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Vaginal tearing and childbirth.

My friend and I are both pregnant for the first time. She has decided to have an elective C-section after hearing lots of horror stories about women never having sex again after they give birth vaginally. I’m personally creeped out by the idea of having an elective C-section, but now she’s got me scared. Please give it to me straight: what will happen to my vagina after I give birth? Is an elective C-section a good thing to consider if I ever want to have sex again?

We can’t say exactly what will happen to your vagina (nor can anyone else) as the result of a vaginal birth, but what we can tell you about what might happen. And we won’t hold back.

In vaginal birth you might tear, bruise or get what are lovingly referred to as “skid marks” – a kind of graze on the inside (or outside) of your vagina. Even in a relatively smooth birth, the thing does take a bit of a beating. You may not want to go near it for quite a while. But time, as they say, heals all wounds, including those in the nether regions. In most cases, a near-total recovery will be achieved weeks to months after the birth, depending on how major the damage. When you first venture into the sexual arena again, sex may be somewhat uncomfortable, or even painful. This is usually due to a combination of things: tenderness, tightness, hormones (which inhibit lubrication), anxiety about pain. These problems usually diminish with time. No matter what horror stories you’ve heard, problems with healing are rare. Also keep in mind that women are told not to have sex until six weeks postpartum no matter what kind of birth they have!

Your friend may have caught wind of what is sometimes referred to as “perineal sparing” via elective C-section. Some studies have shown that women who give birth vaginally are more likely to have damage to the pelvic floor. The pelvic floor muscles are like a sling that hold together all the bits. A damaged pelvic floor is slacker, which could theoretically affect one’s sex life, though incontinence is the main concern. It’s hard to untangle the stats about vaginal births and pelvic floor damage when they are so firmly embedded in a pretty divisive and controversial debate about elective C-sections! C-sections – even elective ones, which are safer and easier to recover from than emergency ones, come with their share of unpleasant (and potentially dangerous) risks and side effects. And these risks are exactly why the debate about elective C-sections rages on (see the Babble message board on the subject here) among health care practitioners and pregnant women alike.

But, as far as we can tell from the studies available, here’s the deal: There is a slight increased risk of temporary pelvic floor damage (most often in the form of urinary incontinence) from a vaginal birth. This means a squirt of pee when you sneeze or cough now and again for about the first year or so. Long-term effects are rare. Many women have stress incontinence later in life but gravity, genetic disposition, age and other health issues are considered the main causes. (There was a study of incontinent nuns that helped prove this.)

The mythology of the stretched-out, gaping, flappy, big ol’ momma vagina is mean-spirited and false, yet remains a source of utter terror to many pregnant women. Really, we’ve worried, too! But the idea that birth will leave you with an orifice the size of a beer can is just plain crazy. The vagina was meant for birthing as well as sex, that’s why it’s so flexible! Look, we’d be lying if we said your vagina will be 100% good as new. But there are some ways to prevent pelvic floor damage in a vaginal birth:

• Tell your doctor or midwife you do not want an episiotomy or forceps delivery, or find a practitioner who rarely does them.

• Kegels, kegels, kegels.

• Prep the perineum by massaging oil on the area before and during labor. There’s no proof this works but some swear it helps.

• Do not push too early on. Wait till the baby is very low down. (Too much strenuous pushing before the baby can wear the muscles out – your doctor or midwife should be able to guide you through this).

And as for your second question about C-sections saving sex lives:

There’s no doubt that many parents’ sex lives take a hit after kids enter the picture, but the real reasons have a lot more to do with changing roles, lack of time, and exhaustion than with C-sections or vaginal births. Chances are excellent that your method of delivery will have a lot less of an impact on your sex life than other things (like, for example, the baby).

We’ll end on an optimistic note from the American College of Nurse Midwives: “Some women worry about the impact of vaginal birth on their sex life. While birth certainly impacts intimacy on a temporary basis, no evidence exists to suggest that it is the cause of long-term problems, nor that women who have cesareans face any fewer challenges.”

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