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Episiotomies or tears: What to do about it

I had an episiotomy - what is it?

During labor, the doctor may make a small cut between your vagina and anus. This is done if there is too much tension in the tissues to get the baby out.This is called an episiotomy. 

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I had a tear and stitches - why?

Tears of the perineum are quite common when giving birth. The head of the baby can cause a lot of tension and stretch out the tissues around the vagina to their max. Sometimes, the tissues will tear, mostly between the anus and the vagina. After birth, if necessary, the doctor will stitch up the tear, like other cuts

Is there something I can do about this?

If you have had a tear or an episiotomy, it is important to massage the scar to help reduce pain during sex and reduce risks of problems in the future. Over time, when scar tissues are not worked on, scars can become hard, stiff and painful. 


How do I do this?

Find the position that is easiest for you:  

  • sitting on the toilet,  

  • standing up with one foot on the toilet seat,  

  • lying in bed, on your back or sideways  

  • sitting on the edge of a chair.  

Your partner can also do this with you.


STEP 1 - Find where the scar is

Ask your nurse or your physio to show you where the scar is. It is not as obvious as a cut on a leg!  Most often it is between the vagina and anus.


STEP 2 - Move the scar 

  1. Place your fingers flat on the scar 

  2. Move the scar right, left, up and down, make circles. You should be moving the skin, not sliding on it 

  3. Keep it tolerable as it can be painful initially 

  4. Massage for 2 to 3 minutes, 4-5x/week until it is not painful anymore


STEP 3 - Pinch your scar 

  1. Insert your thumb in your vagina 

  2. Pinch your scar between your thumb inside and your index outside (if someone else is helping you with this, it will be easier to have their index inside and thumb outside 

  3. Move the scar as in STEP 2 

  4. Massage 2 to 3 minutes, 4-5x/week until it is not painful anymore


STEP 4 - Stretch your scar

  1. Insert your thumb in your vagina 

  2. Press down towards your anus (you can also go slightly to the sides)  

  3. Hold 30 seconds, repeat 3 to 6 times 

Keep in mind that these types of massages can be uncomfortable. However, it should not give you increased pain afterwards.

If this happens, go more gently next time.

When can I start to work on the scar?

You can start approximately 3 weeks after giving birth or when the scar is well healed and there are no more stitches. 

When should I speak to the healthcare team?

  • If you start noticing redness on or around your scar, oozing or bleeding, significant increase in pain or fever, consult with your nurse or physician. 

  • Women who have had a cut or a tear are more at risk of having leaking issues (either urine, gas or feces) 

  • Some physios with the Cree Health Board have extensive training in the field of pelvic health including leaking issues and pain with sex. Don`t hesitate to ask your nurse or doctor to be seen by one of them.


If you have any questions or need some advice, ask your doctor or nurse to be seen by a physiotherapist who has advanced training in pelvic health problems.  There might be one in your community. Or you can contact the pelvic health team directly.

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