This is extremely common, and it heals

Up to 9 in 10 first-time mothers who have a vaginal birth will have some form of tear, graze or episiotomy. This is extremely common, and for most women it heals well within 4 to 6 weeks. If you are concerned about pain, infection or healing, contact your midwife or GP.

This information is for general guidance only.

It does not replace advice from your midwife, health visitor or GP. Read more about our approach.

Episiotomy and perineal tears: recovery and healing after birth

What is the perineum?

The perineum is the area of skin and muscle between the vaginal opening and the anus. During a vaginal birth it stretches to allow the baby through. Sometimes it tears naturally, and sometimes a small surgical cut (episiotomy) is made to assist delivery.

Types of perineal tears

First-degree tear

Affects only the skin of the perineum. Superficial, often heals without stitches. Mild discomfort.

Second-degree tear (most common)

Affects skin and perineal muscle. Requires stitches, sutured by midwife or doctor. Heals within 4 to 6 weeks for most women. The majority of tears are second-degree.

Third-degree tear

Extends to the muscle around the anus (external anal sphincter). Affects 3 to 4% of vaginal births. Repaired surgically, usually in theatre. Recovery longer. Physiotherapy referral strongly recommended.

Fourth-degree tear

Extends through the anal sphincter into the anal canal lining. Rare, around 1% of vaginal births. Requires surgical repair under anaesthetic. Specialist follow-up care essential. Third and fourth-degree tears together are called OASI (Obstetric Anal Sphincter Injuries).

Labial grazes

Small grazes to the inner lips (labia minora). Common, usually minor, heal quickly. Can be uncomfortable when urinating.

What is an episiotomy?

A deliberate cut made by a midwife or doctor with scissors before the baby is born, to enlarge the vaginal opening. In UK practice the cut is diagonal from the back of the vagina to one side (a medio-lateral episiotomy), which reduces the risk of extension to the anal sphincter compared with a midline cut.

Done under local anaesthetic, or topping up an existing epidural. Episiotomies are not routine in England. NICE guidance confirms they should only be done when clinically indicated.

When an episiotomy may be recommended

  • Baby showing signs of foetal distress needing rapid delivery
  • Forceps or ventouse delivery needed
  • Risk of severe tearing into the anal sphincter
  • Certain breech deliveries

Stitches

Most tears and all episiotomies are repaired with dissolvable stitches that do not need to be removed. They dissolve over 2 to 6 weeks. Stitches are usually inserted within an hour of birth.

Local anaesthetic is given before stitching if you did not have an epidural. You should feel pressure but not pain. You will also be examined internally to ensure nothing has been missed.

If you had a third or fourth-degree tear, the repair is done in an operating theatre under regional or general anaesthetic.

Recovery week by week

Tap a stage to expand.

Days 1-3

Managing the first days

  • Pain and swelling are normal and expected. Take regular painkillers, paracetamol alternated with ibuprofen (check breastfeeding compatibility with your midwife).
  • Ice pack wrapped in a cloth for 10 to 15 minutes can reduce swelling. Avoid ice directly on skin.
  • Pour warm water over the perineum while urinating to reduce stinging. Squatting over the toilet rather than sitting may also help.
  • Avoid straining on the toilet. Lactulose or Movicol are safe and recommended. Do not wait until you are severely constipated.

Weeks 1-2

Early healing

  • Swelling and bruising improve significantly.
  • Wash gently with warm water after using the toilet. Dry thoroughly.
  • Expose the stitches to air for short periods. Lie on a clean towel with underwear off for 10 to 15 minutes once or twice a day.
  • Begin gentle pelvic floor exercises as soon as you can, short contractions to improve blood flow and speed healing.
  • Stitches may feel itchy as they dissolve. This is normal.

Weeks 2-4

Noticeable improvement

  • Most women notice significant improvement by week 2-3.
  • Stitches continue to dissolve. You may see threads in your underwear or bath water.
  • Pain during sitting should be reducing. A soft ring cushion can help.
  • Continue pelvic floor exercises, building up the duration.

Weeks 4-6

Mostly healed

  • Most first and second-degree tears heal completely within 4 to 6 weeks.
  • Episiotomies typically heal externally in 4 to 6 weeks.
  • Third and fourth-degree tears take longer, and specialist follow-up is required.

