Every woman who has never given birth has thought about it: What exactly happens to your vagina after you push out a baby?
I know I thought about it before giving birth to my daughter—even celebs think about it!! In a recent interview, former Playboy model Nicole “Coco” Austin, currently pregnant with her first child, told In Touch, “I’m very petite down there.” Adding, “I’m prepared for pain, I just don’t want to go through all the dramatics of ripping.”
Oh, Coco. You are not alone.
With fears like Coco’s permeating our culture—and vaginal “rejuvenation” procedures getting more attention—I'd like to take a moment to spell out what really happens to a woman’s vagina before, during, and after giving birth. The good news? The vagina is an amazingly resilient organ that, for the most part, rejuvenates itself.
To understand what happens down there during labor and delivery, it helps to first understand how the vagina the changes during pregnancy.
“The younger generation talks about everything—but this, they’re scared to talk about!” said Mary Rosser, an assistant professor of medicine in the department of obstetrics, gynecology, and women’s health at New York’s Albert Einstein Medical College. “So many patients whisper their questions about what’s going to happen down there, even behind the closed door of an exam room.”
No need to whisper here, ladies—despite the fact that we’re going to kick off our conversation by discussing DISCHARGE!
“The first thing I tell people is that your vaginal discharge can change during pregnancy,” said Rosser, who is also a fellow of the American Congress of Obstetrics and Gynecology. “You might notice—but there’s nothing to worry about—an increase in white-ish discharge and clear discharge. The milky white discharge you see increases as you go through pregnancy, and as long as it’s not associated with any pain or itching, there’s nothing to worry about.”
Women will also notice changes to their labia. “A lot of women talk about feeling swollen in the vaginal area,” Rosser explained. “That’s because there’s an increase of blood-flow to the area during pregnancy—add in gravity and pressure, and that’s what you’re feeling.”
Another happening? “Some women will also develop varicose veins in the labia, the same kinds of varicose veins you get in the legs,” Rosser noted. “The vulva can have varicosity as pregnancy increases, but they’ll go away after delivery. But—you can see them again during the next pregnancy, and they will look worse.”
Now is when the big changes begin.
During labor, as a woman’s cervix dilates to approximately 10 centimeters in diameter, the vaginal canal and vulva also dilate to about 10 centimeters to accommodate the baby during its trip from the uterus to the real world.
“Mother Nature has designed it so that, in most cases, in the majority of cases, the body does exactly what it’s supposed to do,” Rosser said. She explained that the aptly named hormone “relaxin,” which is secreted in the late second and early third trimester, relaxes the ligaments so that they can stretch, and so the surrounding tissue can spread out right along with it to help facilitate labor and childbirth.
But what about those ladies with "petite vaginas"?
“The vagina is defined by the size of the surrounding structure, the pelvis and its musculature,” explained Holly Sternberg, an OBGYN in private practice in Atlanta (and full disclosure, a dear friend), and “the outside may not match the inside.” That is, “you might have the bones of your pelvis be quite wide—you may have wide hips—but the vagina itself may be quite narrow or vice versa.”
Petite or roomy, during labor, a woman’s vagina does stretch—and she may feel the sensation of being stretched in the process. “The vagina just stretches around the baby,” said Sternberg. “But the vagina itself doesn’t have that much trouble if the rest of the body cooperates.”
Soon after giving birth, a woman will indeed feel differently down there. “Women get very freaked out the day after delivery, when they’ve really had time to think about what’s going on and what has happened,” said Rosser. “They get scared to touch themselves in that area, and when they go to the bathroom.”
And when they do? “You will feel softer,” Rosser said. “The labia will feel more floppy.” But the body hasn’t begun to work its healing magic yet.
(For C-section mamas—while your vagina won't go through the same kinds of changes experienced by those who deliver vaginally, you can still expect some postpartum bleeding. After all, your uterus has to recover from the placenta being detached, as well as shrink back down to size and shed the super-thick lining it built up during pregnancy.)
Sorry, Coco, but tearing during vaginal childbirth is very likely. “Most people do,” said Rosser—especially first-time moms.
“Even though the cervix dilates, sometimes the vaginal outlet may not expand as much as you need it to,” she said. Sometimes a woman’s perineum (the area between the vagina and the rectum) can be notably tight or long, for example, which can lead to tears—or require an episiotomy, in which a medical professional will make an incision to widen the opening.
