Changes that nobody talks about after pregnancy:
Why being intimate is so hard after childbirth. (10 mins)
TLDR*;
- It’s normal for one or both partners to have no sex drive for months after childbirth, though everyone is different.
- Communication about bedroom intimacy with your partner is key – don’t rush it, and make sure it is enjoyable when you get back into it, otherwise this will lead to hesitation and conflict. Make sure you get the conditions right (birth wounds fully healed, babysitter, both parents well rested and in a good mood, don’t rush the foreplay).
- Issues “down there” are very common and can persist for over a year after giving birth.
- It’s not only about being ‘dry’, your vaginal mucosa is thinner and less elastic too, and can make it feel tighter. There are also non-sex things like itching and urinary symptoms that can be an issue.
- If vaginal dryness is your major issue, in the first instance, try a vaginal moisturiser – this is not the same thing as lubricant! This is used every few days at night, and you can think of it as replenishing the normal mucus that exists in your vagina.
- Use lubricant with sex only as needed, and choose your lubricant carefully – ideally use something “iso-osmolar”, “pH adjusted”, and “preservative free”. You don’t want to upset the balance of good and bad bacteria in your vagina. This can lead to smelly discharge (bacterial vaginosis) or a UTI.
- If tightness is your issue, or vaginal moisturiser and lubricant doesn’t work for dryness, speak to your gynaecologist about other options. Depending on the cause (muscular vs connective tissue) different creams might be recommended, or botox or surgery.
- Vaginal issues after childbirth usually get better by themselves after 12 to 18 months. If they don’t see your doctor.
*Too Long, Don’t Read
The non-medical stuff
Is it normal to have no libido after childbirth?
Yes this is completely normal, and affects both men and women. That being said, this article will discuss mostly the female experience.
The birth of a child is an exhausting process and very few parents feel the drive to be intimate right away after childbirth. It may take days, weeks, months, or even years for your libido to return to normal. This is completely normal, and nothing to be ashamed of or worried about. Though everyone is different, on average men typically get their libido back before women.
If you are experiencing a low libido, there is a good chance your partner feels the same way. The first few months following delivery are usually a battle against exhaustion, sleep deprivation, anxiety and uncertainty about raising your child, and it’s hard to get into the mood in this state.
A low libido does not mean that your partner has stopped finding you sexy, its more likely that they are simply exhausted. If either partner wants to be intimate, communication is crucial. Firstly, checking that any birthing wounds are fully healed, that there is enough support both emotionally and practically (in terms of looking after the baby/house), and being well rested is a good start. Finding someone to look after your baby for a few hours and having some alone time is a good idea. When you’re ready to try, even if the conditions are right, be aware that you’ll probably have to spend more time on foreplay to make it comfortable and enjoyable for both of you.
People often worry that if they don’t get things started again, they’ll get into a rut. That might well be the case, but it’s also important not to rush things, as a painful experience may cause hesitation, vaginismus* and lead to further problems. It is important to make sure the first time back is enjoyable and pain-free, as this is more likely to bring the excitement back into your sex life.
*Vaginismus is an involuntary spasm of the muscles around the vagina that results in painful intercourse
The Medical stuff
How long should I wait after childbirth?
The amount of time it takes to fully heal your wounds from childbirth will depend on what injuries you sustained. For anything other than the most minor of mucosal injuries (so grade 2 tears or higher, or a caesarian section wound) it takes most people 6 weeks for the wound to build up enough strength to withstand the strains of sex. Mucosal (grade 1) tears will generally physically heal within 2 weeks. Some wounds may be complicated by infection or dehiscence, and these will take much longer to heal.
However, even if your wound is physically strong enough, the nerve endings may not have healed completely, and there may be varying levels of altered sensation (tingling, numbness, warmth). Depending on the extent of the injury, and how much pain you had during your recovery, you may have ongoing pain or discomfort where your wounds are.
At the end of the day, you are ready when you are ready. Before you have sex, you should make sure your wounds are healed and you are pain free. Make sure you’re both well rested and make sure you organise to have plenty of alone time. Get the conditions right and make sure the first time back is enjoyable.
Is it normal to have issues “down there” after childbirth?
There are a number of changes that occur after birth, aside from healing wounds. The most common issues are: dryness, tightness, pain, itching and urinary symptoms. Underpinning all of this are two main changes that occur in your vagina – thinning of the vaginal wall (making it less elastic, therefore tighter), and a reduction in vaginal mucus production (which reduces lubrication).
