Vaginal Granulation Tissue - Cause, Diagnosis, and Treatment

Introduction

Perineal tearing during vaginal delivery can range from mild to severe, and each woman's body may heal differently. Although most tears can be stitched and healed naturally, excessive healing can result in the formation of granulation tissue at the wound site. Unlike normal vaginal tissue, this tissue is fibrotic and can cause pain, inflammation, bleeding, and discomfort during sexual activity, pelvic examinations, or tampon use. Granulation tissue can be difficult to diagnose in the early stages of healing due to normal postpartum tenderness, but if symptoms persist, such as raw and inflamed tissue or prolonged bleeding, it is likely the presence of granulation tissue.

What Are the Causes of Vaginal Granulation Tissue?

The cause of vaginal granulation tissue is often related to injury or inflammation in the vaginal area. It can occur as a result of perineal tearing during vaginal delivery, surgical procedures in the vaginal area, or other forms of vaginal trauma. Other factors contributing to the development of granulation tissue include poor wound healing, infections, and certain medical conditions that affect wound healing. Some studies suggest that local, topical estrogen creams may increase its occurrence after a perineal tear or episiotomy. This treatment is often recommended for women who have slow wound healing or a reopening of the wound, as a decrease in estrogen levels characterizes the early postpartum period. The use of estrogen creams is thought to aid in the healing process.

How Does Estrogen Help in Slow Tissue Healing and Stitches?

• Slow Tissue Healing - A drop in estrogen levels can significantly impact nursing and lactating mothers, leading to dry and fragile tissue and slowing down the healing process. Topical estrogen is often prescribed to promote local estrogen levels in the tissue and aid in the healing of lacerations. Although some research has suggested that the use of topical estrogen may increase the likelihood of granulation tissue formation, it is not the sole cause. In some cases, granulation tissue may develop as a part of the normal healing process or due to an undissolved suture.

• Stitches - Sometimes, the dissolvable stitches used to close a perineal tear do not completely dissolve and can cause irritation in the tissue. This results in excessive healing and may lead to the protrusion of the stitch, which the patient can feel. If this is the case, it is important to visit a gynecologist for the removal of the remaining stitch and to determine if further treatment with topical estrogen or silver nitrate is needed for healing.

What Are the Signs and Symptoms of Vaginal Granulation Tissue?

The signs and symptoms of vaginal granulation tissue may include:

• Pain or discomfort in the vaginal area.

• Inflammation and redness in the affected area.

• Prolonged bleeding or discharge.

• Pain during sexual activity, pelvic exams, or tampon use.

• Difficulty or pain during urination.

• Tenderness in the affected area.

• A mass or lump in the vaginal area.

• Difficulty or discomfort with bowel movements.

• Skin that appears shiny or granular in appearance.

• Itching or burning in the affected area.

• A foul odor in the affected area.

• Discharge that is unusual in appearance or odor.

How Is a Vaginal Granulation Tissue Diagnosed?

The diagnosis of vaginal granulation tissue is typically done by a doctor, such as an obstetrician, a gynecologist, or a pelvic physical therapist. During a pelvic exam, the doctor will look for the presence of bright red tissue that is located near the perineal tear, as well as a 'raw' or 'tearing' sensation when the tissue is palpated. Other symptoms, such as spotting or bleeding with hygiene, intercourse, or a pelvic examination, may also be present. In some cases, a palpable stitch may be felt along the area of inflammation. To confirm the diagnosis, the doctor may take a tissue biopsy to examine it under a microscope. This can help determine the extent of the inflammation and the presence of granulation tissue. Based on the examination results, the doctor will be able to determine the best course of treatment, which may include silver nitrate, topical estrogen, or surgical removal in rare cases.

What Are the Treatment Options Available for Vaginal Granulation Tissue?

If a patient suspects that they may have granulation tissue, then they do not have to worry as it can be treated. In some cases, the tissue may heal and be reabsorbed on its own, but in others, medical intervention from an obstetrician and gynecologist may be necessary. To treat granulation tissue, a chemical called silver nitrate is often used. This chemical removes and cauterizes the tissue to promote normal healing and reduce pain. In extremely rare cases, surgical removal of the granulation tissue may be required. If a patient experiences pain or bleeding postpartum, or if the perineum seems to be taking longer than expected to heal, it is important to bring this to the attention of a gynecologist or pelvic physical therapist. A quick examination can help determine the cause and provide appropriate treatment. Even a properly healed perineal tear can be painful, as scar tissue may form along the vaginal opening where the tear occurred. This can cause tissue restriction, decreased blood flow, and pain, especially during sexual activity or pelvic exams. If a patient is uncertain whether the pain is due to normal scar tissue or granulation tissue, here are some things to look for.

Normal Perineal Scar Tissue:

1. Tissue that feels resistant when touched in the area of the healed tear.

2. Pain during sexual activity or pelvic exams that feels like 'stretching' or 'pulling.'

3. Potentially difficulty with performing Kegel exercises or relaxing the pelvic floor muscles.

Granulation Tissue:

1. A brightly red, inflamed tissue located near or at the site of the healed perineal tear.

2. An area that feels 'raw' when touched.

3. Pain during sexual activity or pelvic exams that feels 'raw,' 'tearing,' or 'burning.'

4. Bleeding or spotting during hygiene, sexual activity, or pelvic exams.

5. A potentially noticeable piece of suture material in the area of inflammation.

Conclusion

In conclusion, perineal tearing during vaginal delivery can lead to the development of granulation tissue, which is characterized by pain, inflammation, bleeding, and discomfort during sexual activity, pelvic exams, or tampon use. Using estrogen creams may help in the healing process and increase the likelihood of granulation tissue formation. The signs and symptoms of vaginal granulation tissue are pain, inflammation, prolonged bleeding, discomfort during urination, tenderness, and more. Treatment options include the use of silver nitrate, which removes and cauterizes the tissue to promote normal healing or surgical removal of the granulation tissue in rare cases.