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What is a Perineal Repair?

By Erin J. Hill
Updated Mar 03, 2024
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A perineal repair is a surgical procedure used to close tears or cuts in the perineum, a muscular part of the female anatomy that extends from the vagina to the anus. The procedure is most commonly performed after a natural childbirth. Many women develop tears along their perineum in the course of pushing the baby out, and some medical attendants will also intentionally make cuts in this region to enlarge the vaginal opening with the hope of making delivery easier. These sorts of intentional cuts are known as episiotomies. If tears or cuts aren’t repaired, a woman risks infection and further complications. The procedure is usually fairly simple, involving stitches and little else. Bad tears or very deep cuts sometimes require more advanced and invasive techniques, but in general, the procedure is quick and most women heal quickly.

Reasons Why Repair May Be Needed

Perineal repair is one of the most common surgical procedures performed in hospitals, usually as a result of childbirth. Vaginal tearing is very common during a natural delivery, and episiotomies are frequently used by many doctors. In rarer instances, a perineal tear my occur during sexual activity. This is most common in young women and adolescent girls, particularly when their sexual partners are much larger than they are, though it sometimes also occurs as a result of trauma or forced penetration.

Tools Required and Basic Procedure

Repair usually involves the sewing together of the torn or cut tissues to allow proper healing. From a surgical standpoint, the procedure is usually quite simple, though a lot of this depends on the circumstances.

It’s usually the most direct in the case of an episiotomy. An episiotomy cut is generally a straight line from the vaginal opening to the perineum, and it is administered at the same time the baby’s head begins to emerge or “crown.” This procedure provides a straighter cut that is easier to repair, although the damage to the perineum and vagina is often more severe than a naturally occurring tear. Women who have very large or jagged tears usually present the most challenging cases.

Timing

Most medical experts recommend performing perineal repairs as soon as possible after the damage first occurs. In hospital birth situations, it’s common for doctors to stitch women up almost immediately after birth, usually while the infant is being washed and weighed. The site is typically monitored for the next few days to be sure that it is healing as it should.

Care and Healing

It’s usually pretty easy to care for the site after the repair has been performed. Many doctors use dissolving stitches that will simply disappear once the perineum has healed, which eliminates the need for a return visit to have them removed. Additionally, many women find it helpful to take mild pain medications to dull discomfort. It’s usually recommended that the site be kept clean and dry, but soaking the area briefly in a sitz bath can be comforting.

The area is usually sore for several days and a special pillow may be needed to reduce pressure on the vagina and perineum. Healing time varies from woman to woman and can range from a week to over a month, depending on how severe the original injury was.

More Intensive Repair Situations

If the perineum has been ripped or cut very deeply, an additional repair may be needed in the form of more invasive surgery or additional stitching. If the muscles below the skin are severely damaged, the patient may experience severe pain along with fecal or urinary incontinence. Surgeons can address these sorts of problems more completely with reconstructive procedures that are often much more invasive than a simple stitch-centric repair.

Prevention

Many women understandably want to prevent tearing or episiotomies during childbirth, and there are a few things they can try to minimize their need for repair under these circumstances. Some suggest that gentle massage in the weeks prior to delivery may help to gently stretch the area. This can be done using two clean fingers inserted at the bottom of the vagina, and by applying gentle pressure until a slight stinging sensation emerges. Another method is to stop pushing just as the baby’s head crowns, thus allowing it to emerge slowly and gently. This gives the vagina’s flexible walls enough time to stretch naturally, which may prevent serious tears.

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