October Knowledge Drop
Each month for our newsletter, the Lady Blurb, we'll share answers to some pelvic health questions you've submitted. The questions below were taken directly from you! To submit a question for next month, comment below or email us at contact@ladybirdpt.com.
**The answers to these questions are not meant to be used as medical advice. These answers are not meant to take the place of a skilled physical therapist or discussion with your medical provider. If you are experiencing concerning symptoms, please contact your physician.**
This month, we’re answering:
1. How do I know if vaginismus is the cause of my pain with sex?
2. What can I do to support healing in the first couple weeks after childbirth?
3. I feel like air bubbles get trapped in my vagina after childbirth - what gives?
1. How do I know if vaginismus is the cause of my pain with sex?
I loveeeee that shows like Sex Education are shining the light on common sexual pain conditions like vaginismus. I do a happy dance whenever common pelvic pain conditions pop up in the media. But keep in mind, vaginismus is just one relatively common condition associated with painful sex. I’ll share some definitions of common conditions below to help you determine whether vaginismus sounds like your experience.
Pain with sex: Yes, I am seriously going to define pain with sex. For starters, pain with sex is a symptom, not a medical diagnosis. People have pain with sex for a number of reasons. Pain with sex can include pain with clitoral or external stimulation, pain with penetration at the entrance or deeper, pain with orgasm. It can feel like sharp, stabby pain. It can feel itchy or burny pain and it can feel dull (as well as a number of other descriptors). Pain with sex can be caused by lack of lubrication, hormones, muscular overactivity, lack of foreplay and a number of conditions like endometriosis, menopause, yeast infections and STIs.
Vaginismus: Vaginismus is a condition where the pelvic floor muscles involuntarily contract with any attempted penetration. Vaginismus can onset at the first attempt to insert a tampon or have a gynecological exam, at the first attempt of penetrative activity or intercourse. It can also onset after childbirth or other pelvic floor injury or trauma. People with vaginismus will describe their experience of attempted penetration as feeling like the object attempting to penetrate is hitting a wall, like there’s no opening. It is typically associated with significant pain during attempted penetration.
Vulvodynia: Vulvodynia just means pain in the vulva, or external genitalia.
Vestibulodynia: Vestibulodynia means pain at the vestibule, or the vaginal opening. Vestibular pain is often associated with hormonal causes.
If you read the definition of vaginismus and it doesn’t seem to describe your pain, then vaginismus is likely not the right classification for you. I highly recommend working with a pelvic floor physical therapist experienced in treating pelvic pain to help you determine the cause of your pain and an appropriate path forward!
And if you’re interested in learning more about pain with sex after childbirth, check out our webinar on postpartum sex!
2. What can I do to support healing in the first couple weeks after childbirth?
Two of my closest friends gave birth in the past two weeks so this question has come up A LOT in my personal life lately :). Here are 5 things you can do to support healing in the first couple weeks postpartum, whether you had a vaginal or cesarean birth:
Stay hydrated & take stool softeners
Making sure you poop regularly in the first few weeks after childbirth is so important. The way you poop is also important. In fact, poop is so important after childbirth that tip 1 and 2 on our list are going to be poop related. Pooping after birth can be scary but making sure you stay hydrated and take the stool softeners likely provided to you by your obgyn or midwife can make a huge difference. Staying hydrated can be particularly difficult for those new to the lactation journey. Figuring out how much water you need to make up for milk production can take some time. The general recommendation for lactating people is to drink 100-130 oz of water per day, which is much more than most folks are used to drinking. Proper hydration will help to keep your stool soft, and stool softeners will help finish up the job while you figure out your hydration.
Use a squatty potty
The way you poop is just as important as pooping regularly. Avoiding pushing and straining in those early weeks is important to help limit stress on your healing pelvic floor. Using a squatty potty reduces the need for straining and makes it easier for your body to empty. If you don’t have a squatty potty, grab a shoebox, put your feet on it and get your knees over your hips while you’re sitting on the toilet. That will get the job done just as well. It’ll just be slightly less aesthetically pleasing.
And if you struggle with bowel movements, check out these bowel habits for managing constipation.
Use a peri bottle and dab when you toilet
A peri bottle helps to gently rinse your perineum after toileting. This is particularly important for anyone who experienced a perineal tear during vaginal childbirth, but can also be helpful for those who had a c-section after pushing for any period of time. After using the peri bottle to spray the perineal area after peeing or pooping, gently dab with some toilet paper to dry the area.
Rest, rest and then rest.
Rest. Rest. And then rest some more. Rest as much as you an. Rely on your partner or support folks to do as much as they can for you and your newborn. Relying on others is key to resting postpartum. The more you spend in bed the first couple weeks, the more opportunity your pelvic floor has a chance to heal without having to do the job of supporting your organs. The general rule of thumb is to spend your first week mostly horizontal with the exception of self and childcare tasks (like showering and feeding your baby) and to spend the second week mostly sitting. Another rule of thumb is to walk no more than 5 minutes at a time week one and no more than 10 minutes at a time week two.
Practice diaphragmatic breathing
While it’s not recommended that folks do any form of traditional exercise in the first few weeks postpartum, practicing diaphragmatic breathing is a great way to reconnect with your breath, your abdominals and your pelvic floor. Diaphragmatic breathing has the added benefit of nervous system regulation as well. To practice diaphragmatic breathing, take a slow, deep breath in, allowing your ribs to expand and your belly to fill with air. At the top of your breath you should feel your pelvic floor gently relax. Then slowly exhale and feel your abdomen and rib cage sink back to resting as your pelvic floor slowly rises. To get some added nervous system benefit, breathe in for 4 seconds and out for 6-8 seconds. This will help to activate your parasympathetic nervous system, or the rest and digest system of the body.
3. I feel like air bubbles get trapped in my vagina after childbirth - what gives?
This is SUCH a common complaint after childbirth. This feeling can be anything from weird to annoying but there’s a reason this happens. The primary reason people feel air getting trapped vaginally after childbirth is because of anatomical changes that occur following pregnancy and birth. Because the position your tissue sits in can shift after childbirth, this can create an opportunity for air to get trapped in the vagina when you move around, only to exit when you least expect it later in the day. This can happen during yoga or other workouts, or just when you’re shifting positions on the couch.
While this is not the primary complaint of most folks I work with, I’ve had patients report an improvement in this symptom as we worked on their underlying tissue impairments.
Working with a pelvic floor physical therapist can help address sexual dysfunction, bowel and bladder concerns and help you prepare for pregnancy, birth and postpartum recovery. Contact us here to learn more about setting up an appointment with us, today!
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.