Episiotomy (Birth Incision Scar) Repair

What is Episiotomy?

Episiotomy is an incision made during vaginal childbirth to facilitate the passage of the baby, involving the surrounding tissue, including ligaments and muscles, typically made in the lateral or midline area of the vulva and vagina.

Usually, episiotomy is required during the first childbirth, while subsequent births often do not require it due to the increased elasticity of the vaginal structure. The episiotomy incision may involve the vulva (small and large labia),vaginal internal region, and muscles, depending on the individual's anatomical structure.

In cases of large fetuses or vaginal delivery, if an episiotomy is not performed in a controlled manner, deep vaginal tears, as well as urethral and anal tears, may occur. Additionally, irregular and uncontrolled vaginal tears may lead to scarring, causing functional and visual problems. Tears in the bladder and anal regions should be properly repaired.

Uncontrolled tears during normal vaginal childbirth can lead to conditions such as fistulas (involuntary leakage of feces or urine),severe infections, chronic vaginal discharge, inability to engage in sexual intercourse, pain during intercourse, and loss of sexual pleasure.

How Does Episiotomy Heal?

After a normal vaginal delivery, if an episiotomy is performed, tissue healing is typically completed within 3-4 weeks. The three layers of vaginal tissue cut during the episiotomy should be stitched properly in a way that aligns them correctly.

If the episiotomy is deep or there is a risk of infection, sitz baths with solutions such as Betadine are recommended. During the first-week check-up after delivery, your doctor should examine the episiotomy site.

Why Does Episiotomy Scar Occur?

Episiotomy is a common procedure during childbirth, but not every patient requires episiotomy scar revision. The reasons for scar formation vary from patient to patient and can include:

• A large episiotomy
• Delivery of a large baby via vaginal birth
• Bleeding along the episiotomy line
• Inability to align the tissues properly
• Presence of infection or abscess

The most significant factor, however, is the individual's healing process. If the person tends to develop large scars from any injury, the episiotomy will likely heal with scarring as well.

Why Is Episiotomy Scar Revision Performed?

Poorly healed episiotomy scars can negatively impact quality of life and sexual life. Hard tissue in the internal and external vaginal areas can cause pain during intercourse and prevent sexual pleasure. Moreover, if the vaginal opening remains exposed, recurrent infections and foul-smelling discharge can occur.

During episiotomy scar revision, vaginal tightening and removal of scar tissue from the vaginal interior are often performed. If scar tissue in the vaginal interior is not removed, pain during intercourse may persist. Scar tissue on the external vaginal area may also cause pain during walking or from clothing pressure.

For these reasons, episiotomy scar revision or birth scar repair is performed. Episiotomy scar revision positively affects chronic discharge, sexual life quality, and functional life quality.

How Is Episiotomy Scar Revision Performed?

The method of performing episiotomy scar revision is guided by how the episiotomy was done and how it healed. If the incision and scar are small, hard tissues are removed through an incision that may also include the vaginal area, and the vulva and vagina are reconstructed using aesthetic suturing.

If the episiotomy incision is deep, large, and involves the vaginal structure, vaginal tissue adjustment is performed along with the revision. The perineal body, the area between the anus and vaginal opening, is often reconstructed during the procedure.

The procedure typically lasts about one hour. Since it involves surgical suturing, the duration is similar to other procedures.

How Does Recovery After Episiotomy Scar Revision Go?

Episiotomy scar revision is planned after childbirth and should be done at least three months after vaginal delivery, allowing sufficient time for the surgical healing and recovery of both the vaginal and vulvar tissues. Recovery after scar revision tends to be faster than after episiotomy.

Due to increased blood flow in the genital area during childbirth, there is a higher risk of infection and bleeding. However, recovery after episiotomy scar revision is generally quicker, with most women able to return to normal activities within 2 to 3 days.

One common concern for new mothers is whether breastfeeding or holding the baby will be hindered. After surgery, the first milk should be pumped and not given directly to the baby. By the following day, holding the baby should not pose any problems. Showers can be taken on the second day, and sexual intercourse can be resumed 3-4 weeks after surgery.

Does Episiotomy Scar Revision Affect Sexuality?

The episiotomy scar can be located both outside and inside the vagina. Scar tissue in the vaginal area can cause pain, visual discomfort, reduced self-esteem, and negatively affect sexual pleasure, thereby reducing sexual quality of life. These issues improve with episiotomy scar revision, leading to a positive impact on sexual life.

Who Performs the Episiotomy Repair?

Episiotomy repair is performed by an experienced obstetrician who specializes in vaginal delivery and the repair of birth-related incisions.

Can Vaginal Tightening (Vaginoplasty) Be Done Along with Episiotomy Scar Revision?

Vaginoplasty is the most common surgery performed alongside episiotomy scar revision. Vaginal tightening may be recommended during the examination if the vaginal structure has become enlarged due to a vaginal birth and is negatively affecting sexual function.

If vaginal enlargement and its negative effects are noted during the examination, vaginoplasty can be performed alongside episiotomy scar revision to improve both quality of life and sexual life.

What Other Surgeries Can Be Performed Along with Episiotomy Scar Revision?

• Vaginoplasty (Vaginal Tightening): Tightening of the vaginal structure that has been enlarged due to normal childbirth, which negatively impacts sexual function.
• Perineoplasty: The perineal body, located between the anus and vaginal opening, may collapse with vaginal enlargement. This can be repaired during episiotomy scar revision to restore the outer vaginal area to its pre-birth state.
• Cystocele: Traumatic vaginal delivery can lead to bladder prolapse. If this is detected during pre-surgery evaluation, a cystocele repair (bladder suspension surgery) can be performed alongside episiotomy scar revision.
• Rectocele: Prolapse of the rectum into the vagina is known as rectocele. During episiotomy scar revision, the rectocele area can also be corrected.
• Urethral Tears: During traumatic childbirth, especially when an episiotomy is not performed, pressure from the baby's head can tear the urethral opening. If necessary, urethral tissue repair can be performed through techniques like Teflon injection or urethral muscle repair.
• Anal Fissure or Tear Repair: Among the most complex and infection-prone surgeries, anal fissures or tears that lead to unintended fecal leakage can severely impact life and sexual function. These are repaired carefully, with attention to the rectal tissue, using methods like flap techniques to prevent the recurrence of rectovaginal fistulas.
• Labiaplasty: Some women may have asymmetric or enlarged labia due to episiotomy or childbirth. Labiaplasty can be performed to address this, especially when a woman is already seeking correction of asymmetry or size of the inner labia before childbirth.