6 months PP episiotomy scar still very sore, GP doesn't know why

[MeadowHay]

I saw the GP today and had my first internal examination. I get mild pain/discomfort sometimes when wearing very tight jeans, when using tampons a lot on my period, and when trying/after trying to do PFEs. I mentioned this to the GP a few weeks ago amongst some other things and she is a great GP and took me seriously, she said she thought it may be overgranulation of my episiotomy scar tissue and would need an internal. I had the internal today and it turns out the external area of the scar tissue is still tender (I haven't dared to really poke around much) and the internal very much so, she put one finger in and touched it gently and I basically yelped with pain. She said it all looks fine and healed and how she would expect it to look 6 months PP, but she wouldn't expect me to be in that much pain with it still, and she doesn't know why that is. She has referred me to a gynae, I will be seen first week of Feb. This has reaffirmed my view that having sex will be impossible due to pain, and I am majorly catastrophising about a life without sex and never being able to concieve another child. I think the only options for scar-related issues are silver nitrate and surgical, both of which sound hideously painful and traumatic for me (I found my birth very traumatic, and having the internal, even with a trusted GP and DH there, and having taken anti-anxiety medication, in my familiar GP surgery, was really difficult for me). I also know some people have surgery and the same problem occurs anyway.

Has anyone had this before? I know about overgranulation of the scar tissue but the GP couldn't see anything like that, no excess lumps of skin or anything like that, although she did say the gynae would be able to do a more thorough examination. Can anyone reassure me that this isn't the end and that I won't have to suffer so much more? I had a ventouse delivery with an episiotomy and now I wished I'd refused consent for the episiotomy or even refused consent for the delivery and made them do a C-section (the ventouse almost didn't work as well so she can't have been that far down the canal). I feel angry at myself for agreeing to these procedures and I feel so low and 'ruined' .

I just wanted to send you some love

Perhaps some steroid injections to the area (but I know nothing about this I just know they helped my back)

Perhaps gas and air when you have the next internal to help with the pain although maybe you need to be able to feel the pain to explain?

Have you done all the obvious such as treat for thrush etc which can make you sensitive

I know an amazing pain specialist

Dr Singh @ London pain clinic 9 Harley St who saved my life
His colleague Dr Jenner is a pelvic pain specialist

I had the same. The GP gave me oestrogen cream which I used for about 4 months and did help. She also referred me to a gynaecologist who gave steroid injections to the site. I also had a fair bit of acupuncture - I was / still am really a sceptic about this but was desperate enough to give it a go. The three things together did work.

Hot baths seemed to help the pain on bad days, and avoiding really tight jeans.

I really feel for you. I had some very dark days imagining a life without sex and no more children as I couldn't see how I'd ever conceive let alone give birth.

DS is now 3 and I'm 6 months pregnant and happy to say my sex life got back on track!

Same. 13 years on am having surgery as it is still painful, sex would make me wince.

Also felt ruined and still do but you do get used to it. And I had another baby.
Also wish Id been given a section worse bit was they offered but i said no thinking thatd be worse.

I should find it reassuring that you had more babies but the longetivty of the treatment etc is actually making me feel even worse, although I suppose it helps a tiny bit to know I'm not alone. What is the problem though? Why does it hurt so much if there's no overgranulation of the tissue? I don't understand?

Aren't steroid injections to the site really painful in itself? Did the gynae do them? How long did you have treatment for?

For future babies, are you/did you have sections or vaginal births again? I think I'd want a section anyway due to trauma but guess it would be necessary/wise with the physical issue anyway? If I can ever get a penis in to concieve in the first place. I feel so depressed and it's so hard because I don't feel like I can talk to anyone about it. I had a slight complication with my wound around 5 weeks PP when a tiny bit tore open or something and the GP at the time checked and said to use Sudocrem as a barrier cream and it didn't need restitching as it was a tiny dot and would heal itself, which it did, but I was fine before that and I really think whatever happened then is what's ruined all my healing.

I take a low dose of diazepam for my anxiety sometimes anyway so will take that when i go to see the gynae, might take a bigger dose for it. I can't use G&A as it just makes me instantly vomit as soon as I breathe it in unfortunately.

You get knocked out for steroid injections with a sedative
They flood the area with local anaesthetic
Then dose you on pain killers
It really helps
Maybe even Botox in the area if you're over tight in the muscles from being too tightly stitched
If you can afford to go private you can have it resolved very quickly
I had to have my back sorted or I would have become suicidal..

What about anti emetics and gas and air ? Does that work?

I had a similar issue and went to the gp 6 months pp. I was referred to a gynae and they gave me stretching/massage exercises to do on the scar and referred me for pelvic floor physio. I had 6 sessions with the physio which to be honest was painful and not pleasant but it completely changed my life. It turned out that the pain in my episiotomy scar was caused by issues with my pelvic floor and the physio taught me different things I could do at home to help. I'm now 14 months post partum and I'm completely pain free in all situations including sex.

I know it seems horrendous at the moment but there is so much that can be done without having surgery. I really hope it works out for you.

