What happens to your vagina when you give birth

Giving birth vaginally, or partially giving birth vaginally before a caesarean section, affects your vagina and vulva.^​1​ Sometimes the effects can take a while to notice, but others, like a serious tear, may occur at the time.

Understanding how giving birth vaginally affects your vagina and vulva means we need to first understand the actual process of giving birth, particularly when it comes to the muscles, ligaments, tendons and soft tissue.^​2​

• What happens to your vagina and vulva when you are pregnant
• What happens to your vagina and vulva a while after giving birth

The process of giving birth

1. You may experience preparation contractions (Braxton Hicks contractions) where your uterus contracts then relaxes, thought to be your uterus getting ready for labour
2. Cervix softens and thins, preparing to become wider (dilate) to get the baby from the uterus to the vaginal canal (this is typically when the bloody show, see below, appears)
3. The baby’s head sits in place over your cervix, presumably in the correct position (the head engages), and you may feel like you can breathe easier as the baby has left more room for air in your lungs by shifting downwards (lightening)
4. The sac that contains the baby bursts (your waters break) and fluid will come out, perhaps in a dribble, maybe a gush, and this fluid is usually a light yellow (but green or red is bad – contact your health professional immediately)
5. You may have back pain, cramping like period pain, or digestive upsets like diarrhoea
6. Uterine contractions will within 24 hours (and if they don’t, contact your health professional for advice), with the time between contractions timed to see when you should get to where you are giving birth and prepare
7. During birth, muscles at the top of the uterus push down on the baby’s buttocks, pushing it into your cervix, as your cervix opens wider to allow the baby to pass through
8. The pelvic bones and ligaments move and stretch during labour, as does your baby’s skull
9. The folds of your vaginal walls (rugae) unfold like an accordian to allow for the size of the baby
10. Your cervix disappears, but returns later, after birth
11. While all this is happening, a collection of hormones are released to cause the feedback loop that eventually gets the baby out of your body
12. Tearing may occur as the baby travels down the vaginal canal and out your vaginal entrance, via the labia

Vaginal and vulvar bruising

Giving birth vaginally means bruising and swelling, and likely some pain and soreness. This is normal – you just pushed a baby out of your body, and it causes physical damage on the way out.

The damage may range from minor to major, but you can expect bruising and swelling. You may have also had a episiotomy (perineal cut), which will cause some pain and require some healing time.

Vaginal and vulvar bleeding

Lots of blood vessels are popped on a baby’s way into the world, plus all the blood that the baby carries with it from the uterus. This means blood is going to come out of your vagina for a while after labour.

You can expect to bleed for up to six weeks after a vaginal birth, with the heaviest the day or so immediately after birth. This blood will be bright red, because it’s oxygenated and caused by exposed, broken blood vessels.

The bleeding should decrease after this, as your clotting systems stem the blood flow from these open blood vessels. It is normal to see clots here.

Feeling open wide

Your vagina is likely to feel like exactly what has happened, has happened: a big thing has come out of a small, stretchy thing. You may feel like your vagina is wide open and stretchy, which it is.^​3,4​

Your normal elasticity will return after over the coming months, as your body heals and gets back to its new version of normal. Some women feel like their vagina is exactly the same after giving birth, while others may feel that it is a bit looser. Both are normal.

The younger you are when you give birth, the more likely your collagen and elastin fibres are to ping back to their normal shape and strength. As we age, collagen and elastin naturally degrades and is produced less often by your fibroblasts, which is why it can take older women a bit longer to bounce back, and have higher rates of vaginal laxity after birth.

There is no rule here, with each woman responding differently to a vaginal birth. There are many factors involved, including pelvic floor strength, to take into account.

Doing your pelvic floor exercises during and after pregnancy are important, and help you return to normal after a vaginal birth and full-term pregnancy.

These pelvic floor exercises also help prevent future prolapse, so don’t skip or skimp!^​5​ There are plenty of women who suffer from lax vaginal and vulvar tissue after giving birth, which is due to collagen and elastin fibres stretching out, but not popping back into shape afterwards.^​6​

The more babies you have vaginally, the more risk of this occurring. Read about the saggy labia and loose vagina for more information on how to deal with this.

Dry vagina

After birth and during breastfeeding, your body is in a low oestrogen state. Prolactin, your milk-production hormone, blocks oestrogen production, so when prolactin levels are high, oestrogen is necessarily low.^​7,8​

Low oestrogen can result in a dry vagina, since we need oestrogen to keep the vagina and vulva supple and juicy. Oestrogen is also crucial for ovulation, which is why there is a period of infertility after giving birth, which varies by woman.

A dry vagina makes sex or masturbating painful or uncomfortable, and can cause itching and burning. Using a vaginal moisturiser may make it less uncomfortable day to day, and a good lubricant during sex will be important.

Menopausal women and children also have low oestrogen, so typically have drier vaginas. When your female baby is born, she will produce vaginal discharge for a while as the oestrogen in her body, inherited from you, wears off.

If you stop breastfeeding, prolactin will naturally stop being produced in such large quantities, and normal menstrual cycles and fertility will return.

Tips for taking care of your vagina post-birth

• Use a hair dryer on the cool setting to dry your vulva after a shower
• Be extra careful when you go to the toilet with wiping, and use a shower head afterwards to ensure you are very clean after a bowel motion
• Use safe feminine hygiene products, so unscented, uncoloured pads or tampons
• Don’t douche – let your healthy flora keep your vagina healthy
• Keep any perfume or sprays away from your vagina – always
• You may become fertile at any point after birth, so if you aren’t into babies 11 months apart, use protection! There are nursing-safe forms of birth control available
• Keep clothes loose while you heal
• See your doctor if you are in pain, there is a lot of bleeding when it should be drying up, or you are concerned about anything

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