How Loose Does a Vagina Get After a Baby
If yous've been experiencing urine leaks and unsatisfactory sex, and getting the feeling that you've get somewhat lax "down there" later giving birth, you may be suffering from mail-pregnancy vaginal laxity.
Vaginal laxity or vaginal relaxation syndrome occurs when the vagina loses moisture and elasticity – a condition that is aggravated by childbirth and hormonal changes, according to Orchard Clinic, which specialises in postpartum recovery.
Co-founder Cheryl Han said hundreds of women visit Orchard Clinic each month with atmospheric condition such equally urinary incontinence and dissatisfaction with intimacy, with the root cause being vaginal laxity.
How is vaginal laxity treated? First it needs to be determined, experts said.
"When women come up to me proverb 'oh I've just had a babe and now I have laxity in my vagina', I ask, 'do you really?'," said Laura O'Byrne, a specialist senior physiotherapist and co-founder at Health2U.
"Because the first thing we need to address is, what is your vagina? Most women refer to everything down in that location as their vagina when really that's non the example," she added.
"Many women will tell you they don't know what their vulva looks similar because they've never really properly looked. It's a function of them they never actually encounter. Nosotros should exist encouraging a healthy class of cocky-exam."
To testify her point, during a Zoom call with CNA Women, O'Byrne took out a model of a woman's anatomy and pointed out the parts that typically cause issues for a woman after childbirth.
The showtime is the vulva, the outer function of a female'southward genitals – what O'Byrne described every bit "everything on the exterior". The vagina, she said, is a tube inside the trunk that connects the vulva to the uterus. All these organs are independent in the pelvic surface area and are supported past muscles that sit on the pelvic floor.
Another way is to look at the vagina as "only a column, a canal", said Dr Jessherin Sidhu, a general practitioner who specialises in women's sexual health. "That culvert is supported by structures around information technology, like the scaffolding that holds up a building. That scaffolding is the pelvic floor."
WHAT IS VAGINAL LAXITY?
For postpartum women, the walls of the vagina may get lax due to the trauma that pregnancy places on the pelvic floor or the excessive stretching of vaginal tissue through vaginal birth, said Orchard Clinic's Han.
Women who take never given birth may besides experience vaginal laxity.
Post-menopausal women may suffer from vaginal laxity due to hormonal changes associated with ageing, said Han. Even younger women may feel vaginal laxity if they accept a weak pelvic floor.
"You lot can have pelvic flooring issues at whatsoever stage. You can have it not after having a babe, you have it at a young age, at an old age … You can have pelvic floor problems as a homo also. There'southward no bigotry here," said O'Byrne.
"Changes in the pelvic flooring can crusade appreciation of laxity. As the support structures get-go to wear away, that column feels like information technology'south not held up properly, non closed in properly," said Dr Sidhu, who runs InSync Medical clinic.
Vaginal laxity typically causes problems such as urinary incontinence and unsatisfactory sexual activity, which may manifest as a loss of sensation during intercourse or painful penetration due to dryness, experts said.
"Ordinarily when women come through information technology starts with dissatisfaction with penetration," said Dr Sidhu. "Nosotros oft hear this classic statement: 'I experience very loose, like I can't tighten. Whenever I have intercourse, I feel like I have to purposely grip around my hubby's penis.'"
Others may complain of urine leakage whenever they express joy or cough, or when they are engaged in high-impact activities such as jogging, she added.
"Sometimes they'll tell me information technology's dry when they're walking, similar tissues are rubbing confronting each other," said Dr Sidhu.
According to Dr Sidhu, sometimes women don't complain almost a straight symptom of laxity, but an indirect ane such every bit frequent urinary tract infections (UTIs).
"When y'all're perpetually dry, you've lost this defense force barrier … And dry tissues allow bugs to make it quicker, thus increasing the risk of infections.
"Typically, when women are getting more UTIs and you probe further, they might tell you lot they're not satisfied with penetration too. Often dryness can be painful so they don't even commit to a full penetration. And if penetration can happen painlessly, they've lost sensation," she said.
It is worth noting that postpartum issues share common symptoms so, what you may think is vaginal laxity could easily exist something else.
A good dominion of thumb is that a simple problem of vaginal laxity "should only present certain inconveniences such as irritation or chafe" when you're going about your day-to-day activities or even during sex, said Orchard Clinic's Han.
WHEN IS IT NOT VAGINAL LAXITY?
If your business concern is how lax or saggy it looks around your vaginal opening, the trouble you're looking to solve may non be vaginal laxity, but laxity of the labia, which comprises the folds of peel (or lips) on your vulva.
