What to Expect from Your Vagina After Birth
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There's no "bouncing back" once you have a baby. Becoming a mother — a process sociologists refer to as "matrescence" — is one of the most monumental transformations in a person's life. It alters everything from the cells in your body and your brain to your social life, relationships (with yourself and others), and, of course, your vagina.
It took me birthing two children to realize that being pregnant and carrying and delivering two babies is the greatest physical achievement of my life — far greater than any road race I've ever run. Even still, moving forward with my new body postpartum proved to be a process of learning, patience, and compassion. And this is often the case for new parents.
Whether you deliver your baby (or babies!) vaginally or from your belly (a Cesarean or C-section delivery), your postpartum mind and body are going to undergo a whole lot of changes — and your vagina is no exception. Here, exactly what to expect (and when to seek help) in the immediate postpartum days and months when it comes to your vagina after birth.
If You Deliver Vaginally, You Might Tear Down There
Around 53 to 79 percent of women experience some extent of tearing during vaginal delivery, according to the American College of Obstetricians and Gynecologists (ACOG). But it's important to know that many women also don't experience a vaginal tear or perineal laceration, which is defined by the Cleveland Clinic as "an injury to the tissue around your vagina and rectum that can happen during childbirth." What's more, not all of these down there injuries look or feel the same. In other words, there are different degrees of damage, ranging from a first-degree tear (this involves a tear in the skin between your vagina and rectum and the tissue right below it; you might need a few stitches or you might not) to a fourth-degree tear (the most severe tear which involves the skin and muscle of the perineum, the space between the vaginal opening and anus).
It's worth noting, though, that the vaginal area has a big blood supply, which means that for more minor tears, healing is usually fairly speedy (a few weeks) and linear. Also, only rarely do tears — even more severe tears — require repair in the operating room. If you need stitches (which is typical of second-, third-, and fourth-degree tears, according to the Cleveland Clinic), they usually dissolve in a few weeks' time. You might also notice some stinging from your tear when you pee.
Peeing Might Feel Weird at First
During pregnancy, your uterus (where your baby is!) grows tremendously in size, shifting around other internal organs such as your bladder and your intestines. After you deliver? Your uterus begins to shrink and everything starts to move back into its place. That's part of the reason why, the first time you go to the bathroom after having a baby, you might feel like you can't go, might struggle to go, or might not be able to control the flow of urine. Being swollen or cut down there can also impact your ability to pee. Usually, these tinkle troubles resolve within hours as your body relearns how to urinate. And over the following weeks and months, your pelvic muscles will likely get stronger again, ideally helping with any incontinence issues, according to the March of Dimes.
FYI, there's no wiping in those early postpartum days. Most perinatal health experts recommend the use of a peri bottle — a little upside-down spray bottle filled with lukewarm water — postpartum to cleanse your vagina after birth and avoid irritating the area when you go to the bathroom regardless of whether you have a tear or stitches. If you deliver in a hospital, you'll likely receive one of these tools post-delivery. And if not, you can buy them online from health care companies such as Bodily (Buy It, $15, itsbodily.com) and Frida Mom (Buy It, $16, target.com). (Related: Ashley Graham Wants People to Talk About the "Messy Parts" of Postpartum Recovery)
You Might Not Get Your Period
If you're exclusively breastfeeding, you likely won't get your period for several months following pregnancy. This is because prolactin, the hormone that causes you to produce milk, halts ovulation, which means you likely won't have a period, according to HealthDirect. When your period will come back varies. Some exclusively breastfeeding moms notice their periods return once their baby starts eating solid foods or stops feeding at night while others don't see it return until they fully wean, according to La Leche League International.
Ob-gyns are quick to note, though, that while most women who breastfeed exclusively (especially those who have babies who are still waking up to eat at night) won't ovulate, breastfeeding isn't a foolproof form of birth control. Instead,
Depending on how many weeks its been since delivery, you can
Instead, you can chat with your doctor about alternative methods of contraception, such as an IUD or the Pill. For the first three weeks after giving birth, however, you should avoid using any birth control that has estrogen, according to Planned Parenthood. (Related: Why Some Moms Experience Major Mood Shifts When They Stop Breastfeeding)
As for those who don't breastfeed? You can expect your period to return within a few (~six to eight) weeks postpartum, according to the National Health Service.
