Perineal Tear, Scar, and Birth Trauma
Reviewed by Cheryl Long, AHPC-registered physiotherapist, Goji Physio
Perineal tears and episiotomies are common outcomes of vaginal birth. Around 9 in 10 first-time mothers experience some degree of perineal trauma. Most tears are minor and heal well without intervention. But when healing is incomplete, scar tissue becomes restrictive or sensitive, or a more significant tear has occurred, physiotherapy plays an important role in recovery — both physically and in processing a difficult birth experience.
What are the different degrees of perineal tear?
Perineal tears are classified by the structures involved:
First-degree: affects only the skin. Usually heals without suturing.
Second-degree: extends into the perineal muscles. Most common type; usually sutured.
Third-degree: extends into the anal sphincter complex. Requires surgical repair and specialist follow-up.
Fourth-degree: extends through the anal sphincter to the rectal mucosa. Requires surgical repair; higher risk of long-term bowel dysfunction.
An episiotomy is a controlled surgical cut made by the obstetrician during delivery — typically mediolateral in Singapore practice. It heals like a second-degree tear and responds similarly to physiotherapy.
What are the signs that a perineal scar needs attention?
Some degree of perineal discomfort in the weeks after birth is expected. Signs that physiotherapy would be helpful include:
Pain at the scar site that persists beyond 6–8 weeks postpartum
Pain or discomfort with sitting or walking
Sensitivity, numbness, or tightness at or around the scar
Pain with sexual intercourse (dyspareunia) that has not resolved
Bowel or bladder symptoms that began after birth
What does perineal scar management involve?
Once the scar is healed (typically 6–8 weeks postpartum), physiotherapy can begin to address scar mobility and sensitivity:
Scar desensitisation: graded tactile exposure to normalise sensation in areas that are hypersensitive or numb
Scar mobilisation: gentle techniques to improve the mobility of the healed scar relative to the underlying tissue
Patient-led perineal massage technique: our physiotherapist will teach you how to perform the massage to continue at home, which has evidence supporting pain reduction and improved tissue quality
Pelvic floor rehabilitation: addressing any muscle guarding, weakness, or coordination problems that arose as a consequence of the birth
Birth trauma: acknowledging what happened
Birth trauma is a real experience. It can result from physical injury, a difficult or emergency labour, or simply a birth that did not go as anticipated. Many women find that their physical recovery is complicated by distress, hypervigilance, or avoidance behaviours — particularly around pelvic examination or intimacy.
Goji's approach is to follow your lead. A pelvic floor assessment is offered when it is clinically appropriate, never required, and always done with a full explanation of what is being assessed and why. If you are not ready for certain elements of assessment, that is a valid starting point. Recovery is not linear, and there is no timeline you need to meet.
If psychological distress is significant, Goji will work alongside — and can refer you to — a clinical psychologist or counsellor who specialises in perinatal mental health.
What does a session at Goji involve?
Your first session is primarily a conversation. Our physiotherapist will ask about your birth experience, your current physical symptoms, and how you are feeling about your body and recovery. There is no expectation to undergo examination at the first appointment if that is not comfortable for you. The assessment is paced to your readiness, and you have control over every step.
When you are ready for a physical assessment, it may include: external pelvic floor assessment, scar assessment, and pelvic floor muscle function. A structured plan is developed collaboratively, and our physiotherapist will explain the reasoning behind each recommendation.
Frequently asked questions
How long does perineal tear recovery take?
First- and second-degree tears typically show significant improvement within 6–12 weeks. More significant tears (third- or fourth-degree) may take 6–12 months or longer, particularly for bowel and sphincter-related symptoms. Recovery timelines vary considerably between individuals, and physiotherapy can support progress at any stage.
Is it normal to still have pain 6 months after birth?
Persistent perineal pain beyond 3 months is not something to wait out. It can indicate scar tissue adhesion, pelvic floor overactivity, or nerve-related sensitivity — all of which respond to physiotherapy. Please seek assessment rather than assuming it will resolve on its own.
Can physiotherapy help with pain during sex after birth?
Yes. Pain with intercourse (dyspareunia) is common in the postnatal period, particularly with a perineal scar. Scar mobilisation, pelvic floor rehabilitation, and education around the physiological changes after birth can all contribute to improving comfort.
I had a third-degree tear. Should I see a physio?
Yes. Third-degree tears are typically managed by a specialist obstetric team initially, and most hospitals will provide some physiotherapy input before discharge. However, ongoing outpatient physiotherapy for pelvic floor rehabilitation and bowel function is important. Goji is experienced in working alongside this pathway.
I feel embarrassed about what happened during my birth. Is that normal?
Very much so. Feelings of shame, grief, or failure are common after a traumatic or difficult birth, even when the outcome was healthy. These feelings are real and deserve support — not dismissal. Goji's approach is non-judgmental, and you do not need to recount your birth story in more detail than you are comfortable with.
When is it safe to have sex after a perineal tear?
This is a question best answered by your obstetrician in the context of your specific tear and healing. A physiotherapist can support your readiness — both physically and in terms of pelvic floor function — but the green light for resuming intercourse comes from your medical team.
Tell us about your birth and what is affecting you now — we'll take it from there at a pace that works for you.
Reviewed by Cheryl Long, BSc (Hons) Physiotherapy, AHPC-registered
Clinical Director, Goji Physio — Women's and Family Physiotherapy, Lentor, Singapore
Related conditions:
Pelvic Pain & Dyspareunia | Urinary Incontinence | Bowel Dysfunction & Constipation
