Dr Julius Parker: Episiotomy and migraines

Q During the birth of my third child I got a major episiotomy. It took me weeks to recover as the stitches became infected. Six months on I am still finding sex painful. Is this normal?

AI’m sorry to hear you needed an episiotomy and also, like any operation site, having had an infection will have delayed healing. Some degree of localised pain is very common after an episiotomy, and pain during sex is reported by about nine out of ten women, so what you’re describing is completely normal.

The good news is that this is usually an improving situation, even after six months. Some degree of stretching, and scarring, of the vaginal tissues is inevitable. Gently massaging this area can help, and pelvic floor exercises will improve muscle strength and tone.

Many women notice that pain related to sex can be caused by vaginal dryness. Your partner needs to be aware of this, as taking time before attempting sex can help you relax. Using an artificial lubricant, ideally a water-based gel, may be an effective solution. You may also find it more comfortable to try a different position, and also alternatives to penetrative sex.

If the line of the episiotomy scar feels firm or lumpy, as well as painful, this is likely to be scar tissue and may be best removed. You can discuss this with your gynaecologist, who may suggest a straightforward operation called Fenton’s procedure. This is best delayed until at least six months after childbirth.

If you feel your symptoms are gradually improving then over the next six months they are likely to settle. If not see your GP or a gynaecologist.

QMy six-year-old daughter suffers from headaches, which seem to be triggered by strong sunlight. Lately, she has started to complain about her head “going black” and temporarily losing vision. However, when I check her temperature and balance, she seems fine. It’s hard to know if she is accurately reporting what is going on or if she is exaggerating. What should I do?

A By six years old most children are able to describe a headache, but may struggle with more unusual symptoms. If your daughter’s consistently complaining of recurrent headaches she should see your GP, although I suspect, from what you say, she may be experiencing migraine. This is particularly likely if there is a family history of this condition.

Other symptoms that may occur, especially in children, include abdominal pain, nausea and vomiting, and emotional upset, such as crying or irritability. Typically being able to rest and sleep improves migranous symptoms.

About 25% of cases of childhood migraine are associated with an aura. Auras are disturbances of sensation, especially vision, which may be difficult for six year olds to explain accurately. “Going black” may be the best your daughter can do.

Migraines can be triggered by emotional upset or stressful situations, environmental factors such as bright light, dehydration, or specific foods, and tiredness. If your GP suspects migraine it will be helpful for you to keep a diary of your daughter’s symptoms to try and identify any avoidable triggers.

There are other reasons for headaches. Have your daughter’s eyesight tested. Tiredness and anxiety can also cause headaches, so it’s definitely worth having a word with her teacher to check all is fine at school. You’ll know if there have been any changes at home which may be causing your daughter to be upset and you’ll hopefully be able to talk about these.

Headaches often worry parents, and hopefully your GP will be able to reassure you.