Q: Could my old episiotomy scar be causing me pain?

It would be very, very unusual for an old episiotomy scar to become problematic. You say you experience dryness, irritation, and a “tearing feeling,” which sounds to me entirely consistent with vulvodynia (also called vestibulodynia or provoked vulvodynia). Other ways the pain has been described are “sandpaper,” “cutting,” or “ripping.” The most common experience with vulvodynia is pain with intercourse, and usually not with other activities (although sometimes women have sensitivity when wiping after urination). There may or may not be vaginal dryness.

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If the pain you’re experiencing is related to atrophy, which is very common and usually evident by vaginal dryness, the Premarin vaginal cream you describe using should be quite effective for that. A topical steroid, which you’ve also been prescribed, would be helpful if there’s an identified vulvar skin condition or dermatosis, but I’m not sure any of your descriptions indicate that the steroid is beneficial. You also asked about the Mona Lisa Touch, which has been shown effective for atrophy, but not vulvodynia, at least thus far.

For patients with vulvodynia, I use a compounded prescription of low-dose estrogen plus testosterone applied to the opening of the vagina (the introitus) two times a day for 12 weeks, tapering to once a day or less. Another option might be Intrarosa, a relatively new treatment for vulvovaginal atrophy, which I’ve begun using with some vulvodynia patients. Intrarosa is a vaginal insert, used nightly; it’s metabolized to testosterone (and estrogen) in the vagina, so I think this is going to help vulvodynia.

Note that vulvodynia can be difficult to diagnose, because the vulva and vagina may look normal. Describing your symptoms accurately will be extremely helpful!


Dr. Barb DePree MD
Dr. Barb DePree MD

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14 Responses

Dr Barb
Dr Barb

August 31, 2020

Latephat, you should follow up with your doctor about the pain you are experiencing. They will be able to determine the cause of your discomfort and the appropriate treatment for you.

Latephat
Latephat

August 31, 2020

Hello….i had my baby last year April, i had tears then not much tho, which hill view weeks after but now I’m noticing some pain down there ,should i be worried and what can i do?

Dr Barb
Dr Barb

March 30, 2020

Joy, this is something that needs to be examined by your provider. It may be a hemorrhoid, recital fissure or non-healing of the episiotomy but it needs to be properly assessed to find a solution.

Joy
Joy

March 30, 2020

Hi there I had my son a year ago with quite an intense episiotomy and ever since having him I’ve had pretty bad pain down there especially while going number 2 so I grabbed a mirror and checked down there and it looks to be a pea size bulges of scar tissue that is causing my ripping open a scab over and over type pain. Any recommendations?

Dr Barb
Dr Barb

February 26, 2020

Colin, there are several possible causes for this pain, though likely not your partner’s scar. There are options available to help with this pain and discomfort, but to find the correct course, your partner should see their provider to properly diagnose and treat.

Colin
Colin

February 26, 2020

I’m other half is embarrassed to ask or seek advise. But she is going through the menopause and has found intercourse at the point of climax painful (her climax). She has an episiotomy scar (20 year old scar) and is saying the pain is centered around that area. All parts of the love making process is fine and enjoyable smaller climaxes are uncomfortable but not too painful. Is there something that can be done as we have a very good sex life and we don’t want back down from it. Any advise please.

Dr Barb
Dr Barb

December 16, 2019

Dolores, It is very very unlikely that an old episiotomy scar would be causing pain. I would look to another cause, but I can’t tell you what might be going on to cause the ‘loose skin’ and discomfort.

Dolores
Dolores

December 16, 2019

I am 64 years old and its been 20 years since I went into menopause. Recently, I have noticed loose skin from my old episiotomy scar. Its been bothering me for months now. I saw a proctoligist because I thought it was a rectal problem. She treated me with rectal creams which did nothing. Then I go to a gyno. Who says its a perirectal abcess. He puts me on Cipro. Meantime, I went to another Proc. Doctor who tells me, its scar tissue from an old episiotomy.
He tells me to discontinue the Cipro. I am so confused, I dont know what to do and who is right.

Dr Barb
Dr Barb

June 27, 2019

Jeanne, It is unlikely that the episiotomy scar is now causing any issues. The most likely cause of the pain she described is vulvodynia. This requires a careful exam, and if that is the diagnosis then directed treatment to that area is an effective treatment option. The vaginal suppositories should be adequately ‘estrogenizing’ the genitals, I suspect topical estrogen cream alone is not likely to be of benefit. Numbing the area is an option, it is usually not an ideal option but certainly a consideration.

Jeanne
Jeanne

June 27, 2019

Wow, just the question that I searched. I have been in menopause since 2001, am 65 now and used an HRT patch since 2007 and since 2015 was switched to Duavee. I also use DHEA vaginal suppositories once a week and have for three years, because the Duavee just didn’t provede the same benefits to my vagina. We have sex usually once per week, but sometimes not for two weeks and always use a lubricant. Just this past month, however, my episiotomy scar started causing pain during vigorous manual stimulation from my husband, which caused me to stop him before I climaxed, so… phooey. I was thinking about asking for some estrogen cream for the area and then thought a cream like the anti-bacterial with numbing quality might work better if I massage the area with that. I certainly would appreciate any advice and will most likely talk with my gynecologist about it, as well.

Lynette
Lynette

February 25, 2019

I am in my 60s and also experiencing pain during intercourse. I’ve tried HRT, creams and tablets to no avail. My gynecologist finally sent me to a physical therapist who found the painful spots right away, and yes, it’s the old episiotomy scar that’s causing the problem! She said it’s quite common for the old scar to become painful after menopause. Massage can break up the scar tissue, but I’m also going back to my gynecologist for a steroid injection. I’ve also heard that laser treatments can help. Good luck and don’t give up finding help. See a therapist who specializes in pelvic floor problems!

Dr Barb
Dr Barb

February 15, 2019

Jeannie, it is likely that the changes of the vulva are related to atrophy (our old term for this was vulvovaginal atrophy, we now call it the genitourinary syndrome of menopause). Replens is for maintaining vaginal moisture and not likely to improve the condition of the vulva, but certainly won’t hurt and no reason not to continue until your upcoming appointment. But there are also some vulvar skin disorders that can occur so it is important for an assessment to be done to properly treat and manage this.

Jeannie
Jeannie

February 15, 2019

I am 62 it has been 15 years since last period I have an appointment in 10 days with obgyn. I
Suspect vaginal atrophy. I am trying replense mean while. My first concern is my old episiotomy scar is apparently tearing. Wondering how thi might be treated. It now has a hangnail appearance and is uncomfortable

Dr Barb
Dr Barb

November 26, 2018

Another consideration is that this is a symptom of genitourinary syndrome of menopause (vulvovaginal atrophy), this occurs after menopause. The absence of estrogen makes the vulvovaginal tissues more thin and fragile and sensitive. Sex becomes more uncomfortable and there is an increased risk for UTIs as well as just feeling the discomfort after sex. This is successfully treated with a number of prescription options.

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