What Are the Degrees of Vaginal Tearing?

Sometimes during childbirth, a baby’s size or speed of delivery can cause unwanted outcomes such as vaginal tearing.

“A vaginal tear, also called a perineal laceration, is an injury to the tissues and muscles around the vagina and rectum,” says OB/GYN, Kristen Aland, M.D. “While it’s certainly an unwanted complication, some level of vaginal tear at delivery is very common among women. More than half of vaginal deliveries will see some degree of tearing.” 

Tears are classified into four degrees based on severity. The degree of tear is determined by the amount and type of tissue injured.

First Degree: A first-degree tear is an injury to the first layer of vaginal tissue. There could be some minor skin tearing in the perineal area, which is between the vagina and anus. Stitches may not be required to repair this tear, as it may heal on its own over a matter of a few days to a week.

Second Degree: The second level of injury is slightly bigger than the first. It will extend deeper into the skin and muscle tissue of the vagina and perineum. “This is the most common tear seen during childbirth,” says Dr. Aland.

Third Degree: A third-degree tear extends from the vagina to the anus. This injury involves the skin and muscle tissue as well as damage to the anal sphincter muscles (the muscles that control bowel movements).

Fourth Degree: A fourth-degree tear is the most severe and the least common. This injury extends from the vagina through the perineal area and the sphincter muscles into the rectum.

What Causes a Vaginal Tear?

There are numerous reasons why vaginal tears occur, which is partially why they are common. A few of the reasons are:

• First delivery
• The baby’s position
• The baby’s size
• The speed of delivery
• Device assistance such as forceps or a vacuum during delivery
• Episiotomy (this procedure widens the vaginal opening in a controlled way but may lead to a more severe tear)

How Are Vaginal Tears Repaired?

The treatment will depend on the degree of injury. A first-degree tear may not require stitches. Second through fourth degree will require stitches. The more severe the tear, the more stitches and repair will be needed. 

“The stitches will dissolve within six weeks, and most women feel pain relief in about two weeks,” says Dr. Aland. “But if there is any sign of infection, you should contact your doctor immediately.” 

Signs of infection include:

• Fever
• Foul-smelling discharge
• Lasting pain

If you experience pain or discomfort with sex after having a tear, you should also talk with your doctor.

Pelvic floor physical therapy is a good option for those recovering from a tear – this can help with pain, increase strength of the pelvic floor muscles, and improve bladder control for incontinence.

Future Risk of Tearing

“In general, just because you had a tear during one of your deliveries, it does not mean it will happen again,” says Dr. Aland. “Women who experience more severe tears run a slightly higher risk of a future tear, but the risk is usually low enough that vaginal delivery is still possible.”

There are some practices you can use to try and prevent tearing, like: 

• Perineal massage: After 34 weeks of pregnancy, you can try perineal massage to try and encourage stretching during delivery. 
• Practicing good prenatal care: Maintain a healthy weight, take prenatal vitamins and keep an active routine.
• Lubrication: During labor, you can lubricate the area. You may also apply a warm compress to the perineum while pushing. 

“Women with a history of inflammatory bowel disease (Crohn's disease or ulcerative colitis) may be at a higher risk for complications from tearing, so on a case by case basis your doctor may talk with you about considering a Cesarean delivery,” adds Dr. Aland. “Every pregnancy is different; don’t be afraid to ask your doctor about any concerns you have.” 

Next Steps & Resources:

• Meet our source: Kristen Aland, M.D.
• To make an appointment with Dr. Aland or an obstetrician near you, call 800-822-8905 or visit our website.
• Find a childbirth class near you.

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.