"Typically, when women come to me afterwards giving birth, they think it'due south the vagina they're concerned well-nigh, but it's actually the vulva that has changed," said O'Byrne, who was formerly a physiotherapist with Jurong Health.
"If you expect down and your labia is stretched out, then it'due south a labia laxity effect," she added.
O'Byrne classifies labia laxity equally an aesthetic issue – something that physiotherapists typically do not deal with. Women who have this concern may seek the help of plastic surgeons specialising in procedures such every bit labiaplasty.
If you're feeling a sense of heaviness or pressure internally, information technology could exist the sign of a prolapse, said Han.
A prolapse occurs when the pelvic floor is and so weakened, frequently due to the strain of vaginal nascence, that information technology tin no longer support internal organs such as the bladder or the uterus. These may then slip out of their normal position and crusade persistent discomfort. In severe cases, they may protrude into the vagina and even skid out the vulva.
DIAGNOSING THE Status
Experts shared that for women who suspect they may accept vaginal laxity, it is best to see a pelvic floor physiotherapist or a women'southward health specialist.
"Y'all wouldn't go to a pelvic floor physiotherapist if you were giving birth to a baby, so don't go to a gynaecologist to rehab your pelvic floor – that'due south not what their specialty is," said O'Byrne.
If you do consult a gynaecologist, chances are you will exist referred to a physiotherapist for rehab.
"Hospitals like KK Women's and Children'southward Infirmary do have a department of women's health physiotherapists … They're non your regular physiotherapists, focusing on sports medicine. They really focus entirely on pelvic floor muscles. Information technology's a sub-specialty," said Dr Sidhu.
A consultation with a specialist GP or physiotherapist will typically begin with questions near a client's lifestyle:
- Age and feel in significant milestones such as pregnancy
- What blazon of commitment did you have — vaginal or Caesarean?
- Have you lot had any surgeries in the pelvic area?
- What is your daily routine similar?
- How much fourth dimension exercise you spend sitting?
- How frequently do you practice?
- How frequently do you pee in a day?
- What kind of job do you take? Is it the kind of task that forces y'all to put off relieving yourself until the end of your working hours?
- What medication are you taking, including hormones?
- Accept you had pelvic floor physiotherapy?
The conversation may then move towards those pertaining to actual functions:
- Can you control your float? Are you leaking urine?
- Are you getting pain from penetration?
- Are you having pains around your vulva?
- Can you control your bowel movements?
- Can you control your flatulence?
There may also be concrete examinations.
Dr Sidhu said she would first bear an external bank check, and not exclusively to the lower region.
"We look for elements of things like dryness elsewhere because women with menopause volition mutter of irritability and dryness in other areas. When we do focus on (the lower) area of the torso, we look for dryness in the vulva," she said.
"Nosotros also look for shrinkage of tissues. Sometimes, that area in a younger person is supposed to look very supple – in that location are squeamish folds and ridges here and there – and there's a level of hydration.
"But when you expect at someone who'south suffered tissue ageing in the vulva, you meet that the tissues are really quite dry in appearance. They might take scarlet dots in that location and they might not have the elasticity," she added.
An internal check might involve a speculum, a tool too used in Pap smears.
"Again, on the inside, you might see similar things like a loss of these nice little folds. They seem more than flattened out, the tissues are thicker and there's a lack of hydration. You lot're not looking for how much liquid there is in the canal – that's not hydration. Hydration is what the tissues wait like, the walls," Dr Sidhu added.
Doctors may also use modalities similar ultrasound scans to guess the force of a patient'due south pelvic floor.
"When y'all breathe in, the dynamics of your muscles modify – your diaphragm moves upwardly and down. At different times of your breathing, they look at how this ring of muscles effectually your vagina moves. "Sometimes you see a lack of motion in this ring and y'all may go 'ah, the muscles there are a footling weak – they're non moving and contracting the style they should'. From here you lot tin deduce that the muscles are weak or very tight," she said.
WHAT CAN Be Washed?
"Unfortunately, for a long time nosotros've just told women 'oh, you lot've had a infant, information technology's normal to leak'. That's non the case at all. We should not exist saying 'oh it'due south normal, you're okay'. We should be saying 'no, nosotros demand to address that'. There'south lots of things nosotros can exercise about (your condition), we can address it appropriately," she said.
"A expert and strong pelvic flooring is something nosotros should all take."
Physiotherapists like O'Byrne will typically recommend a rehabilitation programme.
"In France, after giving nascency, women expect to see a pelvic floor therapist 10 times. As far as they are concerned, we demand to rehab and prepare everything that just went through all the trauma of giving birth. It'due south a full contact sport - no one comes out unscathed," she said.
