Nagging concerns about the health of your nether regions can cause anxiety. We answer your awkward questions. By Francoise Gallet
Will childbirth stretch my vagina to the point that sex is no longer pleasurable? What if my vagina is too ‘loose’ for my partner? What if I tear, will sex hurt and will I be able to hold in gas, urine and a stool when I need to? Nagging concerns about the health of your nether regions post childbirth can cause anxiety. Fear not, there’s an answer for just about any concern.
Your pelvic floor
It’s not only your vagina that’s affected during childbirth. Between your pubic bone and the sacrum (which is the base of your spinal column) is your pelvic floor and other connective tissue layers. The perineum is the area between the vagina and the anus.
“These different layers of muscles, ligaments and tissues act like a hammock to support your uterus, vagina, bladder and rectum,” explains Hester van Aswegen a physiotherapist working at the pelvic floor unit at the Wits Donald Gordon Medical Centre. “During pregnancy, all of these muscles and connective tissues are affected,” she explains.
Your pelvic floor:
- Keeps you continent (prevents leaking gas, urine or stools)
- Prevents prolapse (sagging of the bladder and uterus)
- Helps with pelvic and spinal stability, providing a solid base upon which all other trunk muscles work when moving
- Plays a role in sex (voluntary contractions contribute to pleasurable sensations).
No get out of jail free card
“During pregnancy, all the muscles and connective tissue in the area are affected. This means that a C-section doesn’t offer you a get-out-of-jail free card,” explains Corina Avni, a women’s health physiotherapist in Cape Town. Pregnancy alone is enough to stretch and strain the musculature of the pelvic floor as well as other core muscles such as your abdominals and lower back muscles.
Although a C-section can protect your pelvic floor from the stretching involved with vaginal delivery, a C-section incision to your abdominal muscles impacts core stability and, ultimately, your ability to control the muscles of your pelvic floor. “The decision of whether to opt for vaginal birth or a C-section isn’t a simple one,” says Hester.
Stretching and recoiling
“It’s completely normal for the vagina to stretch during childbirth. Learning how to voluntarily relax your vagina and pelvic floor correctly will help your vagina stretch as much as it needs to when birthing your baby,” says Corina.
The numbing of an epidural causes loss of voluntary control over your pelvic floor. “Women who haven’t learnt to relax their pelvic floor are too tight, which could lengthen their second phase of labour (where the baby moves down the birth canal),” she explains.
“One of the great things about the vagina is that it not only has the elasticity to expand, but also the capacity to recoil,” explains Hester. This is why it’s important to be able to voluntarily tighten the muscles of your pelvic floor.
Depending on how much it was stretched, the vaginal opening may return to a point very close to its original structure – given enough time and pelvic floor exercises.
As normal as it is for your vagina to stretch during childbirth, it’s also normal to experience swelling and bruising of the pelvic floor. This means you can expect some leaking (urine or stool) and back pain for about six weeks post birth.
“You may also find that urinating or passing a stool is painful for a week to 10 days post birth, explains midwife Pippa Hime.
This is also true for women who tear their perineum during childbirth. Unless it’s a third- or fourth-degree tear (a laceration that extends to the anus), the swelling and discomfort should ease within10 days when the stitches heal.
“Post birth, it’s also worth adjusting your physical expectations of what’s appropriate in terms of long-term exercise choices,” suggests Corina. Women who have given birth (vaginally or via C-section) shouldn’t expect to have the tone needed to manage the biomechanics of exercises like star jumps. Running without the correct and continual activation of the pelvic floor should also be avoided. If you’ve given birth, ditch the boot camps and the road marathons, and find a way to exercise that will help you grow an awareness of your pelvic floor.
Now, about sex…
This vaginal change almost inevitably leads to concerns around sexual pleasure – and whether your partner will notice the difference.
“Unless you experience a major birth trauma (such as a third- or fourth-degree tear), your partner shouldn’t notice much of a difference,” reassures Hester. Try shifting your preoccupation with your partner’s sexual enjoyment to pursuing sensations that are enjoyable for you,” urges Corina. “If you’re enjoying sex because you’re present and dynamically engaging your pelvic floor, chances are your partner will be enjoying sex too.”
Remember to give your pelvic floor and vagina time to heal sufficiently before resuming sex. Most healthcare providers suggest you wait until after your six-week, post-birth check-up.
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