What to know about vaginal tear degrees

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When vaginal tears occur during childbirth, they often happen because the baby’s head or shoulders are too large to pass through the vaginal opening. This type of tear can also occur when the delivery is assisted by a vacuum or forceps.

A vaginal tear can also happen as the result of an episiotomy. This is a surgical procedure. It involves making an incision to widen the opening and facilitate the delivery.

Certain factors raise the risk of tearing during childbirth. These include:

• the size of the baby
• a prolonged second stage of labor
• induced labor
• the baby being in the occiput posterior position, with the back of the baby’s skull resting against the back of the pregnant person’s pelvis
• first delivery
• being of Asian descent

When the baby is in the occiput posterior position, it can have trouble tucking its head in. This makes it harder for the baby to pass through the smaller part of the pelvis. It can lead to tearing during delivery.

Outside of childbirth, vaginal tears can also occur from penetrative sex and pubic hair removal.

Find out more about other types of vaginal cuts and tears.

There are four degrees of vaginal tears. The amount and type of tissue that is injured determines the degree of the tear.

First-degree tears

First-degree tears involve a surface injury to the moist vaginal tissue. It may or may not involve the skin of the perineal area, which is the area between the vagina and anus. A person does not always need stitches to repair or treat a first-degree tear.

Second-degree tears

Second-degree tears are more serious than first-degree tears. They affect the moist vaginal tissue and the perineal muscles, but not the muscles around the anus. Second-degree tears may need stitches.

A 2020 study found that among 644 women, second-degree tears occurred in 35.1–78.3% of first-time deliveries and 34.8–39.6% of subsequent deliveries.

Third-degree tears

Third-degree tears affect vaginal tissue, perineal muscles, and muscles of the anal sphincter. These muscles surround the rectum and help a person pass bowel movements.

Injuries to the anal sphincter may occur in up to 11% of vaginal deliveries.

Below are the three sub-categories of third-degree tears. They show how much of the anal sphincter is injured.

• A: The tear goes through less than 50% of the anal sphincter.
• B: The tear goes through more than 50% of the anal sphincter.
• C: The tear goes through both the external and internal anal sphincters.

Third-degree tears happen far less often than second-degree tears. In the same study from 2020, researchers found that 1.1–4.1% of the women in the study had experienced this type of tearing.

Fourth-degree tears

This is the most serious degree of vaginal tear. It extends further through the sphincter muscles into the lining of the rectum.

This type of tear happens rarely. The 2020 study found that it affected 2 out of the 644 women.

Doctors can repair most vaginal tears by administering stitches in the delivery room after birth. A doctor will numb the area with a local anesthetic before beginning the repair.

While stitches are a common approach, there is limited evidence to support the use of stitches for first- and second-degree tears.

First-degree tears and some second-degree tears may not need stitches if the wound is not heavily bleeding and the tear has not changed the natural structure of the vagina. If a tear does not need stitches, a doctor may repair the area with a skin adhesive instead.

Third- and fourth-degree tears require more extensive repairs. A doctor will administer a regional or general anesthetic and will perform the repair in an operating theater rather than the delivery room.

After repairing the internal and external anal sphincter, the doctor can stitch up the rest of the tear. Rarely, a person may need a second procedure to complete the repair.

A person may feel pain or soreness for 4–6 weeks after any vaginal tearing. A person may also be able to feel their stitches for up to 3 months, particularly if the stitches are around the anal area. The stitches will dissolve or fall out over time.

Several complications are associated with vaginal tears.

The most common short-term complication is bleeding. The application of pressure and a surgical repair can control the bleeding and minimize blood loss.

Aside from bleeding, a person with a vaginal tear resulting from childbirth may experience:

• delayed bonding with the baby
• infection
• pain and difficulty having a bowel movement
• stinging and pain during urination
• reopening of the wound

More long-term complications may include:

• painful intercourse
• bowel incontinence
• urinary incontinence
• vaginal or anal fistulas

Below are some strategies for preventing infection and minimizing the discomfort of vaginal tearing after childbirth:

• Keeping the area clean: Washing the vagina, anus, and perineum daily with water helps speed up recovery and prevent infection. Avoid using any products on the area and change sanitary pads regularly.
• Taking pain relief medication: Over-the-counter options such as ibuprofen (Motrin, Advil) and acetaminophen (Tylenol) can help.
• Taking antibiotics: A doctor may prescribe these to prevent bacterial infections.
• Staying hydrated and having a balanced diet: This can help prevent constipation, which could be painful for someone with anal stitches. A person can also use laxatives.
• Using water while urinating: Keeping a pitcher or bowl by the toilet and pouring water on the genitals while urinating may help relieve a stinging sensation.

If a person notices an increase in pain, a smell coming from the area, or any bleeding from the tear, they should speak with a doctor. These may be signs of infection.

Experiencing complications during childbirth can also cause emotional distress. Some people with vaginal tears may feel embarrassed by the symptoms of the tearing.

People who have had vaginal tears may also be at risk of developing post traumatic stress disorder.

A person should speak with a healthcare professional if they have been emotionally affected by a vaginal tear. A mental health professional may be able to provide additional support.

Learn more about available mental health resources here.

Experts have yet to agree on the best way to prevent vaginal tearing, but there are some techniques that a person can discuss with their doctor to minimize the risk during childbirth.

A doctor may suggest massaging the area between the vagina and the anus to reduce the risk of a tear. Perineal massage may work by:

• relaxing the muscles in the area
• increasing blood flow
• stretching the vaginal tissue

Some studies have shown that when a medical professional performs a perineal massage during childbirth, tearing is less likely, and any tear that occurs tends to be less severe.

However, other research suggests that this massage only provides only minor, inconsistent risk reduction.

Other techniques that may prevent or minimize vaginal tearing include:

• lying on one side during childbirth and delaying pushing
• applying a warm compress during the second stage of labor

Most vaginal tears heal with no long-term complications. First-degree tears may heal on their own without needing stitches.

Vaginal tears should heal within 4–6 weeks. However, complications from tearing, such as incontinence or pain during intercourse, can last longer.

A person should not hesitate to speak with a doctor if they are concerned about any complications that may happen during or after childbirth.

Vaginal tears often result from childbirth. There are four degrees of tears, based on the amount and type of tissue affected.

A doctor can repair first- and second-degree tears in the delivery room after the birth. Third- and fourth-degree tears are more severe and may require more extensive surgery under general anesthesia.

A person can take some steps to minimize the risk of tearing during childbirth, such as having a perineal massage, using a warm compress, and lying on one side during the delivery.