Texas OB/GYN Heather Bartos has a favourite quote: “Why do people say 'grow some balls?’ Balls are weak and sensitive. If you wanna be tough, grow a vagina." Frequently misattributed to Betty White, this quote is funny, if a little explicit and gendered. And while the citation might be faulty, Bartos says the sentiment is accurate — especially when it comes to vaginal birth.
Bartos, the founder of MindShift Medicine, explains that a new baby doesn’t just mean changes for your lifestyle and sleep schedule. You’ll also probably experience some shifts down south. “The vagina is basically a tunnel for your baby from the uterus to the outside world,” Bartos says. “It stretches enough to push, say, an eight- to 10-pound baby out of it. And before you give birth, we usually wait for the cervix to dilate a full 10 centimeters. If you stretch out your index finger away from your thumb, it can be even bigger than that distance.”
But your vagina can “tolerate” all that and more, Bartos says. It’s a resilient little thing. And while your nether regions may undergo intricate and admittedly uncomfortable transformations as you welcome your bouncing bundle of joy, those changes aren’t as permanent or painful as you might think. Still, you probably will have some questions about what’s going on down there. And we have answers — of course, there are many exceptions and the beauty of both births and vaginas is that they are all different — there are all kinds of things that can make a difference, including whether you choose to deliver vaginally or have a cesarean sections. With those caveats, we've worked worked with OB/GYNs and experts to come up with a comprehensive guide to your vagina after birth.
Will my vagina be sore after birth?
There will be the obvious initial soreness that accompanies pushing something melon-sized out of you. You’re going to feel a bit achy in the days, weeks, and possibly months after delivery. Part of the pain may come from tearing that occurs as the baby comes out.
Will I have to get vagina stitches?
The American College of Obstetricians and Gynecologists notes that 53% to 79% of vaginal deliveries will include some type of laceration or tear. These are generally divided into four degrees of severity, according to Mayo Clinic.
There’s first degree — which refers to tearing of the skin around the vaginal opening and the rectum. You may or may not need stitches for this, and you’ll usually heal within a few weeks.
Then there’s second degree, which means the issue is deep in the vagina and its tissues. You’ll likely need stitches and a few weeks to heal for this kind of vaginal rip.
There are third degree tears, which effect the muscle that surrounds the anal sphincter. If this happens, you might need surgery and more than a few weeks of recovery to correct it. It can lead to painful sex and the leaking of stool if it isn’t corrected properly.
If that wasn’t enough to make you cringe, the fourth and scariest degree of vaginal tearing affects the anus and the mucous membrane lining the rectum. A fix for this will also involve surgery.
Luckily, ACOG has guidelines to help doctors reduce the severity of tears, and prevent third and fourth degree issues. And, these extreme lacerations aren’t that likely, although it’s hard to pin down official rates. The Royal College of Obstetricians and Gynecologists noted in a 2015 report that third and fourth degree issues only occur in 3 in 100 women having a vaginal birth. It’s slightly more common if it’s a woman’s first delivery, the report notes.
Another bright spot: There are things you can do post-birth to reduce the pain. Bartos recommends ice packs, for one. You should wrap them in a towel to make sure they're not too cold for your skin. She also recommends using a light anti-inflammatory such as Motrin or Tylenol. She also says that the numbing spray Dermoplast — which relieves itching and pain surrounding cuts — is life-saver for many moms. You can also try Epifoam, which is a topical foam that decreases pain and swelling.
Mayo Clinic recommends trying a sitz bath, or applying a chilled witch hazel pad to the area. If it stings when you pee, they say to use a squeeze bottle to pour warm water to the torn area as you relieve yourself. In general, it may also help to sit on a pillow when you’re hanging around the house rather than a stiff chair or couch.
Will my vagina be wider?
Dr. Victoria Lynn Handa, M.D., a professor of gynecology and obstetrics at Johns Hopkins School of Medicine, says there haven’t been many studies on whether your vagina will be wider after birth than it was before. With that said, she says the miracle of birth is a beautiful thing, and women shouldn’t have to worry about the idea that their vaginas will be “looser” than before.
“I don’t think it’s right to think of it as: Will my vagina ‘go back to normal’ after birth,” Handa says. “I don’t know that it ever is ‘back to normal…’ What happens is amazing. That humans and other animals recover from birth and go from the huge uterus and dilated cervix, and two days later have it be so much dramatically smaller. It’s a miracle that the human body can do that. So, while I think it’s not true that we always get back to completely normal, women should know that what they do is amazing, and not feel judged.”
Bartos adds that things might feel a little more loosey goosey directly after giving birth to a human, but says once your body stops producing a hormone called relaxin (which weakens the muscles and ligaments in the reproductive system) after pregnancy everything starts to tighten.
