Many women who deliver vaginally experience second degree perineal tears. These are deeper than first degree tears, and involve both the skin and muscles. Stitches are required to close these types of tears.
Women with a second degree tear need to wait until their stitches are healed before engaging in sex. They should also take measures to reduce the likelihood of tearing.
Wait at Least Six Weeks After Delivery
Pregnancy and delivery change a lot about your body. Even if you don’t have a 2nd degree tear, your vaginal tissue may be thinner and more sensitive than it was before the birth. You may also have bleeding, and you’ll probably need an episiotomy if you had a C-section. This can make it a little uncomfortable to have sex.
It’s usually recommended that you wait at least six weeks after delivery before having sex that involves penetration. This is to give your uterus, cervix and vaginal wounds time to heal. It can take longer if you had a C-section or perineal tear, since these areas aren’t healing as quickly.
During this period, you and your partner can practice having oral sex. This can help stretch and soften the scar tissue, which may hurt less over time. You can also try applying an ice pack to the area to reduce pain. Taking over-the-counter pain relievers like acetaminophen and ibuprofen can help as well. If the pain doesn’t subside, talk to your health care provider. They may suggest trying a different type of pain reliever or a topical estrogen cream that helps with vaginal elasticity.
Talk to Your Health Care Provider
A second-degree tear can be uncomfortable, but it shouldn’t be painful. If you feel discomfort, it’s important to talk to your health care provider and see if the problem is due to an infection or other factors.
Your health care provider can examine your vagina and ensure that the tear is healing properly. They may recommend over-the-counter pain relievers to help ease the pain. You can also ask for a numbing spray or cream to help with lubrication.
The best way to know when you are ready to resume sexual activity is to listen to your body. You may have to wait a few weeks before the pain goes away and the tenderness eases.
It can be difficult to find the right balance of sex and recovery after birth. Trying to rush back into intimacy can actually make the problems worse. The pressure and pain can cause more damage to the repaired area, and the anxiety you have about sex can heighten the sense of every little twinge. It’s a destructive cycle that you can avoid with the right precautions and support.
Try a Sitz Bath
For some women, sitz baths can provide relief from pain and itching in the perineal and anal area. A sitz bath is basically a small pool of water in which you sit, with only your hips and buttocks submerged. You can use a bathtub or a basin specifically designed for sitz baths, or a container you have at home.
Before you fill your tub or basin, scrub it to make sure it’s clean. Then, fill it with 3 to 4 inches of warm water. Add any ingredients your doctor recommends for your condition, such as salt or medicine.
For example, if you have a Bartholin cyst—a fluid-filled sac near the labia that can cause pain and itching in the vaginal area—sitz baths can help a Bartholin cyst burst on its own, according to Banner Health. Also, if you have an anal fissure — a tear in the skin around your anus or anal canal that causes pain before and after pooping — sitz baths can relax the muscles and help the anal fissure heal over time.
Try Topical Estrogen Cream
Estrogen is a crucial female hormone that’s responsible for vaginal health, mood stability, restful sleep and healthy skin. But a loss of estrogen as women move through perimenopause can result in dryness and other uncomfortable symptoms, including urinary tract infections and burning during sexual intercourse. While more severe menopausal symptoms like hot flashes may require oral estrogen, milder ones can be effectively alleviated with a topical estrogen cream.
A topical estrogen cream can help because it treats the tissue directly, which reverses the thinning of vulvar and urethral tissues that’s caused by low levels of estrogen and helps restore the pH of GSM to normal, so it’s less susceptible to urinary tract infections, burns and irritation during sex. Another treatment option is the long-acting estrogen gel Replens, which can be inserted up to three times a week and provides both moisture and estradiol, restoring tissues to their premenopausal glory.
A third option is a vaginal ring that releases estrogen in a slow-release manner, called Estring. Since this is a local treatment, less of the estrogen goes into the bloodstream than with a pill or patch, which can lower your risk for cancers and cardiovascular events.
