From the Guidelines
A first-degree vaginal tear can typically be allowed to heal by secondary intent without suturing, as it is a superficial injury that involves only the vaginal mucosa or perineal skin without affecting the underlying muscle tissue. This approach is supported by the fact that the severity and morbidity experienced after perineal injury is dependent on the extent of perineal damage, and first-degree tears are generally less severe 1. Allowing a first-degree vaginal tear to heal by secondary intent can help minimize the risk of wound complications, such as infection and dehiscence, which can occur with suturing, especially if the primary surgeon is inexperienced or unfamiliar with repair techniques 1.
Some key considerations for allowing a first-degree vaginal tear to heal by secondary intent include:
- Keeping the area clean by rinsing with warm water after urination or bowel movements, patting dry gently, and changing perineal pads frequently
- Using sitz baths for 10-15 minutes 2-3 times daily to promote healing and provide comfort
- Managing discomfort with over-the-counter pain relievers like acetaminophen or ibuprofen
- Monitoring for signs of infection, such as increased redness, swelling, or purulent discharge, and seeking medical evaluation if symptoms worsen or persist.
It is essential to note that if the tear is bleeding significantly, appears deep, or is causing severe pain, medical evaluation is necessary as it may actually be a higher-degree tear requiring repair 1. Additionally, if there is uncertainty about the extent of the tear or the best course of treatment, it is best practice for another trained provider to reexamine the tear and provide guidance on management 1.
From the Research
Healing of First-Degree Vaginal Tears
- First-degree vaginal tears can be allowed to heal by secondary intent, as conservative care of minor hemostatic first- and second-degree lacerations without anatomic distortion reduces pain, analgesia use, and dyspareunia 2.
- A study comparing the effects of first-degree perineal tear repair using adhesive glue versus conventional suturing found that tissue adhesive is better than subcuticular suture for repairing first-degree perineal tear as it causes less pain and has shorter recovery time 3.
- Another study recommends that for women with first-degree or second-degree perineal tears, no suturing or glue compared with suturing is recommended for the outcome of pain 4.
Management of Perineal Tears
- The management of perineal tears should include careful inspection and/or palpation by the obstetrician and/or the midwife to exclude a 3rd or 4th degree perineal tear 5.
- Daily cleaning of the area under running water is recommended, particularly after bowel movements, and therapy should also include the postoperative use of laxatives over a period of at least 2 weeks 5.
- Early secondary repair of labial tears, 1st and 2nd degree perineal lacerations and episiotomies can provide an anatomically acceptable result in the majority of cases without risk of serious complications 6.
Pain Management
- Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment for pain management after a vaginal delivery with perineal trauma 4.
- Epidural morphine (≤2 mg) is recommended among women with labor epidural analgesia and severe perineal tears, with adequate respiratory monitoring 4.
- Ice or chemical cold packs are recommended for postpartum pain first-line treatment due to their simplicity of use 4.