Vaginal tears after childbirth range from shallow scrapes you can barely see to deep injuries that extend toward the rectum. What a tear looks like depends entirely on its severity, graded on a scale from first degree (skin only) to fourth degree (through to the rectal lining). About 80% of women who deliver vaginally experience some degree of tearing, and that number rises to 91% for first-time births.
First-Degree Tears
A first-degree tear is the mildest type. It involves only the surface skin of the perineum (the area between the vaginal opening and the anus) and the thin layer of tissue just beneath it. These tears can also occur around the urethra, near the front of the vaginal opening.
Visually, a first-degree tear looks like a shallow cut or graze. The edges are typically close together, and you may see minor redness, slight swelling, or a thin line of raw-looking skin. Bleeding is usually minimal. Many first-degree tears heal on their own without stitches, and they can be difficult to distinguish from general swelling and irritation after delivery. If you’re checking with a mirror in the days after birth, a first-degree tear may simply look like a small, pinkish scrape.
Second-Degree Tears
Second-degree tears are the most common type that requires stitches. These go deeper than the skin, extending into the muscle layer of the perineum, and they may reach further into the vaginal tissue itself.
A second-degree tear is more visibly open than a first-degree tear. You can often see a clear split in the tissue with separated edges, more noticeable swelling, and heavier bleeding. Because muscle is exposed beneath the skin surface, the wound may look deeper and darker pink or red compared to the surrounding tissue. After stitching, the area typically appears swollen and bruised, with visible suture material holding the edges together. The stitches are usually dissolvable and don’t need to be removed.
Third- and Fourth-Degree Tears
Third-degree tears extend from the perineum into the anal sphincter, the ring of muscle that controls bowel movements. Fourth-degree tears go even further, passing completely through the sphincter and into the mucous membrane lining the rectum. About 6% of first-time vaginal deliveries result in a third-degree tear or worse.
These severe tears are not something you would typically identify by looking on your own. They involve structures that aren’t easily visible externally, and they’re diagnosed by your delivery team during a careful examination after birth. What makes them distinct is the depth and direction of the injury: the tear tracks downward from the vaginal opening toward and into the anus. Fourth-degree tears create an open connection between the vaginal canal and the rectum. A rare related injury called a rectal buttonhole can occur when the sphincter stays intact but a hole forms between the back passage and the vagina, which can cause gas or stool to pass through the vagina.
Both third- and fourth-degree tears are repaired surgically, usually in an operating room with appropriate pain relief.
How Tears Differ From Episiotomies
An episiotomy is a deliberate surgical cut made in the perineum during delivery. It looks distinctly different from a natural tear. The edges of an episiotomy are clean and straight because they were made with scissors or a scalpel, while a spontaneous tear has irregular, jagged edges. Episiotomies are cut either straight down (midline) or at an angle (mediolateral). One important consideration is that an episiotomy can sometimes end up being bigger or deeper than a natural tear would have been.
What Normal Healing Looks Like
In the first few days after delivery, any tear or repair site will look swollen, bruised, and red. You may see dark-colored stitches or feel small knots of suture material along the wound. Mild bleeding and soreness are normal during this early phase. Over the first one to two weeks, swelling gradually decreases and the tissue starts to knit together. The redness fades to pink, and the stitches begin to dissolve. Most first- and second-degree tears feel significantly better within two to three weeks, though full healing of deeper tissue can take several more weeks.
Sometimes the body overheals the wound, producing raised red patches of tissue called granulation tissue. These bumpy, bright red spots can be uncomfortable and may bleed when touched. Granulation tissue is sometimes mistaken for infection, but the two look different and are treated differently.
Signs of a Problem
A healing tear that develops complications looks noticeably different from one that is recovering normally. The key visual warning signs of wound breakdown or infection include:
- The wound opening up. You may see a gap where the edges were previously held together, or notice stitch material coming away from the skin.
- Pus-like discharge. Yellow or green discharge from the wound site, often with a foul smell, indicates possible infection.
- Increasing redness or spreading redness. Some redness is expected, but redness that grows outward from the wound or becomes more intense over time rather than fading is a concern.
- New or worsening bleeding. Light bleeding in the first days is normal. Bleeding that restarts after it had stopped, or that increases, suggests the wound may have opened.
Some women discover wound breakdown on their own by checking with a hand mirror. If the tear site looks like it has separated, appears to have a gap between its edges, or is producing discharge that wasn’t there before, it’s worth having the wound assessed. Wound breakdown does not always require restitching. Smaller separations sometimes heal well on their own with proper wound care, while larger breakdowns may need surgical repair.