An episiotomy is a surgical incision made between the vaginal opening and the anus during childbirth. This procedure was once routine in many deliveries but has become less common in recent years. However, around 1 in 10 women delivering vaginally still have an episiotomy.
Even when an episiotomy is not performed, the perineum—the area between the vagina and anus—may still tear during childbirth. These tears can vary in severity, from minor to more extensive.
Regardless of whether it’s from an episiotomy or a tear, repair of the perineal tissue is commonly performed after childbirth. In some cases, the repair may not heal optimally, leading to discomfort and pain. Factors contributing to suboptimal healing may include suture selection, technique, and the depth of the tear.
If you’re experiencing ongoing pain or discomfort due to scarring from an episiotomy or tear, dyspareunia, or pain, then a surgical revision may be an option. This procedure cuts out the old scar and carefully reapproximates the tissues. The tissue is then closed layer by layer with sutures to help ensure proper tissue alignment and optimal healing.
We use a long-acting local anesthetic – e.g., Exparel® or Endura-KT® – that blocks pain for about 48-72 hours. Using this approach, most patients experience little to no pain. The utilization of long-acting local anesthetics has truly revolutionized the patient experience. By incorporating these advanced local anesthetics into the procedure, we’ve significantly enhanced patient comfort. We also offer patients the option of a follow-on long-acting anesthetic 2-3 days after the first long-acting anesthetic. Although few people request a second injection, we want patients to be aware of this option to alleviate concerns about post-procedure pain. Patients are given prescription pain medicine to have on hand, if needed. However, most patients don’t end up taking it.
During the procedure, dissolvable stitches are carefully placed, eliminating the need for later stitch removal. Following the surgery, patients are often advised to wear compression garments, such as snug leggings, along with several pads. This combination serves to maintain pressure on the surgical site, reducing the risk of hematoma formation. After approximately 72 hours, patients can typically discontinue using pads, while compression garments are usually recommended for an additional week to support proper healing and minimize swelling. This post-operative care regimen aims to optimize recovery and promote favorable outcomes following the procedure.
Most of the time, an episiotomy scar revision is done in the office under local anesthesia (long-acting). However, when combined with other procedures or because of patient preference, conscious sedation or general anesthesia may also be options.
Generally, with the long-acting local anesthetic that we use, most patients go back to work the next day. However, patients need to refrain from vaginal intercourse and tampon use for 4-6 weeks. Most other activities can be resumed in 1-2 weeks.
Dr. Desrosiers understands that each patient is unique and requires individualized care. With his expertise and dedication to achieving exceptional results, Dr. Desrosiers is committed to guiding you through your scar revision journey with confidence and support.
To learn more about scar revision or to schedule a consultation with Dr. Desrosiers, please contact us at 305-403-2922 or concierge@ArthurMD.com.
