Its probably what frightens us most about childbirth. The blood, we can handle; the pain, we can live through, but the thought of tearing or being cut down there makes us quiver with fear.
Almost all women feel scared about this, says midwife Gail Johnson of the Royal college of Midwives, but I can assure you, the thought of it is far worse than the reality.
Giving birth vaginally is bound to take its toll on one of the most sensitive areas of the body. But being prepared is better than scaring yourself silly imagining all sorts of scenarios. So, here, to calm your fears, are the facts from the experts
What exactly is a tear?
It is damage to the skin, tissue and, occasionally, muscles of your vagina and perineum (the area between your vagina and anus). It can be anything from a nick in the skin to a deep laceration, and is caused by the pressure of your babys head as she comes into the world.
I know it sounds scary, says John Bidmead, consultant obstetrician and gynaecologist at Londons Kings Cross Hospital, but your perineum is actually designed to stretch, tear and heal. Indeed, most midwives and obstetricians would rather let you tear than make a surgical cut.
Does every woman tear? No, says Mr Bidmead. Id say around one-third of women having their first baby tear and 10% of those having subsequent babies.
What makes a tear more likely?
Tears can happen to anyone, but are more likely if your baby is big, comes out face up or with her head in an awkward position. You may also tear if the delivery is fast or you need forceps or a ventouse.
Is there anything I can do to prevent tearing?
Some women swear that massaging the perineum before the birth with vitamin-E-rich oil makes it less likely to tear. There is no proof, says Gail, but it is a positive way to prepare you for the birth. What matters most is listening to your midwife at the pushing stage. Shell advise you on when to push, and when to stop and pant and allow yourself to open up gradually. You are less likely to tear if you take the pushing stage slowly.
Does it hurt?
Your perineum is numb and stretched, so you are unlikely to feel it tearing, say Gaby.
Will I need stitches?
If its a small tear, probably not. With a longer, deeper tear, the midwife or consultant might numb the area and pop a couple of stitches in just to stem the bleeding and help close the wound, says Mr Bidmead. If the tear is very serious, though and this is unusual it will need careful repair in the operating theatre.
What is an episiotomy?
During birth, if your midwife can see that your baby needs more room to pass through quickly you may need to be given an episiotomy, which is a small cut (2-3cm). Find out what to expect and how you will heal if you need one, click here