Cervical and vaginal involution postpartum

The cervix is patulous and haemorrhagic immediately after delivery. After about 1 week post-delivery the cervix has contracted to about 1-2 cm dilatation. By the end of the end of the second week there is closure of the cervical os. Cervical lacerations heal spontaneously and the external os becomes a transverse slit.

The vagina returns to almost its prepartum condition after about 3 weeks.

In general, perineal injuries (including spontaneous tears and episiotomies) heal rapidly due to a rich pelvic vascular supply, with initial tissue closure typically achieved within 1 to 2 weeks post-delivery, while complete structural remodelling of deeper layers occurs over 4 to 12 weeks depending on the severity of the trauma.

The healing time of a particular tear will vary with the “degree” of tear (1,2,3).

First-degree tears:

• superficial injury involving only the perineal skin or vaginal mucosa.
  • tissues heal rapidly and spontaneously, often within 1 to 2 weeks
  • suturing is frequently unnecessary unless required for haemostasis.
  • long-term structural or functional morbidity is rare

Second-degree tears and episiotomies:

• anatomically, a standard episiotomy mirrors a second-degree tear.
• initial surface healing and closure of the muscle bed typically occur within 2 to 4 weeks
• complete tissue remodelling and strength are expected by 4 to 6 weeks
  • episiotomies and second-degree tears significantly increase the probability of localised perineal pain and wound-healing problems at the third postpartum week compared to intact perineums

Third- and fourth-degree tears (obstetric anal sphincter injuries [OASI]):

• severe injuries involving partial or total disruption of the anal sphincter complex (third-degree), or extending through the anal mucosa (fourth-degree)
• complete structural and muscular healing requires 6 to 12 weeks
• long-term tracking shows that between 15% and 61% of women continue to suffer varying symptoms of anal or flatus incontinence and chronic dyspareunia following primary repair (3)

References:

1. Adanna Okeahialam N, Thakar R, Sultan AH. The clinical progression and wound healing rate of dehisced perineal tears healing by secondary intention: A prospective observational study. Eur J Obstet Gynecol Reprod Biol. 2022 Jul;274:191-196.
2. Lewin S et al. Wound Healing After Vaginal Delivery, Episiotomy, and Cesarean Section Delivery Among Women With IBD: Results From the PIANO Registry. Inflamm Bowel Dis. 2025 Aug 1;31(8):2106-2111.
3. Villot A et al. Prise en charge des périnées complets (déchirure périnéale stade 3 et 4) : revue de la littérature [Management of third and fourth degree perineal tears: A systematic review]. J Gynecol Obstet Biol Reprod (Paris). 2015 Nov;44(9):802-11.