Q&A
Postpartum Episiotomy Pain
Question:
My doctor performed an episiotomy when I gave birth six weeks ago. It's still hurting. How long does it typically take for an episiotomy to heal and will it hurt during sex?
An episiotomy, the incision made between the vaginal opening and perineum to enlarge the birth canal, will typically heal within about 10 to 14 days. Any stitches used to repair the episiotomy will usually be absorbed on their own within about 10 days, but the pain can take longer to go away.
But there are several factors involved which can affect the rate of healing:
The extent of the incision and lacerations...
Incisions straight down to, but not involving the rectum, or "midline" episiotomies tend to take less time to heal as they're less extensive, compared to "mediolateral" episiotomies which are directed at an angle to the left or right side and involve more muscles. Also, if there are any associated lacerations, the tenderness may last longer.
Assisted delivery...
If the delivery was assisted by forceps or a vacuum extraction, there may be underlying muscle and pelvic floor damage and bruising.
Birth complications...
A long, difficult labor, or postpartum complications such as hemorrhage, can also mean longer healing time for the mother.
By the sixth week postpartum, your perineum should be healed sufficiently to have intercourse with minimal discomfort, and if so your doctor will give you the all-clear for resuming sex with your partner.
If you experience pain during intercourse, there could be a few reasons: One of them could be vaginal dryness. If you are breastfeeding, estrogen levels naturally dip and this can cause dryness and make intercourse uncomfortable. Using a lubricant such as KY-jelly can help.
In some cases, the episiotomies could have been sutured too tightly after the birth, reducing the size of the vagina and making intercourse painful for the first few times. If you think this may be a problem, see your doctor for advice on how to perform special stretching exercises to widen the vagina.
My best advice: Don't hesitate to bring up your concerns with your care provider and ask for an exam. He or she can help identify the underlying causes for your discomfort. If your episiotomy is not fully healed after 6 weeks, your doctor will be able to advise you on medication to best speed up recovery.
