Perineal refashioning problems

[EL228]

I'm hoping someone can give me some reassurance or guidance as I am having a bit of a rough time at the moment.

I had my DD 15 months ago and ended up needing an episiotomy. I have no idea which type as I was so out of it afterwards (mainly with delight at meeting DD but also exhaustion) that I don't remember being told. I was stitched up by a midwife who seemed to do it very quickly. Anyway it didn't heal properly. Some of the stitches split after a few days and more after about a week. I went back to hospital (fun with a week old baby) and was seen by a doctor there who said that they wouldn't re-stitch until I had healed.

Fast forward a few months and things healed up however I was left with a sort of weird flap of skin covering about half of the entrance to my vagina (imagine a sort of skin door that remained permanently closed!!- sorry TMI!!) It wasn't painful at all except during sex which was unsurprisingly excruciating and would split and sometimes bleed. (sorry gross I know!)

I finally went to see my GP and was referred for perineal refashioning which I had done last week under general anaesthetic. I got my period the day before the surgery and so I phoned the hospital to see if I should still have the op and I was told that it would be fine. Afterwards the surgeon told me that the surgery went well however within a few days I was feeling really unwell and the pain was horrendous. Turns out I have contracted an infection and so I'm now on two types of antibiotics to try to get rid of it.

I went to see the surgeon this week and he told me that during the operation they saw that my muscles hadn't been stitched together at all in the original episiotomy (they had just reattached the skin which is why I had that weird flap) and so that had been done. He thought that the stitches holding the muscles together had survived the infection but the ones in the skin hadn't. I now have a gaping wound with raggedy bits of stitches hanging out (which the junior doctor I saw first thought it would be a good idea to pull on- I screamed and burst into tears- I don't think she'll be doing that again to anyone in a hurry!!!). I've been told that it can't be re-stitched now as the area is still infected and the tissues are fragile. I will have to wait (again) to see how it heals and may need to have the whole thing done again!

I'm feeling really quite down about it. We were hoping to start trying for baby no.2 but I have no idea if or when I will be able to even start thinking about having sex again. It took us 3 years to conceive DD and we were on the verge of starting IVF when I got pregnant. I am late 30s and I'm so worried that all this will mean that we won't end up having any more children. I am also terrified of having surgery upon surgery and making the problem worse each time. I am so upset and cross that the mistake was seemingly made by the midwife in not stitching me correctly in the first place and leaving me in such a mess.

Has anyone been through anything similar? I could really do with some reassurance that this isn't as bad as it seems at the moment!

Thanks.

Anyone??

Hi OP,
I didn't suffer the exact same problems so didn't want to mislead you but since no has posted.

What is similar is that I too was bleeding after sex and had to have surgery to correct it. I had a multiple instrument (ventouse x2 forceps x1) with episiotomy which left me with a number of issues. One was that after healing the entrance to my vagina was too small (GP couldn't use a regular size speculum to examine me). I had lots of physio but after massaging and using dilators failed, I had a Fenton procedure 18 months after birth. Fortunately I did not catch an infection and everything is as good as can be now.

I did declare endometritis a month postpartum. It took a few weeks for things to settle down and feel normal again down there.

With each problem it felt like it took forever to heal/get better (particularly the too tight vagina) and it did get me down. The idea that childbirth had done this to me horrified me. I declared severe depression and was followed by a psychiatrist. I felt I had been brutalised and remember asking her if this feeling would go away. In short she said it should, with time. She was right. With time, support from her and the surgery I feel better now.

I'm sorry you're going through this. I hope time will help you too.

Thank you Positivevibe. I know exactly what you mean about being horrified by the idea that childbirth has done this. I think I was so unprepared by the possibility of something like this. NCT glossed over episiotomies (and other interventions) and certainly no mention was made of the long term problems that might be suffered. I appreciate that they probably did this so as not to scare us but it meant that it all came as a massive shock which I think has made things so much harder to deal with. It might just be me but I would prefer to have all of the information rather than someone else deciding how much I can cope with.

