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An episiotomy is a minor surgical procedure where the skin and underlying muscles of the perineum—the area between the vagina and the rectum—is cut at the end of the second stage of labor (crowning) to assist in childbirth by enlarging the birth canal opening and allowing the baby to pass through more easily. Although episiotomies are common, they are not routine—in the U.S, about 60% of all vaginal births do not need an episiotomy. The final decision to do an episiotomy is not decided until you are ready to give birth. You can try to avoid needing an episiotomy with perineal massage, and listening to your labor and delivery team about when to push and when not to push. Having an episiotomy does not add time to your hospital stay.

The Episiotomy Procedure

Mediolateral episiotomy

Note: The scissors shown are incorrect – the scissors actually used are blunt on the tips to prevent injury to the mother or baby.

An episiotomy begins with a local anesthestic (either a nerve block or an epidural injection) to numb the area where the cut will be made. Two fingers are placed between the scissors and the baby’s head for protection. This is followed by a one inch blunt-scissors cut, either a mediolateral cut (an angled cut to one side of the vagina to avoid the anal sphincter muscles) or a mid-line or median cut (a straight cut of less than an inch towards the anus).

The cut enlarges the vaginal opening and helps in the delivery of your baby. If you need a forceps or vacuum delivery, the length of the incision will be longer than it would be without an instrument assisted birth. Once your baby is delivered and the placenta removed, the birth canal is examined for any tears that need repair. The episiotomy incision made in the vaginal skin, muscle and perineal skin is stitched closed in layers using absorbable sutures. The vaginal skin is repaired first, then the muscle and finally the skin of the perineum. Stitching usually takes about 10-20 minutes. The incision is closed soon after delivery to prevent blood loss and reduce the chance of infection.

The median incision is easiest to make and repair, but if it has to be extended or tears it does not give any protection to the anus. The mediolateral cut is more difficult to repair but it gives the best protection against damage to the anal sphincter and best suits the purpose of the cut.

Why Do You Need an Episiotomy?

A normal vaginal delivery involves intense labor contractions and requires a pushing on the mother’s part. Time and patience is required for the labor to produce a baby. Pushing by the mother can cause tears in the vagina.

An episiotomy may be performed to prevent jagged tears which are likely:

  • if your baby presents face first and not the crown of the head first
  • if you have a scar from earlier tears
  • if you’ve had previous surgery to repair a tear or uterine prolapse

An episiotomy may also be performed:

  • if your baby is suffocating due to lack of oxygen (the umbilical cord gets “kinked” or compressed, or there appears to be umbilical cord problems and the baby needs to be delivered quickly
  • if your baby is large or its head is too big
  • if your baby is in distress in the birth canal
  • if your baby’s shoulder gets stuck in the vagina
  • if there is an emergency and there is not enough room to deliver your baby with forceps
  • if your baby presents bottom first (breech) and needs more room to get out
  • to prevent overstretching of the muscles which may lead to prolapse later

One of the main reasons for an episiotomy is to avoid tears since it is felt that a clean, surgical cut is easier to repair than a natural tear. Natural tears in the perineum can happen as your baby passes through the vagina. Injury to the perineum can be:

➪ when the surface is nicked, but may not need stitches for repair
➪ when the lining of the vagina and some connective tissue is torn
➪ a tear that goes through the muscle around the anus
➪ a tear that goes through the vagina and into the rectum

Stretching of the skin and small tears may not need repair. An episiotomy or tears that need repair will be repaired with stitches while you are on the delivery table.

Advantages of an Episiotomy

Although there is pain and discomfort after an episiotomy, there are advantages to having one.

  • An episiotomy can make the process of delivery much easier and the mother doesn’t need to put in much effort in pushing to deliver the baby.
  • Your baby can be delivered quickly in certain emergency situations.
  • There is less trauma to the vaginal tissues. If the skin is allowed to tear, the tear can be jagged and much harder to repair than a clean cut made with scissors. You can also tear in a place that could cause more serious injury in the rectum or anus. Preventing tearing of the muscle ring around the anus is very important as this could lead to later trouble with bowel movements or fecal incontinence.
  • Tears can take longer to heal than an episiotomy.

Possible Complications of an Episiotomy

An episiotomy can cause pain, bleeding, swelling, bruising or get infected. It can also have complications if the incision extends into the rectum or the episiotomy wound isn’t sewn back together well. Avoid intimate relations for several weeks until the episiotomy is completely healed. In some cases, there may be painful relations even after the episiotomy incision has completely healed.

