The joy of motherhood also comes with morphological and physiological changes. During pregnancy and after childbirth, a woman’s body undergoes transformations. Heavily solicited during pregnancy, the perineum is a group of muscles located between the pubic bone and the spine. This area – also called the pelvic floor – naturally relaxes due to the passage of the baby. When perineal re-education is not enough to remedy it, other treatments can be considered. Another common issue : a painful episiotomy scar, with pain that intensifies during intercourse. How can these postpartum discomforts be alleviated ? What can medicine offer to reduce their post-pregnancy consequences ?
The perineum – also called the pelvic floor – refers to a complex structure of muscles, tissues, and ligaments, forming a kind of hammock in the lower pelvis, between the pubic bone and the coccyx. The perineum plays a vital supporting role for the abdominal cavity organs, mainly the intestines, bladder, and uterus. Its flexibility and tone are essential for urinary and fecal continence. The word "perineum" is telling in itself, derived from the Latin perineum and Greek perineos, both meaning “around the evacuation pathways.”
Motherhood puts the perineum under significant strain. During pregnancy, the perineum must support the constant weight of the baby and placenta. During vaginal delivery, the perineum stretches to allow the baby’s passage and may be incised (episiotomy) to prevent tearing.
After childbirth, the perineum is no longer the same. Postpartum intimacy is often affected. Pregnancy and childbirth cause a relaxation of the perineum. Stretched and lacking tone, it can no longer fulfill its functions properly.
Consequences include :
• Uncontrolled urine leakage during physical effort (lifting a heavy load) or coughing.
• Vaginal air leakage.
• Fecal incontinence.
• Absence of sensation during penetration.
Perineal relaxation requires specific care through perineal re-education to prevent more serious outcomes such as genital prolapse (organ descent). Gynecologists, midwives, and physiotherapists guide women through perineal re-education, carried out over several sessions with targeted exercises. Resuming physical activity should only happen with approval from these specialists.
Once perineal re-education is completed, if the relaxation persists and depending on the diagnosis, medical vaginoplasty may be considered. This non-surgical procedure involves narrowing the vaginal canal through hyaluronic acid injections or vaginal lasertreatment. In some cases, medical vaginoplasty can reduce urinary and sexual discomfort caused by perineal relaxation.
After pregnancy, there is no rush to resume sexual activity. Listening to oneself, talking to one’s partner, and waiting for sexual desire to return are good practices to restore a fulfilling sex life in a body that feels different. However, pregnancy and childbirth can lead to physiological changes that affect sexual pleasure. The ability to contract the perineum during intercourse enhances sensation and intensifies pleasure. Conversely, perineal relaxation can significantly reduce sensitivity. Vaginoplasty can help correct this.
If an episiotomy was performed (an incision of the perineum to facilitate the baby's passage and prevent tearing), the scar may cause pain, particularly during penetration. It is essential to wait at least several weeks and until the presumed end of healing before considering vaginal intercourse. But in some cases, the pain persists. Why ? The healing process can lead to adhesions in the suture areas inside the vagina.
This pain can be treated through specific physiotherapy sessions, but also with a medical procedure. After a thorough gynecological examination and based on the diagnosis, hyaluronic acid injections or laser treatment can help restore elasticity and thickness to the vaginal mucosa and stimulate natural lubrication. In certain cases, these techniques can effectively treat dyspareunia (chronic pain during intercourse) and vaginal dryness.
Pregnancy can also alter the volume and shape of the labia majora. Some women turn to a specific procedure aimed at enhancing the 1 - Insérer un espace insécable avec labia majora augmentation.
Article written by Dr Romano Valeria
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