A perineal tear after birth looks like a raw, reddish split in the skin and tissue between your vagina and anus. Depending on severity, it can range from a shallow graze that’s barely visible to a deeper wound with visible stitches, significant swelling, and bruising that spreads across the surrounding skin in shades of purple, blue, and yellow. Most tears happen during vaginal delivery, and up to 9 in 10 first-time mothers experience some degree of tearing.
What Each Degree of Tear Looks Like
Tears are classified into four degrees based on how deep they go, and each one looks noticeably different.
A first-degree tear is the mildest. It involves only the surface skin of the perineum, the area between the vaginal opening and the anus. It looks similar to a shallow scrape or a small split in the skin. You might see some redness and light bleeding, but there’s no deep wound. These often don’t need stitches at all. Minor tears that aren’t bleeding and haven’t distorted the surrounding tissue can be left to heal on their own, and clinical guidelines confirm that repairing them doesn’t improve short-term outcomes compared to leaving them alone. When repair is needed, surgical glue is sometimes used instead of stitches.
A second-degree tear goes deeper, extending through the skin and into the muscle layer of the perineum. This is the most common type. It looks like a more defined cut or gash, often with visible raw pink or red tissue beneath the skin surface. These tears usually involve more noticeable swelling and bruising around the wound. Most second-degree tears are closed with dissolvable stitches. The stitched area looks like a line of small knots along the wound, with the surrounding tissue puffy and discolored.
A third-degree tear extends through the perineal muscle and into the muscle that surrounds the anus (the anal sphincter). It looks like a longer, deeper wound stretching closer to or reaching the anus. This tear always requires stitches and is repaired in layers. About 2.7% of all vaginal births result in a third- or fourth-degree tear, with the rate rising to 4.6% for first-time mothers. Assisted deliveries using forceps or vacuum increase the risk further, with 5.3% of instrumental vaginal births resulting in these more severe tears.
A fourth-degree tear is the most severe. It extends through the anal sphincter and into the tissue lining the rectum. The wound is visibly deep and long, and the repair involves multiple layers of stitching.
What It Looks Like in the First Few Days
In the hours right after delivery, the perineum is swollen, tender, and often deeply bruised. The tissue around the tear appears puffy and tight, making it hard to distinguish the wound edges from the general swelling. The color of the area ranges from deep red at the wound itself to purple or dark blue where bruising has spread. Some blood-tinged discharge is normal, and the tissue feels warm to the touch.
If you have stitches, they’re typically made from a material that dissolves on its own over the coming weeks. When fresh, they look like small, dark or purplish threads holding the wound edges together. The skin around the stitches can appear puckered or slightly raised. Over the first several days, the most intense swelling starts to go down, and the bruising begins shifting from dark purple to greenish-yellow as your body reabsorbs the blood under the skin.
You probably won’t get a clear visual of the tear yourself without a mirror, and what you see may look more alarming than it actually is. Swelling exaggerates the appearance of everything in those early days. The entire vulvar area can look unfamiliar, puffy, and discolored even in areas that weren’t torn.
How the Appearance Changes as It Heals
First-degree tears that only involve the skin typically heal within a few weeks. The raw area gradually closes and the redness fades. Second-degree tears take roughly 3 to 4 weeks to heal. During the first week or two, the wound still looks red and tender, but you’ll notice the swelling decreasing and the bruising fading. By weeks 3 and 4, the wound edges should be mostly closed, and new pink skin covers the area. The tissue may still feel firm or slightly raised where scar tissue is forming.
Third- and fourth-degree tears take about 4 to 6 weeks to heal, sometimes longer. Because these repairs involve deeper layers of muscle, the surface may close before the deeper tissue fully recovers. The scar itself typically settles into a thin, pale line over the following months, though some women notice the tissue feels thicker or slightly different in texture permanently. Most people have a checkup at 2 to 3 weeks postpartum and again around 6 weeks, where a provider examines the healing.
As stitches dissolve, you may notice small pieces of thread coming away on toilet paper or in your underwear. This is normal and doesn’t mean the wound is reopening. The stitches gradually soften and break down, usually disappearing completely within a few weeks of delivery.
What Doesn’t Look Normal
Some redness, swelling, and tenderness are expected during healing. But certain changes signal a problem. A wound that was closing and then opens back up is called wound dehiscence, or breakdown. You might see the wound edges separating, exposing raw tissue underneath. Sometimes stitch material comes away too early, before the tissue has had time to knit together, and the wound visibly gaps open.
Signs of infection include increasing pain rather than gradually improving pain, new bleeding that starts days or weeks after delivery, and a pus-like discharge from the wound that may be yellow or green and have a foul smell. The skin around the wound may become increasingly red, hot, or swollen rather than less so. A fever alongside any of these changes is another red flag.
If the wound looks like it’s getting worse rather than better at any point during the first several weeks, or if you see the wound opening up, that warrants prompt medical attention rather than waiting for your next scheduled checkup.
What Affects How Severe a Tear Looks
Several factors influence the size and depth of a tear. First-time vaginal deliveries carry a higher risk of more significant tearing because the tissue hasn’t stretched this way before. Assisted deliveries with forceps or vacuum extraction roughly double the rate of severe tears compared to unassisted births. A baby’s size, position, and how quickly the final stage of delivery happens all play a role too.
An episiotomy, a deliberate cut made by a provider to widen the vaginal opening, looks different from a natural tear. It’s a clean, straight incision rather than the irregular edges of a spontaneous tear. The healing process and appearance over time are similar, though the scar tends to be more linear. Natural tears can look jagged or follow unpredictable paths along the skin and tissue, which is why they sometimes look more dramatic even when they’re relatively minor.
Tearing can also happen in places other than the perineum. Tears along the vaginal wall, around the urethra, or on the labia are common. These are usually superficial and only need repair if they’re actively bleeding or if the tissue has been significantly displaced. A labial tear, for example, looks like a small split along the edge of the inner or outer lips, and it heals quickly once the swelling resolves.