By Heather Rupe, DO

During delivery, the vagina is stretched to the size of a bowling ball. A bowling ball. So, it’s not going to be “the same” afterward. But it can function normally again – it just needs a little time and care.

How quickly a vagina will recover from delivery is as unique as the vagina itself. The biggest factor, of course, is how the delivery went. While vaginas are built to expand, they’re not made of elastic, so sometimes there’s tearing. This can often be reduced by using lubrication, massaging the perineal muscles, and taking direction from your birthing coach as the baby crowns. But at the end of the day, it’s just impossible to predict. I have seen women push out 10-pound babies without needing a single stitch; I’ve also seen women deliver 6-pound babies and end up with vaginas that looked like a bomb went off inside them. Thankfully, the vagina has plenty of blood flow to it, which promotes healing, so most vaginal tears heal within about 6 weeks after giving birth.

As those who have pushed a child out of their vagina know all too well, though the tear may heal quickly, that doesn’t mean that your lady parts are back to “normal.” Most women’s vaginas are not truly back up to speed until breastfeeding is over. The lower estrogen levels during breastfeeding can lead to dryness, pain and lower sex drive. Usually these effects can be overcome with some extra lubricant and TLC in the foreplay department.

You might also worry that your vagina has been stretched out, like a well-loved turtle neck sweater that’s lost a bit of its shape and elasticity. For most women, though, vaginal looseness doesn’t affect their sexual function or the enjoyment of their partner. If you do note a decreased sexual response, remember that the vagina is a muscle, and the best treatment for weak muscles is exercise – which brings us to Kegel exercises. Kegels are key to getting the pelvic muscles back into shape. If simple Kegels don’t help then pelvic physical therapy can often improve pelvic muscle support and improve sexual response. Brooke Faught, WHNP, director of The Women’s Institute for Sexual Health agrees, “For women that complain of vaginal laxity (loosening) or decreased sexual pleasure after having a baby, I strongly encourage pelvic floor physical therapy. I explain that orgasm is contraction and released of the pelvic floor muscles and the stronger the muscles, the stronger the orgasm.” That’s motivation!

What I would not recommend is the use of herbal “treatments” intended to “tighten” your vagina in order to enhance sexual feeling. These usually contain some type of caustic chemical that works by irritating the skin, causing an immune reaction that makes the vagina swell. I recently had a patient get a second degree vaginal burn from an herbal vaginal suppository she bought on the internet.

Vaginal laser therapy, sometimes marketed as “vaginal rejuvenation,” is FDA approved for treatment of dryness and pain associated with vaginal atrophy. It is not intended to “tighten” the vagina, although some women who have had the treatment report this response.

Before you resume sexual activity, check with your doctor at your 6 week postpartum visit to confirm everything’s okay and ready to go. Once you’re sexually active again, if you’re having trouble with pain or vaginal looseness – and if lubrication and Kegels aren’t helping – follow up with your doctor to find a safe and effective treatment.