Increased size and laxity is a major issue for many women after natural childbirth.
Unfortunately, this issue can have a devastating impact on body image, self-esteem,
and relationships, and this is a really embarrassing problem for many women to discuss.
Hi, I’m Michelle, and I’m a pelvic floor physiotherapist,
and today I’m going to share with you seven things you can do to address this issue. Now,
I’m going to be going through the seven things and they're in the timestamps below,
if you'd like to skip the first bit to get to those things. But I really want to share with you,
first of all, the feelings of four women that have shared with you their feelings today,
and also to how you can measure your own natural size as well, and what is average natural size.
So let's get right into it. I’m going to start with the comments from the ladies that have
kindly shared their comments with you and their thoughts with you, so that you can hear how this
issue affects different women. Now, here's what some of the ladies have said to me:
I'm 37, my birth injuries caused me insecurities, low self-esteem in my marriage and the constant
fear that if my husband were to cheat, he would realize how truly awful, low sensation,
friction intimacy is, and I’d be alone for the rest of my life. This is always on my mind.
Okay, I’ve got another three to share with you. I feel I was lied to by my
obstetrician about how my size would be after the delivery of my small baby. I’m embarrassed,
I feel less of a woman and somewhat useless to my husband. I have no sensation, no tone,
no feeling inside at all. I have so many regrets about natural delivery, and I just want my old
self back, and even after surgery 15 years ago, I was informed that I will never be the same.
It feels as though I have no connection with my husband at times because I feel deformed,
and all I did was have a baby. I was 36 years old at the time.
Okay, the other two are shorter, so we'll go on with those. I can't bend over with making
noises for hours after intimacy, and it's really embarrassing. Things have never felt the same,
and I can no longer wear tampons, I'm 41.
And this is the last one. When a woman says not tonight dear,
I have a headache, it may be something so personal
that she finds it difficult to explain it to her partner, and this is from a woman aged 58.
So I think those comments are really revealing, aren't they?
They show that many women feel with this issue, low self-esteem, low body image;
many women have said to me they're anxious about the situation, it can lead to depression.
And so, this is a really difficult issue to discuss with other people, women feel isolated,
and it's really hard to find good information to know what to do. So what is normal size,
let's talk about that, first of all, before I go through the seven solutions for you at home.
Now, when I looked at the research on this, normal size is actually quite interesting. This is a
vaginal dilator, and women use vaginal dilators just to help them with size issues – some women
with pelvic floor spasm and pelvic floor muscle tightness, that's a different issue altogether.
But this is approximately the normal relaxed size, and studies have found that the average,
or, I call it average, I’m not going to call it normal, let's call it average size is 3.7
inches long and 1.1 inch wide. So that's about 9.6 centimeters long or about three centimeters wide.
But the tissues are stretchy, they're elastic, they're distensible obviously, and so they can
actually become much larger for childbirth, for intimacy. And so, that is the normal size.
Now, how do you check your normal size? Well, what you can do is you can use two fingers inserted,
and really what you should feel is the sides, at about three centimeters of depth and up to
three centimeters of depth internally, you should feel the sides against the fingers.
Now, if you can do that with your fingers, and I think you can see clearly in these images here,
if you can do that, it means that the pelvic floor muscles might have been stretched or they might
have been damaged during childbirth. And this is called, this can be called Levator avulsion,
when the pelvic floor muscles tear completely off the bone. Now, you can see in the images up here,
you can see here the image of normal where the pelvic floor muscles will still be
surrounding the area, the internal area or here you can see the increased width,
and that's what you'd be feeling with that large gap if you can insert your fingers and you need to
separate them wide with that larger gap that is that laxity issue that I’m referring to.
Now, there's two main causes of this issue,
and this has been looked into by Professor Peter Dietz and his researcher, co-worker,
and they found that the number one reason for this type of injury during first time delivery is
forceps, and the other major cause is prolonged second stage of labor, so that's the prolonged
pushing phase. So they're the two main causes. And I want to bust a myth right here, increased size
is not due to increased frequency of intimacy; and there's been a very good study on 500 women,
comparing women that were involved in intimacy and women who weren't,
and there was no difference in length or width, so I just want to bust that myth right away.
So now let's get to the seven solutions, and I want to go through these in detail with you now.
Our first solution is Kegel exercises, but I’m not talking about regular Kegel exercises,
I’m going to show you a special way of doing these for technique and for strength, even if you've had
injuries to your pelvic floor muscles and you're suffering from these size issues.
Now, I'd like to show you a muscle here. This muscle is called puborectalis, it's one of the
pelvic floor muscles, it actually goes right around, from the pubic bone at the front,
right around the back passage and back through to the front.
Now, even women that have muscle injuries to their pelvic floor muscles higher up, often still have
this muscle intact. Now, the way you activate this is two steps, let's go through them now.
The first step is to lift and squeeze in and around the back passage, the anus, and move it
forwards towards the pubic bone. So I've got a diagram here or a picture here that can give you
that image. So, as you lift and squeeze, try to lift and squeeze and bring the muscles forward
towards the pubic bone, and then slowly relax down. Can you feel that action at home? That's
the first part or the first step of these Kegels. Now, the second part is – obviously, make sure you
rest and relax the muscles after you've contracted them. Now, the second part is to, moving forward
in and around through here, in and around through the opening, I want you to try and squeeze around
the opening and also to lift inwards, but really focusing on the sides squeezing together as if
you're narrowing a clock face like bringing the nine and the three together here as you can see
here, and really squeezing and lifting together and then lowering that down. So can you try
that sitting nice and tall where you are? Try and imagine the clock face, try to visualize squeezing
the sides together and lifting inwards, and then lowering down and then relaxing. Now, then putting
those two steps together, one and two through the back passage and also through the vagina, lifting
and squeezing and trying to draw forward, can you do that – there's a lot to think about there,
isn't there? That's the technique trying to draw up through the back passage, narrow as you lift,
lower everything down and rest and relax. Now, if you need more information about the technique,
you can refer to my Kegels exercises, and that's listed above, that's for beginners.