Longer term

Sex, scar care and ongoing comfort

  • Pain during sex is very common in the first 3 to 6 months after any perineal trauma. It usually improves with time.
  • Water-based lubricant helps when you are ready to resume sex.
  • If pain persists beyond 6 months, ask for a referral to a women's health physiotherapist and discuss with your GP.
  • Scar massage from 6 weeks once healed: 5 minutes daily with clean fingers and plain oil softens scar tissue.

Pelvic floor rehabilitation

All women should be offered a pelvic floor referral after birth, especially after perineal trauma. Pelvic floor exercises can start as soon as you feel comfortable. Even with stitches, gentle contractions are safe and beneficial.

Third and fourth-degree tear follow-up

  • Review at 6 to 12 weeks with an obstetrician or specialist.
  • Referral to a women's health physiotherapist.
  • At 3 to 6 months, an assessment of anal sphincter function.
  • Discussion about future births, including whether a planned caesarean or epidural might be advised.
  • Bladder or bowel symptoms should be reported promptly. They are treatable, especially when addressed early.

Assisted delivery and perineal trauma

Forceps delivery carries a higher risk of more significant tearing (8 to 12% OASI) than spontaneous vaginal birth (3 to 4%). Ventouse is slightly lower (around 4%). Your obstetrician will discuss this if assisted delivery is being considered. See our assisted delivery guide.

Perineal massage from 34 to 36 weeks reduces the risk of tearing and episiotomy. It is evidence-based, and your midwife can show you how.

Emotional impact

Experiencing a significant tear or episiotomy can be distressing. It is normal to feel shocked, upset or worried about long-term effects. If you feel traumatised by your birth experience, speak to your midwife, health visitor or GP. AIMS and the Birth Trauma Association (birthtraumaassociation.org.uk) offer information and peer support.

Related guides and tools

Postnatal recovery guide→ Recovering from a caesarean→ What happens during birth→ Birth trauma support→

A note from our team

This guide reflects NHS UK, NICE and RCOG guidance on perineal tears and episiotomy. Read more about us.

Frequently asked questions

How long does an episiotomy take to heal?
Most episiotomies heal externally within 4 to 6 weeks. The internal healing and comfort during activities such as sex can take a little longer. Pain during sitting and walking should improve significantly by 2 to 3 weeks. If pain is worsening rather than improving after the first few days, contact your midwife or GP.
Will I feel stitches being put in?
You should feel pressure but not sharp pain. If you had an epidural it can be topped up for stitching. Otherwise, local anaesthetic is given to numb the area. Tell your midwife or doctor at any point if you are feeling pain, so more anaesthetic can be given.
When can I have sex after an episiotomy?
Whenever you feel ready, usually from 6 weeks onwards. There is no strict rule, and physical healing varies. Use a water-based lubricant as hormonal changes, especially while breastfeeding, often cause dryness. Some discomfort during the first few times is common and usually eases. If pain persists beyond 3 to 6 months, ask your GP for a referral to a women's health physiotherapist.
Is it normal for stitches to feel itchy?
Yes. Itching as stitches dissolve is very common and a sign that healing is progressing. You may also notice thread-like pieces in your underwear or bath water as they dissolve, typically over 2 to 6 weeks. If the area looks increasingly red or swollen, or has pus or an unusual smell, contact your midwife or GP.
What is a third-degree tear?
A third-degree tear extends from the perineum into the muscle around the anus (the external anal sphincter). It affects around 3 to 4% of vaginal births and requires surgical repair, usually in an operating theatre. Together with fourth-degree tears, these are called OASI. Referral to a women's health physiotherapist is strongly recommended, and specialist follow-up is provided.
How do I know if my stitches are infected?
Signs of infection include: worsening rather than improving pain, increasing redness and swelling, pus or unusual discharge, an unusual smell, or a high temperature (38°C or above). If you have any of these, contact your midwife or GP within 24 to 48 hours. Untreated infection can cause stitches to break down.
Will I always tear in future births?
Not necessarily. Having had a tear does not mean you will have one next time. Perineal massage from 34 to 36 weeks in future pregnancies, and slow guided pushing as baby's head crowns, both reduce the risk. If you had a third or fourth-degree tear, specialist follow-up will discuss whether to consider caesarean for future births.