Perineal tears often occur in vaginal delivery, either spontaneously or through interventions such as an episiotomy.1,2 Approximately 85% of vaginal deliveries occur in perineal tears, which is more common in primiparas (90.8%) than multiparas (68.8%).1,3 Perineal tears can cause bleeding, infection and postpartum pain associated with the risk of depression, dyspareunia and adversely affects the quality of life and sexual health.4,5 The American College of Obstetricians and Gynecologists (ACOG) classifies perineal tears into four grades: Grade 1st is lacerations to the perineal skin only, Grade 2nd is lacerations to the perineal muscle, but not including the anal sphincter, Grade 3rd is lacerations to the anal sphincter muscle and Grade 4th is lacerations to the anal sphincter muscle anal sphincter and rectal epithelium.5

Grades 1st and 2nd are about 50% of the time at delivery. In grade 1st, because the tear is considered small, repair by suturing may not be carried out depending on the doctor's advice, while in grade 2nd, it is recommended to do suturing. Grades 3rd and fourth require more complex repairs and must be performed in the operating theater.1 Suturing the perineum can increase postpartum pain, impacting daily life, baby care, and the mother's comfort, so health workers must help mothers manage the pain they experience.6

The purpose of this study will be to review several studies regarding the repair or treatment of perineal tears after vaginal delivery.

This research is a literature review research from various articles in PubMed and ScienceDirect databases. The keywords used in the search were ‘perineal tears,’ ‘perineal wound,’ and ‘perineal laceration’. The search results found 8,246 related articles on Pubmed and 25,902 articles on ScienceDirect. Furthermore, the results will be filtered through the database by taking articles published in 2016–2021, research articles, and free full text from 124 Pubmed articles and 452 ScienceDirect articles filtered successfully. The articles that have been obtained will be evaluated based on the inclusion criteria in this study, namely: 1) not review articles, 2) the English language is available 3) articles containing clinical trials or experiments for repair or treatment of perineal tears, 4) perineal tears discussed are grade 1st and second or episiotomy.

Articles considered appropriate will be reviewed by taking data, journal title, place and date of research, objectives, research samples, research design, the measurement used, and research results.

Nine articles were found that matched the inclusion criteria. Three articles examined the effect of this type of suture on perineal pain, and another six discussed treatments to reduce the adverse effects of perineal tears—five articles using a visual analog scale in assessing postpartum perineal tears pain (Table 1).

This review found that the type/technique of sutures used in repairing second-degree perineal tears or episiotomy affects the perineal pain felt by postpartum mothers. The gold standard for repairing perineal wounds is to use absorbable sutures.15 However, suturing the second-degree perineal skin tears can increase postpartum pain compared to unsutured or given surgical glue.4 The technique/type of perineal suture can affect perineal pain, where continuous sutures experience lower perineal pain, better sexual activity, and lower need for analgesia than mothers who are interrupted sutures.7,9 This is due to the use of less material and also fewer knots.9 Post-suturing pain is caused by the inflammatory response of the sutures, which can last until the sutures are removed or absorbed by the body.4 Leaving the perineal skin unsutured, especially in grade 1st and grade 2nd perineal tears may reduce postpartum pain from day 14 to 6 weeks, in addition to reducing the use of analgesia and the incidence of dyspareunia at three months postpartum, but can leave gaping scars and long-term effects of this action is not yet known.5,15,16

Postpartum care, especially for mothers who have perineal tears, needs to be considered to prevent chronic pain after delivery, help mothers control pain, prevent constipation and monitor urinary retention.5,17 It is necessary to use various pharmacological and non-pharmacological methods and safe drugs for the mother to reduce postpartum pain or maternal morbidity due to perineal tears and the side effects of perineal tears.14 The provision of far-infrared radiation therapy, capacitive-resistive radiofrequency therapy, pelvic floor muscle training in early postpartum did not provide additional impact in reducing perineal pain or sexual function. However, radiofrequency therapy helps reduce perineal discomfort when walking.11 Cold therapy on the perineum for 20min can reduce perineal pain and increase the release of endorphins and stimulate the healing process.1,5,6,13 Administration of TheresienOl (a natural oil) can reduce perineal wound pain and reduce swelling and erythema. The described medicine acts by the following mechanism: 1) Hydrates tissues; 2) Reduce bacterial invasion and inflammation; 3) Stimulates migration and proliferation of fibroblastic and endothelial cells; 4) Stimulates epithelialization.14 The medications reviewed in this article do not cause any adverse health effects.

Sutures and technique/suturing second-degree perineal tears or a postpartum episiotomy can affect perineal pain. Cold gel pad therapy and treatment with natural oil on perineal wounds can affect perineal pain and wound healing.

The authors declare no conflict of interest.