The happiness of motherhood also comes with morphological and physiological changes. During pregnancy and after childbirth, women’s bodies transform. Highly solicited during pregnancy, the perineum is a group of muscles located between the pubis and the spine. This area – also called the pelvic floor – undergoes natural relaxation related to the baby’s passage. When perineal rehabilitation is not enough to remedy it, it is possible to consider other treatments. Another frequent problem : a painful episiotomy scar, with pain intensifying at the moment of sexual intercourse. How to alleviate these discomforts of the post-partum ? What does medicine propose to lessen its post-pregnancy consequences ?
The perineum – also called the pelvic floor – refers to an interwoven set of muscles, tissues and ligaments, forming something like a hammock at the level of the small pelvis, between the pubis and the coccyx. The perineum plays a crucial supporting role for the organs of the abdominal cavity, mainly the viscera, the bladder and the uterus. Its flexibility and tone determine the body’s urinary and fecal continence. The origin of the word perineum is moreover evocative, since it comes from the Latin name « perineum » and the Greek name « périneos » which mean « around the evacuating passages ».
The maternity period puts the perineum to the test. The perineum during pregnancy must withstand the constant pressure of the weight of the baby and the placenta. During a vaginal delivery, the perineum stretches to allow the baby to pass and may be incised (episiotomy) to avoid tears.
The perineum after childbirth is no longer the same as before. The post-partum intimacy is therefore compromised. Pregnancy and childbirth lead to a relaxation of the perineum. Stretched, less toned, it can no longer adequately perform its functions. Consequences : uncontrolled urinary leakage in case of effort (carrying a heavy load) or coughing, vaginal gas leakage, fecal incontinence, or even an absence of sensation at the moment of penetration. The relaxation of the perineum requires specific management through perineal rehabilitation, in order to avoid more serious effects such as genital prolapse (organ descent). Gynecologists, midwives and physiotherapists support women in the rehabilitation of their perineum, which is carried out over several sessions with targeted exercises. The resumption of sport must not take place without the green light from these specialists.
Once perineal rehabilitation is completed, if the relaxation problem persists and depending on the diagnosis established, it is possible to resort to medical vaginoplasty. This procedure, performed without surgery, consists of narrowing the vaginal canal through injections of hyaluronic acid or by vaginal laser. In some cases, medical vaginoplasty can reduce urinary and sexual discomfort induced by the relaxation of the perineum.
After a pregnancy, resuming sexual intercourse is not urgent. Listening to oneself, talking about it with one’s partner, feeling sexual desire return… are the right reflexes for regaining a fulfilling sexuality with this very different body. However, pregnancy and childbirth may have caused physiological changes that hinder sexual pleasure. The ability to contract the perineum during sexual intercourse enhances sensations and intensifies pleasure. Conversely, perineal relaxation sometimes significantly reduces female sensation. Vaginoplasty can help remedy this.
If an episiotomy was performed (incision of the perineum to facilitate the baby’s passage and avoid the risk of tearing), the scar can generate pain, amplified at the moment of penetration. It is essential to wait at least several weeks and the presumed end of healing before considering vaginal penetration. But in some cases, the pain persists over time. The reason ? The healing process can cause adhesions at the level of the stitches placed inside the vagina.
The treatment of this pain can be carried out through specific physiotherapy sessions, but also through a medical procedure. After an in-depth gynecological examination and depending on the diagnosis, hyaluronic acid injections or laser treatment can help restore elasticity and thickness to the vaginal mucosa and stimulate natural lubrication. In some cases, the use of these techniques facilitates the treatment of dyspareunia (chronic pain during sexual intercourse) and vaginal dryness.
A pregnancy can alter the volume and shape of the labia majora of the vulva. Some women choose a specific procedure aimed at the augmentation of the labia majora.
Article written by Dr Romano Valeria
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