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Evidence LibraryPostpartum and the first yearWhat nobody warns you about
Evidence Library · What nobody warns you about

Painful sex at one year, sorted by how badly you tore

One in four women with no tear or a small one. More than one in two after a severe tear. A full year later.

This is the table that women are almost never shown, and it is the one most likely to change what a woman concludes about herself.

554 women in Denmark, all having a first baby, were sorted by how much damage was done to the perineum. They were examined and asked about sex twelve months later.

What happened to the perineumPainful sex at 12 months
No tear, a labial tear, or a first-degree tear25%
Second-degree tear38%
Third- or fourth-degree tear (through the anal sphincter)53%
25%
No tear or minor tear
Painful sex at 12 months
38%
Second-degree
Painful sex at 12 months
53%
Third or fourth degree
Painful sex at 12 months

Those percentages are the plain risk, not a comparison. One woman in four with little or no damage still has pain a year on. After a severe tear, it is more than half. Adjusting for other differences, women with a second-degree tear were about twice as likely to report pain as women in the first group, and women with a third- or fourth-degree tear about twice as likely as well.

This is one study, in one country, in women having a first baby, at one point in time. It does not tell you what happens at eighteen months or after a second birth. It does tell you that a year is not long, and that the size of the tear is a real and knowable thing that changes the odds.

Ask this before you leave the hospital, and again if sex still hurts"What degree tear did I have, and is it written in my notes?"
"Given that degree, what proportion of women still have pain at a year?"
"Sex still hurts. I would like to be examined, not reassured."
Where this comes from:
557. Gommesen D, Nohr E, Qvist N, Rasch V. Obstetric perineal tears, sexual function and dyspareunia among primiparous women 12 months postpartum: a prospective cohort study. BMJ Open. 2019;9(12):e032368.

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