Now, the second part of this Kegels technique is that we need to thicken the muscles,
we need to train for strength and for power. Now, a relaxed approach isn't going to do this,
training for strength means that you actually use your maximal contraction strength. That
means that with each exercise you do, you lift and squeeze really strongly, and you lower it down and
completely relax it, provided that you've got the correct technique, and then you take a rest. So
you use your maximum effort each time. It's also going to help you if you do the exercises or if
you can progress to doing the exercises standing up, so you're lifting against gravity rather than
lying down. Now, ideally you try to aim for about eight to 10 of these exercises, three times a day,
and you're trying to hold for about 10 seconds. So you're imagining if you're in the gym, you're not
doing hundreds of exercises of light exercises, you're doing a really strong contraction, lifting
and lowering, as if you're really trying to build up the muscle strength and the muscle thickness.
Now, the second point that I’d like to make is to exercise for power. Now, power contractions are
different, they're fast, strong contractions. So this means doing a really strong quick one-second
lift, and lower down, using the same technique that I’ve already mentioned, strong lift of one
second and lower it down. Can you do that now with me? Strong, lift inwards, and lower down.
And ideally, trying to aim for up to 10 of those strong lifts and lowers,
maybe you can do that one set a day maybe you can do up to three sets a day.
All right, let's move along to some of the other strategies aside from Kegels. The third strategy
I’d like to give you is to try to think about using your pelvic floor muscles during intimacy.
Now, it's going to be impossible to hold and contract during the whole process,
but maybe you can think about some intermittent contractions, maybe some on-off contractions,
particularly during the withdrawal. Now, that's not evidence-based, but it might help
you to improve your sensation of lifting and squeezing and then relaxing during intimacy.
The fourth strategy I'd like to give you is positioning. So positioning can help you improve
your sensation during intimacy and this might mean, it might be a matter of trial and error,
but some women find that having their back to their partner during intimacy can help improve
their sensation; and other ladies also find that using a pillow underneath the pelvis,
so that's not the lower back, that's lower down to lift the bottom, if you're lying on your back, and
that can actually change the position as well, and also for some women that can improve sensation.
Now, the next thing I’d like to talk about is lubrication, it's really important that you use
good lubrication and a quality lubricant. Don't use an oil-based or a petroleum-based lubricant,
for one, these are really thick and they're difficult to remove and clean and, as a result,
bacteria can grow in that type of a lubricant. You're best to choose a water-based lubricant,
and some of the really nice water-based lubricants, and I’ll leave a link below,
are these types of lubricants that you can see here. These are water-based,
it means that they're easily cleaned and washed and bacteria doesn't accumulate.
So some of the water-based lubricants might not last as long as you'd like,
in which case you can use a lubricant that actually has some silicone in it as well. The
only difference is that these are slightly more expensive and they are a little bit more difficult
to clean off than the water-based lubricants, but that's just information for you to use.
Another solution for you is to use Ovestin or vaginal estrogen. Now, this is something that you
need to speak with your doctor about. Estrogen can be used internally via a cream or via a pessary,
and it's inserted. And it can be used to thicken the wall, so thicken the internal walls,
and it's also often used after pelvic floor surgery. Now, this is not for everyone,
it can be very useful for women during menopause and also after menopause
and it also helps with lubrication. So there's a double benefit there in terms of thickness
of the walls as well as lubrication. It's a prescription-based medication and, as I said,
it's not for all women, particularly not women who are at increased risk of breast cancer.
Finally, I'd like to talk about dealing with the issue of anxiety, depression,
and body image with this issue. Now, this is a really challenging issue to discuss with anyone,
I really understand that. But if you can find someone that you can discuss the issue with,
might be a counselor, it might be a trusted friend, that can be a really helpful place to
start. Now, we've got our regular techniques that we can use, relaxation, mindfulness, so
maybe during intimacy, thinking about not how you're performing but being in the moment,
and the what rather than the how can be a really useful strategy. Relaxed deep breathing is also
a really useful strategy. And finally, I’d like to mention self-compassion. I think,
as women, we can be our own worst critic, and very hard on ourselves,
and I’d like you to think about how you would feel and how you would react if a trusted friend talked
about this issue to you – what would you say to that person? And maybe write down a few of the
suggestions or the few things that you would say to this person if they were revealing that
they had issues with size, decreased sensation and relationship issues because of this issue.
So we've gone through quite a few things there, haven't we? We've talked about Kegel
exercises, we've talked about technique, positioning, lubrication, Ovestin cream,
and also too the really important issues of dealing with anxiety and depression. And I
really hope that this information can give you a platform for moving forward with this issue,
and also too, I would really appreciate it if you can share this video with other women that
are suffering from the same issue, and if it helps you, if you could give it a like below,
because then YouTube will share that video with other women that are experiencing the same issue.
So thank you so much for watching today. I really hope this video
content helps you move forward with your intimacy and your life, and I look forward
to bringing you more information about this in weeks to come. Bye for now.