5 reasons Your Menstrual Cup Might Not Fit Right After Childbirth

Menstrual cups are amazing. They’re great for the environment (helloooo reduced waste!) and much like tampons they come in different shapes and sizes to allows folks to find the right fit for their body. But it’s not at all uncommon for menstrual cups to not quite… fit right after childbirth. This can present as difficulty inserting the cup in the first place, difficulty keeping the cup in, or discomfort while you’re using it.

So what gives? There are a number of reasons the fit of your menstrual cup might change after childbirth. The most common reasons for discomfort inserting or wearing a menstrual cup postpartum include:

• Pelvic floor muscle tightness

• Pelvic floor muscle weakness or laxity

• Hormonal changes in the pelvic floor

• Scar tissue

• Muscle coordination changes

And for those of you wondering if it matters whether you gave birth vaginally or via cesarean… honestly, it doesn’t. Pregnancy itself impacts your pelvic floor regardless of the method of birth. Both vaginal and cesarean birth impacts your pelvic floor. The information in this post applies regardless of how you gave birth.

Keep reading for a breakdown on each of these common reasons including why each one can occur, how they impact cup insertion and wearing, and what you can do about it.

Now, on we go.

1. Pelvic floor muscle tightness

People often expect pelvic floor muscles to be weak or lax after childbirth and while that’s a possibility it’s certainly not a reality for everyone. Birth is a beautiful, intentional, uncontrolled trauma to your pelvic region. And just like with all physical trauma, the impacted muscles can respond with spasm. Spasmed or tight pelvic floor muscles can contribute to a host of common postpartum symptoms, and can impact your menstrual cup, too. Tension in your pelvic floor can make it difficult or nearly impossible to insert your menstrual cup. Tightness in these muscles can also contribute to pain while inserting the cup, discomfort or pain while the cup is inserted, and difficulty or pain while removing the cup.

Seeing a pelvic floor PT is the absolute best way to determine if you have pelvic floor muscle tension and the best way to create a personalized plan to address your tension. With that said, some simple pelvic floor muscle relaxation techniques can be found here.

2. Pelvic floor muscle weakness or laxity

Pelvic floor muscle weakness or laxity can also occur following childbirth. Similarly to pelvic floor muscle tension, weakness and laxity can contribute to a number of pelvic floor symptoms after childbirth. They can also impact your menstrual cup! Those with weakness are more likely to have an easier time getting the cup in, but may notice that keeping it in is a problem. Because your pelvic floor muscles use passive strength and muscle tone to hold the cup in, weak muscles can have a harder time doing their job, allowing the cup to fall down or even out throughout the day. Muscle weakness can also contribute to difficulty keeping the cup in during a cough or sneeze.

Similarly to with tension, seeing a pelvic floor PT is the best way to create an appropriate and personalized rehab program for your pelvic floor postpartum. Kegels aren’t enough to strengthen your pelvic floor - learn why here.

3. Hormonal changes

Postpartum and for as long as you lactate, your pelvic floor lacks estrogen, a hormone vital to tissue and muscle health. Decreased estrogen in the vulva and vagina can lead to thinning and dryness as well as skin sensitivity. These hormonal changes can contribute to sensations of itching, burning or tearing when inserting anything vaginally, including your cup. Dryness resulting from these hormonal changes can also contribute to discomfort during insertion.

While estrogen does typically return to pre-pregnancy levels when you stop producing milk, topical estrogen creams have been found to be an exceptionally safe and effective means of addressing these symptoms postpartum. If this feels familiar, talk to your OB or midwife about a topical estrogen cream.

4. Scar tissue

According to the American College of Gynecology, perineal tearing occurs in up to 80% of vaginal births. Click here to learn about other forms of tearing during vaginal birth. Scar tissue in your vulva, vagina or c-section scar can contribute to reduced elasticity in the pelvic floor muscles, thus making menstrual cup insertion painful, uncomfortable and challenging. Scar tissue lacks the flexibility that the rest of our skin has, contributing to these sensations.

But don’t fret! There is so much that can be done to address scar tissue! Perineal scar massage and c-section scar massage are two ways to manage scar restrictions postpartum to help your tissue recover. Scar massage can help improve comfort with menstrual cup insertion (and any type of insertion, for that matter!).

5. Muscle coordination

A healthy muscle needs to be strong enough to do the jobs asked of it, flexible enough to move through the full range of motion required for those jobs and well coordinated enough to follow the directions your brain sends your muscle fibers. Coordination can be a huge struggle for the pelvic floor because these aren’t muscles we can’t see. Poor muscle coordination can cause you to have difficulty relaxing your muscles during menstrual cup insertion (ow!) and can cause you to bear down when the cup is inserted causing the cup to come out (annoying!).

And while I’m starting to feel and sound like a broken record… pelvic floor PT is the best way to get your muscle coordination assessed and treated!