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January 14, 2020
By Kimberly Langdon, M.D., OB/GYN
After you give birth, you may be wondering what’s going on with your vagina and if it’ll ever go back to normal. Some changes, like labia swelling or skin darkening, will go away soon after you give birth. Others, however, may take longer to go away, and some changes are permanent. Here’s what you can expect.
During pregnancy, you may have noticed some changes to your vulva (the external parts of the female genitalia), including swollen labia (the flaps of skin surrounding the vaginal opening), darker skin, and varicose veins. These typically go away soon after giving birth.
However, pushing during labor and IV fluids can contribute to pain and swelling around the perineum (the skin between the vagina and the anus) so ice or cold packs can be applied. Pain medications can also be used such as nonsteroidal anti-inflammatory drugs (NSAIDs) or narcotics and a local anesthetic spray for topical use. Again, this swelling and pain should go away within a few days.
If you had a perineal tear or an episiotomy, you may have some lasting vaginal changes, depending on the severity of the tear. After the skin heals, you will likely have a scar, just like any other cut. You may have some symptoms of pelvic floor dysfunction, including incontinence (leaking urine or feces), painful sex, or prolapse (when your pelvic organs fall out of place). All of these symptoms can be addressed through physical therapy or surgery, so talk to your doctor if you experience any of them.
Tampon use is permitted once you are comfortable inserting the tampon and there is no persistent pain. It may take longer for women who had an episiotomy or a laceration (tear). The vagina and perineum should first be fully healed, which takes several weeks. This is the same for resuming sexual activity. Bleeding should be light or nonexistent and there should be no pain during penetration.
Postpartum vaginal discharge or lochia starts after delivery as a large amount of red blood flows from the uterus until the uterus contracts. Thereafter, the volume of vaginal discharge (lochia) decreases. The duration of this discharge, called lochia rubra, is variable. The red discharge changes to a brownish red, and more watery consistency (lochia serosa). It eventually decreases in amount and color and eventually changes to yellow (lochia alba). The period of time the lochia can last averages approximately 5 weeks, but 15 percent of women will continue to have lochia more than 6 weeks after delivery.
The vagina, or birth canal, is a potential tubular space. That means that when nothing is inside of it, one wall sits on top of the other wall, like a pillowcase without a pillow in it. The status of your postpartum vagina depends on how big your baby was, how long it took to push the baby out, whether vacuum or forceps was needed, and the severity of lacerations or episiotomy.
The vagina also shrinks but does not completely return to its prepregnancy size. The increased number of blood vessels and swelling regresses by 3 weeks, and the rugae (folds of the vaginal walls) of the vagina begin to reappear in women who are not breastfeeding.
Many women report feeling that their vagina is loose or lax after giving birth. While the vagina itself may not return to its prepregnant size, you can strengthen the muscles around it, to decrease these symptoms. A pelvic floor physical therapist can help develop a pelvic floor muscle training program for you.
The cervix, or opening to the uterus, begins to rapidly return to a nonpregnant state, but never returns to its original nonpregnant state which is why diaphragms need to be refitted after each pregnancy. The dilated opening (aka cervical os) is usually closed by the end of the first week postpartum.
Painful sex is a very commonly reported symptom in first year postpartum. This can be due to multiple factors, including dryness due to hormonal changes and pelvic floor dysfunction.
Vaginal dryness is a common effect of low estrogen levels, which are common while breastfeeding. During this state, the vaginal tissue appears thin and pale like it does during the menopause, known as atrophy. This causes vaginal dryness and some difficulty during intercourse, but it improves once breastfeeding ends. In the meantime, personal lubricants can help, and if that doesn’t work, talk to your doctor about estrogen creams.
In addition to dryness, pelvic floor dysfunction can contribute to painful sex. Pelvic floor dysfunction is when your pelvic floor muscles aren’t working optimally. Muscle weakness or tightness resulting from pregnancy and childbirth may contribute to painful sex and can be treated by a pelvic floor physical therapist.
Related: What is a pelvic floor?
The good news is that most likely your vagina isn’t going to look drastically different from the outside. In addition, symptoms like pain and incontinence should not be permanent. However, your vagina may not feel exactly the same as before, especially having sex, but that’s not always a bad thing. In fact, according to one study, 20% of women reported their current sexual satisfaction at 6 months postpartum to be better or much better than before giving birth. If you do have any concerns, as always, talk to your doctor.
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American College of Obstetricians and Gynecologists. Vulvovaginal Health. FAQ190, 2015 Nov. Retrieved on January 10, 2020 from https://www.acog.org/Patients/FAQs/Vulvovaginal-Health
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NHS. Vagina changes after childbirth. Retrieved on January 10, 2020 from https://www.nhs.uk/live-well/sexual-health/vagina-changes-after-childbirth/
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