After seeing your body change during pregnancy, it’s totally normal to also ponder the state of your vagina after birth. Are things going to be OK down there? Will it be forever changed? How does one's vagina fare after a C-section vs. a vaginal delivery? And why isn't there a pamphlet or something for all this?
For the sake of this article, we'll be talking about some of the common changes that can happen to your vagina after pregnancy and vaginal delivery. (Of course, this is by no means an exhaustive list, and some people with C-section deliveries will experience some of these effects, too.)
Now, it's true that pushing a tiny human out of a much tinier hole has an impact. But for most people, it may not be as bad or permanent as you’ve heard. While childbirth is no picnic for your nether regions, your vagina can handle it. “The vagina is very resilient,” Sherry Ross, M.D., an ob/gyn and women’s health expert and author of She-ology: The Definitive Guide to Women's Intimate Health. Period., tells SELF. Still, it can take anywhere from 12 weeks to a year for your vagina to go back to its pre-birth state, and some things may never be 100 percent the same again, Jessica Shepherd, M.D., a minimally-invasive gynecologist at Baylor University Medical Center at Dallas, tells SELF.
So what, exactly, can you expect? If you give birth vaginally, here are some changes you might experience in your vagina after birth.
1. Your vagina may be drier for a while.
When you’re pregnant, elevated levels of certain hormones, including estrogen, are coursing through your body. Then, after you give birth, your estrogen drops, which can lead to dryness.
Estrogen helps to keep your vaginal tissue moist with a clear lubricating fluid, according to the U.S. National Library of Medicine. Without enough estrogen, not only will you not have the same level of moisture, your vaginal tissue can shrink and become thinner. All of this can make it much drier than normal in your vagina after birth, Dr. Shepherd says.
If you’re not breastfeeding, your vaginal moisture may go back to normal within a few weeks. But breastfeeding can keep those estrogen levels low, which can make you dry the whole time you’re nursing, Dr. Ross says. Once you stop nursing, your vagina should go back to its normal and hydrated state pretty quickly.
In the meantime, using lube can help relieve discomfort during sex, but—let's be clear—it's not just during sex that vaginal dryness can feel incredibly uncomfortable. If you’re dealing with intense, painful postpartum vaginal dryness, ask your doctor about vaginal lubricants or moisturizers made specifically to address this issue. Depending on your situation, they may have OTC recommendations. They may also prescribe estrogen (it comes in various forms, including some you put directly into the vagina) to help increase your vaginal moisture, according to the U.S. National Library of Medicine.
2. Your vagina (and possibly perineum) will be sore as hell.
Your perineum is the area between your vagina and anus. Though it’s not specifically a part of your vagina, it can also tear during a vaginal delivery. ”If you can imagine a cantaloupe coming out of your vagina, it’s no wonder that the perineum is affected during childbirth,” Dr. Ross says. With that said, perineal tearing isn’t a guarantee.
Between 53 and 79 percent of vaginal deliveries will cause some kind of tearing, according to the American College of Obstetricians and Gynecologists, but there are actually four degrees of lacerations, with each building on the ones before it.
- First-degree tears only involve the skin around the vaginal opening or the perineal skin, according to the Mayo Clinic, and they may or may not need stitches. These typically heal within four weeks, Dr. Shepherd says.
- Second-degree tears involve damage to the perineal muscles, which help support the uterus, bladder, and rectum, and usually require stitches, Mayo Clinic. Dr. Shepherd notes that these also tend to heal within four weeks.
- Third-degree tears are lacerations of the perineal muscles and the muscle around the anus. Unlike the less serious tears, these may require surgical repair in an operating room, not the delivery room. These can take up to 12 weeks to heal, Dr. Shepherd says.
- Fourth-degree tears, which affect the perineal muscles, muscles around the anus, and the tissue lining the rectum, are the most serious. Like third-degree tears, these usually need to be fixed in an operating room, but they can take even longer than 12 weeks to heal, Dr. Shepherd says.
According to a July 2016 ACOG practice bulletin, it’s hard to pin down the true incidence rates of different kinds of tearing, but third- and fourth-degree varieties may only make up around 11 percent of all labor-related lacerations.
