How long will the perineal pain from delivery last so I can know how long before I can resume intercourse?
One study that looked at how long, on the average, it took women to recover various functions after normal vaginal delivery found that the median time (time for 50% of subjects) "for perineal comfort in general (including walking and sitting) was 1 month (range, 0-6 months); 20% of women took more than 2 months to achieve general perineal comfort.
For comfort during sexual intercourse, the median time was 3 months (range, 1 to more than 12 months); 20% of women took longer than 6 months to achieve comfort during sexual intercourse. ".
You would think that the pain with intercourse is only present if you have an episiotomy but that is not the case. In another study that looked at postpartum painful intercourse (dyspareunia), they found that 72% of postpartum women had pain especially at entrance to the vagina.
While this pain was more likely if a woman had a vaginal delivery, it was also present in over 20% of women who had Cesarean sections. Women who were nursing also had a higher incidence of painful sexual intercourse.
Therefore, in general, you should expect that it takes about month before perineal discomfort with walking or sitting goes away but it may easily take 2 months. Also it will take about 3 months before the discomfort with vaginal intercourse goes away but it may be 6 months or more.
What differences are there in vaginal symptoms after delivery if I have an episiotomy versus having no episiotomy?
It is very difficult to say for sure what difference in vaginal symptoms occur on the basis of having or not having an episiotomy. Even in older studies in which episiotomies were routinely performed, about 25% of women did not get one either because they delivered too fast or there was no concern whatsoever that the baby would cause tearing.
The randomized trials that have been performed in which half the women had routine episiotomy (only 73% actually had them as intended) and the other half had episiotomies in restricted to situations in which the doctors thought they would significantly tear if it was not performed (27%), can show us what happens when there is a decrease of almost 50% in the episiotomy rate.
These studies tell us that there is no difference in painful intercourse or incontinence by whether episiotomy was performed routinely or not. If episiotomy was causative of painful intercourse (dyspareunia) then we would have expected there to be a higher incidence of such problems in the group that had 50% more episiotomies.
This is also consistent with the study that found that the postpartum pain with sex was only located at the exact site of the incision line in 6% of cases when over 45% of women complained of discomfort with intercourse upon vaginal entry.