December 24, 2019

By now, you’re probably caught on to how much post-birth recovery can vary. This wide range of normal is partly why so much of the current medical advice you hear is so generic and unhelpful (“Just take it slow”). This can be especially annoying for anyone who had a second degree tear during birth, which are not severe enough to be considered Obstetric Anal Sphincter Injuries (OASIS) and are often lumped together with superficial first degree tears. But second degree tears can be quite substantial, involving the tearing of muscle, and they’re common enough that you should have a better idea of what to expect.

What is a 2nd degree tear?

A second degree perineal tear is a tear in the perineum (the area between the vagina and the anus) that includes the skin and muscles. Unlike first degree tears that only involve the skin, second degree tears usually require stitching, which is typically done in the delivery room with local anesthesia.

Related: How a perineal tear or episiotomy affects your recovery

How common are 2nd degree tears?

Second degree tears are the most common type of tear. In one study of over 600 women who had a vaginal birth, 55% had a 2nd degree tear.

No or 1st degree tear - 34%
2nd degree tear - 55%
3rd or 4th degree tear (OASIS) - 11%

However, studies show a significant increase (11% to 25%) in OASIS when women are re-examined, which implies that a large number of second degree tears are actually third or fourth degree tears. This is important because the care recommendations for OASIS, which include pain management, measures to avoid constipation, and pelvic floor exercises, are not followed for second degree tears, but may have similar benefits.

How long will it take for a 2nd degree tear to heal?

The skin part of the wound usually heals within 2-3 weeks. The stitches also dissolve within a few weeks, so you may start to feel less tender around this time. However, since second degree tears involve the muscle below the skin, it’s not always clear how long this part of the tear takes to heal. In fact, many studies show that symptoms can last much longer than this. For example, one study found that almost 1 in 5 women with second degree tears reported perineal pain at 6 months postpartum. So even if the external tear is healed, you may not feel back to normal for months.

What can you do to help it heal faster and feel better?

• Keep the area clean to minimize the risk of infection. Change your pad regularly and don’t have sex and use tampons until cleared by your provider. Wash your hands before and after you go to the bathroom.
• Avoid constipation so you don’t burst your stitches. Water, high-fiber foods, and stool softeners can help.
• Try ice packs, witch hazel pads, sitz baths, and pain meds to reduce pain and swelling.
• Do pelvic floor exercises to strengthen the muscles and increase blood flow. Belly breathing, pelvic tilts, and kegels are good examples of gentle pelvic floor exercises that you can do on your own. A pelvic floor physical therapist can help treat pain and any other symptoms that might persist after the wound is healed.

Related: How to start rehabilitating and strengthening immediately postpartum

When can you have sex again after a 2nd degree tear?

Generally, it’s not advised to have sex before the 6-week checkup because of the risk of infection. However, once your provider examines the tear and confirms that it’s healing well and the risk of infection is low, it’s more of a matter of when you’re ready. Again, it’s a wide range of normal, but the average time to resume sex after a 2nd degree tear is 8-9 weeks. However, over 10% have not resumed sex at 6 months. Painful sex, also referred to as dyspareunia, can be fixed, so don’t be embarrassed to talk to your provider about it.

Related: What to do about painful sex after childbirth

When should you go see a doctor?

Infections are the most common complication of a 2nd degree tear, so if you have any of the following, call your provider.

• Pain that doesn’t go away or that gets worse
• Redness or discharge
• An offensive smell
• Fever (over 38℃ or 100.4℉)

Pelvic floor dysfunction is also another reason to talk to your provider. If you have any urinary or fecal incontinence (leaking), painful sex, or feeling like your pelvic organs are falling out, pelvic floor physical therapy might be a good option.

Sources:

American College of Obstetricians and Gynecologists. (2016). Your Pregnancy and Childbirth: Month to Month, 6th edition.

Cunningham, F. G., & Williams, J. W. (2014). Williams Obstetrics, 24th edition. Stamford, Conn: Appleton & Lange.

University of Michigan. Episiotomy and Perineal Tears. Retrieved December 22, 2019 from https://www.uofmhealth.org/health-library/zx3823

Prevention and Management of Obstetric Lacerations at Vaginal Delivery. ACOG Practice Bulletin No. 165. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;128: e1-e15 doi: 10.1097/AOG.0000000000001523. Retrieved on December 22, 2019 from https://journals.lww.com/greenjournal/Fulltext/2016/07000/Practice_Bulletin_No__165__Prevention_and.46.aspx

Care of your perineum following 1st and 2nd degree tears. Mid Essex Hospital Services NHS Trust. Retrieved December 22, 2019 from http://www.meht.nhs.uk/EasysiteWeb/getresource.axd?AssetID=19080&type=full&servicetype=Attachment

Postpartum sexual functioning and its relationship to perineal trauma: A retrospective cohort study of primiparous women. Signorello, Lisa B. et al. American Journal of Obstetrics & Gynecology, Volume 184, Issue 5, 881 - 890. Retrieved December 22, 2019 from
https://www.ajog.org/article/S0002-9378(01)55770-1/fulltext

First- and second-degree tears. Royal College of Obstetricians and Gynaecologists. Retrieved on December 22, 2019 from https://www.rcog.org.uk/en/patients/tears/first-second/

Leeman L, Rogers R, Borders N, Teaf D, Qualls C. The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women. Birth. 2016;43(4):293–302. doi:10.1111/birt.12258. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125543/