Through a rehabilitation programme overseen by a physiotherapist, a woman tin correctly understand her anatomy, identify the cause of the laxity and obtain guidance in restoring the functions related to the condition, O'Byrne explained.
Nosotros need to rehab and ready everything that only went through all the trauma of giving birth. It's a full contact sport – no 1 comes out unscathed.
If a patient is diagnosed with weak pelvic muscles, a therapist may recommend kegel exercises. The pelvic muscle-strengthening exercise popularised by American gynaecologist Arnold Kegel must be properly prescribed and taught.
"When you tell someone to do 300 kegels, outset of all, some women don't know what that is. Also, telling someone to just go and do 300 kegels is a waste of the person's life. You need to brand handling specific to the person.
"For instance, yous need to first check that her muscles are weak and non overactive. Because if they are overactive, she should stop doing pelvic floor squeezes and instead relax them downward first," said O'Byrne.
Relaxing an overactive pelvic floor involves "downward training", a musculus relaxation method that may include diaphragmatic animate and body scanning.
"This is where we get the muscles to 'learn to relax and let go'," said O'Byrne. "Information technology'due south usually more challenging than strengthening someone up as information technology's usually easier to learn to contract a musculus than it is to relax information technology."
And so how long does it take earlier you become results from rehab? O'Byrne said information technology depends on the severity of your issues.
"With some women it can be every bit simple equally one or ii sessions for a straightforward consequence like minor pelvic floor weakness, which tin can be corrected with exercise. With more complex cases such as 4th-caste tears and pain, in that location is usually some improvement after a few sessions only it can take a few months to meet significant change," she said.
A pelvic floor assessment with a physiotherapist costs around S$190 at the Health2U clinic, and clients typically come for a session in one case a week or every two weeks, said O'Byrne. A rehab package, which includes 5 face up-to-face consultations and access to the clinic'due south 8-week online programme comprising workout videos and a private Facebook group, can set you lot dorsum around S$650.
Many clinics, such as Orchard Clinic, supplement muscle rehabilitation with electromagnetic or radiofrequency therapy.
"Radiofrequency works to tighten the inner walls of the vaginal canal and improve skin texture of the labia or outer lips of the vagina, while electromagnetic therapy works to strengthen the pelvic floor," said Han, adding that such treatments can range between S$300 and Southward$1,200.
One treatment uses what is called the Emsella HIFEM technology to save issues such as urinary incontinence caused by weak pelvic floor muscles. Patients sit down in a chair during the session and information technology harnesses electromagnetic energy to simulate thousands of musculus contractions, hence "re-educating the muscles and creating greater muscle retentiveness", according to the dispensary.
About seventy per cent of Orchard Clinic'due south clients see positive results by the first month and 90 per cent experience results by the sixth, said Han. Positive results include increased vaginal tightening, improved urinary incontinence and intimate satisfaction.
InSync Medical's laser therapy treatment, FemiLift, involves a probe beingness inserted into the vaginal canal and fabricated to spin around.
The vapouriser inflicts "micro injuries" on the vaginal wall, signalling to the torso that information technology needs to heal the tissue that has been scarred, said Dr Sidhu.
"When y'all ablate tissues like that, you're giving your body an accelerated signal, telling information technology to go and heal the tissue properly. You force healing on that part of the vagina that otherwise would not happen," she said.
FemiLift is also said to promote collagen product, which in turn boosts hydration in the vaginal walls and leads to tightening of the culvert. This helps to solve a host of postpartum issues including dryness, recurrent infection, urinary incontinence and "looseness".
Light amplification by stimulated emission of radiation therapy is, however, nonetheless an invasive procedure, but Dr Sidhu assured it is "quite safe in the right hands".
"Heat therapy forces and promotes tissue growth and tissue healing, so we're accelerating that process by applying controlled micro injury to that area of the vagina. This is something that'southward been done on the face all the time.
"What you lot need is a professional person that knows about the settings and which modalities to use on you … As information technology is a minimally invasive process, at that place is a pocket-sized amount of risk. And how exercise yous know that the hazard is appropriate for you lot? Find a doctor trained in this department, someone who has used lasers a lot," she said.
FemiLift takes 10 minutes per session, with InSync Medical requiring clients to attend at least three sessions a month. A package of three sessions also as a follow-up session 12 months afterward the procedure costs S$iv,500.
CNA Women is a new department on CNA Lifestyle that seeks to inform, empower and inspire the modernistic woman. If you take women-related news, problems and ideas to share with u.s.a., email CNAWomen [at] mediacorp.com.sg .
Source: https://cnalifestyle.channelnewsasia.com/women/vaginal-laxity-causes-treatment-pregnancy-childbirth-278911
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