Severe tears & pelvic floor injury
It Still Hurts Down There: Perineal Pain Months After Birth
The short answer
Soreness after a tear or episiotomy usually settles within a few weeks. If you're still in pain three months or more after the birth, when sitting, walking, going to the toilet or having sex, something may not have healed properly. Common causes include a repair that didn't bring the tissue back together well, tight or thick scar tissue, a tear that was worse than recognised, or nerve injury. Many of these can be improved, sometimes with a straightforward procedure. If the pain stems from a poor repair, a missed tear, or delays in getting you help, a claim may be possible.
"You should be healed by now."
Everyone keeps telling you that. Your stitches dissolved long ago. Your six-week check said everything looked "fine".
But sitting still hurts. You perch on one side of your bottom. You avoid long car trips. Going to the toilet brings a sharp sting, or a deep ache. And sex, if you've tried, feels impossible.
You might have started to wonder if it's in your head, or if you're simply not as tough as other mums.
Pain months after birth isn't weakness. It's a sign something hasn't healed the way it should.
You're not alone in being dismissed. Amy Dawes of the Australasian Birth Trauma Association told the NSW inquiry that women often feel dismissed when they report ongoing pain after birth, and that this worsens their mental health. Research by Birth Trauma Australia, reported by AAP in 2025, found that poor pain and injury management is one of the biggest contributors to birth trauma.
How long perineal pain should last
| Time after birth | What's common | When to get checked |
|---|---|---|
| First 2–3 weeks | Soreness, stinging when you wee, discomfort sitting or walking | If pain is getting worse, or the area is hot, swollen, smelly or opening |
| 6 weeks | Mostly healed. Some tenderness is possible | If you still need pain relief, or can't sit comfortably |
| 3 months and beyond | Most women are largely comfortable | Any ongoing pain, tightness, a lump, or painful sex |
If you're in the third row, please don't wait any longer.
Common causes of pain that won't go away
A repair that didn't heal well.
If the layers of tissue weren't brought back together well, the area can heal unevenly. That can leave a ridge, a gap, a tight band or a misshapen opening. The Royal Hospital for Women's perineal trauma guideline lists significant pain and disfigurement as reasons for a secondary repair.
Scar tissue.
Some scars become thick, tight or sensitive, especially after an episiotomy or a tear that broke down and healed slowly.
Granulation tissue or stitch problems.
Small patches of overgrown healing tissue, or a stitch that didn't dissolve, can cause localised pain, bleeding or discharge. These are often simple to treat once they're found.
A tear that was worse than recognised.
If a sphincter tear was missed and stitched as a minor tear, you may have pain as well as bowel symptoms. See severe perineal tears.
Nerve injury.
A long or difficult birth can stretch or compress the pudendal nerve, which supplies the perineum. That can cause burning, shooting or electric pain, often worse with sitting.
Pelvic floor muscle problems.
After injury, pelvic floor muscles can become tight and overactive, guarding against pain, which itself causes pain. Others are weakened or torn, as in levator avulsion, which can bring a dragging ache, especially with prolapse.
If this is landing for you, and you've been told you "should be healed by now" when you clearly aren't, I'd be glad to listen. No pressure.
Getting it properly assessed
- Ask your GP to examine the area, not just ask about it, and to refer you if anything looks wrong
- Ask for a referral to a hospital perineal clinic, urogynaecologist or gynaecologist with an interest in birth injuries
- See a pelvic health physiotherapist. They can assess scar tissue, muscle tension and nerve symptoms
- Keep a simple pain diary: when it hurts, what makes it worse, and what you've tried
- Ask for your birth records, especially the notes describing your tear and repair
Women who had a severe tear should already have had specialist follow-up. The Royal Hospital for Women's severe tear procedure sets clinic reviews at around 4 weeks and 4 months. If that didn't happen, ask why.
What can be done
The right treatment depends on the cause. It might include:
- Pelvic health physiotherapy: scar massage, muscle relaxation, graded exercise, nerve desensitisation
- Treating granulation tissue or removing a retained stitch, often a minor procedure
- Medication for nerve pain, or local treatments
- Corrective surgery to refashion a poorly healed perineum, sometimes called a perineoplasty or secondary repair
- Treating any underlying sphincter or pelvic floor injury that's been missed
- Psychological support, because chronic pain after a traumatic birth affects your whole wellbeing
The Australian Physiotherapy Association's 2025 position statement notes that symptoms can appear straight away or develop later, and that support may be needed for a year or more. It has also called for Medicare funding for pelvic health physiotherapy after birth injury, because access is so uneven.
When ongoing pain may be negligence
Pain doesn't automatically mean anyone did anything wrong. But a claim may be worth exploring if:
- your tear was more severe than recorded, and was missed
- the repair was poorly done, leaving you with deformity or pain needing corrective surgery
- your pain or wound problems were dismissed for months. See "It's normal after a baby" and when being dismissed by a doctor becomes a legal issue.
- you weren't offered the follow-up a severe tear requires
The NSW Parliament's 2024 Birth Trauma report heard from many women whose injuries and pain were overlooked. For what compensation can cover, including corrective surgery, physiotherapy and the impact on your life, see living with a pelvic floor injury, and what a claim can cover. If the issue is a diagnosis that came too late, our page on delayed and missed diagnosis claims explains more.
Looking after you.
Chronic pain wears you down, especially while caring for a baby. PANDA is on 1300 726 306. The Gidget Foundation offers free counselling for new parents. Amy Dawes's piece in O&G Magazine, "Your normal isn't our normal", may also help you feel less alone.
Frequently asked questions
Is it normal to still have perineal pain six months after birth?
Most women are largely comfortable by then. Ongoing pain at six months isn't something to accept, so please ask for an examination and a specialist referral.
Can a badly healed tear or episiotomy be fixed?
Often, yes. Depending on the cause, treatment ranges from physiotherapy and minor procedures to corrective surgery.
Can I claim compensation for ongoing pain after a tear?
Possibly, if the pain stems from a missed tear, a poor repair, or delays in treatment. Independent experts review your records to work out whether the care fell short.
Is there a time limit?
Yes. Time limits often run from when you knew, or ought to have known, about the injury and its cause. Please get advice early.
A closing thought
You may have been told, in a hundred small ways, to get on with it. But you can't heal from something nobody has properly looked at.
So here's a question: what would it mean to sit down, go for a walk, or be close to your partner without bracing for pain?
Keep reading: Maternal birth injuries: what we must talk about · Birth trauma and obstetric negligence
This article is general information only. It is not medical or legal advice, and it doesn't replace advice from your own doctor, midwife or physiotherapist. Reading it does not create a lawyer–client relationship. If you are in crisis, please call Lifeline on 13 11 14 or 000 in an emergency.
