Episiotomy & Perineal Tears: What You Need to Know After a Vaginal Delivery

Pushing a watermelon sized child out of your vagina might not seem natural, but it is.  There is no sugar coating it, let's talk about the possibility your vagina might tear during vaginal delivery. Today you will learn the truth behind your vagina after a baby comes out of it.  The different types of perineal tears versus an episiotomy and potential complications. And answers to the most common questions I get as a physician like: will I get stretched out down there, what could happen to my vagina during vaginal childbirth, and is there anything I can do to get back the vagina I once had? I definitely can't leave your vagina hanging (literally), so I will discuss 4 ways to tighten your vagina so no one ever knows you’ve had a child, or what I like to call "pre-pregnancy pussy."

What is an Episiotomy? Perineal Tear after Vaginal Delivery Pregnancy Pukeology Podcast

Listen to "Episiotomy and Perineal Tear: What You Need To Know After a Vaginal Delivery Pregnancy Pukeology Podcast Episode 35" on Spreaker.

 

Will I Get Stretched Out Down There?

The majority of women believe that having a tight vagina improves sex performance. Some women even fear getting pregnant to avoid getting loose down there. The truth is, having a loose vagina or tight one does not affect your sex performance. Another fact is that you will surely be stretched out down there after giving birth, but your vagina will get back to its pre-birth size a few days after birth.

The vagina is made up of muscles that can stretch and contract. When stretched out, for example, during sex or when the baby is getting out they tend to gradually go back to normal when the stretching force is removed, just like rubber band. However, your vagina may remain slightly wider than normal if you give birth to a very large baby or have had multiple deliveries.

How can You Tell Whether You are Stretched Out Down There?

A regular tampon can help you tell whether your vagina is slightly wider. The pre-birth vagina is able to hold a tampon when inserted down there, but a slightly wider will not and the tampon will slide out over time. The good news is that you can quickly get your vagina back to normal with Kegel exercise. When done correctly during and after pregnancy, three times a day for five minutes, Kegel exercise can tighten things up quickly.

Your vagina and vulva will have a different color before and after birth due to changes in pregnancy hormones. Estrogen and progesterone hormones are high during pregnancy, as a result, blood flow to the vagina and labia increase making them darken and slightly change shape. The changes in color and shape usually disappear gradually after birth when the hormones level out.

Giving birth always makes your vagina sore. This has been associated with tearing and bruising of the vagina during birth. According to the American College of Obstetricians and Gynecologists, 53% or more of vaginal deliveries cause tearing around the birth canal. 

The period you will feel sore is determined by the severity of tearing. Healing generally takes 4 to 12 weeks. If, however, you experience a significant tear of your vagina or the perineum during birth, you will be stitched or taken to theater for surgery to repair to put things together.

What is an Episiotomy?

Laceration of the perineum (the area between the vagina and anus) during childbirth is called a perineal tear. The risk of vaginal tearing is high if you are overweight, give birth for the first time, fast birth, and get assisted vaginal deliveries like the use of vacuum or forceps, and in malpresentation such as babies in face-up position.

Sometimes a cut may be made by your healthcare provider into the perineum and vaginal wall when giving birth. This is called an episiotomy. It is done to increase the space for the passage of your baby. This happens when the baby is to be born fast, in instrumental births or when you are at a high risk of a very severe perineal tear.

Types of Perineal Tears

Four degrees of tears exist, ranging from simple laceration of the vaginal wall to complex tears that involve the wall of the rectum.

Perineal Laceration: 2nd degree tear

First Degree Perineal Tear

It is the least severe type of vaginal laceration involving the lining of the vagina. It does not involve the vaginal muscle and therefore no stitches are required. Recovery is fast and relatively simple.

You will experience mild pain in the first one week after delivery when you cough, sneeze, sit up or have a bowel movement.

Second Degree Perineal Tear

Cut through the vaginal lining and extend to the submucosa (deep tissues) of the vagina. These are the most common type of vaginal tearing which require stitches. The recovery period is also long and you will experience moderate pain whenever you do something that increases pressure down there such as coughing or having a bowel movement.

