SEXUAL HEALTH

When you give birth, the baby travels through the cervix and out through the vagina (also called the birth canal). The entrance to the vagina must stretch to allow the baby through. Sometimes the skin between the vagina and anus (the perineum) might tear or be cut by a doctor or midwife to allow the baby out. This is called an episiotomy.

After having a baby, it’s not unusual for women to feel that their vagina is more loose or dry than usual, and to have perineal pain or pain during sex. This page lists a few of the changes you might notice and tips on what you can do.

Wider vagina

Your vagina might look wider than it did before, according to Dr Suzy Elneil, consultant in urogynaecology at University College Hospital, London. “The vagina can feel looser, softer and more ‘open’,” she says. It may also look and feel bruised or swollen. This is normal, and the swelling and openness should start to reduce a few days after your baby is born.

Your vagina will probably not return completely to its pre-birth shape, but this shouldn’t be a problem. If you’re worried, talk to your health visitor or GP.

“We always recommend pelvic floor exercises,” Dr Elneil says.Pelvic floor exercises (sometimes called Kegel exercises) help to tone the vaginal muscles and your pelvic floor muscles. This will help to prevent incontinence (urine leaking) and can help your vagina feel firmer. It's not uncommon for women to experience incontinence after childbirth, but pelvic floor exercises can help limit this. They can also help sex feel better.

You can do pelvic floor exercises anywhere and at any time, either sitting or standing up:

• Squeeze and draw in your anus at the same time, and close up and draw your vagina upwards.
• Do it quickly, tightening and releasing the muscles immediately.
• Then do it slowly, holding the contractions for as long as you can (but not more than 10 seconds) before you relax.
• Repeat each exercise 10 times, four to six times a day.

You may find it helps to imagine you’re stopping a bowel movement, holding in a tampon or stopping yourself urinating.

You could fit the exercises in while washing up, queuing in the supermarket or watching TV.

Dryness in the vagina

It’s normal for the vagina to feel drier than usual after childbirth. This is linked to the lower levels of oestrogen in your body compared to when you were pregnant.

For breastfeeding mothers, levels of oestrogen are lower than in those who aren’t breastfeeding and the dryness can be more marked. “Once you stop breastfeeding and your periods have returned, the levels of oestrogen revert to pre-pregnancy levels,” says Dr Elneil. "If you’ve noticed dryness, it should improve."

If the dryness bothers you, talk to your health visitor or GP. If you’ve started having sex again and the dryness is causing problems, you can use a lubricant – you can buy lubricant in pharmacies, supermarkets or online. If you’re using latex condoms, make sure the lubricant is water-based, because oil-based products (such as moisturiser and lotion) can make latex condoms tear or rip.

Try to talk about this with your partner if it’s causing problems in your sex life. That way, you can deal with it together rather than worrying about it on your own.

Soreness and stitches in the perineum

“The vaginal area can feel painful or sore in the immediate period after childbirth,” says Dr Elneil. “This usually improves within 6-12 weeks after the birth. We always recommend pelvic floor exercises to help make the situation better in this case, too.”

Your perineum can feel sore, especially if your skin tore or you needed stitches to repair a tear or episiotomy after giving birth. Painkillers can help, but if you’re breastfeeding talk to your midwife, GP or pharmacist before you buy any over-the-counter painkillers. It’s important to keep the perineal area clean, so always wash your hands before and after changing your sanitary pads and make sure you change them as soon as you need to. Have a bath or shower every day to keep your perineum clean.

If you’re worried about how your stitches are healing, talk to your health visitor or GP – this is especially important if you have a lot of pain or discomfort, or you notice a smell.

Depending on the size of the wound, you might have a scar when the tear or cut is healed. 

Pain during sex

There’s no right or wrong time to start having sex again after you’ve had a baby. Don’t rush into it. If sex hurts, it won’t be pleasurable. If your vagina feels dry, try a lubricant during sex to see if that helps.

If you have discomfort around your perineum, it might be worth your health visitor or GP having a look to check that it’s healing in the right way.

It’s not unusual to feel less like having sex than you used to – you’ve given birth, you’re looking after a tiny baby and you’re probably feeling very tired. It's important to talk about this with your partner, rather than just avoiding sex. If you both know what the situation is, you can deal with it together.

If you continue to feel pain during sex, talk to your GP.

Don’t forget to think about contraception after having a baby – it’s possible to get pregnant three weeks after giving birth.

Source:    From the UKs NHS direct website.