It's not just you who would like to be told of possible complications but from what I can see the let's-not-scare-women/hypnobirthing/refuse-medical-interventions/carry-on-treating-women-as-children/your-baby-is-healthy-isn't-that-enough/pro-natural-childbirth lobby is too strong.
The Birth Trauma association seems to want more transparency about risks. They are running a project called MOM which you may be interested in.
I hope you get better soon.

Thanks Positivevibe. I've had a look at their website and it looks like a useful resourve. The MOM project is yet to launch it seems but there is an email address to contact to register interest which I think I will do. Thanks again.

Urgh typo. I meant resource!

Hi EL228,

I would be optimistic about how your perineum is going to heal. This is all given the limited info you've given, but here's why:

You've done exactly right in noting the difference between perineal muscle and skin...

Your episiotomy (which was almost certainly a right medio-lateral episiotomy) will have cut through certain perineal muscles as well as skin, and you may also have torn the area called the perineal body, between your vagina and anus. This is quite a common birth injury.

It sounds like due to the stitches coming apart (often due to some infection) the skin had to heal by secondary intention (heal over slowly like a graze, rather than quickly like a cut stitched together). Also, the muscles underneath didn't knit together (muscle takes longer to heal than skin) leaving you with a deficiency of muscle directly under the vagina. But you also had a skin bridge where the skin has healed too tightly. This was probably a result of how you were stitched rather than the infection.

Your recent operation was primarily to divide the skin bridge and stop sex being painful (probably something called a "Fenton's procedure"), but they've also "built up" your perineal muscle so that the muscular entrance to the vagina is a little narrower. Sounds confusing but it's possible to have too tight skin but too loose muscle, because if the skin is kind of "empty" and not supported underneath by muscle, it will get overstretched during intercourse and give you pain or tear, which sounds like it was happening.

Your skin has unfortunately opened again, but it's extremely unlikely to to heal back into the skin bridge that you had before. It sounds like the muscle that has been repaired underneath is still intact.

So, your skin needs to heal like a graze (again!) but the muscles should be OK this time. And as that skin bridge was cut, it's unlikely to reform, even if it doesn't heal exactly in the position the surgeon hoped it would when they repaired it.

I hope that all makes sense!

When your skin has healed over, use a very gentle, non-scented lubrication gel or moisturiser like diprobase to massage where the scar is, and gentle stretch it as you can tolerate. Skin heals over quickly but will start off quite stiff and inelastic - the process of becoming softer and stretchier takes longer and some regular massage of that area will help.

That's way too long but I hope it helps!

Had a Fenton’s a year after. A year of hell. No one wanted to acknowledge there was a problem. Even wiping after the loo hurt me.
Birth Trauma Association is a great resource.
Really glad you are getting help soon. Stick at it .

Thank you so much DoctorMonty! That's a really helpful explanation that joins up the few bits I have been able to glean from looking online and what I was told by the surgeon. I had another appointment with the GP yesterday and he says that the area is no longer infected so hopefully it should start to heal now. It's been a pretty miserable few weeks but I'm hoping I'm on the mend now fingers crossed. Thank you too shhhfastasleep I'm sorry you had such a horrible experience too and I'm glad it worked out for you in the end.

I too had an episiotomy that didn't heal correctly. After 18 months of general daily discomfort and pain during intercourse I finally went to the GP who thankfully referred me to an excellent gynae who did a Z plasty procedure. After that healed it was genuinely life changing! In my head I think I had just accepted that following childbirth I should just put up with the pain - I'm so so pleased I got help. Am pregnant now with dc2 and will be having a elcs in Jan.

Op have you complained about this mw, after all you have been through I hope she realises she has stitched you wrong and isn't doing it to another poor woman now.

Hello
I’m to hear all you’ve been through. I have been through very similar it’s been traumatic. Have you healed? I hope you don’t mind asking but were you able to have more children?

i never knew an episiotomy could be so detrimental 🥲