How to Care for an Episiotomy

An episiotomy takes about 4—6 weeks to heal depending on the size of the incision, material used for the stitches and the lifestyle of the mother after delivery. By the time the stitches are absorbed, the skin is strong and the edges should not separate. If you see stitches on your sanitary pad, check your episiotomy with a mirror to make sure the skin is still closed and looks healed.

Most mothers don’t feel any pain while episiotomy is being done because of anesthesia. However, the recovery period can be painful and the stitches uncomfortable for the mother, especially when sitting. The following tips can help relieve pain and discomfort:

  • Cold therapy—using ice packs—on the stitches numbs the area and reduces pain and swelling. Ice can be used during the first 24 hours. Don’t apply the ice directly to the skin. Ice should be applied 20 minutes on and 10 minutes off several times a day. Swelling of the skin can cause pulling of the stitches.
  • Ring cushions inflated with air, water or made of foam can make sitting more comfortable.
  • The incision site should be cleaned with warm water and plain, unscented soap when you use the bathroom. The hospital may give you a peri-bottle for spraying water on the area.
  • A warm bath or sitting in a tub of warm water for 20 minutes several times a day can help relieve pain. After the bath, the incision site should be patted dry with a soft towel.
  • Expose the stitches to the air at least twice everyday for 10 minutes or so.
  • Witch hazel can be applied to the site to sooth the soreness (Tucks Pads, Tucks Clear Gel) or a topical anesthetic (Americaine, Dermoplast). You can make witch hazel pads with soft 2” x 2” non-sterile gauze pads and witch hazel. Always apply the witch hazel to a clean gauze pad so you will not get germs into the witch hazel. To make cold witch hazel pads, keep the bottle of witch hazel or some pre-soaked witch hazel pads in the refrigerator.
  • Over-the-counter medications like acetaminophen may be taken to relive the pain. However, don’t take any medicine without talking with your doctor, especially if you’re breastfeeding.
  • Take the sting out when you urinate by pouring warm water over your perineum while you pee
  • Straining with constipation puts pressure on the stitches during bowel movements. Drinking plenty of fluids and eating a balanced diet with plenty of fiber helps prevent constipation. Ask your doctor about using a stool softener (Colace) to make stool easier to pass without straining. If you are breastfeeding, taking a stool softener may cause loose stools in your baby, too. Holding a pad of toilet paper against your stitches during a bowel movement can help relieve pain from the stitches. After a bowel movement, wipe from front to back with toilet paper. Then gently wipe or pat, again from front to back, with witch hazel pads to reduce minor itching or burning. Use a clean piece of toilet paper or witch hazel pad for each wipe. Drop used toilet paper and pads into the toilet after each wipe.
  • Squeeze your buttocks together while sitting or getting up from a seated position to help ease discomfort from your stitches.
  • If you can’t relieve the pain or if you have a fever above 104.5° F, call your doctor right away as these could be signs of an infection which needs to be treated.
  • It is very important to prevent infection of your stitches that can infect the vagina. Read here for hygiene information about perineal care after vaginal birth.

After you get home, call your doctor:

  • If you have any signs of infection such as fever and chills, redness, pain or swelling at the incision site that does not get better every day, or you have a foul-smelling discharge or bleeding from the episiotomy site
  • If your pain isn’t controlled with the medicines your doctor prescribes
  • If you have problems controlling your bowels or bladder that does not go away.

Always wash your hands thoroughly before and after going to the bathroom or changing a sanitary pad. Proper handwashing is the best thing you can do for yourself and your baby to prevent infection. This link will tell you more about proper handwashing, when to use soap and when it’s OK to use gel sanitizers.


Hemorrhoids are swollen veins of the rectum. Hemorrhoids can be caused by pressure from your baby’s head or your pushing during the final stage of labor. It’s easy to confuse pain from stitches for pain from hemorrhoids. Read here for more on how to care for the perineum and hemorrhoids.

Long-term Effects of Episiotomy

Because of the good blood supply to the area, episiotomies heal quickly and usually without problems. Episiotomy stitches are absorbed by the body and do not need to be removed. The pain and discomfort can be relieved by medications and by using ice packs within 24 hours followed by warm baths. You can walk as soon as you feel able. Everyday activities can be resumed shortly after the procedure, though the stitches might take some time to heal completely.

