What is the management of a first-degree vaginal laceration (vaginal tear)?

From the Guidelines

First degree vaginal tears typically heal well with minimal intervention, and management involves cleaning the area with warm water or a mild antiseptic solution like chlorhexidine 0.05% to prevent infection, without the need for suturing, as they involve only the vaginal mucosa and heal spontaneously within 7-10 days 1. The primary goal in managing first degree vaginal tears is to promote healing, prevent infection, and minimize discomfort.

• Cleaning the area with warm water or a mild antiseptic solution is essential to prevent infection.
• Pain management includes over-the-counter analgesics such as acetaminophen 500-1000mg every 6 hours or ibuprofen 400-600mg every 6-8 hours for 2-3 days as needed.
• Sitz baths with warm water for 10-15 minutes, 2-3 times daily, can provide comfort and promote healing.
• Patients should maintain good perineal hygiene by changing perineal pads frequently, wiping front to back after urination or bowel movements, and gently patting the area dry.
• Sexual intercourse should be avoided until healing is complete, typically 1-2 weeks.
• Patients should be advised to report signs of infection such as increasing pain, redness, swelling, purulent discharge, or fever. The healing process of first degree tears is facilitated by the excellent blood supply and regenerative capacity of the vaginal mucosa, allowing for rapid epithelialization without significant scarring 1. It is crucial to note that while the provided evidence discusses various aspects of perineal trauma and repair, the management of first degree vaginal tears remains focused on supportive care and prevention of complications, rather than surgical intervention 1.

From the Research

Management of First-Degree Vaginal Tear

• The management of first-degree vaginal tears can be approached through conservative management or systematic suture, with studies indicating that conservative management shows an efficacy rate ≥90% 2.
• Conservative management involves digital compression if bleeding, followed by suture if persistent bleeding, and has been shown to result in less pain at the 1st day follow-up and lower REEDA scores at the 10th day follow-up compared to systematic suture 2.
• Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment for acute pain management after vaginal delivery with perineal tears or episiotomy 3.
• Ice or chemical cold packs are also recommended for postpartum pain first-line treatment due to their simplicity of use 3.
• For women with first-degree or second-degree perineal tears, no suturing or glue compared with suturing is recommended for the outcome of pain 3.

Pain Management

• Epidural morphine (≤2 mg) is recommended among women with labor epidural analgesia and severe perineal tears, with adequate respiratory monitoring 3.
• Transcutaneous nerve stimulation and acupuncture are recommended as adjuvants for pain management 3.
• Local anesthetic infiltration, topical local anesthetic, ointment application, and pudendal nerve block are not recommended due to insufficient or lack of evidence 3.

Suturing Techniques

• For the repair of episiotomy or second-degree perineal tears, a continuous suture compared with an interrupted suture is recommended for the outcome of pain 3.
• The choice of suturing technique for first-degree vaginal tears may not significantly impact the outcome, but conservative management is preferred 2.

Postpartum Care

• Daily cleaning of the area under running water is recommended, particularly after bowel movements, to promote healing and prevent infection 4.
• Therapy should also include the postoperative use of laxatives over a period of at least 2 weeks to prevent constipation and promote healing 4.