Most women find that they are drier after birth. The dryness remains the same for about 6 months after delivery, and then slowly gets better. Most women report going back to baseline 12 to 18 months after delivery. A significant number of women (about 30% or so) actually have dryness before delivery, but the additional dryness is often just enough to tip you over the edge.
What does it mean to have a dry vagina? Well, pain with penetration is the most common symptom, but difficulty with penetration is an indicator too. If you find it hard to get penetrated in certain positions, it’s likely because your vagina is too dry. Sometimes, a woman’s only symptom is that it feels uncomfortably tight without enough lubrication.
The symptoms of increased tightness are pain with sex, and a feeling of increased tightness that doesn’t improve with good lubrication. Whilst a tighter vagina can actually make it feels better, if it felt tight before already, increased tightness might tip you into ‘too tight’ territory and become an issue.
Other non-sex related symptoms include itching and urinary symptoms, which are probably related to imbalances between good and bad bacteria and changes in vaginal pH, but these are less common than sex-related symptoms. These will be covered in more depth in a different article, but are nonetheless issues to remember when choosing products to manage your symptoms.
There are two main contributing factors to issues “down there” – breastfeeding, and the oral contraceptive pill. There are substantial benefits to breastfeeding, and many doctors recommend using the oral contraceptive pill if you don’t want to use barrier protection. Neither of these factors are easily modifiable. You’re going to have to find some other way of dealing with your problems.
Fighting dryness
It is important to understand how you normally become wet “down there”. There are two important steps in this process, the coating of the vagina in mucus, and the hydration of the mucus that makes it act as a lubricant. The mucus is made up of mucopolysaccharides and other large molecules (lets call these macromolecules) and a fluid component consisting of varying levels of water and electrolytes. These macromolecules are secreted by the uterus and cervix, and eventually travel down to coat the vagina and labia. The special thing about these macromolecules is that they have the property that they can absorb water very well, and when they get hydrated enough, they puff up, and begin to slide over each other and act both a protectant as well as a lubricant.
The hydration part comes when you are aroused. Pores form inside the vaginal surface and liquid from a place called the ‘interstitium’ flows through these gaps and into the mucus, hydrating it and making it flow better.
Dryness can therefore arise either when there is a decrease in macromolecule production and deposition into the vagina, or a decrease in the hydration of the mucus, leading to mucus that is less wet and more sticky. The most common reason why mucus production is reduced is a drop in oestrogen levels, which causes the cervix and uterus to reduce the amount of macromolecules they secrete, but of course if you’ve had surgery to remove your cervix or uterus, you won’t be able to make any mucus. As for the hydration part, changes in oestrogen levels changes the amount of blood flow as well as the thickness of the vaginal skin, and changes the amount of hydration that the macromolecules can get.
What then is a vaginal moisturiser? Well, vaginal moisturisers are generally made up of macromolecules like polysacchirides and oil molecules, so you can think of it as ‘topping up the macromolecules in the vagina.’ These macromolecules cling to the surface of your vagina for several days, and like the mucus that your vagina makes, will absorb the fluid that your vagina secretes when you get aroused, forming a slippery layer that feels like natural vaginal mucus.
How is this different from a lubricant? Well the main difference is that a vaginal moisturiser is delivered directly into the vagina, whereas a lube is usually put on to whatever is “going inside”. However, there are some other differences. The ideal vaginal moisturiser is fairly thick and should feel like it will cling to the inside walls, whereas a good lube will feel fairly wet and slippery. Also, the idea behind a moisturiser is to use it regularly every few days, even if you’re not being intimate. Vaginal mucus serves all sorts of other functions, other than lubrication for sex. Probably the most important one is that it acts as a food source for the good bacteria and helps to regulate the balance between good and bad bacteria in the vagina, helping to prevent bacterial vaginosis* and UTIs. On the other hand, many lubricants increase the risk of bacterial vaginosis and UTIs by upsetting this balance by having a pH that is too high, and containing strong preservatives that upset the balance of good and bad bacteria.
In general, regardless of if you’re looking for a vaginal moisturiser or a lubricant, you should look for a product that is iso-osmolar, has a pH that’s slightly acidic (3.5 to 5), and if possible preservative free, though the realities of manufacturing mean that usually some kind of preservative is required.