Ways to Avoid an Episiotomy

It’s a good idea to talk to your doctor about your feelings about an episiotomy. Include your thoughts, as well as your doctor’s thoughts in your birth plan.

There are times when an episiotomy is unavoidable. However, there are ways which can help prevent it. The following methods can be tried to deliver your baby easily and without having an episiotomy.

Perineal Massage

Massaging the perineal and vaginal area helps in stretching the tissues and aids in childbirth without episiotomy or tearing of the skin and muscles. Massage should be done for at least 5—10 minutes everyday beginning with week 34 until delivery. Lubricants like KY jelly, olive oil, vitamin E oil, almond oil or pure vegetable oil should be used for massage. Make sure your fingernails are trimmed and your hands are clean before doing the massage. Also, talk with your doctor before starting the massages, especially if you have a history of vaginal infections or are at risk for preterm birth.

To do perineal massage: apply a water soluble lubricant like vitamin E to the thumb or index finger, and insert the finger or thumb into the vagina about an inch. Slide the finger with pressure in a semicircular motion, starting at the side of the vagina and moving down toward the anus, and back up to the other side of the vagina. Do the massage for a 5 minutes every day. Clean off the excess oil when you finish so you won’t get it on your clothes. When you go into labor, tell your obstetrician that you have done perineal massage. There is no guarantee you won’t need an episiotomy, but by doing the massage you may reduce trauma to the perineum during delivery.

Do Kegel Exercises

Muscles of the perineum used doing Kegel Exercises

Muscles of the perineum used doing Kegel Exercises

You were probably doing Kegels while you were pregnant and you should keep doing them after your baby is born. Pelvic muscles are just like any other muscle—exercise makes them stronger. Kegel exercises include tightening and relaxing of the pelvic muscles. Kegels can help strengthen the perineum muscles which support the organs in the pelvis (uterus, bowel, bladder).

First you have to figure out which muscles to exercise. To find these muscles, alternately start and stop urinating while using the toilet. However, when you do Kegel exercises, don’t do them while you’re urinating. Do Kegel exercises lying, sitting, standing, walking, and driving to make the pelvic muscles the strongest.

Kegel Exercise: Tighten the perineal muscles slowly a small amount at a time, like an elevator going up 10 floors. The release the muscles slowly—one “floor” at a time. Repeat. Start off with 5-10 times and then work up to 20-30 each time. Do the exercises 3 times a day—morning, afternoon and evening. Try to keep up a regular schedule each day such as after meals, in the shower, or just before bedtime.

Try not to squeeze your buttocks or abdomen while you tighten up as this puts pressure on the pelvic floor muscles. Keep the muscles of your abdomen, thighs and hips relaxed.

Think about your perineal muscles when you are lifting, sneezing, coughing or laughing and do Kegels then, too. After a while it will become a habit and you won’t have to think about it.

Correct Breathing and Pushing During Labor

Controlled breathing, along with proper pushing, helps you have a non-emergency vaginal delivery and avoid an episiotomy. Pushing only when you’re told to can give your perineum time to stretch and avoid tears.


  1. Immaculeta sylvia says

    Please what if the tear got opened due to severe cough and pressure during stooling, it’s been 2years now and is there any possibility for the doctors to restitch/resew it thanks.

  2. Lee Williams says

    I gave birth to my son in 1997, & he was 3 weeks early, weighing 5 pound 13. I was induced & my labour was only 4hrs & 40 mins. I had an episiotomy which I had no complications. I guess I’m one of the lucky ones.

  3. Denise morrry says

    I had an episiotomy 25 years ago why dose it keep getting really tight and sore

  4. Serious itching,and it’s over 10years now,pls what can I do to stop the itching????

  5. LYDIA ALI says

    I had an episiotomy done about 9years ago but it swollen red and painful what do I do pls.

  6. Response to Jenn‘a post from April 2020:
    “Ever since he was born it’s as if I have an extra pouch that goes into my labial and anus and bowel movement will fill that pouch space. I can feel it through my vagina, through my buttcheeks, and even raising my feet on a stool for the past 5yrs now I have to externally and sometimes internally through my vagina manipulate the tissues to make to stool come out. I’m NOT constipated, I just have NO muscles down there. For 29 years now. And I’m 46…it’s so sad and embarrassing.“

    This is EXACTLY how I feel still 7 months PP, as well as right sided discomfort from a bartholin gland cyst that the pain hasn’t totally resolved from, and it’s extremely frustrating! Have you talked to your doctor about this? Did they have anything to say to help? Is it really just weak muscles causing this? I don’t want to be like this forever and am getting very frustrated!

