Dear Alice,

I have given birth to three children. My last child was delivered without an episiotomy. I have noticed a change in the size of my vagina as a result of this. I am too embarrassed to have sex because I feel too loose. Is this common with multiple childbirths? I am too ashamed to ask anyone this. Please let me know if there is something that can be done to repair my womanhood.

Dear Reader,

It’s quite common for people to experience weakened or loosened pelvic floor muscles, so rest assured — you’re not alone! The pelvic floor supports the uterus, bladder, small intestine, and rectum, and when these muscles are weakened, it can affect sexual activity, bladder control, and more. There are a few courses of action that people may choose to follow based on their specific needs, but it may also be helpful to start by asking a couple reflective questions.

Before taking steps to “repair your womanhood,” it might be helpful to investigate your motivations in doing so. You mention that you’re embarrassed to have sex because of the perceived looseness of your vagina. Do you know where that embarrassment originates? Do you feel that your body must be a certain way to please your partner? Has your partner made any comments to you? What messages have you received about the function and purpose of your vagina throughout your life that have you concerned about its tightness? Communicating openly with your partner might be a helpful starting point to address your anxieties and needs around the changes in your body. Perhaps you’ll find that your partner doesn’t share your concerns, or maybe the two of you can explore other sexual activities that don’t rely on a tight vagina at all.

Some other questions to ask yourself are whether you’re experiencing physical discomfort or reduced pleasure from weakened pelvic floor muscles. Are you experiencing incontinence or the frequent need to use the bathroom? Are vaginal looseness or weakened pelvic floor muscles interfering with your daily life? Are you going through menopause, during which time people sometimes experience a weakening of their pelvic floor, along with a number of other changes? Answering these questions for yourself might help you decide which, if any, of these strategies may be appropriate you:

  • Kegels: One common, non-invasive method of tightening the pelvic muscles is Kegels since they're thought to have the potential to both improve bladder control and heighten orgasm intensity. They consist of tightening the pelvic muscles (which can be located through stopping the flow of urine midstream). A person could do Kegels by tightening the muscles hard and releasing. Over time, they could build up the number of Kegels that are done in a given day. A person could also experiment with the length and number of Kegels that they do. A change in muscle tone likely won’t happen instantaneously, but after six weeks of the exercises, a difference might become more noticeable.
  • Vaginal cones: Another related course of action could be the use of vaginal cones. Vaginal cones are tampon-sized objects that come in various weights; the user starts with the lightest cone, inserting it into the vagina and holding it there so that it doesn’t fall for fifteen minutes, twice a day. After a person masters the lightest cone, they can gradually work their way up to the heaviest. Vaginal cones have been found to be equally effective as Kegels in strengthening the pelvic floor.
  • Electrical stimulation: Electrical stimulation consists of using an electrical current to cause the vaginal and pelvic floor muscles to contract, just as they might through Kegels. It consists of inserting a small, tampon-sized probe into the vagina and emitting low electrical signals for 20 to 30 minutes.
  • Laser treatment: This option works to thicken the vaginal walls and increase connective tissue by upping the production of collagen, elastic fibers, and blood vessels in the area. Laser treatment involves sending pulses of laser energy into the vaginal canal to thicken and firm up the tissue.
  • Surgery: At the most invasive end of the spectrum, there are a couple surgical options that serve to tighten the vaginal canal. Vaginoplasty with perineoplasty is another surgical option that does tighten the vaginal canal and changes the appearance of the perineum (the area between the vulva and the anus) through a day-long procedure that requires general anesthesia. It requires suturing deep in the vaginal canal and that patients refrain from physical activity for four weeks and from sex or tampon insertion for six weeks. The surgery has been found to have few complications and high levels of patient satisfaction.

Pregnancy, childbirth, and aging change the body. These changes don't have to be seen as automatically negative, but if they're distressing to you, there are a range of options you can take to address them. Speaking with a health care provider about your specific concerns could help you identify what approach may be most appropriate for you. Hopefully a combination of self-reflection and information on what’s out there can help you choose the course of action that’s best for you!

Alice!

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