Closure

Case notes

A 29-year-old woman, para 0010, sustained a second-degree perineal laceration during a spontaneous vaginal delivery that was repaired. However, during the immediate postpartum period, the patient had extensive vulvar edema, a spinal headache that required a blood patch and prolonged bed rest, and a sensation of vaginal tightness.

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Despite these sequelae, she was breastfeeding successfully. She had a history of irritable bowel syndrome and anxiety; in particular, she expressed concern throughout the pregnancy at her ability to deliver a healthy child vaginally. She was also anxious about her ability be a successful mother, but she denied any previous psychiatric treatment.

At the 6-week visit, a 1-cm area of labial conglutination was clearly visible ( Figure ). The patient admitted to obsessive cleaning of the perineum with various antiseptics, local anesthetic gel, frequent sitz baths, and an excessive use of soap. She was offered a trial of local estrogen cream but preferred to try coconut oil. At another visit 3 weeks later, complete epithelization of the area was evident.