Client Question: If I have pelvic floor tension, am I more at risk for perineal tearing during birth?
Perineal tearing is a very common occurrence during a vaginal delivery, particularly in a first birth. But is your risk higher if you’ve had chronic pelvic floor tension or pain syndromes like vaginismus or dyspareunia (painful sex)? When a client asked me about this I looked into what the current research said. Here’s what I learned.
Pelvic Floor Tension Syndromes Were Not Listed As A Risk Factor For Perineal Tearing
Several studies looked at risk factors for severe perineal injury and vaginismus or pelvic floor hypertonicity were not listed as risk factors. Factors relating to baby weight, baby position (occiput posterior), and time spent in later stages of labor were most noted as increasing risk for perineal tearing. Younger maternal age and first-time birth also increased risk. General incidence of perineal tearing is high, up to 84%.
Perineal trauma: incidence and its risk factors
Risk factors for severe perineal trauma during childbirth: An updated meta-analysis
There Is Some Increased Risk For Perineal Tearing If You Have Pelvic Tension Syndromes Like Vaginismus Or Dyspareunia
Studies that looked specifically with women with vaginismus or dyspareunia did note higher rates of overall perineal tearing in these groups, but did not see higher rates of severe tearing (3rd or 4th degree tearing). However, 1st and 2nd degree tears are extremely common for all birthing people and typically have no long-term effects. Any lingering issues with perineal scar mobility and discomfort can be addressed with a pelvic floor PT in the postpartum period.
Obstetric outcome of women with primary vaginismus
Delivery in patients with dyspareunia - A prospective study
Perineal Stretching/Massage In The Weeks Leading Up To Delivery Can Help Reduce Risk Of Perineal Tearing
I know hearing how often tearing occurs and how pelvic floor tension can increase it may seem scary. However, prenatal perineal stretching can reduce the risk of perineal tearing, so this can help offset any increased risk you may have. Aside from getting the muscles and skin used to stretching, it can also lower the fear and anxiety response that the studies with vaginismus noted were higher in those patients.
Conclusion
In conclusion, if you have pelvic floor tension you may have some increased risk of perineal tearing (but not the higher degree tears that cause more dysfunction). However, there are many other factors that you won’t control that may impact your risk more than your pelvic floor. Risk of low degree perineal tears are high for all birthing people and generally do not have any long-term impact. All birthing people can reduce some of the risk by learning and practicing perineal stretching in the weeks leading up to birth. Ask your OB, midwife, or pelvic floor physical therapist about perineal stretching!