Perineorrhaphy

Body: 

I have looked up and read previous posts regarding this on the forum. 5 months postpartum and had a "2nd degree tear" that opened and again was restitched at 1 week out and yet was not completely stitched up (1 cm left open -not sure why -and healed apart), also the restitched part is kind of webbed. I went to an OB to discuss having this repaired as it annoys me as I can feel the skin opening all the time, and it also makes me feel bad emotionally. The OB GYN knows my backstory and I explained most of my issues, I asked if they could do a repair superficially -like just the skin and that I am not looking for restoration of function as I dont believe that is possible - the MD agreed and actually said the surgery often makes things worse, but said that if I am looking for correction of anatomy and just that it could be done.

I know from reading on here that Christine said it can never be repaired and also that the back wall of the vagina can become adhered the the rectal wall and "have to function as one" What does this mean or what would be the consequence of this happening?

The MD said could do just repair of the skin basically and barely into the deeper layer - would not be trying to put muscle back together, etc, but would have to go a tiny bit up the back wall cut. This scared me, but I really do not want to feel open and ripped down there anymore. However I do not want to make my issues WORSE. I feel sometimes like I am barely making it through as it is. I specifically also asked if this had any chance of pulling on the front wall in effect because of stitching the back part, and was told no it would not. I don't want it to pull any other organs down or try to stitch muscle back, I just want the perineum to be closed as it was before and the opening to not stretch back in a weird way that can continually close and reopen. Essentially like an epis repair
Can anyone explain more detail about the adherence between walls issues I have seen mentioned and the changing of dynamics to pull other tissues?

Also, I did not have an epidural or episiotomy but tore because of position and probably the force which I pushed, midwife did not do anything to perineum - what does Christine advise to do when women tear naturally during childbirth? Not have it repaired at all? (If its more than skin and wont repair on its own) If a man had a penis tear, there would be no way that they would just go on with it because "its still functional" I feel so lied to as in prenatal classes they always said its not a big deal to tear and if I had known how big of a deal and how many issues its caused I would have hopefully prepared myself better, educated myself to be in a slower pushing position or demanded a c section (which I DID NOT WANT AT ALL) but at least I wouldn't have a broken vagina :(

Hi Kate,

I know it doesn’t help much to hear, but we are an entire generation of women before you who received unwanted and un-consented episiotomies. It is true that the opening is never the same, but when we have our reproductive hormones it hardly seems to matter because vulva skin is elastic and the real tightening and gripping during sex is coming from the pelvic wall muscles. I think most women my age would agree that at least our generation didn’t have to deal with the extreme self-consciousness of the appearance of the vulva that is so prevalent today. I never thought or cared about what my vaginal opening looked like.

I can’t tell you whether a very careful, superficial repair would improve your condition or not. As you must know, they can’t simply bring the two edges together and stitch them closed, but must make a cut, or colporrhaphy, so that the raw edges can knit together. This means making the opening smaller, which sounds like what you are looking for.

The danger with a deeper posterior colporrhaphy is that the fascia layers between vagina and rectum become fused together. When you bend over to touch your toes, your vagina and rectum move independently due to sliding motion of the inner fascia layers. Same is true when you have a bowel movement or sexual intercourse. If the back vaginal wall is permanently fused to the front rectal wall, these organs must move as one unit. The result is a surprising loss of flexibility. Pulling of the bladder toward the back is a common result, which has been widely published in the gynecologic literature over decades. Here are the words of one of our members, Blissedout:

“I had fascial plication/vagina trimmed and posterior wall sewn back with the result that fexibility, as Christine said is gone and a bladder prolapse is now unmasked and descending with a bulge on the outside front wall which feels awful!”

Perhaps you found this lovely post by Granolamom:

“I dont even remember all the ins and outs of my own history anymore but in a nutshell, my perineum is a mess. I never tore through my sphincter though, so that's a good thing. I've had more babies anyway and it hasnt gotten worse. I dont know if the unrepaired tears are 'why' I developed a prolapse, but that doesnt even matter anymore because my prolapse is well controlled. if you dont have a prolapse now, dont go borrowing trouble, but do read all you can here and adopt the posture, which will be your best bet in attempting to prevent POP.
as christine said, I did toy with the idea of having my tears repaired, but felt that the risk of surgery did not outweigh the benefits.
I will be very honest with you, the worst part of this messed up perineum is the psychological stuff. there is a real loss here, a loss of body integrity, possibly a loss of what you feel is your femininity, or beauty or female strength. it is so many different things to different women, but I do think the commonality is that something feels taken. and that loss, even if you cant pinpoint what it is exactly or why its so important, is real and deserves to be mourned. the grief process has been well studied and defined, and I can tell you that I spent YEARS mourning the loss of my perineum and I did come out the other side with full acceptance. I am healthy and strong. I have birthed more babies with this less than perfect perineum of mine, I've carried them on my back and danced with them in the rain. I'm ok, and so will you be. not the same, but ok. and that is life, none of us get through it unscathed. you will find your new normal, and you can still live a full and happy life. for now its scary, I know that, but maybe you can trust me just a tiny bit..maybe enough to take the edge off the fear..that you will be ok.”

I think this is one of those journeys you are going to have to take on your own, Kate. Perhaps the psychological aspect of a careful repair will help you feel healed. What must be avoided however is a too-tight, inelastic vagina.

How are you coming along with the WW work? You’ve probably heard us say that the vagina closes in two ways. The round, drawstring closure (kegel) is one, which just like a drawstring purse, never fully closes. The other closure follows the movement of the bony pelvis. When we’re in WW posture the back vaginal wall clamps down against the front vaginal wall creating a closed, airless space. This is the real, tight closure that protects against prolapse and incontinence. The “gaping” vagina that gynecology has terrified many a woman with can only happen when the pelvic wall is slack. Lift your tailbone and the entire area tightens up.

Please keep us posted on your progress!

Wishing you well,

Christine

Thank you so much for your kind words and information. That quote from granolamom is so touching and makes me cry. I don't really know what I would have done without your site, wisdom, and info I have gained. Thank you.
I guess I do have to really think about it, I appreciate your opinion. As far as the whole woman work, its a work in progress. I try my best to do posture, even while constantly carrying a baby who now weighs over 20 pounds :) I often feel what is like a bulge in the front (not coming out but if I feel up, if that makes sense, unfortunately I was never one to explore my anatomy before having a baby) and I have read on here about the need to get the "organs over the pubic bone" but I haven't been successful at getting the bulge above the pubic bone. I try to pull myself into posture as often as I can and have also bought the 2nd wheel yoga (haven't had a chance to do yet) I lost a lot of muscle in pregnancy and especially for the months after when I was afraid to move, after all this happened. Its a slow process. I just want to once again not constantly "be aware of" or bothered by the feeling down there. I definitely don't want to make it feel worse, inelastic, or have back wall and rectal wall fused together.
I also took your suggestions of honey and fermented foods and still could improve my diet, I believe I damaged my digestive system and organs over many years. I am trying to spread the word about this work and these concepts. Thank you again so much.