How Your Vagina Changes After Birth

Short-Term Vaginal Changes After Birth

• Vaginal bleeding and discharge (lochia): After giving birth, you’ll experience lochia, a mix of blood, mucus, and tissue as your uterus sheds its lining. It starts heavy and bright red, often heavier than a period for the first 3 to 10 days. Over 2 to 8 weeks, it lightens to pink, brown, and then yellowish-white. The amount and colour may vary with activity, and it might stop and restart before fully subsiding. Both vaginal and caesarean section deliveries involve this discharge.
• Soreness, bruising, and swelling: Your vagina and perineum (the area between your vagina and anus) may feel tender, bruised, or swollen after a vaginal birth due to stretching. Even with a caesarean section, vaginal exams during labour can cause swelling or discomfort. Soreness may be more pronounced if you had tearing or an episiotomy (a surgical cut to widen the vaginal opening).
• Vaginal itchiness and dryness: Hormonal changes after birth can lead to vaginal dryness. This is especially due to a drop in oestrogen, which is more common if you’re breastfeeding. The vaginal tissue becomes thin, dry, or inflamed. If you had stitches from tears or an episiotomy, you might also notice itchiness as they heal. These stitches usually heal within a month.
• Burning and pain from tears: Vaginal or perineal tears are common in first-time vaginal births, affecting about 9 in 10 women. These range from minor skin grazes to deeper tears involving muscles. Small tears heal in 7 to 10 days, while larger ones may take up to 6 weeks. You might feel burning or tenderness during this time.

Long-Term Vaginal Changes After Birth

• Scar tissue: If you had vaginal/perineal tears, scar tissue forms as the area heals. This tissue can cause slight pulling or discomfort even after recovery. It may take about a year for this scar tissue to remodel and loosen up.
• Changes to appearance: Your vaginal opening might appear wider or more open after a vaginal birth due to stretching. The vulva (the external area including the labia) may also change colour, often darkening during pregnancy due to increased oestrogen and progesterone. This shift might be temporary or permanent. The vagina itself, a muscular tube, regains most of its pre-pregnancy tone over time.
• Changes to vaginal muscle tone: Vaginal births can slightly weaken the pelvic floor muscles. This minor loss of muscle tone might persist even a decade after delivery. It can also affect how intercourse feels for some individuals, though the change is often minimal.

Factors Influencing Vaginal Changes

• Type of delivery: Vaginal births stretch the vagina and perineum, especially if you push for a long time or need tools like forceps or vacuum extraction. A caesarean section may help avoid strain on the pelvic area if the baby hasn’t descended far. But if you push before the caesarean section, the area can still experience pressure and stretching.
• Baby’s size and birth history: A larger baby or multiple vaginal deliveries can increase stretching. Each progressive birth may stretch the vagina slightly more due to repeated strain over time.
• Tears or episiotomy: An episiotomy or natural tearing during delivery can lead to short or long term vaginal changes.
• Hormonal changes: Pregnancy boosts oestrogen and relaxin, which help the vagina and pelvic area stretch for birth. These hormones drop after delivery, affecting vaginal lubrication and tissue elasticity.

How Vaginal Changes Might Affect You

• Painful intercourse: After a vaginal birth, the stretched vagina or dryness from low oestrogen can make intercourse tender or painful for weeks to months. A 2018 study on 832 first-time mothers notes 37.5 per cent of individuals report pain with intercourse 6 months postpartum, and 46.3 per cent note less interest in sexual activity.
• Incontinence: Weakened pelvic floor muscles and nerves from pregnancy and birth increase the chance of urinary leakage, especially when laughing, sneezing, or exercising. This risk is higher after vaginal delivery but can occur after a caesarean section too.
• Difficulty with bowel movements: Weak pelvic muscles and pain medications can slow your first postpartum bowel movement. It may take 3 to 5 days before you have your first stool after birth. Your doctor may prescribe a laxative or a fibre supplement to help with this issue. Vaginal birth may also cause haemorrhoids (piles) or anal fissures.

Tips to Manage Vaginal Changes After Birth

• Prepare with perineal massage: In the last few weeks of pregnancy, gently massaging your perineum may reduce the risk of tearing or needing an episiotomy. Ask your healthcare professional for guidance on how to do this safely.
• Do kegel exercises: Strengthen your pelvic floor by doing Kegels. This involves tightening and relaxing the muscles you’d use to stop urine flow. Kegel exercises may help strengthen the pelvic floor, but it’s best to check with a healthcare provider or pelvic floor therapist for guidance tailored to your needs..
• Handle lochia and discharge: Use adult diapers in the first few days for heavy bleeding, then switch to sanitary pads.
• For soreness and swelling: Apply ice packs in the first few hours after birth to reduce swelling. Try sitz baths with warm water in the days after to soothe the area. Avoid sitting directly on hard surfaces to lessen discomfort.
• Manage vaginal dryness: Use pH-balanced, water-based lubricants for intercourse once your doctor allows you. Vaginal moisturisers can also help restore moisture to the vagina and vulva. Stick to fragrance-free body moisturisers for dry skin.
• Care for tears and stitches: Use a spray bottle with warm water to clean the area after urinating, then gently pat dry. For pain, try over-the-counter relievers like ibuprofen, sit on a padded ring, or use ice packs. Always check with your doctor before taking any medication.
• Address scar tissue: Once healed, massage scar tissue with vitamin E oil to improve flexibility, but only after stitches dissolve and healing is complete. Consult your doctor before starting this.
• Support muscle tone: Walk, run, or do weight training to boost overall fitness and help vaginal muscles regain tone. Maintaining a healthy weight will also support your recovery.

When to Seek Medical Help

• Heavy bleeding (soaking more than 2 pads per hour for over 1 to 2 hours).
• Blood clots in lochia larger than a quarter.
• Vaginal discharge with a foul odour.
• Fever above 100.4°F.
• Worsening pain, redness, or discharge from tears, stitches, or a caesarean section incision.
• Severe lower abdomen pain.
• Pain, swelling, or tenderness in your legs.
• Chest pain, coughing, or gasping for air.
• Continuous nausea or vomiting.
• A headache that won’t improve or comes with vision changes.
• Feelings of hopelessness lasting over 10 days, or thoughts of harming yourself.

Will Your Vagina Return to Normal?

FAQs on How Your Vagina Changes After Birth

1. Why do I experience vaginal dryness after giving birth?Hormonal changes like a drop in oestrogen after delivery and during breastfeeding can cause vaginal dryness.
2. Can vaginal birth change the appearance of my vagina?Yes, the vaginal opening may appear wider and the vulva may change colour due to stretching and hormonal effects
3. Can vaginal changes after birth affect sexual activity?Yes, vaginal dryness and soreness can make intercourse painful for weeks or months. But this usually improves with time and care.