4 Types of Perineal Tears

woman in hospital bed giving birth

Since your baby's head is the size of a cantaloupe during childbirth, it's no wonder many women experience vaginal tearing. These lacerations (also known as perineal tears) happen in the perineum, which is the area between the vagina and rectum. Women giving birth for the first time have an increased risk of perineal tearing because their tissue isn't as flexible. In fact, 95 percent of first-time mothers experience it. 

There are four degrees of perineal tears, ranging from mild lacerations in the vaginal lining to deep cuts that affect the anal sphincter. (Try not doing an involuntary Kegel while reading that!) Luckily, the most common lacerations aren't the most severe. Here's all you need to know about the types of perineal tears and how to heal them.

First-Degree Perineal Tears

As the least severe type of perineal tear, first-degree lacerations are superficial. "The tear is just into the lining of the vagina," says Katie Page, a certified nurse-midwife in Forest, Virginia. "While this doesn't involve muscle, sometimes it does require a little suturing." Most of the time, however, no stitches are needed, and recovery is relatively simple. Expect mild pain while sitting up, having a bowel movement, coughing, sneezing, and having postpartum sex—but these discomforts should go away in a week.

Second-Degree Perineal Tears

The most frequent laceration, second-degree perineal tears involve the vaginal lining and deeper (submucosal) tissues of the vagina. These types of tears require more stitches and have a slightly longer recovery period. Like with first-degree tears, you should expect discomfort doing anything that causes an increase in downward pressure, such as coughing, sneezing, or having a bowel movement.

Third-Degree Perineal Tears

Third-degree tears go into the deeper layers of the vagina and the muscles that make up the anal sphincter, says Sherry Ross, M.D., an OB-GYN and women's health expert at Providence Saint John's Health Center in Santa Monica, California. "Your doctor will need to sew each layer separately, with special attention to closing the muscle layer supporting the sphincter." You may need anesthesia, and recovery will take longer. Expect two to three weeks of pain, followed by several months of discomfort when having sex or taking a bowel movement.

Fourth-Degree Perineal Tears

This deep tear encompasses all of the above and extends right through to the rectal lining. "This is a very delicate and thorough repair that involves closing multiple layers," says Dr. Ross. "Thankfully, this is the least common tear experienced. Generally, third- and fourth-degree tears happen when the baby's shoulder gets stuck or when a vacuum or forceps are used." Note that severe tears can lead to pelvic floor dysfunction and prolapse, as well as problems with urination and bowel movements.


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