A perineal tear or episiotomy normally finishes healing within about 4 to 6 weeks after delivery. If it's still painful, keeps reopening, or there's ongoing discharge months later, that's outside the normal healing timeline and is worth a specific examination — not something to keep waiting out. There are a handful of well-recognised reasons this happens, and most of them are treatable once identified.

Why a repair can fail to heal properly

  • Infection at the repair site. This is the most common reason a wound that seemed to be healing suddenly breaks down or starts discharging — infected tissue doesn't hold stitches well and can reopen partially or fully.
  • Wound breakdown (dehiscence). The repair can separate along the stitch line, sometimes from infection, sometimes from pressure or strain on the area before the tissue has fully knitted together.
  • A deeper tear than initially recognised or repaired. Tears that extend further than the original repair accounted for (including into the anal sphincter) can leave an area that doesn't heal as expected if it wasn't fully addressed at the time.
  • Granulation tissue. Excess healing tissue can form at the wound site, which looks like it isn't closing properly and can bleed or catch during movement, but is a different problem from an open wound and is managed differently.
  • A retained stitch or suture reaction. Occasionally the body reacts to the dissolvable stitch material itself, causing localised irritation, discharge, or a small area that won't settle until the stitch has fully dissolved or is removed.

Signs this needs an examination, not more waiting

  • Pain that is getting worse, not better, past the first few weeks
  • Visible gaping or separation of the wound edges
  • Discharge, especially if it's foul-smelling, yellow or green, or accompanied by increasing redness and swelling
  • Fever, which points toward infection and needs prompt attention
  • The area reopening after seeming to heal, whether spontaneously or after a specific activity
  • Pain during sex, sitting, or passing stool that persists well beyond the initial recovery weeks

A perineal repair that's still causing problems months after delivery is not something you're expected to just live with. There's almost always a specific, treatable reason, and it needs an in-person look to identify.

What the assessment and treatment usually involve

  • A direct examination of the area, since appearance (infection, dehiscence, granulation tissue, a retained stitch) guides treatment and can't be reliably judged from symptoms alone
  • A swab test if infection is suspected, to identify the organism and pick the right antibiotic
  • Treatment of granulation tissue, if present, which is usually straightforward (commonly a simple application in clinic) and resolves the problem once treated
  • Re-suturing, in some cases of wound breakdown, once any infection is cleared — not every reopened wound needs this, and your doctor will judge based on how much separation there is and how it's healing
  • Removing a retained stitch, if one is found to be the cause

What you can do while waiting for your appointment

  • Keep the area clean and dry, and change pads frequently
  • Avoid strain on the area — heavy lifting, prolonged standing, or constipation (straining during a bowel movement puts direct pressure on a perineal repair)
  • Don't attempt to resume sex until you've been assessed and cleared, if healing is in question
  • Don't self-treat with over-the-counter creams for what you're assuming is a simple delay — the right treatment depends on which of the causes above is actually present

For what a normal, uncomplicated episiotomy repair and healing process looks like, see episiotomy: what actually gets cut, and how it heals.

Frequently asked

How long should a perineal tear or episiotomy normally take to heal?

Most repairs are substantially healed within 4 to 6 weeks, though some tenderness can linger a little longer. Ongoing pain, reopening, or discharge beyond this window is outside the typical pattern and worth getting examined.

Is it normal for the wound to reopen a little after I resume normal activity?

No — a properly healed repair shouldn't reopen with normal activity. If it does, that points toward incomplete healing, infection, or a wound that separated more than it should have, and needs to be looked at rather than monitored at home.

Can I tell if it's infected just by how it looks?

Not reliably on your own. Redness, discharge, odour, and fever are the signs that suggest infection, but a proper examination (and sometimes a swab) is what actually confirms it and identifies which treatment is needed.

Will I need surgery again if it hasn't healed properly?

Not always. Many causes — infection, granulation tissue, a retained stitch — are managed without further surgery once identified and treated. Re-suturing is sometimes needed for significant wound breakdown, but your doctor will only recommend it if the degree of separation actually calls for it.

Does this affect future deliveries?

A perineal tear or episiotomy that heals properly, even if it took treatment to get there, doesn't generally change your options for a future vaginal delivery. Discuss your specific healing history with your doctor when planning a future pregnancy so it can be factored in appropriately.