I wrote NO EPISIOTOMY in bold font on my birth plan. "What's an episiotomy?" My partner asked loudly, in a waiting room full of pregnant women. (I told him it was a very painful, high-scoring Scrabble word.) My doctor wanted to respect my wishes, but warned that sometimes, the procedure is unavoidable. I wondered what a possible episiotomy could mean for my recovery. Would it take me longer to heal? And what about sex? Will an episiotomy make sex hurt later?
According to the National Health Service, only about one percent of women report severe, debilitating pain after an episiotomy — a procedure in which a doctor makes a small incision in the perineum to widen the vaginal opening. But the severity of your pain, and the time it takes to heal, depends on the degree of the incision, explains Josie Bouchier of Holistic Health for Women, and an expert at The Tot.
"Routine episiotomies in the U.S. are no longer recommended unless in the case of an emergency, so I don't see it too often in my clinic," writes Bouchier in an email interview with Romper. "But, yes, women can definitely experience pain during sex even after waiting the full six weeks to recover." Luckily, the amount of pain is normally no more than you'd experience after a natural tear, according to Bouchier.
Episiotomy or no, you shouldn't be getting busy with your partner for six weeks postpartum. Why? Because it takes that long for your cervix to close, and for the lochia — vaginal discharge composed of blood, mucous, and uterine tissue — to clear. Because you're basically an open wound after you give birth, Bouchier explains that having sex too soon can put you at risk of infection.
Additionally, "Early intercouse can disrupt the suture that repaired the skin and underlying tissue," writes Kameelah Phillips, MD, of OBabymaternity.com, in an email interview with Romper. And that could mean an extended recovery time for you. Besides sex, Phillips warns against early exercise and aggressive cleaning.
It's important to show yourself a little extra TLC after an episiotomy. Bouchier wants women to know that it may be painful to walk or use the bathroom, and that you should avoid lifting anything heavier than your baby while you heal. Using a stool softener can prevent painful constipation, and binge-watching This Is Us will keep you off your feet.
Even if your episiotomy heals beautifully, your first time might still be painful. But that can happen after any birth.
"Sex can certainly be uncomfortable after an episiotomy," writes Phillips. "It can also be uncomfortable after any delivery with vaginal lacerations or breastfeeding, which can lower estrogen and cause the vaginal walls to feel dry."
In fact, more than 90 percent of women suffer vaginal or perineal lacerations during birth, explains Sara Twogood, MD, OB/GYN and Contributor to The Bump. "I usually tell patients to go slow, use lubrication, and don't expect intercourse to feel the same as before pregnancy. If the pain with sex continues more than a couple times I usually refer them to a pelvic floor physical therapist." Twogood notes that very rarely, pelvic health is permanently impacted by a vaginal birth. So if you receive a referral to a pelvic health therapist — an underutilized resource, according to Twogood —take advantage of the help available.
Postpartum life isn't easy, and aches and pains abound. While no one's standing in line to get that episiotomy, it might be necessary in an emergency. If you receive one, hold off on sex until you heal completely, and contact your doctor immediately should you notice any signs of infection, such as redness, tenderness, or heat.