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MiddlesexMD

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

by Dr. Barb DePree MD


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!


22 comments


  • Rebecca, This sounds as though this may have something to do with pelvic floor muscles, and this wouldn’t be surprising following a pregnancy, delivery and healing following that. This is a big event for the pelvic floor and it is not unusual to have some pelvic floor muscle dysfunction. I would recommend a visit to a pelvic floor therapist for assessment and treatment. (In some countries pelvic floor PT is a covered benefit for postpartum women! I wish that were true in the US….)

    Dr Barb on

  • Erica, The biggest risk factor that is modifiable for developing uterine cancer is obesity, maintaining an ideal body weight is the single most important thing you can do to decrease that risk.

    Dr Barb on

  • Hello. I had a baby 8 months ago and now have had some frustrating issues. I have a yeast infection which I am working on resolving. I get random pains in and around my vagina. There is no burning. Its like a subtle throbbing. It sometimes radiates from my scar from delivery. I had a 2nd degree tear. (But sometimes I have the pain at the front and above my vagina where the pubic hair starts and sometimes in between the labia and no pain from the scar). Its all very inconsistent. It flairs up randomly from the scar or not. Could my scar be causing some inflammation in other areas around it? I went to the doctors for a swab and have no bacterial infection. And my yeast infection is almost gone. Any thoughts of what I should look into? I have no pain when touching the areas when they are in pain.

    Rebecca on

  • 45 year old mom of 4. All 4 births resulted in episiotomy or tearing. My only complaint is that I have a patch of skin that is constantly irritated. I was assuming it was irritated scar tissue. It burns when urine trickles down onto the skin. I already eat a plant based diet so it’s not caused from constipation. Just hoping for additional information so I can heal my precious skin. Thanks!

    Erica on

  • I’m 65, 10 yrs +/- in post menopause, experiencing tissue thinning and stage 2 pelvic organ prolapse and more recently tenderness or irritation at old episiotomy scar, even with Imvexxy 10 mcg xtwice a week and Replens. Glad to find this discussion. I heartily recommend finding a uro-gynecologist who specializes in menopausal and post-menopausal care. My experience has been they are very conversant in the care of women’s reproductive systems.

    Tess on

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