vaginal tear

Sheath tear: description

A vaginal tear is a bleeding injury to the vagina. It usually develops during a natural vaginal birth or a vaginal-operative delivery. In the latter case, the child is also delivered by the vagina, but in contrast to spontaneous birth aids such as forceps (forceps delivery) or the suction cup (vacuum extraction) needed to help the child to the world. These instruments increase the risk of developing a vaginal rupture.

Sheath tear: Explanations based on the anatomy

A vaginal tear can occur in different sections of the vagina. It is a muscle tube and connected at the top of the cervix with the cervix. In some cases, the vagina can rupture there and there is a vaginal tear (Kolporrhexis). But it can also tear the labia. Then one speaks of a labia tear. The dam between the vagina and the anus may also tear in the event of a vaginal tear.

Sheath tear: symptoms

After a spontaneous birth or pliers or Saugglockengeburt a mother can bleed heavily from the vagina. The bleeding can also be weaker or run into the body. The vaginal tear is then often recognized only after a postnatal examination by the gynecologist. A vaginal rupture can be both extremely painful and not very painful. A labia rupture, ie a laceration of the labia, usually hurts very much, because the labia have many nerve endings. If a rupture of the labia occurs during the child’s head, one often sees a so-called blood collar in the neck of the newborn.

Sheath tear: causes and risk factors

The reason for a vaginal tear is most often a vaginal birth. Even with a spontaneous delivery, a vaginal tear can occur, but it is more common in a pliers or Saugglockengeburt. Further risk factors for a vaginal tear are a deep rupture of the perineum or a too small episiotomy (episiotomy). Too much pressure during childbirth can result in a vaginal tear. In addition, low extensibility of the vaginal tissue (for example, scarring), as well as fears and cramping of the mother, increase the risk of the occurrence of a vaginal tear. Various factors of the child can also contribute to the development of a vaginal tear. These include a large head and shoulder girdle, a head posture deviating from the norm, and an arm next to the head.

Sheath tear: Prevent

To lower the risk of vagina rupture before birth, the pregnant woman can specifically train her pelvic floor muscles. Also, a daily massage of the perineum in the last three to five weeks before birth can help because it improves the tissue elasticity a little. During delivery, some measures can also prevent a tear. This includes the relaxation of the mother in the delivery room. It can also help if the midwife repeatedly covers the outer vagina with moist, hot compresses during the birth period.

Sheath tear: examinations and diagnosis

Your gynecologist diagnoses and treats a vaginal tear. Should he have the suspicion of a vaginal rupture, he asks – if he was not the actual doctor – the following questions to raise your medical history (anamnesis):

• When did you give birth?
• How did the birth go?
• Have you had a baby before?
• Do you have pain or discomfort in the vagina?

Sheath tear: physical examination

Subsequently, your doctor examines the vagina. To do so, lie on your back with your legs spread wide and the doctor inserts a so-called speculum (an elongated, spreadable instrument) into your vagina to unfold it. In this way, a precise examination of the entire vaginal mucosa is possible and a Scheidenriss can be detected early. This speculum examination should be routinely done after each vaginal delivery.

In addition, the doctor examines the so-called dam, ie the skin bridge between vagina and anus. Here, a ridge tear accompanying the vaginal rupture may be present. With some time interval to the birth one can already see a bleeding from the vagina of the mother with a Scheidenriss without further examination.

Sheath tear: other possible diseases

In a postpartum (postpartum) hemorrhage, the physician must differentiate other causes from a possible vaginal tear. These include:

• Uterine atony (inadequate contracting of the uterus)
• Placenta retention (incomplete detachment of the nut cake)
• tear of the perineum
• bleeding disorders

Sheath tear: treatment

A vaginal tear is usually treated surgically. The two sides of the tear are sewn together again. This happens with resorbable (self-dissolving) threads. The seam technique is either a single seam, that is, several individual threads are set. Or a continuous seam is chosen.

Before the vaginal tear, the corresponding spot is anesthetized. This takes place as so-called local anesthesia. In this case, the anesthetic (for example, mepivacaine or lidocaine) is either injected under the mucous membrane of the vagina or applied as a spray. Local anesthesia prevents the pain stimulus from being transmitted via the nerve pathways. After a short exposure time, the vaginal tear can be sutured painlessly. In the case of a particularly deep or near-uterine rupture of the vagina, as well as a labial tear that involves the clitoris, the suture should be under general anesthesia, otherwise it can be very painful.

Sheath tear: treatment outside a clinic

Should a vaginal tear occur outside of a clinical facility, transportation to a nearby clinic should be arranged. Until then, the patient should be stored according to Fritsch. This means that the supine patient gets a high-suction compress placed in the vagina and crosses the legs at knee height.

Sheath tear: treatment in special cases

If not only a simple vaginal rupture but a vaginal tear of the uterus (Kolporrhexis) are present, in most cases a surgical treatment via a stomach opening (laparotomy) must be done. A vaginal tear often bleeds heavily and can be life-threatening. Since many arteries that feed the uterus are damaged by the tear, the uterus often needs to be removed to save the patient’s life.

A longitudinal labia rupture does not always have to be sutured because it often bleeds for a short time. However, a transverse labial tear almost always requires surgical treatment.

Sheath tear: Disease course and prognosis

Overall, the vaginal rupture has a good prognosis. He usually heals within a few days. Since normally absorbable (self-dissolving) sutures are used for the suture, they need not be pulled later.

Wound healing may possibly be disturbed by bruising (hematoma). These must then be surgically removed (“cleared”), so as to give the vaginal tear the chance to heal. Other reasons for a further gaping wound despite surgical treatment (Nahtdehiszenz) can be:

• infection
• Wound healing disorder z. B. by a suppressed immune system
• unsuitable suture

These complications must be treated specifically to help with vaginal tear to achieve a good cure. In addition, it is more common in wound healing disorders that the result is suboptimal from a cosmetic point of view.