Brief overview
- Causes and risk factors: Mostly due to childbirth (use of forceps or suction cup), large child, positional anomalies.
- Course and prognosis: Usually good, healing after a few days. Sometimes complications, hematoma, severe bleeding, wound healing disorders, scarring.
- Treatment: Surgical suture
- Symptoms: Bleeding, pain.
- Examination and diagnosis:Vaginal examination with speculum
- Prevention:Perineal massages before birth, moist warm compresses during birth.
What is a vaginal tear?
A vaginal tear is a bleeding injury to the vagina. It usually occurs during natural vaginal birth or vaginal surgical delivery.
Vaginal tear: explanations based on anatomy.
A vaginal tear occurs at different sections of the vagina. It is a muscular tube and is connected to the cervix at the upper end via the cervix. In some cases, the vagina tears far up at the junction with the cervix. Sometimes the tear extends into the labia or perineum.
When does a vaginal tear occur?
The reason for a vaginal tear is most often a vaginal birth. A vaginal tear also sometimes occurs during a spontaneous birth. However, it is more common with a forceps or vacuum cup birth. Other risk factors for a vaginal tear are a deep perineal tear or an episiotomy that is too small.
How long does it take to heal from a vaginal tear?
Overall, the vaginal tear has a good prognosis. It usually heals within a few days. Doctors usually use absorbable (self-dissolving) stitches for the suture, so they do not need to be pulled out later.
Sometimes bruising (hematoma) interferes with wound healing. Doctors may remove the bruise to help the vaginal tear heal better. In certain cases, the wound does not heal despite surgical care (suture dehiscence), for example, due to the following causes:
- Infection
- Wound healing disorder, e.g. due to a suppressed immune system
- Unsuitable suture material
These complications require special treatments to ensure that the vaginal tear heals well. In the case of wound healing disorders, it happens that the result is not cosmetically satisfactory.
What is the treatment for a vaginal tear?
Before the vaginal tear suture, the doctor anesthetizes the corresponding area (local anesthetic). The anesthetic is either injected under the mucous membrane of the vagina or applied as a spray. The local anesthetic prevents the pain stimulus from being transmitted via the nerve pathways.
After a short exposure time, the doctor sutures the vaginal tear without the woman feeling any pain. If the tear is deep, close to the uterus, or if a labial tear extends into the clitoris, the suture is performed under general anesthesia.
Treatment outside a clinic
If a vaginal tear has occurred outside a clinical facility, the patient is transported to a clinic. This involves the woman lying on her back with her legs crossed and a compress in her vagina to stop the bleeding.
Treatment in special cases
Because many arteries that supply the uterus are damaged by the tear, it is sometimes necessary to remove the uterus. This may be life-saving for the patient.
A longitudinal labial tear usually bleeds only briefly. Therefore, doctors do not always suture it. A transverse labial tear, on the other hand, almost always requires surgical treatment.
How does a vaginal tear manifest itself?
After a spontaneous birth or a forceps or suction cup birth, women sometimes bleed heavily from the vagina. In the case of a vaginal tear, the blood may leak into the body. In this case, the outward bleeding is only weak. The gynecologist usually detects the vaginal tear during the postpartum examination.
A vaginal tear sometimes causes severe pain, but in some cases it causes little pain. A labial tear, on the other hand, usually hurts a lot because the labia carry many nerve endings.
A vaginal tear is diagnosed and treated by your gynecologist. If he suspects a vaginal tear, he will ask the following questions, among others, to obtain your medical history (anamnesis) – unless he was the delivering doctor himself:
- When did you give birth?
- What was the birth like?
- Have you given birth before?
- Do you have any pain or discomfort in the vagina?
Physical examination
Your doctor will then examine the vagina using a so-called speculum (vaginal mirror). This allows him or her to examine the entire vaginal lining and detect a vaginal tear. This speculum examination is routinely performed after every vaginal delivery.
The doctor also examines the perineum, i.e. the skin bridge between the vagina and the anus. Here, a perineal tear is sometimes present concomitant to the vaginal tear.
Other possible diseases
- Uterine atony (insufficient contraction of the uterus).
- Placental retention (incomplete detachment of the placenta)
- Perineal rupture
- Blood clotting disorders
How can a vaginal tear be prevented?
To reduce the risk of vaginal tears, daily massage of the perineum during the last three to five weeks before delivery is helpful. This improves tissue elasticity a little. To support the elasticity of the tissue, midwives sometimes apply warm, moist compresses to the pubic area during childbirth.
