Someone a fan of Forgotten Weapons?

I know there is a difference, but so far I only found sources on episiotomy and the stitches following that procedure, but no sources on stitches after natural tears.

I have said nothing about husband stitches, although I read about the practice (or urban legend) while googling the subject of pereneal stitching. I also have never said that doctors should let tears happen (and leave untreated?), so count me equally confused.

[removed]

Thank you!

Thank you for your answer and source! Very interesting.

Hi there! Glad you're engaging with this.

> but I still remember one comment of "don't worry about how the tissue looks here, it'll feel the same and neither will notice, it doesn't have to be aesthetically pleasing. Her husband and her are gonna love this."

Yeah, that comment makes me wince a bit, too. I'm trying to picture a posterior repair surgery and where somebody might say that and really mean it. Maybe a bit of puckered vaginal mucosa? It might have been a surgical situation where she had sorted the underlying support structures and it left the mucosa looking a little odd...? I'm making this up.

I think that if your impression of this urogyn was otherwise positive, and she was otherwise compassionate and patient-centered, you can forgive a comment that didn't land right and we can give her the benefit of the doubt.

I remember a very sweet 60-year-old patient whose husband was absolutely doting. They were such a sweet couple in pre-op, and he was so warm and positive... and then as we were about to wheel her away he said "va a estar coma una quinceñera, si?" (And it'll be like it's her sweet sixteen, right?) (Except fifteen not sixteen.) And we all winced and groaned... but she laughed! And when I checked how she felt about it, said she was happy for him and looking forward to that, too.

So it's important to remember that, even if you're trying to have perfectly feminist and respectful language, your patient might not... and that's okay! Meet them where they are. Don't reflect negative ideas back at them, but engage with the positive in what they're saying.

> At this point I'm interpreting it as something the patient wanted for their own sake?

I think so. Or something that your attending has heard many times from patients. No urogyn wants to do a repair that winds up uncomfortably tight. Even if the doctor isn't compassionate, that's a miserable patient that keeps coming back unhappy! Who wants that? We're surgeons. We like to get things done right once and have them be fixed and that's it.

> (she is a great surgical educator, actually let's me cut and stitch and enjoys teaching)

I think that it's good for you to keep in mind in public forums that people are reading your words without an understanding of supervision in medical teaching.

Like, I know that we're talking, say... putting a single stitch in the exit site of a retropubic sling in an incontinence surgery... not doing the imbricating stitches of a posterior repair. And I suspect that the cutting is the trimming the excess mucosa once it's been freed up from the underlying tissue, not making the opening incision on a cesarean. i.e., appropriate times for uncertain hands, where errors can be easily guarded against or corrected.

But how will your words sound to somebody who has their surgery next week and is really nervous?

I got a digital version, I will let you know what I have found as soon as possible. Thank you!

[removed]

It causes the woman tremendous pain during intercourse. Many women who have had this done to them are unable to have pleasurable sex ever again without additional reconstructive surgery.

[removed]

Is it super painful or something, why is it so offensive? If I was getting stitches and the doctor said adding another would improve my wife's sexual experience, I'd be like 'lets do it'.

This is gold. Med Student here. I was never sure how to broach the husband stitch matter with my OBGYN attendings, usually during deliveries the perineal repairs have made perfect sense! For all the reasons you mentioned. Where it's gotten a bit more grey for me is where I was a part of a particular vaginal reconstruction+prolapse repair surgery (the former was an add on by the patient) with an awesome urogyn I've learned under (she is a great surgical educator, actually let's me cut and stitch and enjoys teaching) , but I still remember one comment of "don't worry about how the tissue looks here, it'll feel the same and neither will notice, it doesn't have to be aesthetically pleasing. Her husband and her are gonna love this." It was very frank and I enjoy that about her sense of humor. I was at a bit of a loss though about what to make of that on a grand scale as it did remind me of the "husband stitch." At this point I'm interpreting it as something the patient wanted for their own sake? Kind of like how some men opt for penile lengthening/entension surgery? (Although that's less common) I'm no expert on this topic I'm just trying to parse the situation with the now very negative, rightfully so, perception of the husband stitch. I understand a major difference here is of course the patient being the one to make this choice. Ie there's a respect for autonomy here. (At least from what's visible on our end)

I should clarify too, I only participate in procedures or surgical operations with patient permission as to how exactly I'm participating*

Husband stitches are an urban legend. If sex hurts after childbearing, it's more likely to be vaginismus or some other pelvic PTSD. Postpartum physical therapy can often resolve it.

It was - and is - a very real thing.

"A very singular character was Trotula, a noblewoman from the Norman family of De Ruggiero from Salerno, active and famous around 1050...she was the founder of the modern Obstetrics and Gynecology, and wrote the book “De mulierium passionibus ante, in et post partum” (The sufferings of women before, during and after delivery). Among other indications, she wrote “it is necessary to stitch perineal lesions due to delivery”, a very modern thought."

