Perineal lacerations are classified into four degrees based on how deep the tear extends during vaginal delivery. First-degree tears are the most superficial, affecting only the skin, while fourth-degree tears are the most severe, reaching all the way through to the rectal lining. Most vaginal births involve some degree of tearing. In one prospective study of first-time mothers, about 59% experienced a first- or second-degree tear, and roughly 7.4% had a third- or fourth-degree tear.
First-Degree Tear
A first-degree tear is the mildest type. It involves only the perineal skin and the superficial tissue just beneath it, without reaching any muscle. These tears often heal on their own within a few weeks and usually don’t require stitches unless there’s notable bleeding or the edges of the skin don’t sit together neatly. About 18% of first-time vaginal births result in a first-degree tear. Many people experience these as minor stinging or soreness that fades relatively quickly.
Second-Degree Tear
A second-degree tear goes deeper than the skin and extends into the perineal muscle. This is the most common type of laceration during vaginal delivery, occurring in roughly 41% of first-time births. Because muscle tissue is involved, these tears almost always need stitches, which can typically be placed right in the delivery room with local numbing.
Continuous stitching (one running thread rather than individual knots) is the preferred technique because it tends to cause less pain afterward and reduces the chance of needing stitches removed later. Healing generally takes about three to four weeks. During that time, sitting and walking may be uncomfortable, and you’ll want to avoid tampons, menstrual cups, and sex until the area has fully healed.
Third-Degree Tear
A third-degree tear extends through the perineal skin and muscle and into the anal sphincter, the ring of muscle that controls bowel movements. Because this muscle is involved, the repair is more complex and sometimes needs to be done in an operating room rather than in the delivery room. Regional or general anesthesia may be used instead of just local numbing.
Third-degree tears are further divided into three subcategories based on how much of the sphincter is damaged:
- 3a: Less than 50% of the external anal sphincter is torn.
- 3b: More than 50% of the external anal sphincter is torn.
- 3c: Both the external and internal anal sphincter muscles are torn.
Recovery typically takes four to six weeks. Third- and fourth-degree tears are collectively known as obstetric anal sphincter injuries (OASIS), and they carry a risk of longer-term symptoms like fecal incontinence and sexual dysfunction, particularly when the damage is more extensive.
Fourth-Degree Tear
A fourth-degree tear is the most severe. It extends through the perineal skin, the perineal muscle, the entire anal sphincter complex, and into the rectal mucosa, the delicate lining inside the rectum. These tears are rare, occurring in well under 1% of vaginal births. Repair usually takes place in an operating room and may involve more complex techniques beyond standard stitching to restore both the sphincter and the rectal lining.
Healing takes at least four to six weeks, sometimes longer. Fourth-degree tears carry a higher risk of anal incontinence than third-degree tears, and that risk can persist. Research on over 182,000 women in Scotland found that a subsequent vaginal delivery was associated with increased anal incontinence in women who had previously sustained a fourth-degree tear, but not a third-degree tear.
What Increases the Risk of a Severe Tear
Several factors make third- and fourth-degree tears more likely. A 10-year study found that the strongest predictor was vacuum-assisted delivery, which nearly tripled the odds of a severe tear in first-time mothers. Other significant risk factors included a larger-than-average fetal head circumference (which raised the odds by about 50%) and an abnormal head position during delivery, such as the baby facing upward instead of downward, which roughly tripled the risk.
First-time mothers are about 2.4 times more likely to experience a severe tear compared to those who have given birth before. Forceps delivery, rapid labor, and having a larger baby are also consistently linked to more extensive tearing. Shoulder dystocia, where the baby’s shoulder gets caught during delivery, may increase the risk nearly fourfold, though this complication is itself uncommon.
What Recovery Looks Like
For first- and second-degree tears, recovery is generally straightforward. Pain and swelling peak in the first few days and gradually improve. Ice packs, sitz baths, and over-the-counter pain relief are the mainstays of comfort during healing. Most people feel significantly better within three to four weeks.
Third- and fourth-degree tears require more patience. The four-to-six-week healing window is a minimum, and some discomfort or sensitivity may linger beyond that. Pelvic floor rehabilitation can help restore muscle strength and coordination, which is especially important when the anal sphincter has been damaged. Symptoms like difficulty controlling gas or stool after a severe tear are not uncommon in the weeks following birth, but for most people they improve as the tissue heals and the muscles regain function. For a smaller number, these symptoms can become a longer-term concern that benefits from specialized follow-up.