Perineal repair is surgery that rebuilds the muscles and skin between the vagina and anus (the perineum) when they remain weak, separated or scarred after childbirth. It aims to improve support, comfort and symptoms such as a gaping vaginal opening or painful scar tissue. It is usually considered after pelvic floor therapy, and recovery takes several weeks.
- Duration
- About 1–2 hours
- Anesthesia
- Local with sedation, spinal or general
- Hospital stay
- Usually same day or 1 night
- Back to desk work
- About 1–2 weeks
- Intercourse
- Usually after about 6 weeks
- Cost guide
- ₩1,500,000–5,000,000
What is perineal repair?
The perineum is the area between the vaginal opening and the anus. Beneath the skin lies the perineal body, where several pelvic floor muscles meet. Tears or an episiotomy during vaginal birth can heal with the muscles separated or with tight, painful scar tissue.
Perineal repair (perineorrhaphy) reopens the area, removes problem scar tissue and stitches the muscle layers back together, then closes the skin. Its main purpose is functional: support, comfort and symptom relief. Mainly cosmetic reshaping is covered under perineoplasty, and scar-focused surgery under episiotomy scar revision.
Which symptoms may lead to a repair?
- A wide or gaping vaginal opening, or a feeling of looseness
- Air or water entering the vagina, or vaginal wind
- Pain, tightness or a tender scar at the vaginal opening, including during sex
- Discomfort when sitting or a visible notch or skin bridge
- A feeling of reduced support, sometimes with mild prolapse
If you have bowel leakage or difficulty controlling wind, the anal sphincter may also have been injured; this needs specific assessment and sometimes referral to a colorectal specialist. Symptoms of looseness without a perineal defect are discussed on our vaginal laxity page.
Treatment options compared
| Option | Best suited for | Notes |
|---|---|---|
| Pelvic floor muscle training | Mild weakness, early after birth | First-line; often 3 months of regular exercises |
| Pelvic floor physiotherapy and biofeedback | Weak or poorly coordinated muscles | Guided program; no downtime |
| Treatment of scar pain | Tender or tight scars | Topical treatment, massage or local injections may be tried first |
| Surgical perineal repair | Clear muscle separation, gaping or scar problems that persist | Usually at least 6–12 months after birth and once breastfeeding changes settle |
| Combined pelvic floor surgery | Perineal defect with prolapse | May be combined with prolapse repair |
If you plan more vaginal births, discuss timing: a future delivery can stretch or tear the repaired area again.
- Gaping or weak vaginal opening after birth
- Tight or tender scar tissue
- Discomfort when sitting or during sex
- Reduced feeling of pelvic support
- Aims to rebuild the perineal muscles
- Aims to remove problem scar tissue
- Many patients notice better comfort and support
- Continued pelvic floor exercises support results
Your perineal repair at Yoonho, step by step
- Private consultation Dr. Joonho Cho reviews your birth history and symptoms in English and examines the perineum and pelvic floor.
- Planning Findings, options, risks and a written estimate are discussed. Pelvic floor therapy may be suggested first.
- Preparation Pre-operative tests are arranged; fasting instructions are given if sedation or general anesthesia is planned.
- Surgery Scar tissue is removed, the separated muscles are brought together in layers, and the skin is closed with dissolvable stitches.
- Recovery You rest until comfortable and go home with written aftercare on hygiene, sitting and bowel care.
- Follow-up Wound checks, guidance on returning to exercise and sex, and continued pelvic floor exercises.
Recovery and possible risks
- Day 0–3 Swelling and soreness are expected. Ice packs, pain relief and a cushion help; keep stools soft.
- Weeks 1–2 Most women return to desk work. Rinse after using the toilet and pat dry.
- Weeks 2–6 Stitches dissolve. Avoid heavy lifting, intense exercise, tampons and intercourse.
- From about 6 weeks Gradual return to sex and full activity once cleared at follow-up.
Possible risks include bleeding, infection, wound separation, pain during sex if the opening is made too narrow, scarring, and symptoms persisting or returning. Careful planning aims for comfort rather than maximum tightness.
Cost and insurance for international patients
As a general guide, perineal repair costs about ₩1,500,000–5,000,000, depending on the extent of repair, anesthesia and whether other procedures are combined. A written estimate is given after consultation.
- Coverage depends on whether the repair is considered medically necessary — see health insurance for foreigners.
- English receipts and a diagnosis are available for insurance claims.
Perineal repair at Yoonho Women's Hospital in Apgujeong, Seoul is part of our surgical gynecology service and is led by Dr. Joonho Cho, whose focus includes reconstructive gynecology and the pelvic floor.
Why international patients choose Yoonho
Frequently asked questions
How long after childbirth should I wait?
Usually at least 6–12 months, so tissues can heal and pelvic floor therapy can be tried first. Your doctor will advise based on your findings.
Is perineal repair the same as vaginal tightening?
Not exactly. Perineal repair rebuilds the perineal body at the vaginal opening; vaginal tightening procedures address the vaginal canal. Some women need one, some both.
Can I have another vaginal birth afterward?
It is possible, but a future birth can stretch or tear the repair again. Many women wait until their family is complete.
How long should I stay in Seoul?
Plan at least 1–2 weeks for surgery and an early wound check. Tell us your travel dates in advance.
Will it hurt to sit?
Sitting is usually uncomfortable for the first one to two weeks. A cushion, pain relief and soft stools help.
OB-GYN Specialist · Ph.D. · Medical Director
M.D., M.Med. & Ph.D., Chung-Ang University · OB-GYN specialist training, Eulji University Medical Center · Member, Korean Society of Obstetrics and Gynecology
Last reviewed: . This page is for general information and does not replace an in-person consultation.
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