Written by Jessica McKinney, PT, MS and Samantha Pulliam, MD and sponsored by
The vagina is strong, resilient, and designed to birth a baby! That said, pregnancy and childbirth certainly can put it to the test and a period of recovery is necessary for everyone. Things may feel different for a few months and up to a year post-partum, and for some women, ‘down there’ may never feel or look 100% the same.
Let’s get some terminology straight. People often refer to the vagina, when they really mean the vulva – the outside, visible part of the female genitalia. It includes: the vaginal opening, the urethral opening (where urine exits the body/pee comes out), the labia majora and labia minora (the outer and inner lips, which protect the openings of the vagina and urethra), and the external part of the clitoris, called the glans clitoris.1 The vagina is the inside part of the female genitalia. It’s a flexible tube that connects the uterus, or womb, to the vulva.
If you delivered vaginally, you’ll likely feel sore and swollen for the first few days or weeks after giving birth. This is a normal response to childbirth. It is very common for the perineum – the space between the vagina and anus – to tear to a small degree. Perineal tears are graded, depending on severity.
- First-degree tears involve just the skin, may not require stitches, and often heal on their own within four weeks.
- Second-degree tears involve skin and superficial pelvic floor muscles, may extend into the vagina, usually require stitches, and typically heal in four weeks.
- Third-degree tears involve the pelvic floor muscles, including the anal sphincter muscles. These are more serious, may require surgical repair in an operating room, and can take up to 12 weeks to heal.
- Fourth-degree tears are the most extensive, and involve the pelvic floor muscles, including the anal sphincter muscles and the lining of the rectum. These also may require surgical repair in an operating room and may take more than 12 weeks to heal.
While the majority of women, an estimated 53 to 79%, experience perineal tearing during vaginal delivery, most of these are first or second degree tears. About 11% of perineal tears are third or fourth degree. If you happen to fall into that minority, early repair and pelvic floor muscle exercises or physical therapy can minimize long-term effects. Discuss any concerns with your health care provider, especially if things don’t seem to be healing properly, you have persistent pain, or are having problems controlling your bladder or bowels.
If you’ve experienced any degree of perineal tear or had an episiotomy – an incision or cut into the perineum, usually done if the baby is stuck or in distress – you’re likely to have some pain and swelling while the area heals. Ice pads or a shallow bath with cool water (sitz bath) can be very helpful. You may also try rinsing warm water over the area after (or while) you pee to reduce burning and discomfort. Talk to your doctor about lidocaine to numb the area, if daily activities become too uncomfortable. If you notice any signs of infection, such as increased swelling, abnormal discharge or foul odor, are having pain that does not improve or worsens in the days and weeks after birth, contact your health care provider right away.
Sometimes things feel different…
Your vagina is designed to stretch during childbirth, and often, it will return to its original (or close to its original) shape and size. If your baby was very big or you’ve had multiple vaginal births, it’s likely your vagina may not return to its pre-pregnancy shape and size. For many women, this may not be very noticeable or of great concern. For some women, the vagina or vaginal opening may feel more loose or open after childbirth. Pelvic floor muscle exercises (a.k.a. Kegels) can help! If you’re not quite sure how to do them, or if you’re doing them right, ask your doctor or midwife to assess at your postpartum check-up, or find a pelvic floor physical therapist.
To find a pelvic physical therapist, practitioner directories can be found at the following:
- The American Physical Therapy Association’s “Find a PT” tool: Select “Practice Area” as “Women’s Health”, and then search by your location.
- Herman and Wallace Pelvic Rehabilitation Institute www.pelvicrehab.com
- Pelvic Guru https://pelvicguru.com/directory/
If you’ve had a C-section, you’re less likely to experience this sensation. But, you might – especially, if you were in labor for a while before your C-section, which may have stressed and stretched the pelvic floor. Pregnancy itself also puts a great deal of pressure on these tissues, so pelvic floor muscle exercises can be beneficial for you, too!
Another way things can feel different…
Vaginal dryness is also common after delivery and can become very uncomfortable. This happens because of a decrease in estrogen levels. Estrogen helps to maintain the lining of the vaginal wall, so that it is thick, moist, and pliable. Breastfeeding keeps estrogen levels low, and some women experience symptoms of vaginal dryness and skin that feels thinner and more delicate. Once you’ve stopped breastfeeding, hormone levels usually return to normal fairly quickly, and your vagina should soon feel back its normal state. If vaginal dryness becomes painful, talk with your doctor about treatment options. There are over-the-counter topical creams or lubricants, and in some cases, a prescription estrogen cream or suppository may be helpful.
About the authors:
Ms. McKinney is a physical therapist and has specialized in pelvic and women’s health throughout her career. Her background includes women’s health education, advocacy, and business and program development in the US as well as in low-resource global health settings. She currently serves as Vice President of Medical Affairs and Clinical Advocacy at Renovia Inc.
Dr. Pulliam a fellowship-trained and board certified urogynecologist, a subspecialty of medicine focused exclusively on female pelvic health. She has been in clinical and leadership positions at Massachusetts General Hospital and the University of North Carolina (Chapel Hill), as well as within the American Urogynecologic Society, and she currently serves as the Chief Medical Officer at Renovia Inc.
- Moore K, Dalley A, Agur A. Clinically Oriented Anatomy. Lippincott Williams & Wilkins; 2013.
- American College of Obstetricians and Gynecologists. Prevention and Management of Obstetric Lacerations at Vaginal Delivery. ACOG Pract Bull Number 198. 132(3):e87-e102. http://www.mayoclinic.org/the-anal-.
- Rothrock N, Cella D, Savarese DMF. Postpartum perineal care and management of complications. UpToDate. 2017;d(figure 1):1-18. doi:10.1007/s11920-014-0463-y.
- American College of Obstetricians and Gynecologists. Labor, Delivery, and Postpartum Care. Freq Asked Quest FAQ192. 2016. https://www.acog.org/Patients/FAQs/Assisted-Vaginal-Delivery.
- Farage M, Maibach H. Lifetime changes in the vulva and vagina. Arch Gynecol Obstet. 2006;273(4):195-202. doi:10.1007/s00404-005-0079-x.
- American College of Obstetricians and Gynecologists. Vulvovaginal Health. Freq Asked Quest FAQ190 Women’s Heal. 2015. https://www.acog.org/-/media/For-Patients/faq190.pdf?dmc=1&ts=20190118T2109581063. Accessed January 18, 2019.