It’s probably not something you’ll chat about with your friends over coffee, but for many women, a bit of information about exactly what to expect ‘down there’ following childbirth is helpful.
After all, forewarned is forearmed, and it sometimes turns out that the horror stories you've been hearing are in fact wild exaggeration, or at least, extremely rare.
After childbirth – what to expect
The first thing to bear in mind is that the vagina is impressively stretchy (it can expand up to 10cm to fit the baby’s head through), and that any changes that do occur are, more often than not, reversible, particularly with the help of pelvic floor exercises.
There is good evidence that regular pelvic floor exercises not only reduce the risk of urinary incontinence during pregnancy, but after delivery help the vagina return to the “non-pregnant” state.
After birth, it is very common to have a feeling of “vaginal laxity,” which could result in either incontinence or prolapse. Just over 40% of women will experience a tiny amount of urine that’s released when you’re laughing or sneezing. About 10% will experience symptoms of prolapse. You’ll probably know if you’re one of them from the heavy feeling around the vagina, as if something is 'coming down', or from noticing a bulge in the area.
Sex after childbirth
Sex is unlikely to be at the forefront of your mind after childbirth, particularly as your estrogen levels drop, encouraging the production of breast milk but also lowering your libido in the process.
However, when you do feel ready to have sex again, the most important thing for you and your partner is to take it slowly.
Remember that lower estrogen levels may result in vaginal dryness, so have plenty of lubricant on hand. And, if laxity is a problem, increase friction and tightness by trying positions where the woman has her legs together, or is on top for deeper penetration.
Thankfully, few women are left with significant long-term problems, however, below are some treatment options:
Improving your pelvic floor:
Pelvic floor physical therapists can teach you how to strengthen your pelvic floor muscles, and there are many apps that can remind you to complete your daily workout. There are also various vaginal inserts that can be used such as vaginal weights that are effective non-invasive solutions to tighten the vagina and improve urinary incontinence.
The surgical route?
While surgery is rarely the first option to correct postpartum vaginal pain, there are some instances when surgery is appropriate:
Persistent pain: If the pain is mostly occurring at the bottom of the vagina, episiotomy revision may be necessary. Recently, vaginal laser treatments have become available, however, they usually cost about $3,000, and the scientific data regarding their success are lacking at best.
Stress Urinary Incontinence: Persistent leaking when coughing, laughing, sneezing, or exercise is often best treated with a 15 minute outpatient procedure called a sling. This procedure carries a success rate of about 90%
Pelvic Organ Prolapse: A persistent vaginal bulge cannot be corrected by simply performing kegal exercises. Surgery is usually performed as an outpatient, and also carries a success rate of about 90%.
Most importantly, if you feel persistent pain, then don’t suffer in silence – a urogynecologist such as Dr. Littman should be able to help.