Now, if moisturisers (+/- lubricant with sex) isn’t working for you, it’s time to go and visit a gynaecologist to talk about your options, which at the moment is basically some sort of oestrogen product. Those of you in the know might have heard of other products, perhaps a suppository or a cream, that reverses these vaginal changes. What about these? Well, we don’t have a comprehensive knowledge of all of the products out there, but we’ll bet that they either contain oestrogen, or vitamin E as the key ingredient.
Oestrogen-containing products are very effective, but should be used in consultation with your doctor as they can cause significant side effects, and can increase your risk of certain cancers on top of that. If you’re going to use oestrogen-containing products, you should be followed up appropriately by your doctor. But what about vitamin E (Tocopherol)? Well the jury is still out on this one. There has been a recent RCT (Randomised Controlled Trial) that found that it was as effective as oestrogen for vaginal symptoms. As far as we are aware, there is still disagreement among the medical community about its mechanism of action, effectiveness and safety. Again, your Gynaecologist will be the one to talk to about that, but as more evidence and safety data comes out we will update this article and our products.
*Bacterial vaginosis is a condition in which the balance between good and bad bacteria is upset inside the vagina leading to a foul, smelly discharge from the vagina
Fighting Tightness
Tightness can be a symptom of dryness, so the first step is to make sure that dryness isn’t the issue. If that doesn’t work, then you should go see your gynaecologist. Generally, tightness could be a muscular issue, or a connective tissue issue. Muscular issues generally come about when there is anxiety about pain/hesitancy about having sex, but also can occur due to infection/trauma/surgical repair and scarring. A reflex contraction of the pelvic floor muscles called vaginismus is the most common cause of muscular causes of tightness. Over the long term, this is associated with chronic pain and vulvodynia. The best treatment for this is prevention, and this is why we so strongly recommend getting the conditions right the first time back, and making sure it’s enjoyable. For vaginismus, your doctor might recommend a local anaesthetic or counter-irritant cream to help relax the spasm, and failing that, try mechanical methods like vaginal dilators, botox injection or surgery.
Connective tissue issues generally have to do with a loss of elasticity in the vagina, however can also be a result of scarring or surgical repair. Generally speaking, the options are an oestrogen cream, vaginal dilators or surgery, but the best thing for you should be decided between you and your gynaecologist.
**The promotional bit.
At downthere.healthcare we have three things that we care about. Listening, Liberating and Learning.
In medicine there is a concept called ‘Level IV’ evidence, which says that in the absence of rigorous scientific experiments, the next best thing is expert opinion. We disagree! We think that listening to the opinions of people who actually have to deal with these issues is much more important. We want to know what your experiences are, what you want to know, and what you’d like from us.
We want to liberate the people with conditions that have (until now) been swept under the rug. They are common! We are all born with butts, penises and vaginas (or combinations of) and use them in different ways. They are all subject to conditions and illnesses just like anywhere else in the body. You shouldn’t feel embarrassed to talk about it. If you share our values and want to do your bit to help us de-stigmatise these conditions, tell everyone you can about us, share our videos and articles, and don’t be afraid to talk about the issues you are having. This only works if you are brave enough to get the movement going.
We don’t pretend to know everything. We think there is always something to learn and something to improve. We appreciate your advice so get in touch with us and let us know where we can do better. (something about other companies here)
With that in mind, for vaginal problems, we’ve listened to real people and we are working on a few projects under the code name “VFF”, and if you like what you see, we’d love it if you could show your support. If you’re interested, become a product tester here:
VFF vaginal moisturiser will be a:
- Thicker vaginal moisturiser that clings to the vagina better, and lasts longer
- Contains no petrochemicals or artificial preservatives
- pH adjusted, and iso-osmolar to prevent messing with the balance of good and bad bacteria in the vagina
- Contain red-cabbage extract that will change from pink to blue if the pH of your vagina gets too high, allowing you to detect a problem early
VFF intimate wash and conditioner will (be):
- A body wash specially formulated to be gentle on sensitive areas prior to sex
- pH adjusted to avoid messing with the balance of good and bad bacteria
- Leave the genitals silky smooth and improve lubrication
VFF lube will be a:
- pH adjusted, iso-osmolar, water based lubricant that won’t mess with your bacterial balance
- Self-preserving, using a mix of essential oils
- Made of all natural, ethical, plant-based ingredients
- Come in a variety of adult fragrances, making oral sex more enjoyable
If you want to be updated on the progress of these projects, subscribe to updates.