Expect Some Bleeding
In the weeks following both a vaginal and C-section delivery, you bleed from your vagina for about four to six weeks. This is because throughout pregnancy, the placenta (the organ your body grows to support your growing baby) and other tissues that supply the fetus with oxygen and nutrients develop. After you deliver both your baby and the placenta, the tissues that were surrounding your baby slough off from the inside cavity of the uterus, explains Madeline Sutton, M.D., a board-certified ob-gyn, medical epidemiologist, and public health expert. And this causes postpartum bleeding or lochia, which is essentially the (totally normal) result of your body ridding itself of all the extra blood, mucus, and tissue it created over the past nine months. "During the weeks after giving birth, lochia goes from bright red to dark brown to light yellow or white, before stopping altogether," she says.
But if you notice excessive bleeding (generally, if you're soaking through a pad or more in one hour), call your doctor ASAP. This could indicate that there's still some placenta in your uterus or possibly even an infection if bleeding is accompanied by fever or foul-smelling discharge, explains Odile Bagot, M.D., an ob-gyn in Strasbourg, France, and author of Your Vagina: Everything you Need to Know. (Related: Ashley Tisdale Opened Up About Her "Not Normal" Postpartum Experiences)
Structures Around Your Vagina Will Change
ACOG recommends new mothers maintain close contact with their health care providers in the first three weeks postpartum. But the truth is that many new moms aren't seen in person until six or eight weeks postpartum depending on the method of delivery (if you deliver by C-section, you're generally seen eight weeks postpartum as opposed to six weeks for vaginal deliveries). (See also: What to Expect at Your Next Ob-Gyn Appointment Amid — and After — the Coronavirus Pandemic)
During this postpartum exam with a doctor or midwife, no matter when it is, your health care professional does an internal check to see if your uterus has shrunk down to its normal size, if the cervix (the tissue connecting your uterus and vagina that opens to allow your baby to pass down) has closed, and if you have any pain or abnormal discharge, explains Dr. Bagot. Your provider will also evaluate the quality and the tone of your perineum (the area between your anus and vagina) which could have changed due to the stressors of pregnancy and labor and delivery (it could be weaker, looser, or even tighter!) and also ensure any tears are healing well, she says.
Ob-gyn Andrea Alexander, M.D. also notes that during this follow-up appointment, your provider isn't just concerned about how you're doing down there, but will also likely (and, if not, should!) follow up on your mood, given that perinatal mood and anxiety disorders, such as postpartum depression and postpartum anxiety, impact about one in seven new moms, according to Postpartum Support International. (Related: The Pregnancy and Postpartum Mental Health Issues No One Is Talking About)
Your health care provider will also likely talk with you about your birth control choices and ensure that you're set up for the right screenings (e.g. Pap smear). They might also assess any potential scar tissue build-up if you tore during delivery or had a C-section (and, thus, have an incision scar). While scar tissue is a normal reaction to your body healing, your doc might advise you to massage these areas to help reduce the likelihood of pain or discomfort from scar tissue build-up.
You Might Not Feel Ready for Sex — and That's Okay
You've likely heard that after you have a baby, you're usually "cleared" for sex at your six- to eight-week postpartum follow-up appointment. "We recommend waiting six weeks before you have sex again because we want to make that any lacerations — vaginal lacerations, perineal lacerations, cervical lacerations — have healed and that your cervix has closed," says Heather Irobunda, M.D., an ob-gyn in New York.
Keeping sex off the table for at least six weeks also decreases the risk of infection down there (it's part of the reason health care professionals advise against using tampons in those early postpartum weeks). Your body has wounds and potentially tears and using tampons or menstrual cups could up the likelihood of an infection. And that's why ACOG (and medical professionals) recommend the whole "waiting for sex" for both those who delivered vaginally and via C-section.
Don't feel ready for sex at six weeks? You're definitely not alone. "Some people don't feel ready to have sex around that time because they may feel sore still or just not ready," says Dr. Irobuna. "That's completely normal. Everyone takes different amounts of time to heal. You should start having sex only when you're ready."
A lack of sleep, PMADs, learning to adjust to a new family life, and physical healing also all play a role in how "ready" you feel for sex, notes Dr. Bagot. Something else that plays a role? Breastfeeding.
