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Perineal trauma can effect up to 85% of women after vaginal delivery. The consequences of this include perineal pain and dyspareunia (pain during sexual intercourse). Your perineum is a small muscular area between your vagina and anus.

Immediate postpartum tips and advice:

1. Ice is nice – place an ice pack on your perineum for the first 24 hours

2. Change sanitary pads often to keep the area dry as much as possible

3. Wash your perineal area with cold or warm water (whichever is most

4. When using your bowels it’s helpful to place a pad over the perineum

5. Lie down as much as possible

6. Pain relief may be prescribed by the physician

7. Start your pelvic floor exercises

8. Ensure you have having a healthy diet with plenty of water and fibre

to reduce swelling

comfortable to you) when you pass urine and gently pat dry

to support your pelvic floor

to avoid becoming constipated

A minor tear normally heals spontaneously and pain should ease in the first days. At your 6 week follow up you should be well on the road of recovery. However with larger tears, and persistent pain and problems with sexual intercourse, women should seek the help of a women’s health physiotherapist to manage the scarring and avoid long-term problems such as pain, bladder and bowel dysfunction and sexual dysfunction.

 

–>  When can you have sex again?

This greatly depends on your physical level of wellness and comfort however most health care providers suggest:

– After about 3 weeks in case ofnormal delivery without any tearing or stitching

– Wait about 6 weeks in cases of episiotomy or second degree tear. The sutures need to have healed completely

– Waiting for a longer period in cases of third or fourth degree tears and only after examination by the gynaecologist

 

–> How can you manage pain and discomfort during sex?

It is normal to feel some degree of discomfort, tightness or pain the first time you have sexual intercourse with your partner especially if there was any tearing.

Some useful tips include:

– Use a good quality, water soluble lubricant

– Allow plenty of time for foreplay

– Breastfeeding can cause vaginal dryness by reducing the production of oestrogen –the doctor could recommend an oestrogen lubrication cream

 

Do not force yourself to have sex and if necessary allow yourself more time before sexual activity is resumed. In some cases, although time passes a woman might still feel pain around the perineum especially during intercourse. Perineal massage is a useful technique to learn to manage any scarring that might be the cause of pain. It is useful to have a full examination by a women’s health physiotherapist to identify the

cause of the pain and also to learn how to perform perineal massage techniques.

–> What is Perineal massage:

– This type of massage can be started in the last few weeks of pregnancy in preparation for birth to help the relaxation of the pelvic floor and stretching of surrounding tissues.

– Can be a useful technique for women who have had an episiotomy/tear, undergone biopsies and/or reconstructive surgeries

– Massage helps to mobilize the pelvic floor muscles making them more supple and flexible

– carolyn@willingness.com.mt