What are the best options for healing an episiotomy wound?

Question

Hello doctor,

I had a normal delivery last year. There were episiotomy stitches that opened, and the wound had not healed properly. I can see a wide gap that hurts when walking or standing for too long. It is also affecting my married life.

My gynecologist suggested that it was totally up to me whether I wanted to have it restitched or not, and there would be three to four stitches. What should I do? What are the possible solutions?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Thanks for sharing that it sounds like you are going through a physically and emotionally tough situation. Let us break this down clearly to help you understand your options and make a decision that is best for your healing and well-being.

After an episiotomy, if the stitches open (wound dehiscence), it can lead to a wide gap in the perineal area, pain or discomfort when walking, standing, or during intercourse, and sometimes delayed healing due to constant movement or friction in that area if it has not healed on its own, even several months after delivery. This indicates the wound healed "open" without closing the tissues properly.

One option is restitching (perineal repair surgery). This involves a minor surgical procedure under local anesthesia (such as Lidocaine (Xylocaine)) or short general anesthesia, where the area is cleaned and stitched again. The procedure usually takes place as an outpatient or daycare surgery, meaning you can go home the same day.

Recovery time is around two to four weeks, with much better healing expected. The benefits of this procedure include properly closing the gap, reducing pain when walking or standing, restoring comfort in intimacy, and improving emotional and physical confidence. The risks are mild bleeding, infection (which is low risk), or scar tissue (rare).

Alternatively, you could leave it as it is with conservative management. This may be okay if the gap is small and you do not have much pain or issues in your daily life. Since you do have pain when standing and during intimacy, this may not be ideal long-term.

Conservative options like pelvic floor therapy (which can involve exercises or physical therapy to strengthen the pelvic floor muscles) can help with discomfort, but they will not close the gap.

Given that it has been ten months since delivery, the wound has not healed properly, and you have ongoing discomfort that is affecting your quality of life and relationship, restitching might be the right choice for you. It is a simple, low-risk procedure that can make a big difference in your comfort, mobility, and confidence.

Ask your gynecologist the following questions:

Can it be done under local anesthesia (like Lidocaine (Xylocaine))?
Will it be a daycare procedure?
What post-operative care will you need?

And most importantly, this is about your body and your comfort, do not feel guilty or hesitant. Healing right is part of self-care.

I hope this helps.

Thank you.