  7. Had episiotomy 12 years back and the part is growing out , can it be cut off.

  8. I have had 3 children. My oldest is 29. My youngest is 19. An episiotomy was done with the birth of my 1st child. And I still tore all the way into my rectum and forceps were used. With my second son I didn’t want any of this to happen again so I walked and walked and walked all day while I was in labor. I was 4cm before going to the hospital. 6com when I arrived, and I asked to continue walking. When shift change the new nurses coming in didn’t think I was in labor I was so calm. As I went to circle past they say stop at your room and buzz so we can check you. When I got there I peed, and then the pressure became so intense I had to lower the bed and throw myself back, I couldn’t sit. When they came in, he was crowned but still no water broke, so they broke it…dear God the pain. In 2 pushes he was out. 6 yrs later my last love now 19 was born. I didn’t have to be cut but forceps were needed again. Ever since he was born it’s as if I have an extra pouch that goes into my labial and anus and bowel movement will fill that pouch space. I can feel it through my vagina, through my buttcheeks, and even raising my feet on a stool for the past 5yrs now I have to externally and sometimes internally through my vagina manipulate the tissues to make to stool come out. I’m NOT constipated, I just have NO muscles down there. For 29 years now. And I’m 46…it’s so sad and embarrassing.

  9. I had an episiotomy before two months…The stitches have healed but the place where the tear was done,it feels like a pimple and it pains a lot…My mother says that these are stitches inside and they will heal but after two months I am not able to sit properly….I can’t lay straight….It pains a lot….Please tell me how much time will it take to heal?

  10. I had my son 10 year ago n now started pain its unbearable so what is treatment
    I m suffering from 10 months

  11. Please what if the tear got opened due to severe cough and it been 16 years now and is there any possibility for the doctor to resew it thanks.

  12. I had an episiotomy (forceps delivery). Some knots are went into my vegina. I can get it but I can’t take it out because one end of thread is fixed to vegina. I can’t take it out because of pain. Can it fall off easily? It’s 22 days now.

  13. Is it possible for episiotomy repair after 9years

  14. Hi.. I have undergone normal delivery (forceps were used) … My stitches are removed but i have pain on my right side in vagina.. I could not walk when I walk I feel like there is somewhere other skin touching my painful part n not allowing me to walk .. I have to open n close my legs every 1 min when I walk to feel relaxed.. But at the end I feel like sitting on bed again

  15. Lovie Bartholomew says

    Is it possible to undergo episiotomy after 10 years?

  16. I had episiotomy repair but still having pains what should I do

  17. So i had my son 7 weeks ago and at 2 weeks my mediolater incicion episiotomy started gapping so i went back they took out the old stitches and gave me new ones just a little over 4 weeks with the new stitches they all fell out and the incicion is closes but since yesterday i realised that i have a open hole on my incion its still small about 3×3 mm and how deep i don’t know itsal little painfull but don’t have to use painkillers ….should i be worried ?will it heal on it’s own?I’m seeing a pharmacist in a few days just to check but I’m so scared ro go back for stitches for a 3 rd time

  18. Sandra Lewis says

    I had this done 31 years ago and only now I’m having problems itching bleeding putting cream on but nothing is helping, please help I’m a bit embarrassed to go to doctors thank you

  19. After my first child, 38 years ago, I had an episiotomy. I remember the doctor saying he was going to do a ‘new’way of stitching. I have never had any sensation in my vagina since. Should I?

  20. Episiotomy done 10 years ago,,,I have an ongoing tearing ,inflammation and bruises without penetration,,this causes recurrent urinary tract infection and a regular discomfort in my rectum,,as if am constipated even when had a bowel action. Have been given softlex,antibiotics and all sorts of UTI treatment but it doesn’t help,,,what do I do?

  21. i happen to have a sore between my vigina and anus after having my first born 2 months ago which is very painful i can barely sit…I am having constipation problem also so please suggest what might can be do for my problem.?

  22. i happen to have a sore between my vigina and anus after having my first born 3 months ago which is very painful i can barely sit…please what might be the problem..?

