Does Lactation Impact Your Vulva and Vagina?

I’m assuming if you clicked on this page you have a sneaking suspicion as to my answer already, but… (drumroll please) yes! Milk production has a huge impact on vulvar and vaginal health. It might not be a surprise that for as long as you are producing milk, your body hasn’t hormonally returned to a pre-pregnancy state. It makes sense, right? You weren’t making milk before and now you are. Clearly something has changed. 

Let’s start by summarizing how some key hormones change during pregnancy and immediately postpartum. 

During pregnancy, estrogen levels steadily rise, peaking in the third trimester. Throughout pregnancy, estrogen supports development of the placenta, vascularization of the uterus, fetal development and promotes growth in breast tissue. Immediately following the birth of the placenta, estrogen levels plummet to below pre-pregnancy levels. Click here for a great visual on hormonal changes during pregnancy and immediately postpartum.

At the same time that estrogen levels plummet, prolactin levels rise. While estrogen levels are high, estrogen inhibits prolactin’s ability to stimulate milk production. With estrogen levels dropping out of the way following birth, prolactin can achieve its primary function of stimulating milk production.

But how does this impact your vagina and vulva?

Vulvar and vaginal tissues are highly estrogen dependent. Healthy estrogen levels keep vulvar and vaginal tissue flexible, plump and well lubricated. Low estrogen can contribute to dryness and thinning in the vulvovaginal tissue.

These hormonal changes can contribute to a number of common postpartum symptoms including:

  • Sensations of burning and itching 

  • Sensations of tearing during penetration

  • Vaginal dryness

  • Exacerbation of prolapse symptoms

  • Even urinary incontinence!

These tissue changes can also affect tissue healing in those who experienced any perineal, vulvar or vaginal tearing during childbirth.

So what can you do if you’re experiencing vulvar or vaginal symptoms while lactating? 

  1. Ask your obgyn or midwife about a topical estrogen cream. 

    Used locally at the vaginal opening, a topical estrogen cream can help to replenish your tissue with the estrogen it needs. While research has shown that estrogen is safe to use while lactating and that milk supply is statistically unaffected by using a topical hormone, it’s important to discuss any concerns regarding estrogen and lactation with your provider. Check out our discussion with an IBCLC to hear more about the data regarding topical estrogen and lactation.

  2. See a pelvic floor physical therapist. 

    The symptoms described above are often multifactorial. While estrogen deficiency may contribute to pelvic pain, prolapse symptoms and urinary incontinence, the musculoskeletal system often plays a contributing role in postpartum pelvic floor dysfunction. An evaluation with a pelvic floor physical therapist can help you better understand what’s causing your symptoms as well as what you can do about it. 

Have questions about pelvic floor physical therapy or interested in working with our pelvic floor PTs in our Austin office or via telehealth? Contact us here!

Otherwise, sign up for our newsletter to keep learning with us every month and check out our live and pre-recorded webinars to learn more about pelvic health!


This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.

Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.

She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.

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Addressing common causes of pain during lactation