Slide show: Vaginal tears in childbirth
Illustration of a fourth-degree vaginal tear
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Fourth-degree vaginal tears are the most severe. They extend through the anal sphincter and into the mucous membrane that lines the rectum (rectal mucosa). Fourth-degree tears usually require repair with anesthesia in an operating room — rather than the delivery room — and sometimes require more specialized repair. Healing also might take longer than a few weeks.

Complications such as fecal incontinence and painful intercourse are possible. If these problems occur, talk to your health care provider.

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