Also I had a c section so I am not versed at all in this
I would always say a c section is good choice
It's so much more controlled
Wound In a cleaner place etc

I wanted a home birth but had such a bad pregnancy and I nearly died then ended up with a emc under a GA which wasn't ideal but I healed well

Future birth one section one vaginal with second degree tear in Episiotomy scar.
If you can have a section, mine was lovely.
They cut through muscle and nerves with episiotomy, it's a massive thing. Of course it hurts. You're still healing inside for months and months.
Give it time, which is all you can do. I'm sorry for how you feel, it's really awful but you've had a baby and things do change. One of the benefits of episiotomy is it keeps the vagina 'tight', so to speak, so when you do eventually have sex, it is still as before. Not so with a tear left to heal, which made a big difference to me.

No, I mean the only experience I have is in labour but I had anti-emetics prior to using the G&A, actually tried it twice during labour after two different doses of anti-emetics and both times instantly violently retching and vomiting as soon as I breathed any in so couldn't use it .

When I was pregnant, one of my biggest fears was an assisted delivery followed by long-term complications. And that's exactly what happened. I consented to the delivery in the end because I thought that the odds were that I'd have a shorter recovery and that I am young etc so the odds were in my favour and that it was statistically unlikely for me to end up with long-term complications so I took a gamble, and I gambled wrong because despite the stats I have ended up one of the unlucky ones. My only tiny light is that it doesn't look like I have a prolapse of any sort/my pelvic floor seems to have remained intact, which was my biggest fear of all (no issues with continence or anything).

Whilst doing PFEs hurts and aggravates the area, I am worried that if I don't use them I might suffer prolapse way down the line though, did it hurt you ladies when you did PFEs and if so, did you continue to do them anyway? It's not unbearable or anything, just a soreness. I forgot to ask the GP whether I should do them despite the discomfort or just leave it. The first GP I saw said not to do them but he was an idiot and completely dismissed me and wouldn't even examine me, that was about 3 months PP . This new GP did say that she didn't think there was anything I could do to worsen the situation at all, not sure whether that meant I could continue with PFEs if I want, but then I don't really want to be in discomfort do I?! Sigh.

Interesting about pelvic floor physio, I didn't think that would have helped in this instance. The idea of that makes me feel sick with anxiety - I did perineal massage regularly in the weeks leading up to my labour, can you believe it, and now look at me, what a waste of time, I found that horrendously painful, DH had to do it for me and I cried most of the first few sessions with the pain and he was so gentle as well, I suffered through all that to try and reduce tearing/the chance of an episitiomy but had one anyway. I do wonder whether the reg was a big trigger happy with the scissors but DH did watch the business end and said it did look very very tight when DD's head was essentially stuck and not coming out so whilst he isn't a doctor or midwife (different HCP) he reckons I may well have tore badly if she'd continued to pull her out with the ventouse without the cut so...who knows.

I have spoke to my GP about possibility of having an ELCS if we have another baby and she told me that she is confident my trust would grant that no bother on the basis of my birth trauma and mental health problems so it is likely I would go for the option if we concieve another child. It's sad tho cos it's not what I want either really, I want a 'normal' birth, labouring in the pool etc...sigh.

PFEs were painful for me too but after the physio basically stretched my pelvic floor out (very painful but so worth it) for me it was so much better. She said I'd perhaps been over clenching everything in that area and I was tense because I was in pain all the time. I learnt how to relax my pelvic floor properly after doing exercises and that made a huge difference. Please don't lose hope that things can get back to normal, they honestly can.

I had a ventouse delivery and a bad year that over healed. It was only when I tried to have sex around 4 months pp and it was impossible I dared to poo-i and honestly the sight shocked me. The GP referred me to a gyno and i was booked in to have a repair 8 months pp.
It was a short op and healed very quickly-much quicker than after giving birth. All went well and 2 years in sex is fine. Psychologically sex was painful afterwards as I think I was so scared after being unable to have sex before.
I found the idea of having an op finding and stressful as I didn't want to leave my baby as I was still breastfeeding. But I got to the hospital at 7am and I was home by 2.30pm.
I hope you are ok as it was a very dark time for me at a time you should be enjoying your new baby. But the op was fine and a relief to get it all sorted.

For goodness sake so many typos.dared to look not poo!

Floppy, sorry to hear you had to have surgery but glad it worked well for you. I don't think our situations are the same though - my area looks great! Nobody can see anything wrong with it! I've only looked externally and the scar is so neat and small you could actually not even notice it anymore, DH agrees and the GP said both internally and externally it looks great, in theory . She did say the gynae could do a more thorough look at it than her though (US or something maybe? I should have asked but maybe she doesn't know herself tbf, she did basically say she doesn't know what's wrong with it).

Can I just say I wasn't expecting this many candid responses so soon after posting my thread. I am at a very low place right now and crying a lot about it but it is really helping me to have a safe place to talk about it as I don't feel like I can talk to anyone else about it, other than DH but obviously as supportive as he is, he doesn't know much about it and can't really fully understand. Thanks ladies, you're all great, I'm sorry to hear about your suffering. for us all!