Third Degree Perineal Tear

Unlike the first two, third-degree vaginal tears are deep cuts that extend from the vagina to the muscle that makes up the anal sphincter. They are complex to repair as each layer is stitched separately. The pain you experience during repair may warrant the use of the use of anesthesia. After the repair, you will continue experiencing pain two to three weeks and you will also take longer to recover.

Fourth Degree Perineal Tear

It is the worst perineal laceration you may experience while giving birth. The tear extends through the lining of the rectum. Though the least common, fourth-degree tears are very delicate to repair. You will be taken to an operating theater where multiple layers will be closed.

Complications of Perineal Tears

Severe perineal tears can lead to the following:

  • Pelvic floor dysfunction
  • Prolapse
  • Urine incontinence
  • Bowel incontinence

 

You'll Have to Wait About Six Weeks to Have Sex

How long it will take for your vagina to heal, or resume normal sexual intercourse following a perineal tear depends on various factors such as the degree of the tear, diet, compliance to medications, personal hygiene among others. However, the average period to recovery and resumption of sexual activities is six to twelve weeks.

Your healthcare provider will give antibiotics to prevent infection, analgesics to relieve pain, stool softeners to prevent excess pressure while having a bowel movement. You will also be required to avoid the thing that increases pressure down there.

To get your vagina tight again, you will be required to practice the Kegel exercise as mentioned earlier.

You will feel a bit of discomfort at first when having sex, but with time, the discomfort will disappear and get back to normal again.

How to strengthen your vagina muscles?

Strengthening your pelvic floor muscles is a way to strengthen the vaginal wall.  It’s important to know that your pelvic muscles are part of your core that supports your bladder, rectum, small intestine, and uterus.  With age or after childbirth your pelvic floor can become weak leading to accidentally peeing yourself a little bit, feeling the constant need to pee, pain in your pelvic area, or experiencing pain during sex. Has this ever happened to you?

Remember that during delivery over 80% of you will have nausea or vomiting during a vaginal delivery, and even worst from the pain of your girlie parts once you get home.  Protect yourself and grab a NoMo Nausea Band because you never know when your going to need it especially when trying these 4 amazing ways to help you strengthen your pelvic floor.  Think of these as exercises for your vagina!

 


 

Kegel Exercises

To find the right muscle I want you to try to stop peeing midstream.  Imagine your baby is crawling and just got into cleaning cabinet in the bathroom with hazardous chemicals (you know the baby proofed drawer that your husband broke out of rage because he couldn’t open it and said he was going to fix it… that one!) and you need to grab him/her before they put harsh chemicals in their mouth.  You stop peeing immediately that is your Kegels.

  1. Pick your favorite position for this exercise. Most women prefer lying on their back but I personally do mine while I’m driving because I have nothing better to do and I like to time it to the beat of the music.
  2. Tighten your pelvic floor muscles and squeeze your kegels for 5 seconds, then relax for 5 seconds.
  3. Repeat step 2 for a least 5 times in a row

Just like any other muscle, you will build up strength the more that you do it.  Increase the length of time from 5 seconds to 10 seconds. Make sure that you are not tightening your thighs, abs, or butt.  Only tighten and release your pelvic floor.  For best results this vaginal workout should be repeated 3 sets of Kegels 5-10 times a day.  You will definitely see results within a few weeks, and your husband will appreciate it too as it may stimulate your sex drive.

Proper way to do kegel and pelvic tilt exercises

Pelvic Tilt Exercises

Doing Kegels is great but you also need to strengthen your pelvis using the pelvic tilt exercise.

  1. Stand with your shoulders and butt up against a wall
  2. Pull your belly button in towards your spine flattening your back against the wall. For ladies who have a big booty, also known as a “sway back,” it may be harder to actually get your back to touch the wall.  Get as close as you can (I speak from experience being a Latina).
  3. Tighten your bellybutton for 4 seconds and then release.
  4. Perform this pelvic tilt exercise 10 times for up to 5 times a day

Vaginal Cones

Vaginal cone is also called a Kegel Ball. This is a weighted tampon-sized object that you put into your vagina and hold with no hands. Basically it is weight lifting for your vagina.  If you ever want to waste a bunch of time on the internet look up Kegel weight lifting or Kegel Ball exercises and it is incredible how strong some women are.  The one that comes to mind is a woman holds up a surf board with her vagina!  Vaginal cones come in various weights.  They usually come in sets of 3-4 sizes.  The lightest one Try this Kegel ball exercise to get started.

