For some women, yes. An episiotomy can leave problems that last well beyond recovery, and which ones depend on where the cut went and how it healed. The effects are mostly local, at the scar and the muscles around it, rather than across the pelvic organs as a whole. Doctors now avoid routine cuts because the cut itself brought no benefit to mother or baby, and more selective use meant fewer severe tears.1Cochrane Database of Systematic Reviews. Selective versus routine use of episiotomy for vaginal birth If you had one, ongoing symptoms are worth raising, since many have known fixes.
Scar Pain and Painful Sex
The perineum is the area between the vagina and anus, and an episiotomy cuts through its skin and muscle. Pain long after birth can come from the scar pulling tight or from a small knot of damaged nerve tissue inside it.2LWW (Plastic and Reconstructive Surgery). Lipofilling of Perineal and Vaginal Scars: A New Method for Improvement of Pain after Episiotomy and Perineal Laceration The changed shape of the scarred area can also affect how sex feels and lead to sexual problems.3Balkan Medical Journal. Assessment of the Effects of Perineoplasty on Female Sexual Function An angled cut passes closer than a straight-down cut to nerves and tissues involved in sexual sensation.4PubMed Central. Midline and Mediolateral Episiotomy: Risk Assessment Based on Clinical Anatomy
Scar pain often sits at one spot rather than spreading across the area. It may be sharp at the entrance during sex, or feel like a pulling when the area stretches. Sitting for a long time can bring on a dull ache.
Pain beyond the first few months isn’t something you have to accept. Telling your doctor you had an episiotomy helps them examine the scar itself. To get help, ask your GP or gynecologist for a referral to a perineal or pelvic floor clinic, and bring notes on when the pain happens and what triggers it.
A scar that looks neat on the surface can still be stiff underneath, because healing tissue is laid down in a different pattern from the original skin and muscle. Muscles near a painful scar often tighten protectively, which can keep the pain going after the tissue has settled.
The scar is only one possible source of painful sex. Vaginal dryness (common while breastfeeding because of low estrogen), pelvic floor muscle tension, or a healing tear can feel similar. Dryness tends to cause a general burning or rawness, while a scar problem tends to hurt at the same spot every time. A clinician can press gently along the scar and the surrounding muscles to see whether your exact pain is reproduced, which is one of the more useful ways to find the source. More than one cause can be present at once, so treating one and still having pain doesn’t mean nothing can be done.
Four years after birth, painful sex was reported by about 18% of women in a hospital using few cuts versus 21% in one using cuts routinely, a difference too small to be sure of.5PubMed Central. Long- and short-term complications of episiotomy Ongoing perineal pain at four years was 6% versus 8% in the same comparison.6PubMed Central. Long- and short-term complications of episiotomy So lasting pain affects a minority, and many women who never had a cut also report it after birth. The stitching material doesn’t seem to change pain or painful sex months later,7PubMed Central. Absorbable suture materials for primary repair of episiotomy and second degree tears though one continuous stitch caused less pain than many separate stitches.8PubMed. Outcomes of suture material, suture technique and tissue adhesives for repair of childbirth-related perineal trauma: A systematic review and meta-analysis
Treatments for a Painful Episiotomy Scar
Pelvic floor physical therapy is a sensible first step. A specialist physiotherapist can work on the scar by hand to loosen it, and can retrain pelvic floor muscles that are tight or weak. It can help even years after birth. The evidence here comes mostly from clinics, so results vary.
When therapy isn’t enough, surgery is an option that has worked well in reported series. Doctors can cut out the tight scar and close the skin again, or move nearby tissue to cover it.9LWW (Plastic and Reconstructive Surgery). Lipofilling of Perineal and Vaginal Scars: A New Method for Improvement of Pain after Episiotomy and Perineal Laceration This scar-revision surgery cut average pain scores from about 6 out of 10 to under 1 in women with painful sex.10PubMed. Outcomes of revision perineoplasty for persistent postpartum dyspareunia About 9 in 10 of those women had sex more often and enjoyed it more afterward.11PubMed. Outcomes of revision perineoplasty for persistent postpartum dyspareunia Injecting a woman’s own fat under the scar eased pain right away in 18 of 20 women by loosening tight scars.12LWW (Plastic and Reconstructive Surgery). Lipofilling of Perineal and Vaginal Scars: A New Method for Improvement of Pain after Episiotomy and Perineal Laceration Injections made from your own blood have helped in single reported cases, so it remains experimental.13Clinical and Experimental Obstetrics & Gynecology. Effectiveness of platelet-rich plasma treatment in perineal trauma: a case report
Fat grafting aims to loosen tight tissue and suits scars that feel stiff or bound down. Excision suits a scar with a clearly tight or tender area that needs removing. Which one fits depends on an examination of your scar, so start with a clinician who examines it and explains why they favor one approach.