Rosser said that even though most OBGYNs will examine a woman vaginally during her pregnancy to feel the bones of the pelvis and try to determine how much space exists, you don’t really know what you’re working with until labor begins and a doctor can see the body’s progression as the baby moves through the vaginal canal.
Fortunately, the treatment for the tearing that Coco—and so many women—fear is pretty straightforward: stitches that will dissolve on their own within six to eight weeks.
“It’s fairly straightforward to sew up most tears,” Sternberg said. “And they look really good when they’re done. It’s amazing to see how people come back at six weeks [postpartum] and are healed. You have a really dramatic tear, but at six weeks, look quite normal again. I am constantly amazed that women’s bodies tear and heal!”
Both doctors stressed to me that these stitches have nothing to do with cosmetics, but rather to repair any torn tissue in the vaginal area. “It’s to control bleeding and restore function,” said Sternberg. “We really want to just make sure it works and is not bleeding.”
(In extreme but rare circumstances, tearing might be invasive enough to damage the rectum and rectal muscle, in which case a specialist will likely be called in to administer the stitches to best ensure the return of a fully functioning sphincter. But, added Rosser, “because there is so much blood flow through that area, most people heal really nicely.”)
While it won't happen overnight, eventually, a woman’s vagina will pretty much return to normal.
“Everything will spring back into shape,” Rosser said, although, “it probably won’t go back to exactly the way it was from before you were pregnant.” The size of the baby, genetics, and any delivery or postpartum complications will influence how quickly and how much you start to look (and feel) like your pre-baby self down there.
“You can be bruised and sore initially,” Rosser said, explaining that this is nothing to fear. “That’s just because the body has been through a lot.” Ice packs will help with swelling in the vulva for the first 24 hours after delivery—and feel good, too.
The best line of defense over the longterm? Good old-fashioned kegels. “It’s just like exercising any other muscle in your body. If you exercise it, it will help,” she said of the classic pelvic exercise. “It will tone the pelvic floor muscles and help with incontinence. Many women have leakage after birth. But if you do your kegels, this improves muscle tone and urination more quickly. And it will also help you later in life after menopause!”
While medical training suggests women perform ten repetitions, ten times a day, Rosser acknowledged that “no one has time to do that!” Instead, if you can squeeze (pun intended) four to six kegels in a day, you'll be in good shape.
Vaginal rejuvenation went "mainstream," if you will, after Real Housewives of Beverly Hills star Brandi Glanville announced to the world that she'd exacted revenge on her cheating ex-husband by having her vagina remade and remodeled—and charged to his credit card. "I decided that since Eddie [Cibrian] ruined my vagina for me, he could pay for a new one," Glanville writes in her 2013 book Drinking and Tweeting.
More recently, this past summer, a writer named Jane Marie penned a popular essay for Jezebel about undergoing vaginal rejuvenation from Glanville's own surgeon, Dr. David Matlock—during which, she reports, Matlock opened the four walls of her vagina with lasers, trimmed off excess tissue, and stitched the muscles back together to her desired level of tightness.
"Matlock initially developed what is now called Laser Vaginal Rejuvenation to cure urinary stress incontinence," Marie wrote, "but a happy side effect was that it tightens up the muscles and 'restores youth' to your hoo-ha."
Broadly speaking, vaginal rejuvenation promises to “re-beautify” the vagina, especially following childbirth—and for some women, as with any cosmetic surgery, the procedure may make them feel terrific. But most vaginas will look pretty much okay on their own.
So what else should a woman expect when she’s no longer expecting? When you see your OBGYN for your six-week postpartum visit, “we’ll check your stitches to make sure they’re all dissolved and healing well,” said Rosser. “We’ll make sure that the uterus has gone back down to an appropriate size," as well as the vulva, perineum, vaginal canal, and cervix—"we want to see that everything goes back to its original approximate location.”
And when it comes to sex, “I always tell people, there is no rhyme or reason to the best time,” she said. “Wait at least six, if not eight, weeks—but really, just resume when it’s most comfortable for you.”
Of course, “Having a new baby will change not just how you feel physically," she added. "You’ll also be exhausted. Your whole life has changed. Let’s be honest—the first thing you think about when you get into bed at the end of the day may not be sex.”
Jen Gerson Uffalussy is a regular contributor to Fusion. She also writes about reproductive and sexual health/policy for Glamour, and television for The Guardian. She lives in Atlanta.