  1. Insert the lightest cone into your vagina (try to insert without lube because you are going to try to hold it and lube will only make it slip out)
  2. Squeeze your vaginal muscles and hold it in place for about 15 minutes twice a day
  3. Increase the weight of the cone as you become more successful at holding it in place.
  4. Challenge yourself by trying to a ballerina squat and keep squeezing to help it stay in place once you have maxed out your weights.

Neuromuscular Electrical Stimulation

Most people have heard of a TENS unit, but wouldn’t even think about using it down there. The way a muscle contracts is thru sending a signal electrically thru the body that innervates the muscle sending electrolytes that cause the muscle to contract. A NMES device is no different but the signal is not coming from the body but from and outer source. A vaginal probe is inserted into the vagina that sends electrical stimulation causing the pelvic floor muscles to contract and relax. This session usually lasts 20 minutes in a doctor’s office or if prescribed a NMES unit at home, you should do this for 20 minutes once every 4 days for a few weeks.

Your Vaginal Will Change Over Time

There are only 2 real factors that can affect how tight you are down there.  The vagina’s elasticity is dependent on age and childbirth.  Frequent sex or lack thereof won’t cause your vagina to lose any of its stretch or stretch receptors. Women who have had more than one vaginal birth are more likely to have weakened vaginal muscles due to the stretch needed to let your baby pass through the birth canal.  It is normal to feel that your vagina is slightly looser after vaginal delivery, but your vagina will snap back in a few days post-partum.  It may not return to its original shape due to suturing (stitching) by your doctor or internal tears causing muscles to get larger on one side or the other.  Remember your vagina is full of muscle and it’s no different than if you tear a muscle in any part of your body, as a protective mechanism it will make surrounding muscles stronger and may even pull muscle from the other side.  Have you ever heard of a person who pulls their hamstring on one side and then the other side starts to hurt because they are compensating the way that they walk? Believe it or not the non-affected side will get larger because it is doing more work, your vagina is the same way so one labia (lip) may get larger after your beautiful baby is born.

The vagina’s elasticity decreases as you get into your 40’s. As you become perimenopausal, your estrogen levels start to drop meaning your vaginal tissue becomes thinner, drier, less acidic, and less elastic or flexible.  All of these reasons make you feel like your vagina is looser than before.

How to Increase Vaginal Moisture?

Vaginal wetness comes from both the Bartholin glands, 2 pea-sized glands located just inside the vagina, and the cervix.  The cervix produces mucus and fluids as a response to hormone changes in the woman’s menstrual cycle, and during ovulation (hence why you want to have sex more during this time of the month).  Both produce moisture when the female feels aroused during sexual activity. This vaginal wetness should be clear, if it is not there are many potential reasons and infection may be in question. Curious what color and smell your vagina currently has?  There’s a great chart on Pregnancy Pukeology Podcast Episode 22: Vaginal Discharge that shows what your vagina is trying to communicate with you.

How to increase vaginal moisture naturally

  1. Stay hydrated by drinking a lot of water. Decrease your intake of caffeine and alcohol because they are natural diuretics, meaning they will deplete your water concentration.
  2. Get healthy fats in your diet. Adding foods rich in soy, flaxseed, and vitamin E may help to restore estrogen hormone levels in your body, thus increasing your vaginal moisture.
  3. Cum more, or get excited more. Notice I didn’t say have sex more, but if it happens tell your husband I said your wel-cum. You need to stimulate your mind and vagina to allow yourself to get wet more often. Your body will respond better with practice. If you get turned on by watching the boys of Baywatch, listening to a little Usher, or playing with yourself (G-spot shaped toys that help speed up the process) JUST DO IT!  If you’re currently pregnant and want some great penetration positions that help you feel good during sex check out Pregnancy Pukeology Podcast Episode 19: Sex during pregnancy and get access to 5 perfect pregnancy sex positions that will make you enjoy sex even more regardless of what trimester you’re in.
May 01, 2020 by Dr. Jacqueline Darna
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