Surgery is usually a short procedure under anesthetic. Healing takes weeks before sex is comfortable. Ask about your surgeon’s experience with this specific revision.
A few things can help alongside treatment. A water-based or silicone-based lubricant reduces friction on a sensitive scar. Taking more time before penetration, and choosing positions where you control depth and angle, can lessen pulling at the scar. A physiotherapist may teach you gentle scar massage to do at home; learn it from them first so you apply the right pressure. These steps help with comfort but don’t replace an examination if pain keeps going.
Bowel Control and Severe Tears
A third- or fourth-degree tear reaches the muscle ring that controls the anus. Births with an episiotomy had about twice the rate of these severe tears, though both rates were very low in one large hospital record.14PubMed. Episiotomy: the final cut? After accounting for first births and large babies, the extra risk from the cut alone shrank in several hospital studies.15PubMed Central. Risk Factors in Third and Fourth Degree Perineal Tears in Women in a Tertiary Centre: An Observational Ambispective Cohort Study A first birth and forceps delivery raise the chance of a severe tear on their own.16PubMed Central. The outcomes of midline versus medio-lateral episiotomy Episiotomy is more often done in situations that already carry a higher risk, such as a first birth, forceps, or a large baby, so the cut and the tear can look linked partly because of why the cut was done.
Doctors use either an angled cut or a straight-down cut. Deep tears happened in about 15% of straight-down cuts versus 7% of angled cuts,17PubMed Central. The outcomes of midline versus medio-lateral episiotomy so US obstetricians recommend an angled cut only when needed.18PubMed Central. Long- and short-term complications of episiotomy In women given a straight-down cut, the chance of leaking stool at three months was about triple that of women who tore naturally.19PubMed Central. Midline episiotomy and anal incontinence: retrospective cohort study The chance of leaking gas was about double.20PubMed Central. Midline episiotomy and anal incontinence: retrospective cohort study
Signs worth reporting include urgency or not reaching the toilet in time, leaking gas you can’t hold back, and staining underwear after bowel movements. These are treatable, so mention them early.
To find out which cut you had, check your birth records or discharge notes, which usually state it. If you’re unsure, ask your midwife or doctor to check.
A muscle injury can also occur without being seen at birth. An ultrasound of the anus can find it,21PubMed Central. Midline and Mediolateral Episiotomy: Risk Assessment Based on Clinical Anatomy so ask for one if leakage persists.
Treatment usually starts with pelvic floor exercises supervised by a physiotherapist, sometimes with biofeedback, which uses sensors to show you whether you are squeezing the right muscles. Changes to stool consistency, such as adjusting fiber or using medicine to firm up loose stools, can reduce leaks because loose stool is harder to hold. If a scan shows a muscle defect and these steps don’t work, a specialist can discuss surgical repair of the muscle ring.
Bladder Leaks and Prolapse
Reviews list episiotomy among factors linked to later urine leaking, along with forceps, natural tears and constipation.22PubMed. Pregnancy- and obstetric-related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta-analysis The link is described as possible, not proven.23PubMed. Long-term effects of episiotomy on urinary incontinence and pelvic organ prolapse: a systematic review Four years after birth, urine leaking was 26% with few cuts versus 32% with routine cuts, not a clear difference.24PubMed Central. Long- and short-term complications of episiotomy A year after first births, leaking rates were similar after a cut or a natural tear.25PubMed Central. Effects of lateral episiotomy on the emergence of urinary incontinence during the first postpartum year in primiparas: prospective cohort study
Many women leak after vaginal birth whether or not they had an episiotomy, because the baby’s passage stretches the pelvic floor and the nerves that supply it, and the cut is only one part of that story. If leaking began after birth, the more useful question is what kind it is, such as with coughing or with a sudden urge, because that guides treatment. Pelvic floor exercises are a standard first treatment, and persistent leaking deserves a referral whatever caused it.
