After labouring for nearly 24 hours, Angela* thought she was through the worst of it. Holding her new baby girl in her arms, her midwife began performing a post-labour check to see if she would require any stitches. She expected to hear that she had some perineal tearing, since she was in quite a bit of pain, but nothing could have prepared her for the moment when her midwife announced that she had torn her clitoris—the clitoral hood, to be exact.
“I remember looking at her and thinking, what?! I didn’t know you could tear that.”
Angela had never heard of this type of tearing. Sure, she was in a lot of pain—her epidural had not worked during either of her births—but the pain wasn’t any worse than it had been after the birth of her son three years earlier.
Elin Raymond, a physician at Michael Garron Hospital in Toronto and a lecturer at the University of Toronto with a specialization in Core Obstetrics and Gynaecology, explains that this isn’t an exceptional case. “Anywhere can tear, to be honest. You can tear through the labia minora, you can have tearing near or into the urethra, you can have clitoral hood or periclitoral tearing—it’s all possible, unfortunately. But, it doesn’t happen very often.” Raymond explains that it simply comes down to stretching. For Angela, while her birth had been quite slow and drawn out, the actual pushing part was quick—she had only pushed for around 20 minutes. “Some people have a tight perineum, so they’ll tear more anteriorly [near the front],” says Raymond. In these cases, the more common posterior tearing, or perineal tearing, tends to be less severe.
Why did no one tell me that epidurals don't always work?Like any other tearing during labour, tears to the clitoral hood are repaired with stitches. Angela’s midwife opted to have the OB at the hospital take the reins since they were dealing with such a sensitive area. “Usually it’s just a skin layer that is open,” says Raymond. “It will heal just fine. It has lots of blood flow.” Once the stitches have healed, most women regain feeling and are able to comfortably enjoy sex. In extremely rare cases, there may be some loss of sensation, but these cases are not the norm and are usually part of a bigger birth trauma. For Angela, healing took around eight weeks.
If women are concerned that the area is not healing well, they may want to seek out the assistance of a pelvic floor physiotherapist, who can work through any scar tissue using stretching and massage techniques.
Amy Gildner is a pelvic physiotherapist at West End Mamas in Toronto. For the very rare cases where loss of feeling may occur, Gildner recommends the same treatment as she would for any other type of tearing. “Tearing results in scar tissue and is really thick and fibrous,” she explains. “Often you just need someone to break down the scar tissue and teach you how to activate those muscles again.” Most pelvic floor physio involves massaging of scar tissue as well as stretching exercises, which can be done at home. “Deep squatting, butterfly, child’s pose. All of these positions are things women are really hesitant to do postpartum because they think they’re going to tear the stitches more,” says Gildner. “Past the six week point, you’ve had the midwife or OB appointment where they’ve checked to make sure the tear is healing correctly, then I encourage [these exercises] because it will stretch out that scar tissue.”
While the idea of clitoral tearing may be enough to put some women off giving birth, rest assured, the chances of it happening are quite rare. Raymond gives a ballpark figure of less than two percent of all tears. “You’re more likely to have periurethral and labia minora tears,” says Raymond. And it’s pretty much impossible to know if it’s going to happen to you.
If your doctor notices that you’re starting to tear anteriorly during labour, they may suggest doing an episiotomy. “If you make a bigger opening posteriorly, then you’ve got less chance of anterior tearing,” says Raymond. But she warns that having an episiotomy isn’t necessarily a better option. For Angela’s first birth, she was given an episiotomy. She found the healing process was much faster the second time around, when she tore her clitoral hood. “Probably within a few weeks I didn’t have any pain,” says Angela. “It felt fine and I felt comfortable having sex again around eight or nine weeks.”
*Some names have been changed.