Perineal region is the small muscular area between vagina and anus. It is the part that stretches, and elongates to accommodate the fetal head during childbirth. If you give birth by natural tear, the perineal area can be swollen and tender. A few examples include in which perineal pain may be significant (lasting for more than 3 days) are:

• Vaginal tear that is common in situations like cephalo-pelvic disproportion - a condition in which fetal head is larger than the vaginal vault and may culminate in tearing of perineum during delivery process
• Episiotomy- a micro-surgical procedure that aims at widening the birth canal to allow easy delivery of fetal head.

How Long Does Perineal Pain Last After Childbirth?

The resolution of perineal pain and discomfort following childbirth depends largely on the nature and depth of trauma.

• In case of normal delivery, only superficial layers of skin are damaged and if it does not require any stitching, the pain will only last for 1-2 days.
• However, in case of vaginal tear or episiotomy that are classified under second degree tears, skin and muscle needs to be repaired (or stitched) under local anesthesia by absorbable sutures. The pain in this type of tear heals in a period of 2-3 weeks (with gradually lessening discomfort with every passing day due to active healing.
• In certain severe cases (like third degree or fourth degree tear as seen in some complicated or poorly managed deliveries) women may develop tear or laceration of anal region or rectum. This type of perineal pain may require months to heal properly.

Some women may experience disturbing symptoms for months or even years like excessive flatulence, incontinence of urine or feces and other similar ailments.

There are also a few signs that you should watch for. In case of any of the following symptoms, report immediately to your healthcare provider for evaluation

• If your symptoms are not resolving or are increasing in intensity
• If you have developed swelling, stringy sensation or bleeding in the vaginal region
• If you have developed foul smelling discharge or release of pus from vagina or episiotomy stitches

How to Relieve Perineal Pain After Birth?

There are several home remedies that can help in resolving perineal pain and discomfort without needing a lot of pain killers. It is always a good idea to speak to your primary healthcare provider regarding the best pain resolving strategies. 

• Ice packs are usually the first line of home remedies that are given to new mothers soon after childbirth by hospital staff. You can use this remedy effectively for the first 12 hours to reduce pain, redness, swelling and discomfort.
• Usually healthcare providers advise pain-killers (mostly non steroidal anti inflammatory drugs that are available as over the counter analgesics like ibuprofen or paracetamol). Mothers who are breast feeding the babies should avoid aspirin. In case of extensive vaginal tearing, your doctor may advice you strong prescription pain killers for quality relief from discomfort.
• Make sure to change your sanitary pads frequently (ideally each time you use restroom)
• It may burn or string each time you pass urine (at least for the first few days). You can ease out the burning sensation by using squirts of warm water on your perineal region (via squirt bottle). Squirting helps in decreasing the burning sensation by diluting the urine.
• Always wipe your perineal region from front to back in order to minimize the introduction of germs in your healing wound
• Initiate kegel exercise to strengthen and stabilize pelvic floor muscles. This helps in early resolution of pain and swelling by restoration of blood circulation
• Avoid sitting in one position unnecessarily as long as your perineal region is still sore
• Changing your sleeping position can also help tremendously in decreasing pain and perineal discomfort. Likewise, avoid excessive activity or exercise that may exacerbate the pain
• After initial 24 hours, most healthcare providers advise sitz bath (small portable basins that can be half-filled with warm water to deliver comforting warmth to the perineal region). Use this 3 times a day, 20 minutes for each time.
• Other helpful strategies include the use of local pain-killers like itch hazel gel, avoidance of constipation by increasing the intake of fiber rich foods and increasing water intake.

When Can You Have Sex Again?

Although, it largely depends on your physical level of wellness and comfort, most healthcare providers allow sexual activity:

• After 3 weeks in case of normal vaginal delivery (without any tearing or stitching)
• After at least 4-6 weeks in case of episiotomy or second degree perineal tear (or until your wound heals completely)
• Even longer wait is needed in case of third degree or fourth degree tearing. Healthcare providers strongly recommend seeing a gynecologist to ascertain the healing is complete.

How to Ease Pain and Discomfort During Sex

It is normal to experience some degree of pain or tenderness at the time of sexual intercourse (especially after episiotomy or tear). You may also feel tightness or excessive resistance. There are a few tips that can help in easing out the discomfort:

• Use a good quality lubricant (ideally water-soluble) for lubrication
• Take your time to relax and ease out in the sexual activity (a lot of fore-play is generally helpful)
• The discomfort is especially pronounced in women who are breast-feeding their babies. High level of prolactin that supports lactation can lead to vaginal dryness by suppressing the estrogen secretion. You can always ask your doctor for an estrogen lubrication cream to reduce the dryness.
• Do not force yourself and if sexual intercourse is unpleasant or painful, wait a little longer to resume the activity.