Don't stop PFEs. I get period type pain when I do them, but you need to keep doing them.
I've got scar tissue and the constant feeling of pressure has stopped me being able to recognise when I need to go to the toilet so I've needed a bladder scan and also a bowel regime.
I also look mangled down below. Just a mess with no clean opening, it gapes. So you sound in a better position than me.
I wonder if some of your pain is psychological in origin-this can be a part of PTSD and feels exactly the same as with physical pain, just has a different cause and therefore requires different treatment. With your anxiety and what sounds like depression I would consider being asked to be referred to the perinatal mental health team. It could be that an antidepressant steps the pain down a notch, which would make things easier, even though the episiotomy itself is the cause. You've been through an awful lot and 6 months is nothing at all. Please try not to panic, things will get better. Can you be intimate in other ways so you don't feel alone?
Also, and please don't feel you must answer, but did you have any sexual trauma before the baby? Because this would feed into what you're suffering now, and have a huge influence on what you're going through-the lack of control, pain, feeling invaded etc. Sorry if that's presumptuous of me x

Yeah, I look fine apparently. I don't ever look at myself so I wouldn't really know what I looked like before anyway. I don't have any history of sexual abuse, I understand why you asked, the perinatal mental health midwife that I saw in late pregnancy asked me that as well when I was so clearly terrified about giving birth, VEs etc, but I don't, I've just been weird about that sort of thing for not clear-cut reason. Probably partly due to my upbringing (sex and anything involved incl. discussion of human and animal reproduction was treated as if it was some gross dirty topic ).

GP has suggested anti-Ds a few times recently (for mood and anxiety) but I'm really not keen on the idea. I've been on them before for years and they really helped when I was depressed but it is such a ballache coming off them and I get really sick for ages whenever I start a new one with side-effects etc so I'm really keeping them as a total last resort.

I get what you mean about psychological element, I have chronic mental health problems mostly to do with anxiety, I have a diagnosis of GAD. I am on the waiting list for CBT atm and as I said, I take diazepam now and then. I think this obviously makes me feel worse and more anxious about it all, and perhaps makes it more difficult for me to ignore the pain when I feel it, but I don't think it's making the pain worse at the site of the scar, e.g. I don't think we could have sex with the pain regardless of how I feel about it - I'm really not in tune with my body as I said above, so when the GP put a finger into my vagina, she could have touched me anywhere and I would have had no clue where it was she touching especially given how anxious I was, but the pain upon her touching the scar site internally made me yelp and jump and she said that was the internal scar site .

We can do other things re: intimacy in theory but we haven't been because I'm always exhausted and DD still doesn't reliably go to bed before 10/11pm by which point I am exhausted and we go to bed too. She doesn't have any long naps in the day other than in the evening and then she will only sleep on one of us. There is nobody who will babysit her for us to spend some time alone together either as she's such a nightmare baby (cries all the time, stranger anxiety, rarely naps for longer than 30 minutes and takes hours to get her to do that etc). It bothers DH a lot more than me but as time goes on it is upsetting me too. We haven't had PIV intercourse since last March because whilst I was pregnant it was uncomfortable and kept being painful for me, although we did other things now and then until DD was born in June.

Thanks for listening to me whinge, I know what I'm going through is nowhere near as bad as lots of other people so I'm sorry for whinging, you're all really resilient and I hope your treatments work well

Thought I'd update this, in case in the future anyone in a similar situation to me is looking for answers, as I was.

I had an appt with the gynae surgeon a few weeks ago. He diagnosed me with vaginismus, which I'm a bit sceptical about . I know there is clearly psychological stuff going on with me but that doesn't explain why when the GP felt about, I only felt pain around the site of the episiotomy scar and not when she first touched me internally, and also doesn't explain why I have mild pain after using tampons for a number of hours, or why I have mild pain during and later on after trying to do PFEs . I told this to him and tbf he did listen and seemed a bit puzzled himself. He did explain though that even if there was something going on that would require surgical interventions, obviously we wouldn't be looking to do that now as I want to have at least one more child, so conservative management would be the way forward anyway. Which is fair enough.

He examined me externally and then internally using a speculum and also I think another instrument? That he put in and then sort of opened up? Or was that just a huge speculum? I was very anxious and cried and was hyperventilating before he even examined me internally so I don't remember the examination that well...but it wasn't painful! He didn't touch the area internally himself but he said if there was pain at the scar site, whatever he did with the instrument would have caused pain, and it didn't, so he doesn't think the pain/issues I'm having are related to my scar site...which is odd. He gave me strong assurances that there is no sign of prolapse at all and that my pelvic floor muscles are very strong even compared to women who have not given birth vaginally before, so that was reassuring. He said a smear test shouldn't especially hurt given I didn't have pain when he had that instrument up me (as I'm due a smear) and the same for sex. DH and I know we should try to have sex sometime but tbh we just don't have time/energy atm. Well, I don't anyway, not to mention my anxiety about it. I now have an appt with a pelvic floor physiotherapist in April to assess me. This was at the suggestion of the physio assistant who was in the consultation with me, but it's more to check/rule things out as the gynae isn't convinced it's necessary but was happy to refer me and see what they say.