No matter the degree, if you tear during your delivery or your doctor cuts the area in what’s known as an episiotomy (this used to be more common but is now most typically done when an infant is large or gets stuck on the way out), you’ll feel pretty damn sore down there while it heals. To soothe the pain, you can try things like applying ice packs to the area, taking sitz baths, or putting cooled witch hazel pads between a pad and your body, according to the Mayo Clinic. (You should wrap an ice pack in something like a napkin beforehand, though, so it's not too cold for you.) You can also use a squeeze bottle to douse the area in warm water while peeing, or look into numbing sprays with lidocaine that you can apply until you’ve healed, Dr. Shepherd says. A squeeze bottle can also become a great makeshift bidet while you have stitches in so you don't rip them with toilet paper.
Then there's the poop factor. Heeding nature's call after childbirth can be painful to the point where you might be terrified to poop, the Mayo Clinic explains. Try to make it easier on yourself by keeping your poop soft and going regularly rather than letting yourself become constipated or dealing with really hard poop, both of which can make you even more uncomfortable. Strategies include eating enough fiber and using stool softeners under the guidance of your doctor, the Mayo Clinic says. Here are some more tips for making pooping as easy and painless as possible.
3. Your discharge gets so heavy you basically need to wear a diaper.
Welcome to the wild world of lochia. This is the residual blood, mucus, and tissue that comes from the vagina when you're postpartum, Alyssa Dweck, M.D., a gynecologist in Westchester, New York, assistant clinical professor of obstetrics and gynecology at Mount Sinai School of Medicine, and coauthor of The Complete A to Z For Your V, tells SELF.
You can experience lochia for four to six weeks after childbirth, and it can change color over time, according to the Cleveland Clinic. It typically goes from an intense red color to a kind of pink or brown hue before eventually becoming yellowish. Once you see how much of it comes out of you, you'll totally understand why postpartum underwear and pads basically combine to form a diaper. While passing a few blood clots no bigger than a plum can be normal, if you see any larger than that, you should get in touch with your doctor.
One other thing: “While you’re still passing lochia ... you may notice a bit of an odor,” Dr. Dweck says. The Cleveland Clinic describes the smell as "a stale, musty odor like menstrual discharge." All of this is perfectly natural, Dr. Dweck says.
4. You could have some scar tissue in your vagina.
If you had a tear or episiotomy after a vaginal delivery, you’re probably going to have some scar tissue in your vagina and on your perineum afterwards. So, yeah, that's a big thing to keep in mind when it comes to anything going in or around your vagina after birth. “The extent of the damage in this area will determine how much you feel scarring in this area [during] sex,” Dr. Ross says.
The scar tissue usually heals over time, making sex more comfortable as you go (just be sure to use plenty of lube and go slowly in the meantime). But if you find that it’s not getting better with time, talk to your doctor. Some women need surgery to remove the scar tissue and address the pain, Dr. Shepherd says.
5. Your period may get heavier—or lighter.
It may take some time for your period to come back after childbirth. (Having lochia after childbirth isn't the same thing as having an actual period.) Being pregnant throws your hormones out of whack, and your body has to reset after a baby has vacated the premises. This is especially true if you're breastfeeding, which causes low levels of estrogen that can hamper menstruation. (But don’t believe that breastfeeding will be good birth control—you definitely still need to use protection if you don’t want to get pregnant while breastfeeding.)
When you do start getting your period again, it may be lighter or heavier than before. If your estrogen is generally lower than it was before you got pregnant, your uterine lining can be thinner, Dr. Shepherd says, giving you a lighter period. If your estrogen is a little higher, your lining may build up more thickly, creating a heavier-than-before period.
6. Your vagina after pregnancy may be a bit wider (or it may not be).
While your vagina and vaginal opening typically shrink back down after stretching during a vaginal birth, having a big baby, a baby with a big head, or several vaginal deliveries could make it less likely to go back 100 percent, Dr. Ross says. The result: Your vagina might be slightly wider than it was in the past. This is by no means something that will definitely happen, but some people do report feeling this way after childbirth. Even if it does happen to you, you may not pick up on it much, or you might. Sometimes, a tampon is actually the giveaway.