Postpartum Sex Might Feel Different — No Matter How You Deliver
"After having a baby, sex can feel different for some people for a variety of reasons," explains Dr. Irobunda. "Due to the birthing process, your vagina and vulva may have changed slightly." Other parts of your body (breasts! belly!) may have changed, too, which can play a role in how you feel during sex. If you're breastfeeding, your breasts may feel full or uncomfortable at times, you could feel "touched out" (breastfeeding, holding, changing, and having a baby on you all day!), or you may have insecurities about the way you feel or look. What's more, you're likely tired and your hormones can be different. All of these changes contribute to sex drive, libido, and, if you're having sex, the ability to orgasm. Just know that every person (and every delivery) is different. "One cannot predict how intercourse will feel after childbirth once she is ready to engage in sex," reminds Dr. Alexander.
Some research suggests that nearly 38 percent of women experience pain with sex six months postpartum. "This can be associated with perineal tears and vaginal dryness from breastfeeding; however, this isn't always a linear relationship as this pain can be noted in women with cesarean deliveries and in those not breastfeeding, too," says Dr. Alexander. If you're having pain with sex, know that while it may be common, it can indicate something medically abnormal is happening — and there are ways to feel better.
And please remember: While the postpartum season is an intense one, it's also temporary. If you're struggling with your sex drive or your desire to have sex, know that you're not alone and that there are other ways to be intimate if you're not ready to return to sex just yet. (See more: How to Build Intimacy with Your Partner)
If You're Breastfeeding, You Could Have Down-There Dryness
Breastfeeding is a wonderful way to bond with and provide immune support and nutrition to a new baby, but if you're breastfeeding, your body will be producing prolactin (key in milk production) in spades. In order to make prolactin, levels of estrogen sink. "Decreased estrogen causes vaginal dryness and thinner vaginal tissue, which can make vaginal sex a little uncomfortable for some," says Dr. Sutton. (See more: What Causes Vaginal Dryness, Exactly?)
If you're experiencing dryness, talk to your doctor. Prescription vaginal estrogen creams can treat symptoms of low estrogen, she notes. "I usually go with a low-dose Premarin or Estrace, but sometimes it depends on what a person's insurance will cover," says Dr. Sutton. But also remember that all of this is your body's natural response to nursing.
If issues such as dryness are bothering you, using a good lube can help, too. (Here's how to pick the best one for you.) But if you're experiencing pain, talk to your ob-gyn or a pelvic floor physical therapist (more on that next!) about potential strategies for pain relief.
Your Pelvic Floor Muscles Might Need a Little TLC
People often talk about feeling more "stretched out" after having a baby. Likely, what they're referring to when they say that is the pelvic floor — the hammock of muscles in your pelvis that sit like a bowl and surround the urethra, vagina, and anus, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development. "These muscles help stop and start the flow of urine, the passage of gas and bowel movements, and they help hold our pelvic organs in your body," explains Alexandra DiGrado P.T., D.P.T., a pelvic floor physical therapist and founder of Boston Pelvic Physical Therapy. "During pregnancy, the changes in hormones and the added weight of our growing baby can cause these muscles to stretch and weaken. During a vaginal delivery, your baby pushes through these muscles and the muscles may stretch up to three times their normal length." (Related: 4 Important Things to Know About Your Pelvic Floor)
"Oftentimes, these muscles experience trauma during the delivery process as they stretch and sometimes tear to accommodate your baby passing through," says DiGrado. "This can lead to pain, leaking pee, urinary urgency, and frequency, gas leaking, or leaking poo." Sometimes, though, the opposite is true and the trauma of the experience can leave some folks with "excessive tension in the muscles," she adds."And this creates pain with intercourse. It's so important to be able to both close and lift the muscles and fully lengthen and release the muscles."
Pelvic floor physical therapists treat many of the issues you might think you just "have to live with" postpartum: leaking pee with a cough, laugh, or sneeze, for example. If you have pubic bone pain, tailbone pain, back pain, pain with sex, are leaking pee or poo, or have a lingering separation of your abdominal muscles called diastasis recti, consider seeing a pelvic floor physical therapist. Sometimes, these services are covered by insurance. (No pain? Then you might just want to try these pelvic floor exercises to help strengthen down under.)
Bottom Line
Becoming a mother and birthing a baby is life-changing. And while it alters just about every aspect of your life, it changes your body and, specifically, your vagina in big ways, too. If you're worried about any of these changes, be sure to bring them up to your doctor. And if you feel like you're not being heard? Seek a second opinion. Just remember: People have been birthing babies for, well, eternity. And while the down-there changes and the healing process of labor and delivery can be overwhelming, with time and support, you will heal and find your way into your new body. (Up next: The Pregnancy and Postpartum Mental Health Issues No One Is Talking About)
