any hope for an intact perineum?

Submitted by chickaboom on November 18, 2011 - 8:42am
Body: 

I just went in for my long overdue 6 week pp check up. I was experiencing pain during sex and I thought that 7 mos after birth was a bit too long to still be feeling this stuff. Aparently my episiotomy was over-stitched and my poor perineum, having borne the assaults of three episiotomies has lost its elasticity to fibrosis. Dr did not really have any remedies other than a vitamin b5 based cream and anesthesia if things get really bad. I thought to myself that I can put up with the stinging and pinching if I know that, were I to be blessed with another baby, I could birth naturally and my perineum would stretch but not tear. Is that wishful thinking? I now know that the perineum has an enormous ability to stretch naturally during childbirth, but what of a scarred unstretchy perineum? Is it doomed to tear one way or another? Dr's answer was that I would tear along old scar lines, at best. What do you ladies think?

I am not, God willing, planning on birthing a baby any time soon, just kind of trying to gather women's wisdom from now.

alemama

November 18, 2011 - 8:59pm

ah well. To say I was obsessed with tearing my perineum this last pregnancy would be an understatement. I did extensive research. Fibrosis. That's a diagnosis that I'd like more information from the doc about. You don't just throw out the word and move on. It's a pretty serious dx not to be given lightly. Did he see the fibers under a microscope? Why is it not just considered scar tissue?
Chickaboom, no one can tell you what your perineum will do. No one can predict what will happen during a birth to your perineum. It's one of those things you will have to experience to *know* the outcome of-
Here's the deal though, you have birthed naturally just fine 3 times- there is nothing that would say you could not do it for the 4th time. To do so without a tear- well, I have read encouraging things from women who have had previous episiotomies or previous tears not having a subsequent tears or cutting so it can be done. I read of one woman who was cut 5 births in a row and during the 6th birth had no cutting or tears.
Here's what I would do if I were you- I'd work that tissue. I'd grab some vitamin E oil and massage it and try to break it up. I'd work it to 'almost' painful stretching and then rest it.
7 months pp seems like too long to be feeling pain with sex- but I promise you it actually is not. The healing process- the formation and breakdown of scar tissue- these things take time. Not 6 weeks time- real time- months and months even.
Listen, you don't have to get cut again. Your tissue may sheer along old scar lines- it may not. If it does, it can heal well on it's own given the right set of healing circumstances (as long as it's not really extensive).
I had baby 5 with no actual tears- this was a posterior baby- born after about 3 hours of labor- with not much time to gently stretch the perineum. All previous births had extensive tearing (except birth 2- which had only a second degree tear).
I'm 7 months out and my perineum is still tender and I didn't even tear!
But I know how strong the desire to avoid tearing can be. Her head was crowning and I was saying 'I don't want to tear' and actually supporting the tissues with my own hands. I read about the tissue and how it 'whites out' right before it tears- So I had my dh watch it and when it started to lose color I sort of held it together with my hand as our baby was coming out. I did have one worry that if I did this, it might cause an anterior tear- but that didn't happen.
It's one of those things to file away and worry about later if it's not a deal breaker for you. If tearing or cutting is a deal breaker- you might want to consider being done all together :)

louiseds

November 18, 2011 - 9:16pm

Hi Chickaboom

An episiotomy or tear repair is surgery. Full stop. I have read that after any surgery the person can expect post-surgical pain for about 12 months afterwards. That means that you need to wait until 12 months pp before assessing whether or not the pain level will decrease in the longer term. It is a big ask, but what alternative do you have?

Louise

chickaboom

November 19, 2011 - 2:45am

Alemama, when I asked her what fibrosis was, she described it as scar tissue. Maybe she's using the words interchangeably when they mean different things - off to google in a bit. But I'm going to try the breaking it up suggestion. My aunt was suggesting lukewarm sitz baths to get the blood flowing in that area. I figured seven months was seven months too late to do anything at all but who knew.

Alternatives- none.

aza

November 19, 2011 - 2:03pm

never too late, chickaboom! Alemama et al have covered so much already, but I would just add that it would be hugely beneficial - whether or not you have any more kids - to really get a feel (literally) for your tissues. And not just your perineum, because though obviously this is a very important part, it is only the doorway leading to so much more. We often think of the vagina as a tube like structure but there is so much more in there. You can feel deeply back to your sacrum and in the back pockets on either side of your sacrum. Most women can (eventually) feel their tailbone, and all the tissues that cover these areas. My advice would be to take your time, go slow, tissues in the vagina respond differently than those of the rest of the body. You will probably feel areas of scar tissue and areas of softness. Try not to judge them - that's what you've got, these are your goods...now what can you do with what you have? It is all very interesting stuff...hope you get a chance to try....best of luck to you!

louiseds

November 19, 2011 - 9:39pm

Aza is a very experienced midwife, a proper midwife. She knows these things from her own experience and from those who have taught her.

Louise

chickaboom

November 20, 2011 - 4:08am

Awesome! Thank you aza. Hope is an amazing thing. I was actually just feeling my posterior vaginal wall yesterday seeing if I could feel my tailbone -which has been mildly achy since giving birth- from there. I don't think I found it but I did feel two ridges running up the back wall with sort of empty space between them. Kind of like a pair of elevator doors slightly open. In fact it feels similar to what a small diastasis recti feels like. what could that be? This is probably out there but could this separation (?) be causing the coccyx pain?