Perineal tears: types and why they occur 2026

It is estimated that more than half of pregnant women will suffer some type of tear at the time of delivery. Not in vain, it is known that the probabilities increase considerably when it comes to a first pregnancy, because the different tissues are not as flexible, so it is usually more difficult for them to stretch to the point of allowing the baby to come out without the risk of excessive stretching, and with it, a laceration or tear.

In this way, in the second, third and subsequent pregnancies the risk of a new tear forming usually decreases greatly, to the point that it is certainly strange or rare for them to occur.

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And, although it may seem obvious, it is evident that a vaginal birth requires the vagina to stretch, and also to do so as much as it can in order to allow the baby's head and body to come out without problems.

Due to the pressure exerted by the baby's head when pushed, it is absolutely normal to experience lacerations or tears in the perineum, which is the area located between the vagina and the anus. What's more, they can also occur in the cervix, although it is not usually so common.

First degree perineal tears

It is mainly considered one of the less serious types of perineal tears, since the lacerations that occur tend to be rather superficial. The tear only occurs in the lining of the vagina. Although this does not prevent it, although it is true that it does not involve the muscles, sometimes it may require a little suturing.

Fortunately, in most cases stitches are not needed, and recovery is generally much simpler. It is normal to feel mild pain at different times, such as when coughing, sneezing, or defecating, but this discomfort disappears within a week.

Second degree perineal tears

This is possibly the most common tear. They involve both the lining of the vagina and the submucosal (deeper) tissues of the vagina. They usually require a greater number of stitches, and the recovery period is a little longer, especially when compared to a first-degree perineal tear.

Likewise, it is common to feel discomfort and pain in certain situations and activities. In short, anything that causes an increase in pressure in the area, such as defecating, sneezing or coughing.

Third degree perineal tears

They are usually lacerations or tears that penetrate the deepest layers of the vagina and also the different muscles that are part of the anal sphincter.

In these cases, the specialist must sew each layer separately, paying special attention to closing the layer of muscle that contains the sphincter, to avoid unnecessary problems in the not too distant future.

Recovery takes much longer, and anesthesia may be needed to perform the suturing. The pain usually lasts between two to three weeks, and it is common for the discomfort to continue for several months, mainly when defecating or having sexual relations.

Fourth degree perineal tears

This is a much deeper tear, which encompasses all of the above and also extends to the lining of the rectum. On this occasion, the doctor must carry out a much more delicate and complete repair, since it involves closing several layers.

However, it is usually one of the least common perineal tears in childbirth, and when it occurs it is most often due to the baby's shoulder getting stuck, or when forceps are used.

It is a tear that is not without risks, since the most serious ones can cause prolapse and dysfunction of the pelvic floor, as well as problems when defecating and urinating.

What are the causes of perineal tear during childbirth?

It is estimated that tearing during vaginal delivery can occur in up to 90 percent of cases. And, as we mentioned at the beginning, first-time mothers are more likely to experience it, mainly due to the lack of flexibility of the vaginal tissue.

In addition to this directly related factor, there are also other reasons that can increase the risk, such as: a larger size of the baby, the pregnant woman is overweight, she is of Asian ethnicity or the baby is in a posterior position during birth.