“Some women notice tampons may not stay inside the vagina like they used to before having babies,” Dr. Ross says. “A slender or regular tampon may be out of the question to use comfortably and may fall out more easily.” It’s not that you put in a tampon and it shoots out of your vagina—instead, it may slowly slide out a bit while it used to just stay put. Like the other changes on this list, this can be a normal part of how your vagina changes after childbirth (although, again, it doesn't happen to everyone).
You may perceive weaker vaginal muscles post-childbirth as having a looser vagina, in which case Kegel exercises may help strengthen your vaginal muscles a bit. Here’s how to do them, according to the Mayo Clinic:
- Find your pelvic floor muscles: These muscles are the ones you employ when you stop urination midstream.
- Work them regularly: To do Kegels, simply squeeze the muscles and hold for five seconds, and then release for five seconds. Squeeze, hold, release, repeat. Work up your way up to contracting the muscles for 10 seconds at a time and relaxing for 10 seconds. Aim for at least three sets of 10 repetitions a day.
- Isolate the muscles: Be sure to focus on tightening your pelvic floor muscles only—don’t flex the muscles in your abs, thighs, or butt. And remember to breathe!
If you commit to doing regular Kegels and are still feeling like your vaginal muscles are too weak, talk to your doctor about pelvic floor physical therapy. A physical therapist dedicated to strengthening muscles in your pelvis may be able to help.
7. You may pee yourself while doing basic things, like laughing, coughing, jumping, or even just walking downhill.
Childbirth can damage your pelvic floor, which is made up of muscles and other tissues that help keep organs like your uterus, bladder, and bowel in the correct positions so they function properly, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Childbirth can also affect the muscles and nerves that control your bladder and urethra (the tube through which pee leaves your body). All of this can lead to pee leaking out of your body at inopportune times, like while walking, jumping, and laughing.
“The good news is [this urinary incontinence] will improve over time, but it is definitely a symptom that is not talked about enough,” Dr. Ross says. This issue’s quite common; 25 to 45 percent of women have some sort of urinary incontinence, whether it’s caused by childbirth or not, according to the NIDDK. What’s more, women are twice as likely as men to have this health condition, and the discrepancy is due in part to pregnancy and childbirth.
Kegel exercises may help reinforce your pelvic floor and combat urinary incontinence, Dr. Ross says. But if you’re not experiencing much improvement or this issue is affecting your life, definitely talk to your doctor to figure out your options, which can range from learning behavioral modification techniques to pelvic floor physical therapy and more.
8. Your orgasms may also change, depending on how your pelvic floor has changed.
“During orgasm, the muscles of the vagina and uterus produce powerful, rhythmic contractions. These contractions are a source of pleasure...as they release muscle tension built up during the [excitement and plateau phases],” Dr. Shepherd says. If your pelvic floor has weakened due to childbirth, those contractions may no longer be as strong, so you might find your orgasms don’t feel as forceful as they used to. But all hope isn’t lost! Here, again, Kegels may help you strengthen your pelvic floor and, over time, regain some of that intensity.
As with incontinence issues and vaginal weakness, if you don't feel like doing Kegels on your own is helping much, talk to your doctor about if pelvic floor physical therapy could be a good fit for you.
9. Your vulva might be a different color.
“We often see pigment changes on the vulva—not necessarily inside the vagina—specifically on the labia and on the perineum (the area between the vaginal opening and anus),” says Dr. Dweck. How much your coloring changes depends on your delivery and resulting scar tissue: “If you had a big tear, things won’t look exactly like they did before,” says Dr. Dweck, who notes that women with lighter skin tones tend to notice pigment changes the most. “They might see blotches of darker pigmentation,” she explains.
While some of these changes can be frustrating to experience, try to remember that they absolutely don’t mean anything’s wrong with you, just that your vagina went through a completely natural change after doing something pretty incredible. And no matter what, know that you shouldn’t be embarrassed to bring any of this up with your doctor—if anyone can help you figure out a fix for something that’s bothering you, they can.
- What to Know About Pregnancy, Childbirth, and Your Pelvic Floor
- 11 Health Conditions You Should Know About If You’re Black and Pregnant
- Yeah, Pregnancy Pains Are Normal. But Here Are Some You Shouldn't Ignore.
Originally Appeared on Self