Like pretty much every aspect of life, the vagina changes after pregnancy. “Many women don't feel comfortable talking to anyone about their vaginal health [in general], and especially after a childbirth experience,” says obstetrician and gynecologist Meagan Haynes. “[But vaginal changes after delivery] are extremely common and need more attention, because our vaginal health is really important to our mental health, physical health, sexual function, and wellbeing.” To get the conversation started, we asked experts what to expect and how to help the body recover.
1. Your vagina might feel like sandpaper.
Dryness is uncomfortable—especially while you’re also healing from tears or lacerations—but it’s a totally normal, incredibly common result of hormonal changes the body goes through postpartum. “Almost every woman will have some level of estrogen depletion after childbirth, whether they're breastfeeding or pumping. Even if they choose to bottle feed, women will experience some level of depletion until the hormones re-regulate after a few months,” says Dr. Haynes. During pregnancy, the body ramps up estrogen production to support the baby and prep the uterus for delivery, but levels plummet postpartum. This causes symptoms that mirror menopause, like vaginal dryness and pain during sex. Breastfeeding and pumping moms will be living in a low-estrogen state until they stop nursing, and if you aren’t breastfeeding, it can still take weeks for hormones to get back in balance.
How to heal: Dr. Haynes suggests using coconut oil or pure aloe vera as a vaginal moisturizer, or a hydrating product like Revaree or Replens 2-3. “Once a person is cleared for penetrative intercourse or placing anything inside the vagina, I typically recommend copious amounts of lubricant,” she says. Lubricant should be thought of for use as needed for relief, while moisturizers can be really beneficial as maintenance therapy. For persistent dryness, or if your body doesn’t respond to over-the-counter moisturizers, ask your practitioner about low-dose topical estrogen creams, like Premarin.
2. Your stitches (or tears or lacerations) will cause soreness.
Postpartum soreness isn’t limited to the vagina. If you have an episiotomy or experience vaginal tearing, it could extend to your perineum. Located between the vagina and the anus, the perineum stretches during delivery, but it’s not as elastic as the vagina. Even if it doesn’t tear, it will be swollen from pushing out the baby’s head. According to the American College of Obstetricians and Gynecologists, between 53 and 79 percent of vaginal births will result in some kind of laceration, and while most don’t have adverse functional outcomes, they can really hurt. Vaginal tears range from first degree (painful, but may not require stitches), to fourth degree (extending from the vagina to the anus and into the rectum and requiring stitches under anesthesia), and are different from an episiotomy. No longer routine, an episiotomy is a cut made by the doctor to widen the vaginal opening during delivery.
“Obstetric lacerations are unfortunately very common,” says Dr. Haynes, “but there are some things a woman can do at home in advance of childbirth that no one really talks about.” Maintaining a healthy weight and staying physically fit during pregnancy have important impacts on the baby’s size (“the smaller the baby, the easier the birth,” she says) and a more toned pelvic musculature reduces the risk for laceration during delivery. “Perineal massage is often something obstetricians do during the pushing stage,” Dr. Haynes says. “People can also star doing it as early as 36 weeks, by using your hands, a warm compress, or your partner to massage the skin between the opening of the vagina and the opening of the anus.”
How to heal: Sitz baths are soothing, frozen maxi pads with pure aloe vera are anti-inflammatory, and a Peri bottle is a less painful way to clean up after using the bathroom. Keep an eye out for constipation—you won’t want to be doing any pushing once you’re home from the hospital. Embrace laxatives, and add fibrous foods to your diet wherever you can.
3. Tears will develop scar tissue.
Whether or not a vaginal or perineal tear requires stitches, it’s common for scar tissue to grow around the area as the body heals. Normal scar tissue will heal on its own, but in some cases there can be disruptions to the normal healing process. Some reasons to call your doctor: increased pain and new bleeding or pus-like discharge, pin-point pain or increased sensitivity in a specific area, or red patches of tissue or excess tissue (called granulation tissue).
How to heal: Scar tissue may improve with massage; however, if the area is still painful after the general soreness recedes, or you’re experiencing any of the issues above, talk to your doctor to find the best treatment option.
4. Your discharge will be different.
Expect bright-red bleeding after delivery—but also prepare yourself for a longer lochia journey. Lochia is the bleeding and discharge that lasts about six to eight weeks after a vaginal delivery. “Lochia happens to everybody after they have a baby, and it's a normal part of the healing process,” says obstetrician and gynecologist Kelsey Kossl. If you had a C-section, you may experience less bleeding after the first 24 hours. Regardless of type of delivery, postpartum women can expect lochia to change in color and consistency over time. It’s normal to have bright-red bleeding the first few days, and occasional clots (if they are larger than a plum, call your doctor). After the first few days, lochia will become more watery and pinkish brown, until it becomes more creamy and pale. Postpartum bleeding “is not like a woman's normal period,” Dr. Kossl says. “It can be very sporadic—heavy one day, light another day. It's tissue, cells and lining from the uterus that you built up during pregnancy and that just needs to be shed and cleared out.” If you’re breastfeeding, you may notice lochia increase afterwards; the hormones released during breastfeeding cause the uterus to cramp, which helps expel unneeded tissue.
