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Approximately nine in 10 new mothers suffer a vaginal tear after birth. This involves injury to the vagina and perineum, which is the space between the vagina and the anus. Depending on their size and severity, these tears can cause various symptoms and often require repair. This guide explores how these tears happen, the symptoms they cause, and how they can be successfully treated for a full recovery.

Let’s start with: What is a vaginal tear?

In simple terms, a vaginal tear is a cut that extends downwards from the vagina, including the vaginal tissues and may extend along the perineum, damaging the skin and muscle in this area. There are several other potential causes of these tears, such as sex; however, by far the most common is childbirth, due to the passage of the baby’s head and body through the vagina, causing the tissue to tear.

Doctors may also make a surgical cut in the same area to help widen the vaginal opening and prevent tearing. However, this is not technically referred to as a vaginal tear but is instead called an episiotomy.

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Vaginal tears range in severity from first- to fourth-degree tears

As previously stated, vaginal tears can vary in size and severity. A classification system exists to help doctors diagnose different types of tears and take the appropriate action to help the patient heal and recover. There are four vaginal tear degrees in total. Learning about the different degrees helps in understanding what a vaginal tear looks like and how it should be treated.

In the following sections, we will look at each degree in detail.

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1st-degree vaginal tear

The least severe form of a vaginal tear, a 1st-degree tear, only impacts the vaginal lining rather than the underlying muscle of the perineum. These tears may also rarely occur around the urethra—the tube that transports urine out of the body. They may lead to pain or stinging, especially when urinating, but they do not generally need stitches and should heal on their own within weeks.

2nd-degree vaginal tear

The most common form, a 2nd-degree vaginal tear, involves both the skin and muscle of the perineum. These tears go deeper into the tissue than 1st-degree tears, and they will need stitches to repair the cut and help the body heal. The stitches are usually applied in the delivery room, shortly after childbirth, and the tear should heal within about 4-5 weeks, in most cases.

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3rd-degree vaginal tear

More problematic and larger than a 2nd-degree tear, a 3rd-degree vaginal tear extends into the ring of muscle around the anus, called the anal sphincter injury. These typically require stitches and surgical repair, which is carried out in the operating theatre. Due to the size of the tear, patients with third-degree tears also need to take laxatives and antibiotics.

After surgical repair, patients will need 6 weeks to heal from this tear. During that time, and afterwards, there is a risk of various symptoms and side effects, including infections, incontinence, and separation of the tear. Proper, comprehensive repair, thorough aftercare, and physiotherapy all help to minimise the risks of additional complications.

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4th-degree vaginal tear

The most severe variety, a 4th-degree tear, extends through the anal sphincter muscles to the rectal lining. These tears have the biggest impact on patients and the highest risk of complications, infections, and side effects. Due to the complexity of the injury, these tears are repaired in an operating theatre.

On average, this type of tear heals in up to six weeks, and during the recovery period, there are risks of incontinence, separation of the repaired tear, and infections. Patients are given antibiotics to mitigate the threat of infection, and this type of tear—as well as others—can lead to emotional as well as physical distress, demanding comprehensive care.

What can cause vaginal tears?

While most cases of vaginal tears are due to childbirth, cuts in and around the vagina may also occur via other means. Various everyday activities may increase your chances of suffering a cut or tear.

Daily activities

Sexual activities are the leading cause of vaginal cuts. Women may suffer cuts to the vagina through having intercourse without sufficient lubrication, or because of sex that is rough or involves the use of toys. Shaving and waxing the pubic area can also cause various small cuts and scratches to the vaginal area, and this may lead to infection in a small percentage of patients.

Certain women are more likely to suffer vaginal cuts due to skin conditions that make the vaginal skin weaker. These conditions include eczema, lichen planus or lichen sclerosus, psoriasis, vaginal dryness, and vulvovaginal atrophy. You may also have drier or weaker skin as a side effect of certain medications, or due to previous surgeries or certain types of radiation therapy. Some women even have weaker skin due to genetics.

Childbirth

As highlighted above, childbirth is the leading cause of serious vaginal tears that require surgical repair. They occur because, even though the vaginal tissue is naturally stretchy and flexible, it can still tear as the baby passes through the birth canal and leaves the body. The majority of women suffer at least some degree of vaginal injury after vaginal childbirth.

Various contributing factors may make it more likely that a woman will suffer tearing. Larger and heavier babies, for example, put more pressure on the tissue, the use of instruments, especially forceps to assist delivery, and prolonged or very fast deliveries also often result in tearing, as the tissue struggles to withstand the pressure over an extended period. First births are also more likely to result in tears, with lower risks for subsequent deliveries.

What are the most common vaginal tear symptoms?

