A Gynecologic Perspective on Body Alterations Following Pregnancy
Posted September 25, 2020
The physiologic changes that occur during pregnancy allow women to undergo physical alterations to their bodies to accommodate and nurture their babies both before and after delivery. These physiologic changes, in terms of objective measurements and lab evaluations, return to normal by about 8 weeks postpartum. However, many women find that it may take closer to 6 months to feel normal again after having a baby. Depending upon whether women have a vaginal delivery versus a cesarean delivery and whether they choose to breastfeed their babies, there can be several additional months of “recovery”.
Women who have vaginal deliveries may require repairs of vaginal/perineal lacerations or may have an episiotomy and suture repair. Occasionally this may result in pain with sexual intercourse. In some circumstances, women may also experience changes in urinary continence or rectal function. Most of these issues resolve with time, but occasionally require medical intervention. Women who have cesarean deliveries avoid the vaginal and perineal injuries, but can still rarely experience altered bladder or rectal function. Many women, regardless of the type of delivery, will have some alterations of their abdominal muscle tone.
Women who choose to breastfeed their babies will have some obvious breast changes, but many will also experience vaginal dryness while breastfeeding which can also cause painful sexual intercourse (this can be treated with a vaginal estrogen cream). Once breastfeeding is completed, the breast changes may remain, but the vaginal dryness resolves.
While the extent of any post-pregnancy symptom dictates whether surgical intervention is necessary, it is generally recommended that women wait for at least a year after delivery before a procedure is done. This allows enough time for the body to complete its recovery and to decide on future childbearing desires. Most of the time, it is advised to wait until childbearing has been completed to consider any surgical interventions. Pregnancy following a surgical repair can often result in recurrence of the symptoms and then require additional repairs that can then be far more difficult and less effective.
Once women are certain that they have no plans or intentions to be pregnant again, it is reasonable to engage in discussions about body image and function. Concerns about the abdomen or breasts are best addressed by a plastic surgeon. Plastic surgeons can restore the abdominal and breast anatomy to an aesthetically desirable form which can provide significant improvement in feelings of desirability that may often concern a woman after having children. Women who have vaginal concerns, urinary problems, or rectal problems should seek council with their Gynecologist.
Pregnancy and childbirth can have a profound effect both physically and psychologically on women and both can have long-term and long-lasting influence. It is important to address a specific concern or issue early on, determine the right time to intervene and allow appropriate time for recovery. As difficult as it may be to delay a surgical intervention, it is critical to a patient’s long-term satisfaction. It is also important to recognize that timing is important, and procedures should be performed by physicians who respect both the desires of their patients and the success of their eventual outcomes.
The above brief comments are made with consultation with Dr. Bibiancy Gutierrez and Dr. Jane Sorokin