It corresponded to the area where the knot was tied after the episiotomy repair. The area of tenderness was only about 5mm wide, and was only noticeable when touched with a Q-tip or the examining finger. The vagina, cervix, uterus, ovaries, labia, and anus were nontender. There was no sign of infection or vaginal dryness. In the patient presented here, the most likely cause is scar tissue of the vaginal tissue.
Scar tissue can develop after vaginal surgery, such as episiotomy repair.
The area of scarring can be quite small, but can cause intense pain when irritated. It is important to note that this can occur even with the best surgical technique. For reasons that are poorly understood, scar tissue tends to develop in women quite often after gynecologic surgery. There are a number of possible treatment options for this patient. Her doctor could prescribe an estrogen cream to apply to the tender area each night for a month or so.