The joy of motherhood also brings morphological and physiological changes. During pregnancy and after childbirth, women's bodies change. Under considerable strain during pregnancy, the perineum is a group of muscles located between the pubic bone and the spine. This area – also called the pelvic floor – undergoes natural laxity as the baby passes through. When pelvic floor rehabilitation is insufficient, other treatments can be considered. Another common problem is a painful episiotomy scar, with pain intensifying during intercourse. How can this postpartum discomfort be addressed? What does medicine offer to reduce these consequences of pregnancy?
Vaginoplasty: an option for pelvic floor laxity?
The perineum – also called the pelvic floor – is an interwoven group of muscles, tissues and ligaments forming a hammock in the pelvis between the pubic bone and the coccyx. It plays a vital supporting role for the abdominal organs, mainly the viscera, bladder and uterus. Its flexibility and tone determine urinary and faecal continence. The origin of the word perineum is telling: it derives from the Latin "perineum" and Greek "perineos", meaning "around the excretory passages".
Motherhood puts the perineum under considerable strain. During pregnancy, it must withstand the constant pressure of the baby and placenta's weight. During vaginal delivery, the perineum stretches to let the baby through and may be cut (episiotomy) to prevent tearing.
The perineum after childbirth is no longer the same as before. Postpartum intimacy is affected. Pregnancy and childbirth cause pelvic floor laxity. Stretched and less toned, it can no longer perform its functions properly. Consequences include uncontrollable urine leakage during exertion (carrying heavy loads) or coughing, vaginal gas leakage, faecal incontinence, or a lack of sensation during penetration. Pelvic floor laxity requires specific care through pelvic floor rehabilitation to prevent more serious effects such as genital prolapse (organ descent). Gynaecologists, midwives and physiotherapists support women through pelvic floor rehabilitation, performed over several sessions with targeted exercises. Sport should not be resumed without these specialists' approval.
Once pelvic floor rehabilitation is complete, if laxity persists and depending on the diagnosis, non-surgical vaginoplasty may be considered. This procedure, performed without surgery, narrows the vaginal canal using hyaluronic acid injections or vaginal laser treatment. In certain cases, non-surgical vaginoplasty can reduce urinary and sexual discomfort caused by pelvic floor laxity.
The keys to sexual pleasure after pregnancy
There is no rush to resume sexual intercourse after pregnancy. Listening to yourself, talking with your partner and allowing sexual desire to return are helpful approaches to regaining a fulfilling sex life in a body that feels so different. However, pregnancy and childbirth sometimes cause physiological changes that hinder sexual pleasure. The ability to contract the pelvic floor during intercourse amplifies sensations and intensifies pleasure. Conversely, pelvic floor laxity can considerably reduce women's sensations. Vaginoplasty may help address this.
If an episiotomy was performed (an incision in the perineum to help the baby pass through and prevent tearing), the scar may cause pain that intensifies during penetration. Waiting at least several weeks until healing is thought to be complete is essential before considering vaginal penetration. However, in some cases, pain persists. Why? Healing can cause adhesions around stitches inside the vagina.
This pain can be treated with specific physiotherapy sessions or a medical procedure. Following a thorough gynaecological 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, these techniques help treat dyspareunia (chronic pain during sexual intercourse) and vaginal dryness.
Pregnancy can change the volume and shape of the vulva's labia majora. Some women choose a specific procedure aimed at labia majora augmentation.