Prolapse is when the bladder, womb or bowel drops into the vagina. Having one or several episiotomies wasn’t linked to prolapse years later,26PubMed Central. Pelvic Floor Disorders After Childbirth: Effect of Episiotomy, Perineal Laceration, and Operative Birth while having two or more natural tears doubled the chance of serious prolapse.27PubMed Central. Pelvic Floor Disorders After Childbirth: Effect of Episiotomy, Perineal Laceration, and Operative Birth One possible exception is women with very stretchy joints from hypermobile Ehlers-Danlos syndrome, in whom prolapse was linked to episiotomy.28PubMed. Gynecologic and obstetric implications of the joint hypermobility syndrome (a.k.a. Ehlers-Danlos syndrome hypermobility type) in 82 Italian patients
Signs of prolapse include a heavy or dragging feeling in the vagina, a bulge felt or seen at the opening, and symptoms that are worse at the end of the day. A doctor can examine and grade it.
Body Image and Emotional Effects
A scar can change how a woman sees her body far more than its size suggests.29PubMed. Episiotomy and body image Women with an episiotomy rated their genital and sexual self-image lower than those without.30International Journal of Women. Body after baby: a pilot survey of genital body image and sexual esteem following vaginal birth In the first weeks they were more likely to feel the birth was traumatic,31PubMed. The postnatal effects of perineal trauma on maternal psychological and emotional wellbeing: A longitudinal study and months later they reported more general anxiety.32PubMed. The postnatal effects of perineal trauma on maternal psychological and emotional wellbeing: A longitudinal study Many women recall consenting to the cut with unease or feeling powerless.33PubMed Central. Choice in episiotomy – fact or fantasy: a qualitative study of women’s experiences of the consent process
How a woman felt during the birth, including whether she was told what was happening and given a say, shapes how she remembers it, so distress can come from the experience as well as the cut. A cut made in an emergency without time to explain it can leave a woman feeling it was done to her, which is different from a cut she understood and agreed to. That is why two women with the same procedure can describe very different memories and recoveries.
Worry about appearance can make sex tense and more painful. Treating pain often improves confidence too, and revision surgery also improved self-esteem for many women.34PubMed. Outcomes of revision perineoplasty for persistent postpartum dyspareunia
Feeling low or anxious for a few weeks after birth is common. Distress that persists for months, or flashbacks and avoiding anything that reminds you of the birth, is worth raising with a clinician. Postnatal depression and birth-related trauma are treatable, and treatment doesn’t depend on whether the cut was medically necessary. Saying plainly that the episiotomy is part of what troubles you gives the clinician useful direction. Many hospitals offer a birth review to go over what happened and why.
Your Next Birth After an Episiotomy
Women with a past episiotomy are more likely to be given another.35PubMed Central. Once episiotomy, always episiotomy? A later birth also carries a lower risk of severe tear than a first birth.36PubMed Central. Risk Factors in Third and Fourth Degree Perineal Tears in Women in a Tertiary Centre: An Observational Ambispective Cohort Study
Having a scar doesn’t mean you will need another cut, because many women with a past episiotomy give birth later without one. A cut is generally decided on the day, based on how the birth is progressing, so talking beforehand sets out your preferences but can’t guarantee the outcome. Mention if the old scar is still painful or tight, because this can affect how the team approaches the birth. Some midwives suggest gentle perineal massage in late pregnancy, and you can ask whether it suits you.
In planning conversations, ask your midwife about the unit’s episiotomy policy, and say whether you want to be asked before any cut. Ask which cut type they use and why.
A cut may still be advised in some situations. A baby in distress may need delivering fast, and forceps births sometimes need more room. Asking for an angled cut if one is needed is reasonable.37PubMed Central. Long- and short-term complications of episiotomy
Some groups have higher risk of deep tears. Shorter women and those with large babies have more of them,38PubMed Central. The outcomes of midline versus medio-lateral episiotomy so discussing these factors with your team can guide birth plans.