Dear Dr G,

Thank you for your informative and entertaining article each week. My wife and I often look forward to your articles. This brightens up our weekend on a dull Sunday.

We have a problem. My wife and I have been married for five years and we have been blessed with a three-year-old boy.

Our sex life has been fantastic when we were trying for the baby. Sadly, everything has been “sagging” ever since the birth of our son (literally)!

My wife had a tough time during childbirth. Besides the prolonged labour, and she had an episiotomy during birth. The wound was infected and had delayed healing.

We started intercourse again one year following the birth of our child, and the intensity of our intimacy has lessened.

We went to see a doctor, and told him that the contraction of the vagina is not as “gripping”. The doctor seems to be dismissive and reckon there is nothing wrong!

I would like to put Dr G on the spot for my wife’s problem. Can you tell me why is the vagina so different after the childbirth?

Can the vaginal wall be so stretched that it is damaged and becomes abnormal?

Should my wife go for a vaginoplasty to return it to the “ideal” state? How is this operation done and are there risks?

Thank you in advance,

Dave

The vagina naturally changes after natural childbirth, as the baby needs to squeeze though the cervix and birth canal to reach the outside world.

Needless to say, some degree of stretching is required. Often times, to facilitate the passage, the skin between the vagina and anus might tear, or needed to be cut. This intervention is called episiotomy.

Despite complete recovery following the childbirth, it is common for women to feel altered sensation of the vagina.

This is usually described as loose, dry and pain during intercourse.

The dryness of the vagina may be due to lower oestrogen level during lactation, and the soreness of the episiotomy wound may persist for a few months.

In the vast majority of women, the vagina tightness would return to its pre-birth status, especially with pelvic floor exercise. However, in some women, the tone of the vagina muscle may remain compromised.

Technically, vaginoplasty is an operation that is performed in a gender reassignment, in order to construct a vaginal cavity out of penile tissues.

However, vaginoplasty is also the term describing the reconstruction performed to tighten up the female pelvic floor muscles surrounding the vagina.

The commonly accepted terminology for such intervention is “vaginal rejuvenation” as the intervention is intended to provide better pelvic muscular control for greater sexual satisfaction.

The vaginal rejuvenation operation is performed by pulling the pelvic floor muscles closer together, and removing the redundant skin and scar tissues.

The intended outcome of the surgery is to provide more friction during intercourse, which may be associated with pleasurable sex.

The vaginal rejuvenation operation itself should be a minor daycare operation. Despite being a minor procedure, there are also risks of infection, bleeding and scarring following the reconstruction.

The actual benefit and ethics of vaginal rejuvenation and other cosmetic genital operations are the subject of scientific scrutiny and debates. On one hand, the ethics of creating the ideals of a “normal” vaginal is ludicrous and questionable.

On the other hand, the feeling of being “abnormal” after childbirth may also generate a negative impact on sexual self-confidence of a woman and her partner that warrants surgical restorations.

One of the greatest and best-known French writers, Victor Hugo once said:

“Human soul has still greater need of ideal than of the real. It is the real that we exist; it is by the ideal that we live”.

When Dr G is put on the spot, his advice is: Ideally, couples should learn to accept and love their bodies the way they are. Explore and appreciate what we can do with our bodies, rather than dwell on what it looks like! Often times, open communication and spicing up the sex life is what is required, before turning to surgery.

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