Postpartum perineal scarring: Can surgery help? What research shows about hope and limitations

Surgery to remove postpartum perineal scarring or excess skin has not yet been studied specifically for its effect on painful scars[1]Nevertheless, clinical guidelines suggest considering surgery when pain does not improve with medications and other treatments[1]Whether surgery is appropriate depends on whether the main concern is appearance, or pain and pain during intercourse.

Is postpartum perineal discomfort uncommon?

Pain or pain during intercourse after childbirth is not uncommon. Some reports indicate that about one in five women experience pain during intercourse within three months after delivery[2].

In 14 out of 17 studies examining perineal scarring, adverse effects on recovery were reported, such as incontinence and perineal pain[3]Perineal pain that persists even after the scar heals well is the most common long-term complication following childbirth.[1].

Can surgery ease pain and pain during intercourse?

The effectiveness of surgery for painful perineal scars after childbirth has not yet been confirmed in dedicated research.[1]Although surgery has been shown to be effective for scars in other body areas, the same cannot necessarily be applied to postpartum perineal scars.[1].

On the other hand, guidelines from the American College of Obstetricians and Gynecologists suggest considering perineal scar surgery when pain does not improve with medications and other treatments.[1]Obstetric textbooks also note that perineal reconstruction can be chosen when perineal scarring is the cause of pain during intercourse[4].

In a 26-year-old woman who had a membrane-like skin and scar at the vaginal entrance and could not have intercourse, the entrance widened after skin-stretching surgery and the scar healed, according to reports[5]However, this is a report of a single case, and the cause was congenital skin abnormality.[5]The same outcome cannot be guaranteed for postpartum scars.

Removing skin only? Or also repairing muscle?

How much surgery is needed depends on the underlying cause of the problem. Perineal reconstruction removes thinned skin and reconnects muscles that tore during delivery to restore the area closer to its pre-delivery shape[6].

The surgical area in perineal reconstruction typically extends from below the urethra to the center of the perineum, stopping slightly above the anus.[4]Whether only the skin or both skin and muscle need to be addressed depends on whether only excess skin is a concern or if there is also laxity or pain.

What are the complications after surgery?

Reports indicate that adding perineal reconstruction increases the rate of difficulty urinating after surgery. In a retrospective study of 715 people who underwent pelvic organ prolapse surgery, 281 of them also had perineal reconstruction[7].

This result is from cases where reconstruction was performed at the same time as prolapse surgery, which differs from surgery involving skin removal alone.[7]Outcomes of perineal surgery are influenced by nutritional status, blood sugar control, smoking, prior surgery, and pressure on the scar[8]If you have diabetes or smoke, inform your surgeon before the procedure.

What else can be tried before surgery?

Trying other treatments before surgery is also an option. These include pelvic floor muscle training, physical therapy to loosen scars, and steroid or PRP injections, though none has sufficient evidence of effectiveness.[1].

An examination around 6 weeks postpartum is recommended to assess scar healing, pain during intercourse, incontinence, and other concerns.[1]If you have any problems, bringing them up at this time will make it easier to plan next steps.

What should you confirm before proceeding?

During counseling, try to organize and communicate the following points:

Concern: Is the main issue appearance, discomfort, pain, or pain during intercourse?[1]

Cause: Is it excess skin, scarring, or muscle laxity?[4][6]

Other treatments: Are there methods to try before surgery?[1]

Health status: Factors affecting scar healing, such as diabetes or smoking[8]

How much surgery will ease your concern cannot be determined by an article alone. During examination, share what troubles you and the details of your delivery, and confirm whether skin removal alone will suffice or whether muscle repair is also needed.