  23. Ladies childbirth is no game. Just had my firstborn at age 27 5 days ago and I am in pain from the episotomy. When the nurse was cleaning my wound a day after birth she said my stitches were too many and I had to wash more frequently at least 5 times a day. I keep searching the net on how other mothers coped with the problem. I cant even enjoy spending time with my baby because the painkillers keep me drowsy most of the day. Please help if you have any more advise. I worry I am losing precious bonding time with my angel.

  24. How long does it take an episiotomy and virginal tear to heal? And how long can I do sitz bath

  25. Magbegor Zino says

    I had an episiotomy 3 weeks ago and I sat in warm water and salt for two weeks,the stitches has fallen off but I looked in a mirror today and the cut is open and bleeding and painful. I’m scared of undergoing another stitch. Please what else can I do for it to heal?

  26. I had episiotomy 3weeks ago, but small part was torn again and since then it has not close up. Don’t know should I be worried?

  27. Delisile Sathekge says

    i had an episotomy done wrong before the doctor who stitched almost closed my virginal hole and had to return and have it done properly bt im noticing that its been opened wide I afraid to sleep with my boyfriend cause of embarassment and also wonder what will I be like in ten yrz time plz help me wht should I do?????

  28. My scar area I just noticed is very red. I had my son 10 years ago. I noticed over past 3 yrs my vaginal area between my vagina and anus would feel raw and sensitive and would sting during urination. I thoughg it was from sex. But I have noticed these issues are happening even when Im not sexually active. So I actually looked down there and sure enoug the skin between my vagina and anus showed a thin red line, which obviosly is where I had been cut. It is smooth, so i think the tissue healed well. Just wandering why it is all the sudden becoming raw?
    I am thinking maybe from wearing thongs? I just started wearing thongs for the first time when I was 28 and now i am 33. Maybe that could be causing it ?

  29. My wife had a baby 3 years ago thru episiotomy. Everything was okay till I noticed recently during our intercourse that the stitches were not properly done or it went off while recovering after pregnancy. The penetration sometimes goes downside inside of real vagina has has to be adjusted to get real viginal penetration. I hope I have explained well. My question is can this situation be fixed after any kind of surgery?

  30. i had my daughter 10 yrs. ago my doctor cut me and didnt stitch me up properly . Now after 10 yrs. i have less then one thumb print size between my vagina and rearend. i know there is supposed to be more space between the two. it doesnt look right it doesnt feel right it doesnt sound right. i know its not very sanitary being that close. u can see inside my vagina which was never like that b4. u can see my cervix just by looking at my vagina. i live in los angeles county, i dont have a doctor any more and i need some help finding a doctor that is capable to re do my episiotomy and be able to do it correctly the first time. i dont understand why doctors cant stitch woman up right after childbirth. my doctor cut me about an inch, but only stitched me up less then half inch back up, how and WHY is that…?? now 10 yrs later im needing it re done. not cool, cuz now its worse then b4. please help me with this im desperate 2 get it fixed, my symptoms are getting worse and more uncomfortable. i really need some guidance with this matter.

  31. It has been over 25 years since I had my episiotomy, however, I find that I have trouble with bowel movements as it seems that the stool moves forward toward the area where the scar is from the surgery, almost like I have lost muscle use over the years, I have to put pressure with toilet tissue and then push to move my bowel. This is not all the time, but it is often and very painful.

    Can the kegel exercise help me now?


  32. I had an episiotomy 8years ago but just two years after I gave birth I started to feel an uncontrollable itching on my stitch it is even swollen whenever I check the pain is unbearable last year I had a d&c due to abnormal uterus thickening…. And I am having prolonged periods like 3months heavy flow nonstop I noticed that whenever I have periods the stitch tend to itch and swell.. It is really unbearable I hope u can give me advice I’m literally crying every night… There’s no witch hazel here in the country where I work pls help thanks

  33. is it possible to undergo episiotomy repair after 7 years of giving birth?

  34. Diane, I’d check to see if there is a stitch or issue or just scar tissue. Do you keloid when you scar?

  35. My scar is very thick and I believe it came with the birth of my first child 37 years ago I had three more babies but with the first one the pain was so bad I could barely move my left leg, I didn’t have that with the others over the year if I get a yeast infection or irritated in any way it gets so sore I can’t touch it to put medication on it…Can you answer why this happens

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