Childbirth is not sexy. The process involves copious fluids, murderous screaming, and rigorous pushing that is not kind to a woman's body. Generally, the vagina is stretched and torn so much along the way that women are left with dramatically different cooches than when they started. As a result, postpartum sex can be daunting and sneezing without peeing becomes a pipe dream.
But what if I told you it doesn't have to be this way?
On a recent trip to Paris, I met up with an old friend—let's call her Émilie—for drinks and much needed catching up. She had a baby about a year ago, and during our walk from the 19th arrondissement to the Canal Saint Martin, the topic of her very fit vagina came up. In fact, she said her vagina was fitter than ever—which is shocking because SHE JUST HAD A BABY. So of course I had to learn her secret.
"In France they give you a cooch coach," she said. Excusez-moi?
A "cooch coach" is the exact term Émilie used, but the more formal term is kinésthérapeute, or physiotherapist. Following childbirth in France women undergo la rééducation périnéale (perineal reeducation), in which a physiotherapist helps transform their pelvic floor from the sloppy mess it has become back into to the tight and fit model it used to be. Since 1985, the state has been providing new moms with these vagina lessons for free because it steadfastly believes that a healthy vagina is good for both the longterm health of the mother and the sex life of the father. (If you didn't already know, France has a universal healthcare system that is considered one of the best in the world.)
America doesn't have a standard postnatal vaginal reeducation program because, in this country, not only does the system treat women's health as an afterthought, but our culture has straight up vilified the vagina. Women in this country are taught that our vaginas look bad and smell bad, that periods are gross, and that, if we want our private parts to bounce back post-childbirth, we'll need expensive vaginal rejuvenation surgery—because now it's even grosser than it was before! But given that last year was the so-called "year of the period," in which menstruation was celebrated like never before, perhaps this year we can take a cue from the French and finally treat postpartum vaginas as the national treasures they are. In France, postpartum vaginal care is considered a medical necessity, not a vanity project.
And French doctors have very real medical concerns. "They are terrified of organ drop in France, so they take this very seriously," Émilie, who is American but married to a French man, told me. Organ drop happens when a pelvic organ, like your bladder, falls from its normal place and pushes against the walls of your vagina—something that can happen to women after childbirth.
Along with working to prevent organ drop, the cooch coach also works to get you back into bed with your husband as quickly as possible. For the French, sex is essential to health and happiness—and it doesn't carry the same shame that it does in this country. Nor does becoming a mother mean forgoing one's identity as a sexual creature. Enter: the cooch coach.
"In each of these sessions, we started by talking about how I was doing and how I was feeling," Émilie explained to me. "We also covered my sex life, and she gave advice on how and when to re-start 'making love.'"
The cooch coach laid out strict guidelines for Émilie's vaginal recovery. She told my friend to start doing Kegels and abdominal exercises immediately, to not run for four months, to not play tennis nor any sports involving pivoting for six months, and to not swim until her "vagina was tight enough to where water wouldn't go up there involuntarily."
But these sessions weren't just about learning: They were about doing. "We spent the majority of the sessions with her gloved fingers up my vagina while she walked me through strengthening exercises," Émilie casually explained to me.
Sitting in her own home, with her instructor's fingers inside her, Émilie practiced clenching before coughing; short bursts of clenching using different pelvic muscles; long, sustained clenches; clench combinations (clench fast, hold hard, release, rest, repeat); and what she called "advanced cooch maneuvers."
The latter included closing the muscles slowly "like the petals of a flower"; closing from "front to back or back to front"; making a sphere "like you're holding a bubble"; performing "corkscrews" with the muscles; clenching the vagina, then the anus, then releasing the vagina, then the anus; and finally a zig-zag clench going up and down, right, left, right left.
After hearing it all, I understood a little better why the cooch coach has her fingers up there. I mean, who really knows how to make a sphere like a bubble? I know I don't.