How to heal: Stock up on large maxi pads and thinner panty liners, and ask your nurse for a stack of disposable underwear to take home from the hospital. “I strongly recommend a diaper,” says obstetrician, gynecologist, and mom Nola Herlihy. If you continue to take prenatal supplements, choose one with iron.
5. Your period will be different.
What your cycle looks like postpartum depends on a few factors. The biggest one is breastfeeding. “Some women don't have any menstrual cycles at all while they're breastfeeding,” says Dr. Kossl. “Other women might. It's less common when exclusively breastfeeding, but it does happen. If you’re not breastfeeding at all, I wouldn’t anticipate a period until at least four to six weeks after delivery.”
The other big factor is birth control. “If a woman chooses to start on birth control in the immediate postpartum period, she might notice some irregular spotting or bleeding,” Dr. Kossl says. “That's the birth control method itself starting to take effect on the lining of the uterus.”
When your period does return, it might be heavier or longer than a normal period. “You might not really get back on the regular cycle that you were used to before the baby for a couple of cycles.”
How to heal: Be prepared for different levels of bleeding. Some days you may need a liner, some days you may need a maxi pad—have both on hand for a few months. “Give it six weeks with no tampons,” says Dr. Kossl. “We don't want you inserting a tampon if you're healing from a laceration, for example.”
6. You start leaking urine sometimes.
“Almost every woman will have some level of leaking when they laugh, cough, sneeze, jump, and pick up the baby in the first couple of weeks after birth,” Dr. Haynes says. “Normally, that’s not a long-term change.” The pelvic floor supports the vagina, the bladder, and the bowel. The pelvic floor muscles help with bladder control, and both pregnancy and childbirth can weaken and cause damage to themas well as surrounding tissues. “During delivery, the baby is being pushed through all that tissue, which weakens tissue strength along with the pelvic floor,” says Rebecca Stern, an ob-gyn. According to one study, the prevalence of postpartum urinary incontinence was 33 percent, and there is a clear association between the number of children a woman has delivered and urinary incontinence. However, only about 5% of women still have symptoms a year later.
How to heal: Kegels are key—and a healthy practice for all women. Even if you aren’t leaking immediately postpartum, pelvic floor exercises can help prevent urinary stress incontinence later in life. Ask your doctor if you’re covered for pelvic floor physical therapy. If you aren’t, kick off your own at-home Kegel practice.
7. Orgasms aren’t the same.
If you’re reading this before you’re ready to return to have sex again, skip ahead and circle back later. When you do return to intercourse with a partner or with yourself, your orgasms may not be as strong. This reduced sensation can come from the same weakened pelvic floor that can cause urinary stress incontinence. The stronger your pelvic floor is, the more powerfully it can contract—and powerful contractions create more intense orgasms. Postpartum, your pelvic floor is in a weakened state (it just supported and sent a honeydew-sized head into the world!). The good news is that the same pelvic floor-strengthening exercises, such as Kegels that can improve bladder control can help get your orgasms back in action.
How to heal: Better sex is great motivation for keeping up a Kegel practice. If you need a daily reminder, check out apps like Kegel Trainer, Squeezy, and Easy Kegel. Postpartum yoga or pilates classes, while not a substitute for physical therapy, sometimes incorporate pelvic floor workouts. Always check with your healthcare provider before beginning any exercise regimen.
8. Your vagina may look different.
“After pushing out a baby, the vaginal opening can certainly be larger,” Dr. Haynes says. Widening is normal, especially if you’ve just delivered a large baby or you’ve had multiple vaginal deliveries, and it could feel softer and looser than before. Soon after childbirth, your vagina should start to shrink, but it might not return to its exact pre-baby shape. Once you are clear to use tampons, a tell-tale sign your vagina has changed shape is if a tampon slips out over time. Hormonal shifts and physical changes to your body during and after pregnancy and delivery (including C-section) can also change the color of your vulva, and the color and shape of your labia,. Over time, these changes may fade or go away completely, but if your they have a new post-baby look for good, that’s also normal.
How to heal: Strengthening and toning the pelvic floor promotes a tighter vagina. “The classic [method] for pelvic floor musculature rehabilitation is Kegel exercises,” says Dr. Haynes. “Basically, a woman would tighten the muscles around the vaginal opening and pelvic floor, hold them for a few seconds, then let go, and repeat a few times in a row, a few times a day—similar to exercising any other muscle group in the body.”
9. It may also feel different if you have prolapse.
Pregnancy, labor, and childbirth can weaken the support system of the pelvic floor, which can cause pelvic organ prolapse. Pelvic organ prolapse is when the tissue supporting the pelvic organs get weaker or loose. A common symptom of prolapse is the sensation of a bulge or pressure. Other symptoms include backaches, a feeling of fullness in the pelvic area, and pain during intercourse. That’s a sign to check in with your doctor. Prolapse can happen soon after pregnancy, but it can also show up later in life. One study showed that by 15 years after their first delivery, 30% of women who had at least one vaginal delivery experienced pelvic organ prolapse.
How to heal: Toning and maintaining the pelvic floor muscles (those Kegels again), and maintaining a healthy weight can help pelvic organ prolapse. In some cases, your doctor and/or physical therapist may recommend a device called a pessary.
Dr. Kelsey Kossl is an adviser to Anya.