“The vagina muscles will shrink back up like a black hole afterwards,” Bartos says.
Will I have to use bigger tampons?
Although, as Bartos puts it, your vagina will likely shrink down after birth, you may or may not notice a few changes in width. If you do, it might happen when you go to put in a tampon. If you used to go with regular or light tampons, you might feel them slowly slip down and out of your vagina. “The average woman doesn’t see enough of a difference to change her tampon use, but there probably are some women who feel delivery makes a difference,” Handa says.
Some women also believe that their vagina is a little “looser” post-birth because the muscles inside are weaker, particularly in their pelvic floor. You can try Kegel exercises to strengthen those muscles and help with some conditions such as urinary incontinence (which can make you pee when you laugh or cough).
Will I pee all the time?
Possibly. Handa says that urinary incontinence can occur for a year or longer after delivery. She notes that it can happen in both women who've delivered vaginally and who've had C-sections. "Some women are experiencing leakage when they cough or strain to pick up their child," she says. "It often times goes away after delivery, or a few months after. If it doesn't, a doctor might recommend pelvic floor physiotherapy or potentially surgery.
Will I have pain during sex?
Maybe, but not forever. In general, health care providers recommend that women wait four to six weeks postpartum to get it on. But Bartos says women shouldn’t feel pressured to do it right away, just because they hit a certain amount of weeks on the calendar. It’s not something to rush into.
She notes that sex may be more painful than it was before for a few reasons. If there was serious tearing, that could cause some cringy feelings.
Will I have a dry vagina after birth?
Will I be able to orgasm?
Yes, but the sensation might change. Because the pelvic floor muscles tend to lose some of their strength after giving birth, there’s a chance that it might feel different when you hit the big O. However, kegels can help with this, and orgasming in itself is a great pelvic floor muscle workout, Bartos says. So, the more you orgasm, the better it will get. If you’re having serious issues with it, and are experiencing symptoms such as urinary incontinence, you might ask your doctor if you should go to pelvic floor physiotherapy, during which they’ll work with you to work and retrain those muscles.
Will I have changes in discharge?
In a word, yes. You’re going to have heavy discharge called lochia for weeks after birth. Ali Wong gets real about this in her 2018 stand-up special, Hard Knock Wife. “Nobody told me about all the crazy shit that comes out,” Wong says of giving birth. “You know what happens after the baby comes out? You know what else exits? Her house. Her living room, her pillows … the Bob Marley poster … all the food that went bad in her refrigerator … for months! So then you have to wear this cartoonishly large pad that’s like the size of a toddler mattress.”
According to Cleveland Clinic, lochia will be dark red in the first few days after you give birth. Don’t be alarmed if you see blood clots in it — but talk to your doctor if they’re larger than a plum. During days four through 10, the discharge will be more watered down and pink or brown. From day seven to 14, it might look more creamy or yellowish, slowly getting back to colours you’re more familiar with. If you had a C-section, you’ll see less lochia, but it will still be there, especially during the first 24 hours after you have your baby.
Will I have to wear a diaper?
That, or a large pad — whatever you’re more comfortable in. They thing is, they don’t want you to put anything in your vagina for four to six weeks after delivery. So, tampons are out — pads or discrete diapers are in.
Will my vagina have scar tissue?
If you had the kind of tears we talked about earlier, you might have some scar tissue inside your vagina or on your perineum, Handa says. This will eventually heal as time goes on, although it might lead to more pain with sex as we discussed ealier. Talk to your doctor if it doesn’t go away, because, in rare cases, women will need surgery to remove it.
Is my vulva going to change colour?
Maybe. “The vulva, armpits, and the back of neck can all get darker when pregnant because of specific hormones,” Bartos says. “You might even have a line going down the middle of your abdomen. It’s darker, the colour of the nipples, and the nipples actually get darker during pregnancy, too.” However, Bartos says this will likely go back to normal after delivery.
Another reason your vulva might change colour around the labia: Scaring.
The colour should eventually return to the one you knew — but if it doesn’t, there’s no reason to be alarmed. The body is just doing its thing.
Will I have changes in my period flow?
Bartos says it might take a while for your period to return after birth because of all the hormonal changes — especially if you’re breastfeeding, which again, can suppress estrogen. This will generally make the periods lighter. When aunt flow finally comes back knocking at your uterus’s door, it might be heavier or lighter, depending on where your estrogen levels are at during that time.
The bottom line: A lot of changes are going to happen during and after child brith, but they’re not bad things.
“I think hopefully, as mothers, we can embrace the role and the inevitable changes that come with our body in bearing children,” Handa says. “After birth, you’ve got the body of a mother and that’s a beautiful thing.”