recovery
Most women who give birth vaginally tear, and most go home with a leaflet and a six-week date. That's fine for a shallow tear. When it's deeper, the gap between "they stitched me up" and "I'm actually recovered" is where the leaks, the painful sex, and the scar that never softens quietly settle in. What changes your outcome is knowing which grade of tear you had and doing the boring six-month work after it. Almost all of that damage is avoidable.
Do · Course Evidence Moderate Chapter Healthcare

The grade decides almost everything: pain, healing time, what can go wrong 1. First-degree is skin only. Second-degree reaches the perineal muscle and needs stitches; it's the common substantial tear, and its outlook is benign, acute pain mostly gone by two weeks. Third- and fourth-degree tears reach the anal sphincter or rectum and are called OASIS: about three to six percent of first vaginal births 2. Even so, properly repaired and followed up, six to eight in ten report no long-term complications at all. What separates good outcomes from bad is early infection control and getting to physiotherapy. If nobody told you your grade, ask.

The first two weeks are pure damage control. None of it is fancy; all of it works.

Then do the six-month job: pelvic floor physiotherapy. The birth that tore your perineum also stretched the muscle hammock holding your bladder and bowel; about three in ten women leak urine at three months even after an uncomplicated birth 5. Supervised training beats a leaflet of squeezes, cutting the odds of incontinence by roughly 37 percent and of prolapse by about 56 percent over the first year. You may have to name the referral yourself at the six-week appointment.

The timelines run separately, and holding them apart is the whole trick. Week one, sitting is awful; by two to six weeks the stitches dissolve and the surface closes.

  • Months two to four: scar tissue softens slowly. Sex becomes possible, but at three months a third or more of women still find it painful 6 7.
  • Months six to twelve: the continence you have now is roughly what you keep without more help. Still leaking or hurting? Escalate rather than accept it.
The fine print — when to skip it, and what people get wrong

Call the same day if things worsen after day three to five: rising pain, fever over 38°C, foul discharge, a gap in the stitches, or new loss of gas or stool control. Infection after OASIS repair can turn a fixable tear permanent 8 9.

  • "A cut prevents worse tearing." Routine episiotomy doesn't reduce severe injury; cutting only when there's a reason means less trauma overall 10.
  • "Six weeks and you're normal." That's when the surface closes; scar, continence, and sex keep moving for months, and leaks respond to training rather than being permanent.
References
  1. 1Sultan AH, Thakar R (2007). Lower genital tract and anal sphincter trauma. Best Practice & Research Clinical Obstetrics & Gynaecology. link
  2. 2RCOG (2015). The Management of Third- and Fourth-Degree Perineal Tears (Green-top Guideline No. 29). link
  3. 3Wuytack F, et al. (2021). Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period. Cochrane Database of Systematic Reviews. link
  4. 4Beleza ACS, et al. (2017). Ice pack induced perineal analgesia after spontaneous vaginal birth: Randomized controlled trial. Women and Birth. link
  5. 5Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, Hay-Smith EJC (2020). Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews. link
  6. 6O'Brien S, et al. (2018). MAMMI Study: Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum. BMC Pregnancy and Childbirth. link
  7. 7Risløkken J, et al. (2025). The severity of second-degree perineal tears and dyspareunia during one year postpartum: a prospective cohort study. Acta Obstetricia et Gynecologica Scandinavica. link
  8. 8Lewicky-Gaupp C, et al. (2015). Wound complications after obstetric anal sphincter injuries. Obstetrics and Gynecology. link
  9. 9Okeahialam NA, et al. (2023). Postpartum perineal wound infection and its effect on anal sphincter integrity. Acta Obstetricia et Gynecologica Scandinavica. link
  10. 10Jiang H, Qian X, Carroli G, Garner P (2017). Selective versus routine use of episiotomy for vaginal birth. Cochrane Database of Systematic Reviews. link
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