[removed]

My first baby had a very large head. I had an episiotomy, and stitches to repair it (nothing extra). Everything went well.

"The team investigating the Gerza archaeological site in Fayoum also uncovered a funerary building, records written on papyrus, pottery, and coffins dating from the Ptolemaic period, which spans from 305 B.C. to 30 B.C., through the Roman era, which lasted from 30 B.C. to 390 A.D. 

The government has said these finds give fascinating insights into the social, economic, and religious conditions of the people living in Philadelphia (which meant, in ancient Greek, "City of Brotherly Love") nearly 2000 years ago. 

The collection of paintings, known as the Fayoum portraits, portrays some of the wealthiest people that existed in these ancient communities. The Philadelphia settlement was home to Greeks and Egyptians over the 600-year period. 

Basem Gehad, the head of the Ancient Philadelphia Excavation project, which led the latest dig, wrote in an email to Artnet News that "no one really knows the context of these portraits," but added, "Now, we can know certainly where they came from, and find more."

Thank you!

Sorry, I don't know any source in English (or Spanish). I remember reading about this on the Italian edition of the National Geographic and from some other reputable sources, but I can't pinpoint them precisely.

When my mom was having her nursing school rotations, she had to spend time in L&D, and recalls a birth she witnessed where the mother tore in 4 different places, including up to her clit. I just can't imagine.

Hi! I'm an ob/gyn.

I don't have an answer to your question, but I have commentary on the current state of perineal laceration suturing that I want to share here to keep some harmful misinformation from spreading.

First off, perineal lacerations are very common. It is very common to have lacerations with one's first vaginal delivery.

They get measured in "degrees." 1st-degree is very superficial, 2nd-degree involves the underlying structure of the "perineal body," and 3rd and 4th degree involve some or all of the anal sphincter.

That's an assessment of perineal lacerations that's very geared towards their significance for future pelvic organ prolapse (having the vagina bulge outward) and dysfunction with defecation. It doesn't include labial lacerations, lacerations that involve the clitoris or clitoral hood, or periurethral lacerations -- those all lack a grading system, and in my experience, get described subjectively.

/u/illraceyou96, /u/Fearless_Reaction592, /u/Snakandahalf -- non-perineal pelvic lacerations are understudied. It's recent that we have good data on what we can do to reduce the risk of perineal lacerations (perineal massage, for example), and I think non-perineal lacerations will be next. I'm going to talk a little bit about why.

Although misogyny is a constant force in our world, there are things that medicine likes and doesn't like to study. Medicine likes studies with clear differences between groups and outcomes: people either did or didn't get a medication, and you look at hospitalization rates after. Clitoral and labial lacerations are tricky because they are soft-tissue injuries happening after the very unpredictable interactions between a fetus/newborn and a vulva... and then the intervention is also very randomized right now, because there's a wide range of how aggressively physicians repair these kinds of lacerations.

So I think/hope that over the next 20-30 years, we'll see development of better ratings to measure labial/clitoral lacerations, which will be followed by proving that they correlate with subsequent risk of pain or sexual dysfunction, and then that will be followed by studies to see if interventions reduce their risk and/or if we can standardize management of them.

(This kind of standardization happened for cesareans in the last decade, for context.)

I've had the privilege of taking care of a lot of people who had unattended deliveries without repair of lacerations. I'd like to say without a doubt that repairing perineal lacerations is good. People who have unrepaired lacerations are at high risk of going on to have pelvic organ prolapse, which can cause issues with discomfort with activity, sexual dysfunction, incontinence, and constipation.

/u/biRdimpersonator brings up the "husband stitch." I've had the good fortune of only training in places with a high degree of compassion and patient-centered care, and during the ongoing takeover of ob/gyn by women. Medicine is becoming less patriarchal and paternalistic. I have never seen a "husband stitch." I have never seen anybody do anything more than was needed to return the vulva (close) to the state it was in before the delivery.

Most of my work is in abortion care. Some urogynecologist might come through here and correct me on the current state of research!

That's definitely a very uncommon tear, relatively speaking, since that area is much more muscular.

There is a difference between a natural tear and an episiotomy done to prevent that tear.

A preventative cut to expand the vagina, so the tearing and rupturing is controlled, has nothing to do with the "husband stich"

So I found this post very confusing.

If a woman ruptures during birth, should the doctor just say, oh well that's nature?

Extra/unnecessary medical procedures are illegal, just adding stitches on the hope/guess that it might make the vagina smaller, is illegal.

So what is the point of this post?

An aside from your research topic, but to address the frequency: Having done a few rotations on ob/gyn l and d, I'd say ~95% or more of women have at least a grade 1 tear. I've only seen one birth out of ~50 that hasn't required stitches. Now you can get away without stitches, but the stitch hides some of the raw skin and prevents some of the pain during urination. There's a widespread belief that there's a "husband" stitch that occurs. Some background research into the prevalence of this notion would be interesting to look into as well.