  • Typical symptoms of a vaginal tear from sex or childbirth include:
  • Itching, burning, or stinging sensations
  • Pain while urinating, having sex, passing stool, or inserting a tampon
  • Swelling or bruising to the vaginal area
  • Bleeding or spotting
  • Pain while sitting or walking
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Vaginal tear after childbirth

In the immediate days following childbirth, patients with vaginal tears are likely to experience various symptoms, including pain and sensitivity. They may find simple activities, like walking, sitting, or urinating, painful and difficult. This can take a toll on intimacy, emotional state, and the post-partum recovery process, on the whole.

Other issues, including weakness or damage to the pelvic floor after birth, can exacerbate symptoms. Women suffering from symptoms or difficulties should consult their doctor or medical team for guidance and assistance.

Most vaginal tears immediately after birth will need specialist treatment, which includes surgical repair. You may also be given antibiotics to fight off any infections and products such as antifungal cream, steroid cream, pain medication, and antiviral tablets.

Your specialist will also explain how to care for your body at home as it heals, with many of the tips listed above also applying here, such as avoiding sexual activity and products that could irritate the area. You may be booked for pelvic floor rehabilitation and physiotherapy to aid in recovery, as well.

Can I have a vaginal delivery if I had a vaginal tear previously?

Yes, having had a vaginal tear should not preclude you from having successful vaginal deliveries in the future. Women who have suffered severe injuries such as 3rd- or 4th-degree tears need further assessment to determine if they are suitable for a vaginal birth in subsequent deliveries.

However, in some cases, such as situations involving bowel control issues or severe emotional distress caused by a past trauma, patients may wish to explore other options. Consulting with a specialist is a good way to learn about options and risks.

Will I tear again the next time I give birth?

There is no way of knowing for sure whether a patient will suffer tearing in future births, even if they had a bad tear the first time. This is because every birth, baby, and body is unique. Statistics show that many women are less likely to tear with each subsequent delivery.

Additionally, it is worth noting that there are methods you can use to reduce your risk of tearing, which we will look at in further detail below. Always remember to air any concerns ahead of time with your pregnancy care provider to help alleviate stress and worries.

Can I give birth without tearing?

It is possible, yes, but the chances are quite low. As mentioned earlier, the vast majority – up to 90% – of women will suffer at least some sort of vaginal tear after birth. You can reduce your risks by using tear prevention strategies, like perineal massages and controlled pushing.

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How to heal a vaginal tear?

When it comes to how to heal tears, and how long does a vaginal tear take to heal, it all depends on the severity and depth of the cut itself. Deeper and larger cuts naturally demand more attention and a longer recovery process.

For minor vaginal cuts

For relatively small and simple cuts, stitches will not be necessary. Instead, you can use various at-home methods to soothe the area and promote healing, including:

  • Sitting in a sitz bath for brief periods (10 to 15 minutes) each day
  • Bathing daily and keeping the area clean and dry
  • Avoiding any touching or sexual activity
  • Wearing soft pads and loose-fitting underwear, or none at all
  • Avoiding products with fragrances or possible irritants
  • Cooling the area with the aid of an ice pack
  • Using over-the-counter pain relievers

When healing is not straightforward: long-term outcomes of vaginal tears

While many women recover well after a vaginal tear, others continue to experience symptoms that affect their quality of life. These may include ongoing incontinence, a feeling of vaginal laxity, scarring or distortion of the vaginal or perineal area, pain, and difficulties with sexual function. These issues can persist for months – or even years – after childbirth and may not resolve with standard postnatal care alone.

At London Women’s Centre, we understand how deeply these symptoms can impact your physical and emotional well-being. Our experts specialise in supporting women who are living with complications of the mentioned childbirth injuries. Whether you are dealing with functional concerns, discomfort, or distress related to your recovery, we offer a range of personalised treatment options to help you feel like yourself again.

If you suspect that your postnatal symptoms may be linked to a previous tear or childbirth trauma, we are here to help.

Can you prevent vaginal tears?

You cannot completely remove the risk of suffering vaginal tears from childbirth or sexual activity. However, there are ways in which you can reduce your risk of tearing, including:

  • Perineal massages can be performed during the final few weeks of pregnancy and during labour itself to help the tissue relax and stretch.
  • Keeping the perineum warm with a cloth during labour helps loosen the tissue and prevents tightness or firmness.
  • Using certain birthing positions, like sitting upright or lying on the side, rather than lying flat on your back.
  • To prevent tears from sex, you can use lubricants to ease penetration, use toys gently, and try positions that help you feel most comfortable.

Caring for your stitches

If you have had stitches to repair a vaginal tear, it is important to keep the area as clean as possible. Change your sanitary pads daily and take daily showers or body washes to help 1st or 2nd-degree tears heal. For more severe tears, follow the instructions of your specialist.

You can also make simple lifestyle adjustments to help heal, like eating a healthy, balanced diet and drinking plenty of water. When you use the toilet, avoid straining. Use a footstool or lift your knees to be more comfortable, take deep breaths, and take your time.