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Episiotomy is a surgical cut in the area between the woman’s vagina and rectum, which makes the vaginal opening larger and enables the baby to pass through more easily. This procedure is usually done using a local anaesthetic. There are two types of episiotomy: midline, where the cut goes from the vagina straight down in the direction of the rectum, and mediolateral, where the cut goes down from the vagina and off to one side away from the rectum. Some episiotomies are deeper than others: some incisions penetrate the thin layer of tissue that covers the vagina; others go deep into the muscle layers beneath.

Episiotomy is a very common procedure, affecting about one-third of births. Some practitioners perform it routinely to prevent the vagina from tearing during delivery. However, there is growing evidence indicating that episiotomy should not be done routinely, but should instead be reserved for births where the baby is in distress or the birth canal is not stretching enough to allow the baby to be born. If episiotomy was only done in cases where the baby truly needs it, the incidence of episiotomy would drop to 10% of births.

There is one main reason why some practitioners prefer to do routine episiotomy: they find the clean, straight cut of an episiotomy easier to repair than a jagged vaginal tear. However, an episiotomy sometimes involves cutting through deep layers of muscle, while a vaginal tear usually only involves the superficial top layers of tissue. As a result, an episiotomy is more likely to result in a higher amount of pain, complications, and blood loss when compared with a vaginal tear. Women who have an episiotomy may have pain during intercourse for months after childbirth. Those who have an episiotomy that reaches the anus have a long recovery period and may develop problems with controlling their bowel movements.

There are a few scenarios where an episiotomy is medically necessary. An episiotomy may be indicated if the baby’s heart rate shows that he is not tolerating labour well and he needs to be delivered quickly. An episiotomy may also be needed if the baby is too large or if forceps are required.

If you are concerned about episiotomy, speak to your health care provider and ask what her thoughts are about this procedure. Find out how frequently she performs episiotomy and under what circumstances. Let her know your feelings, both verbally and in your birth plan. Realize, however, that your birth plan is not a written guarantee, and sometimes things to might not proceed exactly the way you outlined. While episiotomy may not be recommended for routine use, sometimes it may be necessary to ensure the health and well-being of your baby.

Recovering from an episiotomy

If you do have an episiotomy, you will have stitches in the area between your vagina and anus, and the area may be quite painful. Usually it takes about four to six weeks for the area to completely heal. Here are a few ways to help relieve the pain:

  • Use ice packs to numb the area and prevent swelling.
  • Soak the episiotomy site in warm water three to four times a day. This can be made more convenient with a sitz bath you can purchase at the pharmacy.
  • Keep the area as dry as possible between sitz baths.
  • Ask your doctor about analgesics containing codeine​.
  • Check with your pharmacist or doctor about numbing sprays.
  • Drink lots of water and eat foods high in fibre to avoid constipation.

When you’re ready, and after your doctor gives the OK, you can try having sex again. You may feel tenderness at first, so try to relax as much as possible and use a good lubricant to make intercourse more comfortable. Sometimes being on top can help, because you can control what happens during penetration.

Nicolette Caccia, MEd, MD, FRCSC

Rory Windrim, MB, MSc, FRCSC