When not using her fingers, the cooch coach can also use a sonde—known as a "biofeedback device"—which is basically like a little dildo that's hooked up to a computer and can read your internal contractions. The process sounds pretty terrifying, but so is a lifetime of incontinence and painful sex. A sonde can be key to figuring out your weak spots.
While this all may seem like an unnecessary ordeal—old lady fingers and dildos—the benefits are real. Émilie says she's had no problems with urinary incontinence since giving birth, and her cooch coach even identified a serious problem she may have otherwise missed.
"At one point, I told her it was painful to make love, so she poked around and figured out where it was painful, did an exam, and concluded I had an infection on my stitches," Émile explained, adding that the whole thing was taken care of in about a week (and it was all free). If she hadn't been taking the lessons, she doesn't think the infection would have been found.
"Without her, I would have just thought that painful sex was the new normal, and I would have avoided having sex, while letting an infection linger," she said. "For the French, it isn't normal for sex to be painful after about 10 or 12 weeks post-birth, so if it is, they take it really seriously."
Émilie isn't the first to rave about these miraculous French cooch coaches. In 2010, The New York Times noted that "Weeks after giving birth, French women are offered a state-paid, extended course of vaginal gymnastics, complete with personal trainer, electric stimulation devices and computer games that reward particularly nimble squeezing." The program is all meant to lead to more sex and more babies.
In 2013, Ruth Foxe Blader, also writing for the Times, described the outcome of her own cooch coach experience in France, years after giving birth:
Four years later, I can say with confidence that the exercises, far more extensive than the standard Kegels that American gynecologists mention offhandedly, worked. Unlike in the United States, where a hypermedicalized pregnancy is followed by a perfunctory six-week follow-up, in France women aren’t left treading water in a sea of untold postnatal soreness. Many of my American friends have struggled with incontinence. But even a subsequent childbirth has failed to destroy my rock-hard perineum.
In addition, as Émilie—whose whole pregnancy cost her nothing—recounted, the state also sends a person out to check on the baby, perform exams, make sure new moms and dads know what they're doing, and check for signs of postnatal depression. This is in addition to the 10 to 20 vagina lessons provided. For comparison, the average cost of an uncomplicated vaginal delivery in the U.S. in 2008 was $9,600—just for the hospital visit.
So why aren't American women at least exposed to this type of training? In this country, most new moms receive a six-week checkup, possibly a Kegel brochure (if they're lucky), and they're sent on their merry way. On the Mayo Clinic's website for postpartum care, it tells new moms, "You might also ask about Kegel exercises to help tone your pelvic floor muscles" during the six-week checkup, as if it's something that maybe, if you're not too busy, you should consider. Nowhere does it suggest committing to 10 or 20 dedicated perineal training sessions.
"Despite the occasional embarrassment, these sessions actually work," wrote Claire Lundberg for Slate about her own pregnancy in France. Adding, "Americans’ lack of attention to the female body after giving birth is our own version of the modesty gown."
Indeed, the regimen isn't just cultural hearsay—studies have shown that perineal training is highly beneficial for women with pelvic floor dysfunction such as urinary incontinence, pelvic floor dyssynergia, or pelvic organ prolapse. While most studies haven't been conducted on pregnant women or women who've just given birth, the therapy targets many of the problems women suffer from post-pregnancy. And in a study that did involve pregnant women, Swedish researchers found that, among 855 participants, pelvic floor muscle training led by physiotherapists during the second trimester greatly helped with "urinary and anal incontinence in late pregnancy."
And here's the kicker: One study that looked at the literature on postpartum pelvic floor exercises from 1966 to 2002 concluded that "Postpartum pelvic floor exercises, when performed with a vaginal device providing resistance or feedback, appear to decrease postpartum urinary incontinence and to increase strength." Simply doing Kegels, on the other hand, as American doctors recommend, was "ineffective in preventing postpartum urinary incontinence."
Bottom line? Even French vaginas are more glamorous.
Taryn Hillin is Fusion's love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.