Pain of the perineum

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Dear Dr. Myrtle,

Can I heal my perineum damaged during delivery? How long will this take to feel normal again during sex?


Many women experience damage to the perineum (the area between the vulva and the anus) as a natural part of delivery because the perineum must stretch 2-4 times its usual size to allow the pregnancy to pass by. Some tearing of skin, muscles and connective tissue can occur, and is most likely to occur during subsequent pregnancies, or deliveries that happen really quickly. Scar tissue develops as a part of the healing process, and needs gentle massage to re-shape and regain flexibility.

The perineum of the vulva is particularly important for comfortable vaginal penetration, because of the physical structure of the vulva and underlying tissues. During vaginal penetration, the perineal area has the most potential flexibility because there is no bone structure preventing comfortable expansion/relaxation. Therefore, gently bringing your perineum back to flexible health is an important part of your sexual future.

Here are some helpful techniques to heal your perineum right after delivery:

  1. Apply ice packs for the first 24 hours after delivery to reduce swelling, then switch to daily sitz baths with warm water. Some midwives and holistic practitioners recommend the addition of certain herbs to these baths. Check with a practitioner you trust for a recipe.
  2. After bathing, let your perineum air dry and, if possible, expose it to sunlight.
  3. After any bleeding has stopped, use only soft cotton underwear. If the seams of the undies chafe, wear the panty inside out. Don’t be afraid to pamper yourself with a new 6 pack of undies--you’ll want to change them often. Others avoid wearing underwear all together in combination with a skirt. This helps avoid trapping excess moisture against the skin while healing is taking place.
  4. For those experiencing pain from urine splashing against the perineum, a light application of zinc oxide (ex. Desitin, or generic) helps shorten the healing time, and keeps urine from causing the burning sensation.
  5. If your perineum has not healed within six weeks, make sure to notify your health care practitioner.

After it has healed, gently massage your perineum to soften any remaining scar tissue. Using a moisturizing water-based lubricant like Oasis Silk, Sliquid Organics, or Pjur Med Repair Glide, you or a partner can insert one lubricated finger just inside the vaginal canal and gently roll the perineal tissues between thumb and forefinger. Your goal is to gently re-form the scar tissue so that it can be more flexible, as well as circulate more fluids through the perineum to further enhance healing. Some women prefer to perform this massage nightly, which helps to moisturize the tissues while you sleep.

Be prepared to heal yourself before being intimate with your partner. If you are feeling pain with penetration, or you just don’t feel physically comfortable with penetration, hold off on being penetrated. Pain and discomfort are telling you that your tissues are not fully healed and flexible after delivery, and if you damage the skin again, it will take just that much longer to heal.

Contact your health care provider if you are experiencing continued problems after trying some of these suggestions. Your continued sexual health is as important as ever after the delivery.

Take Care.

Dr. Myrtle