how is it repaired?

Recommended repair technique and material for perineal trauma

A thorough, systematic examination of the perineum immediately following vaginal childbirth is essential to ensure trauma recognition, correct categorisation and optimal repair and a digital rectal examination should be undertaken in all women who have had a vaginal birth to exclude involvement of the anal sphincters or epithelium.

NICE (National Institute for Health and Care Excellence) guidelines advise that first-degree trauma should be sutured, (unless the skin edges are well opposed), and in the case of second-degree trauma, the muscle should be repaired as this improves healing outcomes.

A continuous suture repair technique using a fast absorbing suture material should be used for all layers (vaginal wall, muscle layer and skin) as research shows this has less pain for women during the healing period. Both of these recommendations have been incorporated into the NICE intrapartum guidelines and are considered standard practice in the UK (supporting evidence - 1-3).

Repair of a second degree perineal tear / episiotomy

Tears of the labia minora should be sutured whenever possible to promote healing and to avoid long term physical discomfort and improve aesthetic outcome. Evidence is currently limited with regards to optimal methods and materials for repair of labial tears.

Superficial labial or para-urethral grazes that are not bleeding, may not require suturing.

NICE. National Institute for Health and Clinical Excellence. Intrapartum Care. NICE Clinical Guideline 55. 2007.