Private Perth Gynaecologist Dr Matt Thyer offers care at St John of God Subiaco and Mount Lawley Hospitals

Not uncommonly women may site concern about sexual dysfunction following vaginal birth. Concerns such as a lack of sexual interest (libido), pain at the entrance of the vagina, occasionally urinary or flatus incontinence, excessive laxity, reduction in sensation and pleasure. This can lead to reduced confidence with intimacy and lowered self esteem. Particularly where breast feeding is involved there is a significant reduction in natural ovarian oestrogen’s that are produced compounding vaginal tissue sensitivity, dryness and atrophy. Sleep deprivation due to parenting demands will commonly reduce libido.

Generally your Gynaecologist will recommend at least 6 months of observation, disciplined pelvic floor exercises and expectant management following childbirth to see if these problems self-resolve. A Women’s health Physiotherapist can guide your recovery in this way. Occasionally vulval or vaginal oestrogen’s may be of benefit, however caution is required in the context of ongoing breast feeding. 

However despite disciplined exercises sexual function may be sub-optimal. This is because much of the pelvic floor and fascial/connective tissue damage occurs away from the obvious site of injury at the perineum and remains hidden underneath intact skin in other areas of the lower genital tract, commonly between the bowel, bladder, bladder neck and vagina. Perineal tissue melding may be also sub-optimal resulting in long term problems such as inadequate perineal support, a capacious opening of the vaginal entrance, scarring and hardening of tissues that can result in excessive sensitivity and pain.

Where conservative measures prove ineffective or suboptimal, surgery is a reasonable choice of treatment with either scar revision, perineal rebuilding, bladder neck/urethral reconstruction or vaginal repair. The primary consideration here is about further childbearing, as subsequent vaginal delivery may result in repeated or worsened damage. Some women decide to delay surgery until childbearing is completed, while others will elect for repair and consider any future birthing via Caesarean section. 

There are costs and benefits to both approaches. The primary cost to waiting until childbearing is completed is the length of time taken be relieved of symptoms. There is also the argument that delivering further children vaginally will worsen lower genital tract symptoms. Conversely, recovery from pelvic floor surgery is a long process and women need plenty of support especially where parenting demands are often at their peak.

The optimal approach depends on your individual circumstances and desires. However in determining the correct approach for you it is important for you to seek professional advice, individualised to your circumstances that is truly aimed at your medium to long term benefit.

Dr Matt Thyer Private Perth Obstetrician and Gynaecologist has expertise in addressing sexual dysfunction following childbirth and regularly performs pelvic floor and vaginal surgeries to repair birth related trauma. Feel free to contact Dr Matt Thyer to help you navigate any concerns you may have following childbirth.