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

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.

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.

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

Severe perineal tears can lead to the following:

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

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.

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?

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 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.

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.

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.